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Member Practice Update

17 April 2019

Welcome to the Member Practice Update

This weekly Member Practice Update is produced by NHS Redditch and Bromsgrove, NHS South Worcestershire and NHS Wyre Forest Clinical Commissioning Groups for circulation in your practice, to provide you with essential guidance, information and useful support.

Your views and feedback are very much appreciated. If you have any comments, suggestions or contributions for inclusion in the Member Practice Bulletin, please e-mail the communications team.

In this issue:

  1. Primary Care Networks – Extended Hours Access
  2. IQSP Spring 2019/20
  3. Acute Frailty Specialty – Alexandra Hospital
  4. Worcestershire Acute Hospitals NHS Trust - Inflammatory Bowel Disease Helpline
  5. Consultant Connect – Reminder to transfer any data before the end of April
  6. Responsibility for vaccinating at risk renal patients against Hep B
  7. West Midlands Familial Hypercholesterolaemia Service – How and Who to Refer
  8. Prescribing Top Tip
  9. Urgent Treatment Centre at The Alexandra Hospital
  10. Nuclear Medicine Service - Gamma Camera Replacement Programme
  11. Reminder: Controlled Drugs Annual Declaration 2018/19 - deadline 19th April 2019
  12. GP Bitesize Cancer Update - Herefordshire & Worcestershire
  13. Testing for Atrial Fibrillation
  14. Practice Manager Support Programmes
  15. NHS App Update - April 2019
  16. ‘Words Don’t Come Easy’

Find out about local and national events and training here.

  • No Redditch & Bromsgrove news 
  • No specific South Worcestershire news
  • No specific Wyre Forest news 

We Wish you a Happy Easter from the CCGs!

Primary Care Networks – Extended Hours Access 

A lot of practices are seeking clarity on clause 4.6.2 in the Networks Contract Specification. There are numerous interpretations on what this means. We’ve now escalated this to the national NHSE team and will let you all know the outcome.

IQSP Spring 2019/20 

This year the spring IQSP meetings will take place with practices in their Primary Care Networks. From 2020 and over the next 5 years PCNs will have an increasing responsibility for the delivery of QOF and Quality improvement and it is this development which is shaping the IQSP approach this year. As the configuration of network areas is currently taking place, the IQSP meetings will commence in June and continue into early July.

Further details of the arrangements and the Spring IQSP format are in this letter from Dr George Henry - Quality and IQSP Clinical Lead for Worcestershire CCGs and Lynda Dando - Herefordshire and Worcestershire Director of Primary Care.

Acute Frailty Specialty – Alexandra Hospital  

Referral contact number – 07525 922215 (Frailty Assessment Unit)

Frailty Services at the Alexandra Hospital have recently been reconfigured and the Acute Frailty Specialty is now recognised in line with all other specialties within the Acute Trust. The “front door” Acute Frailty Team (FAU) will review all patients who are referred and identified with frailty and acute conditions which do not require another specialty to manage.
Exclusions are:

  • Stroke Pathway
  • Gastroenterology Pathway
  • Cardiology – PCI Pathway
  • Surgical Emergency pathway

Accepted patients could be navigated to any part of the Acute Frailty Specialty (Frailty Assessment Unit, Frailty Decisions Unit, Ward 11 or 12), depending upon the patient’s individual clinical need. Patients aged 65 and over will be screened for frailty using the Rockwood Clinical Frailty Score (CFS). Rockwood CFS is being adopted and used by services across the system and is the CCG nominated tool to deliver GMS frailty assessments. Communicating a patients Rockwood Score based on their stable state (i.e. prior to this deterioration) will enable a quick and efficient response on referral.


Please delete any previous criteria which you may hold for Frailty Services.  If you have any questions regarding the services, please contact Jane Gordijn – Urgent Care Lead 07710 761928 or email jane.gordijn1@nhs.net

Worcestershire Acute Hospitals NHS Trust - Inflammatory Bowel Disease Helpline  

The Trust have advised CCGs that they have had to close, temporarily, their Inflammatory Bowel Disease Helpline.

