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

England - Local PCT News

Barnet PCT / Barnet, Enfield & Haringey Mental Health Trust

Barnet, Enfield & Haringey is proposing to reorganise its mental health services so that patients with mild to moderate mental health problems will be seen by their GP. The GPs will, in turn, be supported by teams of dedicated specialists, including psychiatrists, psychologists and social workers. It is thought that approximately 3,000 people would fall into this category.

Patients with severe or enduring mental health difficulties who are thought to be at risk without extensive care (such as those who would self-harm), would be seen by a psychiatrist and referred to the community mental health teams as before. The trust believes that the "early intervention" aspect of this proposal would serve patients better, but some patient groups have expressed anxiety that those with long-term illness might appear stable enough to discharge to a GP precisely because they are well supported by a CMHT. The consultation runs until 18 July and will go before Barnet PCT's board on 28 July.

Bolton PCT - Non-Medical Prescribing

The Greater Manchester Non-Medical Prescribing Project was devolved from Greater Manchester SHA to Bolton PCT in July 2005. Since then, the PCT has worked to increase the number of staff other than doctors who can prescribe, such as nurses, pharmacists, radiographers, podiatrists and physiotherapists. The three Northwest SHAs* have now collaborated with nine university providers of Non-Medical Prescribing to develop an e-learning tool for the education of professional groups. This tool has created a standardisation in approach as well as allowing a more flexible route to education.

*Greater Manchester, Cumbria & Lancashire, Cheshire & Merseyside

Camden PCT - Diabetes

Local pharmacies, with the PCT's Public Health Department, have been running a 2-week campaign to raise awareness of the effects and prevention of diabetes. This is part of the PCT's overall strategy to address Standards 1 and 2 of the Diabetes NSF.

Castle Point & Rochford PCT - Long Term Conditions

There are currently three Long-Term Conditions Teams run by Community Matrons at the PCT, enabling many older people with conditions such as CHD, Diabetes, COPD and neurological disorders to live independently in their own homes for longer. The first team was established in Thundersley in 2004 as part of the NHS Live initiative. Following its success, two more teams were launched in 2005 covering the areas of Rochford, Wakering, Canewdon villages and Canvey Island. It is hoped that a fourth team for the Rayleigh, Hockley and Hullbridge area will be set up this year. Currently, each team is supporting between 60-80 patients per month.

Colchester PCT - Consultation on Walk-In Centre and Out-of-Hours Services

The recent public consultation on proposals to change the location of the Walk-in Centre and the Out-of-Hours Service was extended by three weeks to include a new, third option - an Integrated Urgent Care Centre (IUCC). This would involve co-locating the Walk-in Centre and the Out-of-Hours Service within the A&E Department on the Colchester General Hospital site. Staff from other services, such as the ambulance and social care services, would also be based there, so that patients could receive the right care from the right person at the right time.

The original two options were:
- for the WIC and OOH Service to remain at The Octagon Building in Middleborough to support primary care
- for the WIC and OOH Service to relocate to Colchester Primary Care Centre in Turner Road, close to Colchester General Hospital to prevent unnecessary admissions

The original eight-week consultation period was extended to the beginning of June, and the board of the PCT will make a final decision in the summer.

Fareham & Gosport / East Hants PCTs - Diabetes Intermediate Care Service

The South East Hampshire PCT Cluster plans to introduce a community-based Diabetes Service that will form part of an integrated primary/secondary intermediate care pathway. This proposal has been "‘in the pipeline" in one form or another for almost six years. The service will consist of two Diabetes Specialist Nurses and a GPwSI, and it will offer:

- Insulin start up groups
- Additional Type2 education groups
- Support and training for practice nurses and other members of the primary care team their patients
- Relevant education to community and primary health care teams
- Triage of people referred by GPs with diabetes who have more complex needs and liaison between primary care and the Diabetes Centre, with referral to the Diabetes Centre where appropriate

It is hoped that this will see an overall reduction in outpatient appointments (33% in first outpatients and 35% rising to 50% of follow-up patients). This would mean savings of £214,028 for 2005/6 to 2008/9, even taking into account an 8% rise in the diabetic population each year - the new model could save £516,863 over the next three years.

Gloucestershire PCTs - Herceptin

Financial constraints have led Cotswold & Vale, Cheltenham & Tewkesbury, and West Gloucestershire PCTs to propose that all spending on new drugs recommended by NICE be deferred under their 29-point savings plan. This will affect the availability of Herceptin. Draft guidance on Herceptin was issued in June, and trusts have three months from July to comply with this. However, a statement from the three county PCTs indicates that while they are reviewing the draft guidance, they will not be making funding routinely available for early-use Herceptin.

Instead, they will continue the current practice of considering individual cases under the Interventions Not Normally Funded exceptions policy. The county has around 420 early-stage breast cancer patients, of whom around 80 could benefit from the drug, although for medical reasons only about half would take it. Jackie Huck is the Director of Service Delivery at Cheltenham & Tewkesbury PCT. She said: "There are different types of NICE guidance. We need to consider each individually."

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

The Chief Executive of Good Hope Hospitals NHS Trust believes that the Secretary of State will approve the two hospitals' merger plans by the end of June. This would initiate a 3-month consultation period, and the merger could be complete by December.

Hull & the East Riding PCTs - Community Pharmacy

More than 100 pharmacies across Hull and the East Riding have collaborated to compile health information packs and will promote a different health issue each month. Weight Management and Five-a-Day are being highlighted during June and July, and themes for the coming months include sexual health, alcohol & drugs and antibiotics & smoking.

Kirsten Hamilton-Meikle, Project Facilitator for the Community Pharmacy Framework Collaborative, said: "The idea of using pharmacies as an outlet to promote good health and wellbeing is not new, but this calendar of health promotion is something we believe will really take off." The scheme is being launched in conjunction with the four local PCTs:

- West Hull PCT
- Eastern Hull PCT
- East Yorkshire PCT
- Yorkshire Wolds & Coast PCT

Maldon & South Chelmsford PCT - Stroke Service

The Stroke Service, run by the PCT's Therapy Service at St Peter's Hospital Maldon, has now been running for six months, and has proved a tremendous success. The service was initially set up with four dedicated beds to provide a rehabilitation service for stroke patients, and now a Stroke Unit of 6 beds is about to be commissioned. Marilyn Rivett, Therapy Services Manager, commented on the progress made by patients: “When the service was first set up, it was suggested that the approximate stay for a patient recovering from a stroke would be six weeks. We were all surprised at this short timescale but in fact, to date, the average length of stay has been 32 days." The PCT is aiming to recruit a Neuro Physiotherapist to the Therapy Service, which already includes a Stroke Clinical Specialist.

Oxford City PCT - Community Pharmacy EHC

Emergency Hormonal Contraception (EHC) is now available free of charge to under 18s at 19 pharmacies across Oxford following the success of a 2-year pilot. EHC is also available from GPs, Family Planning/GUM clinics, and some school health drop-ins.

Sheffield South West PCT - Children's Eczema Clinic

The Sheffield Eczema Clinic has now been in operation for one year, and staff are reporting a significant improvement in the confidence of children, and their parents, to manage their own condition. Hospital time has also been saved, as Consultants have more confidence to refer back to the clinic. The service is based at Jordanthorpe, and was set up by Health Visitors from the PCT with help from Nurse Specialists and Consultants at Sheffield Children's Hospital.

Nora Tebbutt is Head of Primary Care at the PCT. She explained that, generally, eczema has increased five fold over the past 30 years, and can account for 30% of dermatological consultations in general practice. She also indicated the problems that Asian children can have with difficult-to-manage eczema: sometimes the severity of the condition can be under-diagnosed because indications may be masked by racially pigmented skin. It was decided that a nurse-led approach would not only mean that eczema could be diagnosed and treated much earlier, but would also be particularly effective in empowering patients to take control of the disease.

South Norfolk PCT - Financial Action Plan

The PCT has drawn up a recovery plan which includes encouraging the prescription of cheaper drugs, increasing the use of GPswSI and providing care at home to reduce emergency hospital admissions. The PCT had a decifit of £7.2m in 2004/5, and £10.5m in 2005/6. At present, the PCT spends about £30m a year on drugs for its patients, a figure far in advance of other areas. Emergency admissions to the Norfolk & Norwich University Hospital cost the PCT between £800 to £5,000 a time, so it will now try and use its Rapid Response Unit to care for people in their own homes.

Matt Colmer is the Director of Finance at the PCT. He explained: “The £10.5m deficit is actually paying off the previous year's debt, so it is really an overspend of about £3m. “I can understand GPs will have concerns about these measures but we need to get back to balanced finances. To be honest, we are already finding that patients who would previously have been admitted to the hospital are preferring to get care in their own homes.”

Wales - Local Health Board News

Gwent LHBs - Out-of-Hours Service

Local Health Boards in the Gwent area have launched a public consultation on proposed improvements to the GP Out-of-Hours service, which will run until the end of July 2006. The service currently provides care for more than 600,000 people locally. The consultation document proposes a new model of services for the Gwent area, which concentrates on three Primary Care Out-of-Hours Centres, located in Ystrad Mynach Hospital, St Woolos Hospital, Newport and Nevill Hall Hospital in Abergavenny.

It is hoped that these changes will provide better integration with existing hospital services, especially Accident and Emergency Departments. The service is currently provided by Gwent Healthcare for the five Gwent LHBs:

- Monmouth LHB
- Torfaen LHB
- Caerphilly LHB
- Newport LHB
- Blaenau Gwent LHB

Powys LHB - Asthma

The Builth Wells Medical Practice has produced a podcast video demonstrating how to use an asthma inhaler properly. The GPs plan to develop the service to feature campaigns on the importance of flu jabs and cervical screening. Dr Richard Walters, a GP at the surgery, said the idea for the surgery's podcast came when the doctors decided to revamp their five-year-old website, and that podcasts were a natural progression from printed leaflets.

"We find that many people have difficulties using inhalers so the podcast shows a practice nurse demonstrating how to use one." Dr Walters also commented that as the Assembly Government was offering GP surgeries £250 a year to develop and fund new websites, he thought that podcasts would become familiar as more surgeries launch their own websites.

Rhondda Cynon Taf LHB - GP Award

Professor Chris Butler, of Park Lane Surgery, has been awarded the John Fry Award by the RCGP. The award is given to a younger Member who has promoted the discipline of general practice through research and publishing as a practising GP. Professor Nigel Stott commented on a young GP working in a deprived part of Wales achieving such international recognition: "That many young doctors wish to work with him in a challenging environment is testimony to the clinical and academic contributions that he is making to our important discipline in teaching, clinical work and in research." Professor Butler has recently won a substantial MRC grant to study the complex interaction between antibiotic use in the community and the emergence of resistant microbes. In so doing, he will exploit a unique collaboration between microbiologists, epidemiologists, GPs and immunologists who have created an unusual longitudinal database on an all-Wales basis.

Scotland - Local NHS News

NHS Ayrshire & Arran - Diabetes Retinopathy

The new Diabetic Retinopathy Screening (DRS) programme for Scotland has started in NHS Ayrshire & Arran. The screening process will now involve the use of a digital camera, with the image stored so that future comparisons can be made. Patients can have their eyes checked either at one of the 23 participating optometry practices, or at Crosshouse or Ayr Hospital Diabetic Clinics at the time of their annual diabetic review. Diabetic Retinopathy is the biggest single cause of blindness and visual impairment amongst working-age people in Scotland, and in 2003 the Scottish Minister for Health announced that all patients aged 12 and over were to be offered DRS using digital photography from 2006.

NHS Borders - Prescribing Guidelines

NHS Borders has published new prescribing guidelines which, it believes, will deliver a Gold Standard service to patients. The Borders Joint Formulary was compiled with extensive co-operation between specialities, clinical groups and practices throughout the area, and covers prescribing in both primary and secondary care. It covers all therapeutic areas such as the gastro-intestinal, cardiovascular, respiratory and central nervous systems, infections, obstetrics, gynaecology, malignant disease and anaesthesia, and includes palliative care guidance.

David Dalglish is Head Pharmacist at NHS Borders. He said: "This will be a great help both in optimising prescribing and maximising the quality of prescribing. This is not about costs, it is about making the best use of NHS Borders’ annual prescribing budget of approximately £23m." The formulary is available in hard copy, as an installation on GP computer prescribing systems, and will also be on the NHS Borders intranet where it can be regularly updated.

NHS Forth Valley - Dermatology

The new Dermatology Centre at Stirling Royal Infirmary has now been offically opened. The centre is the hub of the redesigned Forth Valley Dermatology Service, which sees between 4,500 and 5,000 new patients each year. This hub is supported by satellite clinics in Balfron, Thornhill, Alloa, Stenhousemuir and Falkirk. The demand for dermatology services increases year-on-year for a number of reasons, including the increased incidence of skin cancer - previous waiting times in excess of 55 weeks and the need to treat people quickly, especially for malignant melanoma, led to the service redesign. The new hub and spoke model combines primary and secondary care. There are now six clinics run by GPs with a Special Interest in Dermatology each week, and 11 nurse-led review clinics.

NHS Greater Glasgow & Clyde - Dermatology

The new Alan Lyell Centre for Dermatology, based at Glasgow's Southern General Hospital, will provide a skin cancer service, biological treatments for chronic skin disease, and will be the regional Contact Dermatitis Service.

Northern Ireland - Local NHS News

Northern HSSB - Substance Misuse

Ballymena could become a model for substance misuse research. While it has the highest number of heroin addicts in Northern Ireland (55%), 75% of them are receiving treatment for their habit, which is more than twice the province-wide average (32%). A Department of Health report has said that these statistics indicate that Ballymena's drug services have been "increasingly successful in engaging with the town's relatively stable and established heroin community", and suggested that future studies should focus on why treatment services in the town are so successful compared to the rest of the Province and the UK as a whole.

One reason cited for Ballymena's success was the joint Probation Board/Northern Health Board-funded project, where probation clients in the area who are identified as having a problem with drugs such as heroin automatically receive an assessment at a treatment service. The report studied the prevalence of cocaine and opiates (heroin, morphine, methadone) addiction in Northern Ireland, and estimates there were 3,303 opiate and/or problem cocaine users in the Province in 2004.

The Eastern HSSB area, which includes Belfast, had the highest rate of opiate use (725) followed by the Northern HSSB area (360), which covers Ballymena and Antrim. This estimated prevalence rate for opiate use in Northern Ireland, at 1.28/1,000 of the population, is considerably lower than elsewhere in the UK and Republic of Ireland. The comparable figure for Scotland is 15.39/1,000 population compared to 8.91/1,000 population for England and 5.58/1,000 population for the Republic.

Northern Ireland - Generic Prescribing

The Go Generic campaign has been launched in Northern Ireland, to encourage GPs to prescribe more non-branded medication. The rate of generic prescribing is low in Northern Ireland compared with other parts of the UK.

Western HSSB - Multiple Sclerosis

The MLA for West Tyrone has claimed that MS patients in Western HSSB are being put at a disadvantage compared with patients in the rest of the province. The claims follow a meeting between Eugene McMenamin and Health Minister, Shaun Woodward. Mr McMenamin said that in the other three HSSB areas, the average waiting times for a first appointment with a Neurology Consultant is 3-5 months, whereas in the Western HSSB area the waiting time is 6-8 months. This is despite the fact that both the Eastern and Northern Board areas have more people waiting for such an appointment. He also said that WHSSB also had the longest waiting times for the MS drug, Beta Interferon.

A spokeswoman for the WHSSB said: "At the end of December 2005, there were a total of 798 WHSSB patients waiting for first outpatient's appointments in neurology in Altnagelvin Hospital. All patients referred urgently to neurology are seen as first outpatients within two weeks. "The WHSSB has, to date, funded 80 patients to receive beta interferon and Altnagelvin Hospital is currently treating 73 patients.

"The longest waiting patient has been on the list since August 2004 and is due to commence treatment on February 1, 2006. The average waiting time is six months. "The WHSSB is seeking funding from the DHSSPS to enable us to treat more of the patients who are currently awaiting treatment."