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Member Practice Update



22 November 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. Thursday 28 November – IQSP Study Day
  2. Rockwood Clinical Frailty Scale Pop Up now available
  3. 111 Services
  4. NHS Health Checks Extension
  5. Update: New 2WW Referral Forms
  6. Updated St Richard's Hospice EMIS referral form
  7. NHS Diabetes Prevention Programme e-learning module now live
  8. September 2019 Workforce Survey Summary
  9. Prescribing Top Tip
  10. In Alliance Newsletter - November 2019
  11. Mid-Career GP Event
  12. RCGP Midland Faculty events


Find out about local and national events and training here

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  • No Redditch & Bromsgrove news 
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  • No South Worcestershire news

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  • No Wyre Forest news




Thursday 28 November – IQSP Study Day 

Agenda for the study day is now available here. We look forward to seeing you there.




Rockwood Clinical Frailty Scale Pop Up now available 

A frailty pop up has been developed to support clinicians in recording Rockwood scores for all appropriate patients, as part of the PCE contract. The frailty pop up is available to download and install here (zip file). For it to run practices will need to set up ‘triggers’, a quick guide for how to set these up is available here.

Once installed the prompt appears in the QOF box as a reminder to undertake a quick Rockwood Assessment of the patient and to give them a frailty score with a view of offering a frailty sensitive approach to their care. Embedded within the pop up is a summary of Rockwood scoring and links to a frailty leaflet that can be printed off for patients, and their supporters, to help them understand what a diagnosis of frailty means. The frailty coding will need refreshing every 12months to take into account improvement/deterioration over time.




111 Services 

You will be aware that the WMAS took over the 111 contract on 5 November 2019. The new provider is keen to ensure ongoing improvements, which we welcome.

With the plans for 111 to book into a few GP appointments, and in view of capacity issues in primary care, we would want to ensure that patients are appropriately directed to primary care services.

If you have any complaints, concerns or issues these can be raised directly with the WMAS via this form. This form is for health professionals only, not patient complaints.




NHS Health Checks Extension  

The NHS Health Checks service is commissioned by Public Health at Worcestershire County Council. The current contract was due to end on 31st March 2020. We are pleased to inform you that we have extended this contract by 12 months. 

The contract variation has been sent to contract holders via InTend. Please log in to view and complete the relevant documents and return using InTend no later than Monday 16th December

If you would like any further information please contact Andrew Boote (Advanced Public Health Practitioner).




Update: New 2WW Referral Forms 

Following the introduction of the new 2ww referral forms at the end of July 2019, Worcestershire Acute Hospitals NHS Trust undertook an audit to evaluate utilisation of the new forms and completion of the ‘mandated’ fields. The audit identified the following:

  • Around 80% of referrals are now being made using the new forms, but around 20% referrals continue to be made using old versions of the forms. The new forms have been designed to standardise the format and identify the key requirements for each cancer pathway to enable the referral to be progressed as quickly as possible once received by the 2-Week Wait Office. It is therefore important the new forms are widely adopted by all practices as soon as possible and all old versions of the referral form removed from circulation and archived from practice systems.

  • The mandatory fields contained on the new forms are not always being completed prior to the referral being made. Around 18% of Lung 2ww referrals and 34% of Urology 2ww referrals are being submitted without an up to date blood test (completed within the last 3-months). The new forms clearly identify the mandatory fields to be completed prior to referral (marked with an * on the forms and flagged as a pre-requirement on the data entry form). Completion of the tests/ investigations/ assessments allows the referral to be progressed without unnecessary delay, enabling patients to undergo all necessary diagnostics including straight to test to confirm a diagnosis. It is therefore essential that all tests/investigations are completed or at least requested prior to referral (to be completed within 48-hours of the referral being made). Other mandated fields such as confirmation of WHO status also need to be completed where appropriate to enable patients to be put on the appropriate pathway ie. straight to test or OPA.

  • Patients are not always being informed they are on an urgent 2ww referral pathway, resulting in some patients declining appointments because they are unaware of the urgent nature of their referral. A copy of the generic Patient Information Leaflet (all cancer pathways with the exception of Colorectal) and 2ww Colorectal Patient Information Leaflet has been circulated to all practices so that systems can be put in place to ensure patients were given a copy of the relevant information leaflet. Please ensure copies of the leaflet are made available to the clinicians (hard copy or electronic) and given or sent to the patient when the decision to refer is made.
     

If you are concerned you do not have copies of the new referral forms and Patient Information Leaflets, please do not hesitate to contact Anita Roberts or a member of the Primary Care Team.




Updated St Richard's Hospice EMIS referral form 

St Richard's Hospice referral form has been altered to accommodate the new ReSPECT  documents, along with a re-branding of our day hospice now being called 'The Living Well Centre '. Please can this referral form be used for all referrals forthwith.

A copy of the EMIS form can be found here. Please import in to EMIS and archive the previous version.




NHS Diabetes Prevention Programme e-learning module now live 

Over the last six months the NHS Diabetes Programme have been working with the Royal College of General Practitioners (RCGP) to develop an NHS Diabetes Prevention Programme (NHS DPP) e-learning module which launched yesterday on the RCGP learning platform: https://elearning.rcgp.org.uk/nhsdpp

The 30 minute e-module is aimed at GPs, Practice Nurses and other Practice staff. The content covers what Non-Diabetic Hyperglycaemia (NDH) is, what the NHS DPP is; how it works and who is eligible. There are also some basics on motivational interviewing. The aim is to provide healthcare professionals with the tools and information they need to make quality referrals into the programme.