The context and background to that decision by the Trust and some clinical advice from the Trust for GPs is available here.


Following the notification from Worcestershire Acute Hospitals NHS Trust that they are temporarily closing their Inflammatory Bowel Disease helpline a clarification in the appendix, giving advice regarding optimising 5-aminosalicylic acid (5ASA) dosage for flare up of disease, is required.  If a patient is taking olsalazine sodium, the dose can be increased to 3g daily in divided doses; with the maximum per dose of 1g.

Consultant Connect – Reminder to transfer any data before the end of April 

Practices will be aware from various communications that Consultant Connect will be switched off at the end of April.

The CCGs have been advised by most practices that the consultation between the GP and consultant is already clearly recorded in the patient record. However, Consultant Connect have asked us to share the process for how practices can transfer any Patient Identifiable Data (PID) to your practice server and then it be deleted from the Consultant Connect ‘Cloud’, if required. We are advised by Consultant Connect that this process is GDPR compliant.  

Transfer to GP Practices

Transfer Patient Identifiable Data (PID) to the relevant GP practices (as Data Controllers) followed by deletion of PID from the Consultant Connect Cloud once all transfers have taken place. If you do not have a login to Consultant Connect, you will be sent a log in to access this information by 1st April.

  • Practices with a log in can then access the Consultant Connect web portal at www.consultantconnect.org.uk
  • Once ‘Signed In’ the practice can access relevant PID, which include NHS Numbers as input by GPs, and download the PID which can be attached to patient records.

If you have any problems with signing in to the Consultant Connect web portal, please do not hesitate to contact Celia Enderby.

The system will be switched off completely on 30th April 2019 and no access to the Consultant Connect web portal will be available.

Responsibility for vaccinating at risk renal patients against Hep B  

The GMS national contract discussions in 18/19 concluded that the responsibility for vaccinating at risk renal patients against Hep B should be clarified and that it would become the responsibility of secondary care.

Whilst a number of trusts now vaccinate their patients, preparations are underway to support all trusts to take on this responsibility. This will be enabled by a formal transfer of commissioning responsibility and prescribing budgets to Specialised Commissioning. This is anticipated to be completed by 1st July. This will give remaining Trusts time to put arrangements in place such as training and PGDs to ensure a safe transfer of care so vaccination can be undertaken in line with patient’s existing outpatient appointments schedules, thereby minimising patient inconvenience.

Advice will be issued to renal services from PHE and the Renal Association setting out how this can be done to ensure patient safety and immunity pre-dialysis.

To ease this transition, we would advise that CCGs work with local renal services and GP representatives to agree any necessary interim processes which may include commissioning an interim service to vaccinate patients during the first quarter of 19/20. As I am sure you will appreciate it is important that patients with end stage renal disease are properly prepared for commencement of dialysis and look forward to your continued support during this implementation period.

West Midlands Familial Hypercholesterolaemia Service – How and Who to Refer  

Familial Hypercholesterolaemia (FH) is a common genetic condition that causes a high cholesterol concentration in the blood, leading to an increased risk of premature coronary heart disease and/or early death. Although management of FH with lipid-lowering therapy, e.g. statins, is highly effective, more than 85% of people with FH in the UK are unaware that they have the condition and are therefore untreated.

Untreated, people aged 20-39 with FH have a 100-fold increased risk of death from heart disease compared to those of a similar age without FH. Early identification of FH is important because if treatment is started early enough, it will give patients a life expectancy similar to the general population. Systematic searching of GP records to find those at high risk of FH is an important method of identifying affected individuals, and allows us to cascade test relatives. Cascade testing is the process of systematically offering DNA testing to the relatives of affected individuals because someone with FH has a 50:50 chance of passing the condition on to their children.
The benefits of cascade testing are early treatment and the avoidance of heart disease.

The West Midlands Familial Hypercholesterolaemia Service (WMFHS) was launched in November 2017. To date, over 240 patients have genetically confirmed FH and hundreds of family members including young children are now eligible for cascade testing. There is a designated FH specialist nurse for the CCG and the service is delivered from multiple GP practices across the area.

Patients can be referred opportunistically or following a systematic search of GP records. Referrals should also include patients with clinically diagnosed FH (based on the Simon Broome criteria) who have not had FH genetically confirmed.

Please see the referral criteria and referral form which should be emailed to Westmidlands.fhnurses@nhs.net.

For more information, please contact Elaine George, Clinical Programme Manager on 0121 371 8179 or via Westmidlands.fhnurses@nhs.net.

Prescribing Top Tip 

Flash Glucose Monitoring – Worcestershire Pathway and Policy

National guidance published on 7th March 2019 outlined the requirements and clinical criteria for use of Flash Glucose Monitoring (FlashGM, specifically Freestyle Libre®) in Type 1 diabetes (exceptions - see below). This guidance has informed arrangements agreed by Worcestershire Clinical Commissioning Groups for the 2019/20 financial year.



  1. Primary care to assess appropriateness at the patient’s next annual clinical review (unless clinical circumstances indicate earlier review).

  2. Primary care to complete EMIS referral form (for appropriate patients), ensuring this is informed by analysis of blood glucose meter download. (EMIS referral form – this was sent out as a link with the 27th March MPU and will need to be manually loaded in to EMIS).

  3. Following referral, diabetes specialist nurses will:

    a.    Assess eligibility for initiation, provide training and initiate use
    b.    Supply sensors during the initiation period (up to 6 months, if appropriate)
    c.    At 4-6 months, assess eligibility for continuation longer-term
    d.    Notify primary care when criteria are met and prescribing transfers to general practice
    e.    Annually review ongoing eligibility for FlashGM

Children and young people:

Consideration of eligibility will be undertaken by the paediatric diabetes team at the next scheduled clinical review.  Sensor supply will be in accordance with the adult arrangements outlined above.

These arrangements mean:

  • Patients may not be able to access FlashGM (specifically Freestyle Libre® sensors) immediately from 1st April 2019.
  • Prescriptions for sensors should not be initiated until notification is received that the requirements for ongoing supply are met.

The CCG will monitor GP prescribing from April, cross-checking with patient initiation in secondary care.


  • Adult patients using FlashGM will be managed jointly between primary and secondary care under the existing enhanced service, “Ongoing Management for Type 1 and Type 2 Diabetes Patients Treated with Insulin”.

  • Patients who have self-funded FlashGM should be managed as outlined above.

  • Where a request for primary care prescription is received from providers outside of Worcestershire, practices must be assured that the patient:

    a.    Meets the Worcestershire referral requirements (see overleaf).
    b.    Meets one of the national clinical criteria for use (see overleaf).
    c.    Has had FlashGM initiated by a specialist service and assessed as suitable for ongoing use (usually at 4 to 6 months).

Separate commissioning policies are available for use of FlashGM in adults and children and young people on the Worcestershire CCG website.  The following table summarises the Worcestershire requirements for adult consideration of FlashGM:

Referral Requirements for Consideration of Flash Glucose Monitoring in Adults

  1. Established Type 1* insulin-dependent diabetes (recommended > 6 months)
    * or Type 2 on haemodialysis or diabetes associated with cystic fibrosis

  2. Completion of a structured education programme
    (unless inappropriate – pregnancy, housebound, residential/nursing home, carer administration):

    - Expert Insulin - Attendance at 4 or more of the 6 planned sessions or
    - DAFNE (Dose Adjustment For Normal Eating) – Attendance at 4 or more of the 5 planned sessions or
    - Completion of a refresher course within the last 2 years (where expert insulin or DAFNE > 2yrs ago)

  3. Optimised insulin regimen

  4. Engaged with active self-management
    (evidenced by regular attendance at review appointments by patient or carer)

  5. Ability to engage with and willing to commit, via a patient contract, to the requirements of FlashGM
    (including use >70% of the time and scanning ≥ 8 times a day)

National Clinical Indications

  1. Type 1 diabetes requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months

  2. Type 1 or 2 diabetes on haemodialysis requiring intensive monitoring >8 times daily, as demonstrated on a meter download/review over the past 3 months

  3. Diabetes associated with cystic fibrosis

  4. Type 1 diabetes during pregnancy

  5. Type 1 diabetes with disability and carer support who are unable to routinely self-monitor blood glucose

  6. Type 1 diabetes with occupational or psychosocial* circumstances (e.g. working in insufficiently hygienic conditions to safely facilitate finger-prick testing) that warrant a 6-month trial with appropriate adjunct support.

  7. Type 1 diabetes experiencing recurrent severe** hypoglycaemia

  8. Type 1 diabetes with impaired awareness* of hypoglycemia

* Psychosocial circumstances and impaired awareness of hypoglycaemia will be assessed by Diabetes Specialist Nurses involving the use of validated scoring tools

** Recurrent severe hypoglycaemia is defined as more than 1 episode within a 6 month period, that:

i.    has required third party assistance due to a reduced conscious level needing treatment with oral glucose gel or IM glucagon and
ii.    is a diabetic emergency

If you have any suggestions for inclusion in the 'Top Tips' then please send them to akingham@nhs.net

Urgent Treatment Centre at The Alexandra Hospital 

Extension of the pilot until end September 2019

The pilot of the Urgent Treatment Centre at The Alexandra Hospital has been extended for a further 5 months in order to allow for a full evaluation to be completed and considered by Clinical Executive.  The pilot will now run until the end of September 2019.

From May to September the operational hours will change in order to reflect feedback through the Operational Group and ED attendances. It is anticipated that a higher volume of patients can be treated by moving the operational hours back slightly later in the day.

Monday to Friday:              14:00 – 22:30
Saturday and Sunday:       14:00 – 22:30

If you have any queries regarding the Urgent Treatment Center, please contact Urgent Care Transformation Lead jane.gordijn1@nhs.net or telephone 07710 761928.

Nuclear Medicine Service - Gamma Camera Replacement Programme 

The Nuclear Medicine Gamma Camera scanner at Worcestershire Royal Hospital has long been overdue for replacement. WAHT now have a replacement programme schedule for this.

The last working day for this equipment will be THURSDAY 2 MAY 2019. It is anticipated that the downtime period will be approximately 8 weeks.

This is the only nuclear medicine imaging facility within the Trust so alternative service provision has been arranged. The majority of examinations will be performed by The Nuclear Medicine Department at The City Hospital Birmingham (Sandwell Trust). A small number will also be performed by Hereford County Hospital (Wye Valley Trust).

This only affects imaging procedures. The service provided for breast sentinel lymph node biopsy will not be affected.

During this period please continue to request using your usual referral pathway. WAHT will manage the out sourcing of requests received. WAHT thanks you for your patience and co-operation over this period.

Any inquiries in the first instance should be made to:

David Palmer
Superintendent Radiographer
Nuclear Medicine Department
Worcestershire Royal Hospital

DDI 01905 760640
Int ext 30250

Reminder: Controlled Drugs Annual Declaration 2018/19 - deadline 19th April 2019  

The Controlled Drug Annual Declarations have been requested on behalf of Dr Chris Weiner, Controlled Drugs Accountable Officer NHS England.

All organisations which prescribe, administer or dispense Controlled Drugs (CDs) need to make an annual self-declaration to identify any local issues in relation to CDs. The declaration refers to activities within the last 12 months and relates to Schedule 2 and 3 controlled drugs, as these are subject to a higher level of governance.

The online self-assessment is a national questionnaire which healthcare professionals are required to register to access. Registration captures organisational data and one declaration can be made on behalf of an organisation.

The self-assessment questionnaire website can be found here.

The deadline for completion is 19th April 2019.

GP Bitesize Cancer Update - Herefordshire & Worcestershire 

Sent on behalf of Dr Alison Riley & Dr Edwina Gallagher

As your local GP Macmillan facilitators we will be distributing a monthly ‘bitesize’ cancer update which we hope you’ll find useful, and here’s the first one! They’re designed to be a short and gentle reminder of some things we already do but occasionally forget, things we never knew and a way of updating you on new cancer developments locally. We hope you find them useful.

Alison and Edwina

This April:

Please remember to give the 2 week wait information leaflet to the patient when referring them on the pathway, and check the appropriate 2ww blood tests have been requested as per the 2ww form.

If you have any queries please do get in touch.

Dr Alison Riley (Worcestershire GP Macmillan Facilitator)
Dr Edwina Gallagher (Herefordshire GP Macmillan Facilitator)

Testing for Atrial Fibrillation  

This week Worcestershire Health and Care NHS Trust caught up with Sarah Hudson, Team Lead for Community Stroke Services in Worcestershire. Sarah is encouraging all staff to test their patients for potential Atrial Fibrillation (AF), which is the most common rhythm disturbance which can cause large embolic strokes. In over 65 year olds, Atrial Fibrillation affects approximately 10% of people and is often asymptomatic.

WHCT has produced a video to support this message.
The risk factors of Atrial Fibrillation increase with age, hypertension, cardiovascular disease, diabetes, a family history of Atrial Fibrillation and/or excessive alcohol intake. Many of the very distressing strokes which cause physical disability, cognitive difficulties and speech and swallowing problems, are as a result of undetected Atrial Fibrillation.
The West Midlands Academic health and Science Network have been running a project in collaboration with NHS Trusts to utilise NICE approved Kardia devices in the detection and prevention of AF Strokes. There are 150 of these that have been distributed mostly to GP surgeries. Despite taking only 30 seconds to use and an extremely high sensitivity, they are not being used.
Please try and save someone from experiencing a devastating stroke by screening your patients – ask your Lead GP whether they have a Kardia device.

Please could you share this message with clinical teams throughout May in support of stroke awareness month. For more information, please contact Sarah Hudson.

Practice Manager Support Programmes  

Whether you are new and learning, or very experienced and just need someone to work through an issue or two, we have a team of practice managers to support you. 

For our newer Practice Managers who would like some mentorship, we can pair you up with a mentor to help guide and support you.  If you are a more seasoned practice manager and just need someone who understands the role to talk an issue through we can help with that too. This support is confidential and there is no cost to the practice, see this flyer for more information, if we can help please get in touch for more details. 

NHS App Update - April 2019 

GP surgeries across Herefordshire and Worcestershire are being connected to the NHS App on 13th of May 2019.

More information is available here and there are three steps that GP surgeries are asked to follow to prepare for the NHS App:

  1. Brief your staff
    There is a frontline staff briefing and video demo to help practice staff understand what the app is, and what they need to do.

  2. Prepare your systems
    Practices need to consider what appointments they make available to book digitally and ensure they are named clearly in their clinical systems. This will help to ensure that patients understand what the appointments are and can book the one they need. There is guidance to help practices consider and update their systems.

  3. Tell your patients
    When practices have briefed staff and prepared their systems, they can promote the app to their patients. There is a range of materials to help practices do this.

Read the full update here.

‘Words Don’t Come Easy’ 

Conversations in Palliative Care
Thursday 11 July 2019 | 9.00-4.30
University of Worcester

9th Annual Worcestershire Palliative Care Conference. Download more information.

The 19th Annual Worcestershire Palliative Care conference focuses on difficult and sensitive conversations we regularly have with patients and their families. At times it is difficult to find the right words (if ever there are right words) when someone is facing death and dying. While we are trying to support patients with their own situation, we expect them divulge their concerns and fears. But how much of ourselves do we also divulge without crossing our professional boundary?

If you would like to book a place, click here to apply.

Call for Posters

This year we would like to create a poster display for delegates to browse during conference breaks to recognise, share and celebrate the excellent work of local individuals, teams and organisations. For more details on how to submit a poster, download more information.

If you have any queries, please don’t hesitate to contact e.dobson@worc.ac.uk or j.fleet@worc.ac.uk.