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Member Practice Update

3 May 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.

Please Note: Following feedback from GP’s this update will now come out on Fridays rather than Wednesdays.

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. Closure of Paediatric Dermatology to GP Referrals
  2. GPFV - Workforce: Mentor Opportunities across Herefordshire and Worcestershire
  3. GPFV - Workforce: Practice Nurse Forum welcomes Karen Story to the May meeting
  4. PCE Update
  5. Enhanced Service Update: Compression Bandaging
  6. Waterside Care Centre – Care Home Cover
  7. Health Check Data Collection
  8. Prescribing Top Tips
  9. Healthy Minds Service – New dedicated support for your practice
  10. Non-therapeutic Circumcision Update
  11. Adverse Childhood Experiences (ACEs) Survey Reminder
  12. Spiritual Health Survey
  13. Hillview Medical Centre, Redditch - Salaried GPs required, 4 – 8 sessions
  14. Worcestershire Medico-Legal Society
  15. The Annual Judy Dale Lecture: Paediatric Palliative Medicine Growing Up – What Next?
  16. Fostering Recruitment Drop-ins

Find out about local and national events and training here.

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


Closure of Paediatric Dermatology to GP Referrals

Birmingham Women’s and Children’s Hospital NHS Trust has taken a decision to close their Paediatric Dermatology service to GP referrals and so will not accept GP referrals received after Friday 3rd May, BCH expect the closure to be in place and until October 2019. This document is a communication from BCH that provides some further advice and guidance for GPs.

Should you wish to raise any queries with regard to this closure of referrals, please refer to the contact details, for BWC, provided in the attached document.


GPFV - Workforce: Mentor Opportunities across Herefordshire and Worcestershire

Building on our existing General Practice Support Team offer, the LMC and CCGs are pleased to offer the following Mentor opportunity.

Are you a GP who has been trained in mentoring/ coaching? Would you be interested in supporting your peers across Worcestershire? If you answer yes to both of these questions, we have an opportunity that you may wish to consider. 

We are looking to recruit a small group of experienced mentors to provide support to GPs with regards to career and personal development.
There is good evidence that peer support and mentoring is an effective way of helping GPs to manage a range of issues.  General Practice can be a long and rewarding career but it is not without its challenges.  By providing timely peer support to GPs who find themselves at a cross road in their career or who are facing personal issues, we hope to retain GPs who might otherwise choose an alternative path.  We know that GPs care for others and often find it hard to seek care for themselves.  Whilst there are national support systems in place for those GPs who find themselves in crisis or in need of medical care, there is little to offer those who simply need some help to find their own way through a difficult time.

Locally, we know from our Workforce Survey results and engagement with GPs, that this type of support would be welcomed. We have managed to secure funding to provide mentoring across our STP as part of our GP retention plans.

The Experienced GP mentoring scheme will be available to all GPs that require support and is a separate offer from the First5 mentor network.
Commitment required from Mentors- will be dependent on each request, each mentee will be offered 3 x 1 hour sessions. Support will be time-limited and no longer than 3 months (unless otherwise agreed by CCG/LMC). 

Mentors will be paid £85 per hour for their mentoring duties.

Training available
Full day Mentor Training session delivered by an experienced GP, Dr Tricia Houston. Lunch and refreshments will be available, in addition a contribution towards backfill for attendance will be made.

Date of training
Wednesday 12th June 2019 9.30-4.30pm, venue TBC. 

What we require from you
If you are interested in being part of this scheme, please complete the attached expression of interest form and send here by 10th May 2019. You must be able to attend the above training date to become a mentor.

GPFV - Workforce: Practice Nurse Forum welcomes Karen Story to the May meeting 

The next Worcestershire Nurse Forum will take place on 21 May 2019 at 12.30pm- 4.15pm at: Worcestershire Young Farmers, Shires Farm, Hawford, Worcester, WR3 7SG from 12.30-4.15pm. The Forum is pleased to welcome Karen Story to this meeting which will be jointly hosted with Herefordshire Nurse Forum.

Karen is the primary care nursing lead in NHSE nursing directorate, leading on the general practice nursing ten point plan. Prior to this she was primary care lead nurse workforce at Health Education England West Midlands leading on Training Hubs (Community Education Provider Networks). She has held previous positions as Primary Care Nurse Facilitator in a CCG / PCT, Primary Care Access Nurse & Clinical Lead Nurse for an NHS Walk – In Centre. She has a background as a general practice nurse and advanced nurse practitioner she also qualified as an independent nurse prescriber. Karen has an MSc in Health Studies. Karen has held various national roles to develop the HEE GPN career framework.

Places are limited, so please ensure that you book your place as soon as possible via www.primarycaretraininghub.co.uk/courses/PN/WNF. When booking, please state any dietary requirements.

In addition, we are pleased to confirm that Nina Lealan, Practice Nurse Lead for Worcestershire has agreed to continue her role at the CCG for a further 12 months.

PCE Update         

Three of the four elements (Best Practice, Referrals, Prescribing) have been agreed with the PCE Clinical Advisors.  Changes to these parts of the proposed 19\20 service specification are minimal because the PCE “ask” is more than what appears in the new QOF QI modules (ie Safe Prescribing & EOL).  We have removed the Hypertension QOF+ targets because of overlap with new QOF indicators. That leaves the section of the contract which focuses upon Neighbourhood teams -  integration, engagement, leadership and reducing unwarranted clinical variation in emergency admissions.  Ruth Lemiech and team are developing this with clinical input and a deadline of 10 May.  Our aim is to share this final proposal with the GP Provider Board as soon after this date as we can.

Enhanced Service Update: Compression Bandaging  

The CCG has agreed to address the anomaly of not commissioning a compression bandaging service in South Worcestershire, and practices will be offered the opportunity to sign up to deliver this service as per the specification, from 1 July, Quarter 2. This will ease the pressure on treatment room services in the South.

In the longer term the CCG’s Quality Team will be developing a county wide service for leg ulcers which will be operational from April 2020. At this point the enhanced service may cease if alternative provision is commissioned. Practices will be kept up to date on developments and will be given three months’ notice of any change.

Waterside Care Centre – Care Home Cover  

The CCG is seeking expressions of interest from South Worcestershire Practices in offering core GMS services, subject to patient choice, and the associated Care Home Enhanced service to  26 dementia nursing beds at Waterside Care Centre, Leigh Sinton,  from 1 June 2019. Severn Valley will continue to provide the service until 31 May. St Saviours cover the other 21 beds within the home.
Please email Caroline Salmon if your practice is wishes to express an interest in providing this service by Friday 10 May 2019.

Health Check Data Collection  

Public health would like to thank all of the GP practices who have been able to send their 5 year NHS Health Check data so promptly.  We will now work to analyse this data as part of our review of the NHS Health Checks programme and will feedback some of the key findings in due course.

Could any practices who have not yet sent their return please contact Andy Boote – thank you again for your co-operation.

Prescribing Top Tips 

Labetalol Tablet Supply Issue

There is currently an availability issue with all strengths of labetalol tablets. Both suppliers are unable to provide stock at this time and it is expected that very little stock will be available until the middle of May.

Labetalol is licensed for the treatment of mild to severe hypertension, hypertension in pregnancy and angina pectoris with existing hypertension. It is most commonly used for the treatment of hypertension in pregnancy.

Prescribers should be aware that no new patients should be commenced on labetalol during this time due to its very limited availability. Patients who do not have enough supplies to last until early May, and who are unable to obtain supplies of labetalol, will need to be switched to an appropriate alternative treatment.

For information on possible alternatives to labetalol for patients affected by this supply issue, please refer to this UK Medicines Information (UKMI) memorandum which advises on management options based on the presenting indication, including the use of alternative anti-hypertensives during pregnancy and lactation.

The key points from the memo are:

  • The clinical management plan for pregnant patients will be different to patients who are not pregnant.
  • Modified release nifedipine is the second line option after labetalol for hypertension in pregnancy. Methyldopa is the third line option but is less well tolerated and is contraindicated in depression.
  • Manufacturers of both nifedipine modified release and methyldopa are confident they can support any additional demand on their products during this time.
  • Nifedipine and methyldopa are not specifically licensed for hypertension in pregnancy.
  • Modified release nifedipine should be prescribed by brand because different versions may not have the same clinical effect. Adipine® MR is a preferred twice daily modified release brand in Worcestershire. The SPC for Adipine® MR states that (when used in pregnancy) it should be reserved for women with severe hypertension who are unresponsive to standard therapy.
  • An alternative beta blocker may be an option for non-pregnant patients but note that the manufacturers of carvedilol and metoprolol have indicated they would be unable to meet demand if patients were switched to this product. Manufacturers of bisoprolol, atenolol and propranolol however have indicated they have capacity to support any additional demand on their products.

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

Healthy Minds Service – New dedicated support for your practice  

Around 50,000 people in Worcestershire experience more common mental health illnesses such as depression, low mood or anxiety. The Worcestershire Healthy Minds service can support them through group courses, 1:1, counselling and online resources.
To support GP’s further, and to ensure surgeries have access to the correct information at all times, Healthy Minds are introducing a dedicated team member linked to surgeries. They will shortly make contact with your practice manager to ask if they can attend your practice meetings.  They will be able to provide information about the range of interventions that Healthy Minds has to offer and will be able to provide booklets/leaflets for waiting rooms.  They would like to make links to improve care for patients with long term health conditions.
This support is in addition to the e-referral process which is now in place for the service. GP’s can now complete the referral process with the patient, allowing the patient to leave the practice with the date and time of their appointment, and you can handover care for the patient to Worcestershire Health & Care NHS Trust, which runs the Healthy Minds service. Patients will be booked into a telephone assessment appointment and are not required to attend a clinic for this assessment.  
As per other services currently available on e-Referral, patients can book their appointment whilst with you, or alternatively they can be given the central booking line number and phone to book at their convenience.

We believe this is a positive addition to e-Referral bookable services, and that you and your patients will benefit from this access. It’s a much better system that will allow patients to access services much quicker. Attached is more information on the e-referral process.

Non-therapeutic Circumcision Update  

Please see below update from Jo Harrison:

I have been asked to share this reminder with you and ask that this is cascaded to provider sites where parents may attend and present their child for medical care, for instance GP practices, emergency departments or walk in centres etc.
There has been a series of cases where male babies/children have under gone non-therapeutic circumcisions which have resulted in significant harm.  This matter is being investigated.
Therefore, please can clinicians who become aware of any harm following a non-therapeutic circumcision report this matter through their normal safeguarding channels (talk to your organisations named safeguarding professionals, liaise with social care teams)
A more detailed briefing is being sent by Jo Harrison to Designated Professionals. If you’d like to discuss this please contact Jo (Mobile – 07876 859941 | Email joanne.harrison@nhs.net)

Adverse Childhood Experiences (ACEs) Survey Reminder  

Public Health, Worcestershire County Council are conducting a survey on ACEs and would like to hear from you. You will need 10-15 minutes to complete this survey.

Worcestershire Health and Well-being Board have identified tackling Adverse Childhood Experiences (ACEs) as a priority and that a joint systems approach is required.  A broad action plan has been developed following an ACE event last year.  A priority action is to map and scope current practice, programmes and services. The main objective of this survey is to identify and explore awareness, activities and opportunities around preventing and tackling ACEs for Worcestershire.

Please click here to access the survey.

All responses will remain anonymous and the analyses will be used to further progress our ACE action planning. All responses will be treated in strict confidence and will be kept securely.

To be completed by May 1st please.

Spiritual Health Survey 

Sent on behalf of Orla Whitehead, Post CCT Fellow and Career Start GP

You are being invited to take part in a very short online survey about how you ask about patients’ spiritual health.

The General Medical Council expects doctors to discuss spiritual health (in Good Medical Practice), and the Royal College of General Practitioners have included it in the curriculum for GPs in training. This survey aims to explore whether a history taking tool may help with this.
As part of the survey, the HOPE history taking tool will be explained, which could prompt reflection for CPD credits.