The course is free and CPD-accredited. It can be accessed by creating a free account on the RCGP Learning site.




September 2019 Workforce Survey Summary 

Thank you to all 83 practices across Herefordshire and Worcestershire for completing the September Quarterly Workforce Survey. The survey continues to support the work of the Primary Care Workforce Team and we continue to work with practices who request our support. 

Key Headlines

There is an increase of 10 GP Headcount across the STP since the previous survey, however we are aware of some practices reporting difficulties with recruitment. Some practices have attended RCGP recruitment evenings and have successfully recruited as a result of this networking.

We have two upcoming engagement events for mid-career GPs and General Practice Nurses in December. We would encourage and welcome attendance as this is your opportunity to help us with our plans to retain more staff in general practice and support with recruitment.
 
Since the last report the following local and national programmes have been put in place or are in the process of being implemented to support our GP workforce, details of these programmes and more can be found in the report:

  • Next Generation GP programme
  • First 5 GP mini-event series
  • GP mentoring
  • Portfolio roles with the hospitals for Breast, Frailty and Elderly Care


The local programmes of work have been developed based on feedback received from our GPs at various events and interactions across the STP. This information has been fed into the Workforce Implementation Group. The team made up of GPs, members of NHSE, the CCGs, the Training Hub and HEE work through the feedback provided to develop and implement the programmes which are deemed to be most likely to have a positive impact on the workforce.

The following programmes are currently with the team for future consideration:

  • PCN portfolio grant scheme
  • Phoenix programme for mid-career GPs
  • Pre-retirement forums for GPs considering retirement
  • Local Welcome back to Work scheme to support GPs returning to work after a period of absence
  • GP Academy – developing a medical education academy and providing training for GPs to support teaching, supervision and mentoring
  • New to Practice programme for new GPs and Practice Nurses

For more information, please get in touch with the Workforce Team sowoccg.workforce@nhs.net




Prescribing Top Tip 

Supply of Adrenaline Auto-Injectors - Update                                                                                           

Practices will be aware that there have been supply issues associated with all brands of adrenaline auto-injectors for well over a year now.

Several arrangements remain in place to help address the ongoing problems with supply. These are summarised below:

EPIPEN®/EPIPEN JNR®

  • Supplies of both EpiPen® and EpiPen Junior® are currently available, but a prescription validation process is in place for both products whereby pharmacies and dispensing practices can order up to two devices per prescription.
  • The DHSC has also approved an extended 4-month shelf life for selected batches of Epipen® (but not Epipen Jnr): See http://www.epipen.co.uk/ for further information.

EMERADE®

  • Emerade® 150 microgram and 500 microgram devices are currently available.
  • Emerade® 300 microgram devices are expected to be available by late November 2019.
  • On 3 October 2019, the MHRA issued a drug alert for all strengths of Emerade® devices following reports from the manufacturer that some devices had failed to activate. In this situation, the needle of the pen was not released from the auto-injector when used, and a dose of adrenaline could not be delivered. Because of the ongoing supply issues a decision was taken to not issue a product recall, but it heightens the importance of users carrying two pens at all times.

JEXT®

  • Jext® 150 microgram devices are currently available.
  • UK licensed Jext® 300 microgram devices are currently unavailable; unlicensed, imported 300 microgram devices have been approved by the DHSC & are being supplied through Alliance Healthcare. The imported product is equivalent to the UK product and is supplied with a UK patient information leaflet. Prescribers may be asked to annotate prescriptions for Jext® 300 microgram devices with the terms ‘specials’ or ‘unlicensed’ in the prescribing line.
  • The DHSC has also approved an extended 4month shelf life for selected batches of Jext® 150 micrograms & 300micrograms.

Practices are also reminded that recommended transitions between paediatric & adult devices are based on weight, and care should also be taken to ensure that paediatric patients are stepped up to the adult device in line with the dosage instructions of the applicable brand - see BNF Online Adrenaline Indications & Doses for further information.


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




In Alliance Newsletter - November 2019 

The November 2019 edition of the In Alliance Newsletter is now available.

Download it here.




Mid-Career GP Event 

Wednesday 4th December 2019 / 6:30pm - 9:15pm The Fownes Hotel, City Walls Rd, Worcester, WR1 2AP

Are you feeling fulfilled in your career? Wondering what’s next or thinking about a change?

We recognise that GPs will have different needs throughout their career, and we are working on designing a programme that supports GPs throughout their career, and encourages them to stay working in our area.

Wednesday 4th December 2019 / 6:30pm - 9:15pm The Fownes Hotel, City Walls Rd, Worcester, WR1 2AP

What is involved:

  • The opportunity to take some time out with colleagues to explore what you want from the next phase of your career
  • Find out about portfolio roles, and opportunities to become involved in medical education
  • Chance to hear from Dr Amanda Webb, founder of the Phoenix GP programme
  • Help us design an offer for mid-career GPs that supports you and other GPs to have a fulfilling career locally in Herefordshire and Worcestershire


Book your place here.




RCGP Midland Faculty events  

Here is a list of future RCGP Midland Faculty events you may be interested in. To register please follow the links: