National Health Service (NHS), PCT & Local Health Board News - April 2006

England - Local PCT News

Ashford PCT - Integrated Clinical Assessment & Treatment

The Ashford Integrated Clinical Assessment & Treatment Services (ICATS) is at the heart of the PCT's strategy to develop more services within primary care, and is currently being piloted at the West View Intermediate Care Centre in Tenterden. GPs are now able to refer patients for triage, assessment and treatment and then, if necessary, into secondary care. Clinical care pathways have recently been revised within orthopaedics, chronic pain and rheumatology, resulting in combined pathways for musculoskeletal care. ICATS will be accepting referrals for hips and knees in the first instance, a back care pathway will be implemented during 2006 and chronic pain services will be developed alongside the pilot.

Cornwall PCTs - Out of Hours

The Out of Hours service in Cornwall is being taken over from Kernowdoc by Serco at the end of March. There had been local fears that this would mean drafting in cheaper doctors from Poland and Germany, but Serco have announced that that they will be employing local GPs because of their skilled knowledge of the area. Serco is a British firm with overseas operations. It won the three-year contract, with an option to extend it to five years, by bidding £5m against the Kernowdoc bid of £7.5m and promising improvements such as a patient transport system for vulnerable people with no other access to clinics. Kernowdoc currently deals with 140,000 calls a year using 300 GPs in Cornwall.

St Ives MP Andrew George said: "I do hope that this episode gives local GPs and Kernowdoc the opportunity to reflect on whether the offer they made was the best they could have made. Next time, when the contract is put out for tender I hope local GPs and clinicians get together to make sure a locally based, more accountable provider is successful because I believe only GPs with local knowledge can provide the best service."

Dartford, Gravesham & Swanley PCT - Osteoporosis

An initiative between the PCT and Darent Valley Hospital has attempted to identify those people locally who may suffer from osteoporosis. Questionnaires were sent to all patients over 65yrs at Gravesend Surgery. Subsequently, 91 patients were given a detailed assessment, and of the 87 who were given a bone scan, 42% were diagnosed with osteoporosis and 39% were osteopenic. As a result, osteoporosis services have been prioritised by the PCT: a new DEXA scanner now operates in the area, and a Specialist Nurse is being recruited by the new Osteoporosis Unit which has been set up in Darents Valley Hospital.

Derby PCTs - Sexual Health

A new Sexual Health Nurse has been appointed in Derby as part of a drive to reduce teenage pregnancies. Sexual Health services are being expanded across the city, and the new nurse will join the Time for Girls Extra Drop-in Service at Roe Farm Clinic.

East Elmbridge & Mid Surrey PCT / East Surrey PCTs - Diabetes

THE 5 East Surrey PCTs have introduced a new Diabetes Guidelines/Resource Pack, and have established a Local Implementation Team to develop a quality-assured screening programme for the early detection of diabetic retinopathy for the whole region by 2006.

East Hampshire / Portsmouth City PCTs - Practice Transfer

The award-winning Portsdown Group Practice is transferring from East Hampshire PCT to Portsmouth City tPCT on 1 April 2006. This is because of an expansion of services in the practice's Cosham Park House Surgery which is in the Portsmouth area.

Gloucestershire Hospitals NHS Foundation Trust - Photodynamic Therapy

Louise Pound, the new Skin Cancer Specialist Nurse at Gloucestershire Royal Hospital, is keen to expand the Trust's use of photodynamic therapy, which uses light-activated cream to destroy tumours. The trust's team is one of only a few in the south west.

Heart of England NHS Foundation Trust / Good Hope Hospital NHS Trust - Proposed Merger

The board of Good Hope Hospital Trust has decided that, under current financial circumstances, their best way forward is to merge with the Heart of England Foundation Trust. Discussions are now starting with Birmingham & the Black Country SHA.

Kingston PCT - COPD

The PCT has done significant work to improve the lives of people with COPD. Over 88% of its COPD patients now have personalised care plans in place, and they also have emergency antibiotics and steroids at home to use if they experience early signs of a chest infection. Patients with severe, moderate and mild COPD have been identified using special software and, so far, 131 patients have been classified as having severe COPD. The PCT now has a Respiratory Physiotherapist and he is working with GP practices and the new Community Matrons to support the severe COPD patients at home.

Lambeth PCT - Repeat Prescribing

A joint Repeat Dispensing Initiative between GP practice staff and High Street pharmacists has been introduced in Lambeth, and patients with stable long-term conditions are now able to collect prescriptions from pharmacies rather than from their GP. Pharmacists are trained and accredited to offer repeat dispensing and are able to review and assess a patient's medication, checking for side-effects and that the patient is taking the correct dosage at regular intervals. Information is relayed to the relevant GP.

The first wave of GP practices providing repeat dispensing include:

- Lambeth Walk Group Practice
- Brixton Hill Group Practice
- Deerbrook Surgery, and
- Myatts Field Health Centre Practices

London NHS - Financial Recovery Plans

John Bacon, Transitional Lead for London, has set out a recovery strategy which will involve all local PCTs and Trusts in London contributing towards bringing the capital's health service into financial balance in 2006/07. Working within the Department of Health’s Operating Framework 2006/07, a pan-London reserve made up of 3% of PCTs’ 2006/07 allocations, specifically from growth monies, will be held by SHAs.

Those Trusts in balance at 31st March 2005 will contribute a minimum 1% surplus. Those organisations currently in deficit will be expected to return to in-year balance within the coming financial year. Mr Bacon said: “The NHS in London as a whole must balance its books and the work to ensure that this happens across London starts now. .. While those organisations with the greatest financial and delivery challenges will clearly be required to make the biggest effort, the duty to ensure financial balance across the capital’s health service is one for the whole NHS community in London.”

Middlesbrough PCT - Practice-Based Commissioning

Middlesbrough PCT developed its Information, Data and Statistics (MIDAS) programme last year, and is now making it freely available to any other interested PCT. MIDAS is a browser-based statistical reporting system for Practice-Based Commissioning. It allows GPs and practice managers to see visual representations of a large number of statistics, including inpatient and outpatient activity, payment by results tariff costs and GP referrals.

The system also uses Ordnance Survey data to map statistics across a geographical area, so that, for example, a map of asthma cases by region in Middlesbrough can be easily generated. Steve Moore, Corporate Information Manager, explained that while the software would be free, the PCT could only offer very limited support.

NHS Hospital / Mental Health Trusts - Proposed Mergers for April 2006

There are several planned mergers due to take place in April of both Hospital Trusts and Mental Health Trusts. The following is a summary showing the new Trust name, followed by which Trusts have been dissolved to form the new organisation:

KENT & MEDWAY NHS AND SOCIAL CARE PARTNERSHIP TRUST
West Kent NHS & Social Care NHS Trust, East Kent NHS & Social Care Partnership Trust

NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST
Nottingham City Hospital NHS Trust, Queen's Medical Centre, Nottingham University Hospital NHS Trust

TEES, ESK & WEAR VALLEYS NHS TRUST
County Durham & Darlington Priority Services NHS Trust, Tees & North East Yorkshire NHS Trust

NORTHUMBERLAND, TYNE & WEAR NHS TRUST
Northgate & Prudhoe NHS Trust, South of Tyne & Wearside Mental Health NHS Trust, Newcastle, North Tyneside & Northumberland Mental Health NHS Trust

OXFORDSHIRE & BUCKINGHAMSHIRE MENTAL HEALTH PARTNERSHIP NHS TRUST
Oxfordshire Mental Healthcare NHS Trust, Buckinghamshire Mental Health NHS Trust

SUSSEX PARTNERSHIP NHS TRUST
West Sussex Health & Social Care NHS Trust, East Sussex County Healthcare NHS Trust plus the learning disability, mental health and substance misuse services of, South Downs Health NHS Trust

South Downs Health NHS Trust will continue to provide a vital range of services to people in Brighton & Hove, and is discussing plans for a new-look South Downs Health with the Brighton & Hove City PCT.

GOOD HOPE HOSPITAL NHS TRUST
The Trust Board has reached the decision that under its current financial circumstances, the best way forward is for them to become part of a larger organisation such as Heart of England NHS Foundation Trust. The Trust has started urgent discussions with Birmingham & the Black Country SHA to find a way for a permanent arrangement to take place. Meanwhile, the Heart of England Trust has been invited to continue to provide management support.

WALSALL / ROYAL WOLVERHAMPTON NHS TRUSTS
The proposed merger of Royal Wolverhampton Hospitals NHS Trust and Walsall Hospitals NHS Trust will not now proceed. Both Trusts sent a letter to the SHA stating that the expected degree of clinical reconfiguration following the Black Country Review would not be as significant as first thought when the merger was requested, and the SHA has agreed.

North Eastern Derbyshire PCT - GP Services

The PCT's acceptance of United Health Europe's bid to run two local surgeries is being considered for judicial review and an injunction has suspended contract procedings. UHE is a private company, and there is some local concern over the selection process

Norwich PCT - Mental Health

A two-year pilot scheme in Norwich has enabled GPs to refer patients to Primary Care Mental Health Workers as an alternative to prescribing anti-depressant medication. Norfolk has three times the average prescribing rate and Norwich's rate is three times higher than that: a total of £34m has been spent on prescribing anti-depressants in Norfolk since 2000. The Mental Health Workers act as a "half-way house" between medication and referral to the mental health services, and have proved so successful that the scheme is about to be implemented across the whole city.

They are able to offer patients various forms of treatment, including guided self-help programmes, relaxation techniques and book prescriptions. The scheme also looks at other factors which could be the cause of depression such as employment situations, housing, finances and family situations. The scheme is part of a national programme to get more mental health workers into primary care, which started as a pilot in the north-east and has expanded across the country.

Slough PCT - Diabetes

Grace Vanterpool, until recently a Diabetes Nurse with Slough PCT, has been awarded the Nursing Standard Nurse of the Year Award for her Action Diabetes project. This targets the south Asian population and has led to a 30% rise in referrals for Diabetes.

Surrey & Sussex - Chronic Care

A new website has been developed by the Surrey & Sussex Transforming Chronic Care Programme. The website covers local initiatives aimed at improving chronic care, including case management, supported self-management and new technology: www.tccp.nhs.uk

West Norfolk PCT - Choose and Book

A new internet-based Choose and Book system is being implemented ahead of schedule in West Norfolk because of early planning and preparation by a joint team from West Norfolk PCT and the Queen Elizabeth Hospital King's Lynn. The DoH has now singled out the team to help other health trusts resolve any teething problems with their Choose and Book projects.

The system allows patients to make a convenient appointment with a Specialist whilst online in their GP's surgery and, so far, 20 of West Norfolk's 22 GP practices have signed up. It is already in daily use in 16 practices, with more than 500 patients and their GPs having booked hospital referrals through the system.

Wales - Local Health Board News

Carmarthenshire LHB - Chronic Disease Management

Carmarthenshire LHB's new Chronic Disease Management plans should be up and running by April. A team of Specialist Nurses will be put into place to cover each part of the county and help patients self-manage their conditions with support. However, there has been some disagreement with the local Social Services Department which believes that the £1.2m allocated by the LHB to the CDM project was originally intended for their plans to deal with bed-blocking. The LHB has denied this, and has said that the modernisation of CDM is vital, as it will help reduce the time spent in hospital by patients suffering from conditions such as heart disease and diabetes.

Gwent Healthcare NHS Trust - Heart Failure

Dr Jacky Austin of Nevill Hall Hospital has won an Excellence Award from the British Heart Foundation for setting up a rehabilitation programme tailored to the needs of elderly patients with heart failure which has led to fewer hospital admissions.

NHS Wales - Inequalities in Health Projects

The Inequalities in Health Fund was set up in 2001 to help tackle CHD in the poorest communities of Wales. A report on the progress of all 62 projects has been published, and further funding announced which will allow the projects to be extended to 2008.

Scotland - Local NHS News

Dundee CHP - Community Pharmacy-led Hypertension Clinics

Helen Christie, from the Perth Road Alliance Pharmacy, has been awarded the Community Pharmacy/GP Partnership Award by the Scottish Chemist Review for her work running the Hypertension Clinic at Ryehill Health Centre. Helen has completed a Supplementary Prescribing qualification, and has worked with the practice pharmacist, GPs and nurses to develop a work protocol and clinical management plan - this allows her to manage her patients’ hypertension and prescribe as appropriate.