Thank you very much for your participation. Please do pass this invite on to other GPs in your practice and beyond who may be interested in sharing their views.

Please contact Orla with any queries.

Hillview Medical Centre, Redditch - Salaried GPs required, 4 – 8 sessions  

The practice is a friendly and cohesive unit, and we are proud to have been voted the highest rated in Redditch 2 years running in the patient survey. We are situated just outside Redditch town centre with excellent commuter links to Birmingham and surrounding areas.

Our list size is 9500 patients and is currently managed by 4 partners, 2 salaried GPs, 1 Paramedic, 3 Practice Nurses, 1 HCA and an excellent administrative support team. We are high QOF achievers and we are actively engaged in our local CCG. We have daily meetings and are currently undertaking several research studies.  As well as the usual services, we provide minor operations and musculoskeletal assessment/injection clinics for several practices. We have motivated and supportive GPs with good sub-specialty areas of expertise.

Our practice has been working closely for some years with 5 others locally as part of an innovative neighbourhood team, which has set us up well for the forthcoming Primary Care Networks.  This will provide GPs with increased opportunities for portfolio careers, career development and progression.

We have part or full-time posts available. Our ideal candidates will be flexible, team players with good communication skills. We are keen to discuss any individual areas of interest or expertise.

If you would like to chat to one of the partners please let us know by contacting linda.pratt@nhs.net or 01527 599765

If you are interested in applying please send your CV to:

Linda Pratt, Practice Manager
Hillview Medical Centre
60 Bromsgrove Road
Redditch, Worcestershire
B97 4RN

Or Email Linda Pratt.

Worcestershire Medico-Legal Society 

‘Stop asking what’s wrong with you and ask what’s happened to you?’ - Another way of thinking about chronic homelessness

Mr Jonathan Sutton, CEO, St Paul’s Hostel, Worcester
Tuesday 21st  May 2019 at 7:30pm
The Courtroom, School of Law, Jenny Lind Building, Farrier Street, Worcester, WR1 3BZ

Tea/coffee and biscuits available

For any further information, please contact:
Dr. Lesley Ann Smallman: lasmallman@btinternet.com

Non-members: Professionals £10; First Year Students free;
Other Students £5

The Annual Judy Dale Lecture: Paediatric Palliative Medicine Growing Up – What Next?  

By Mark Hunter, Consultant Paediatrician at Acorns Children’s Hospices
Thursday 9 May, 5.15 for 5.30pm start, University of Worcester Riverside Building, Hylton Road, Worcester, WR2 5JN
It gives us great pleasure to invite you and your guest to the fifth Annual Judy Dale Lecture, delivered this year by Mark Hunter, 5.15 for 5.30pm start on Thursday 9 May, at the University of Worcester Riverside Building. The lecture will be followed by a wine and canapés reception to which you are also warmly invited.

In his lecture, Mark will reflect on the development of Paediatric Palliative Medicine as well as the scope of the discipline, with reference to boundaries and the challenges of working within a context where death is often an unfamiliar stranger. Practicalities of providing palliative care from the perspective of a hospice based specialist will be discussed in terms of the clinical context of the work. The particular challenges and rewards of working with neonates and infants will be highlighted and some personal recommendations about priorities for the future will be presented.
We do hope you will be able to join us. Please RSVP by Thursday 2 May to Chloe Macpherson at rsvp@worc.ac.uk, or by calling 01905 54 2851.

Fostering Recruitment Drop-ins 

Summer Events in conjunction with Fortis

Hollymount School Fete
When: 05 July 2019 13:00-15:00
Where: Hollymount School, Worcester
Dines Green School Fete

When: 12 July 2019 15:30-17:30
Where: Dines Green School, Worcester
Summer Fun Day
Dukes Meadow, Malvern
26th July 2019
1.30pm to 3.30pm
Summer Fun Day
Westlands, Droitwich
2 August 2019
1.30pm to 3.30pm
Summer Fun Day
Oasis, Worcester
9 August 20191.30pm to 3.30pm