She is currently working on identifying which patients could be monitored and treated at the pharmacy, which would allow her time to see more patients at the practice. Her work is funded through the Pharmacy Strategy and supported by Dundee CHP.

NHS Ayrshire & Arran - Dermatology

Ayrshire & Arran's Dermatology Department is at the forefront of service redesign and innovation in NHS Scotland. The Dermatology Liaison Sister has completed Southampton University's Advanced Dermatology Module and was one of Scotland's first Nurse Prescribers. The department now has two additional Registered Nurse Practitioners who can prescribe for certain conditions.

The Dermatology team includes four Biopsy Nurses, who can perform minor surgical procedures on patients, and four nurses with expertise in Photodynamic Therapy, which is used for some skin cancers and pre-malignant lesions. A Roaccutane Clinic is also available for the treatment of acne.

NHS Greater Glasgow - Organisational and Name Change

Following public consultation, NHS Greater Glasgow will change its name to NHS Greater Glasgow & Clyde in April. This to incorporate the new areas transferred to the board from the dissolved NHS Argyll & Clyde.

NHS Lanarkshire - CHD/Stroke

New Community Clinics have opened in Lanarkshire for patients with early stage vascular disease, or hardening of the arteries. These patients have a greater risk of heart disease and stroke, but many believe their symptoms are just a sign of old age. The multi-professional clinics, based in Airdrie, Coatbridge and Cumbernauld, are led by three nurses, a physiotherapist, a podiatrist and a pharmacist.

Previously, patients were referred to a vascular surgeon at the early stages of vascular disease and waited a long time for an appointment. The new clinics see patients on the waiting list and offer a one-hour consultation to carry out a full assessment. Lifestyle advice can make a big difference in managing the disease. The clinics, which are funded by NHS Lanarkshire’s Vascular Managed Clinical Network, have reduced the waiting list and are now starting to accept referrals from GPs.

NHS Lothian - Diabetes

Type 2 diabetes is four to six times more common among people with a South Asian background than it is in other ethnic groups, and knowledge about the condition can be poor as cultural barriers can hinder both awareness of, or access to, appropriate professional care. A new Diabetes Community Outreach project, run by a multi-lingual pharmacist in Lothian, aims to provide care for such diabetes patients in a culturally sensitive environment. Ethnic minority patients are referred by GPs or practice nurses.

The project is run by a multi-lingual pharmacist who firstly visits each patient to provide diabetes education on a one-to-one basis. Female patients then have the option to attend a regular "Three in One" clinic where no men are present and modest attire is the norm. Checks are made of each patient's HbA1c, blood pressure, cholesterol, weight and waist measurements, followed by a medication review. All test results and therapy recommendations are given to the patient's GP and are recorded on a patient-held record card. It is hoped to recruit more bi-lingual pharmacists to cover the wide range of ethnic minorities who live in the Lothian area.

Northern Ireland - Local NHS News

Belfast City Hospital HSS Trust - Generic Prescribing

The Trust has adopted a Zero Tolerance policy to branded prescribing to ensure that approved/generic names of medicines are used for prescribing, ordering, documentation and correspondence. The Royal Hospitals introduced a similar policy in August 2005.

Northern Ireland - Strategic Framework for Respiratory Conditions

"A Healthier Future - A Strategic Framework for Respiratory Conditions" sets out a 10-year framework for preventing respiratory disease, and for improving the assessment, treatment and care of people with respiratory conditions in Northern Ireland. In 2006/07 an additional £3m will be invested in the GMS contract to enable GPs to expand the range of services they provide for people with asthma and chronic obstructive pulmonary disease and to help patients self-manage their conditions.

Health Minister Shaun Woodward, announcing the publication of the strategy, said that this was the first policy document of its kind for respiratory conditions in the UK. Respiratory disease accounts for nearly 15% of all deaths in Northern Ireland and is a significant cause of disability in society. In 2002/03, there were almost 30,000 admissions to hospital due to respiratory conditions using over 180,000 bed days and costing almost £50m.

Southern HSSB - Out-of-Hours

There are currently three OOH services in the area: Moy, Newry & Craigavon. There are plans to relocate the Moy service back to Dungannon's South Tyrone Hospital in June, and discussions regarding the relocation of the Newry Centre to Daisy Hill Hospital.