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National Health Service, PCT & Local Health Board News
- March 2007
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National Health Service (NHS)
National Health Service (NHS), PCT & Local Health Board
News - March 2007
England - Local PCT News
Bristol Royal Infirmary -
CHD
Following a successful year-long pilot, patients who are taken
to the Bristol Royal Infirmary with a heart attack will now be treated by
angioplasty rather than thrombolysis. Immediate angioplasty will now be
available 24 hours a day, 7 days a week.
It is estimated that if all
heart attack patients in the UK received immediate angioplasty, there would be
500 fewer deaths per year, 1,000 fewer repeat heart attacks and 250 fewer
strokes. Dr Andreas Baumback, Lead Consultant Cardiologist, said the new
service would also cut the time patients spend in hospital, as there is less
damage to the heart.
The Department of Health has recently approved
plans for a new Regional Centre for Adult Heart and Chest Treatment and
Surgery.The £65m development is a joint project of United Bristol
Healthcare NHS Trust and North Bristol NHS Trust. It includes a new Regional
Adult Cardiothoracic Centre to be built at the back of the BRI, plus expanded
cardiology facilities at Frenchay Hospital
Cornwall PCT -
Out-of-Hours
Cornwall's out-of-hours service was taken over by SERCO
in April 2006, but there has been a great deal of local protest about poor
service. The 3-year OOH contract is due for review in April and the PCT has
given SERCO 20 days to improve their service.
Eastern Kent &
Coastal PCT (Shepway) - Medicines Management Team
The Shepway
Medicines Management Team was the Kent Regional Winner in the NHS South East
Coast Best of Health Awards, for helping to reduce dependence on tranquilizers
and sedatives.
The Shepway area had a 14% higher prescribing rate for
potentially habit-forming mild tranquilizers and sedatives, with some GP
practices two or three times the national average. In 2005, the Medicines
Management Team set up a dedicated withdrawal clinic in one of the
high-prescribing practices. 56 patients were invited to attend, and 45 have
either reduced or stopped their medication.
Hull and East Yorkshire
NHS Trust - Chronic Cough Clinical Trials
Professor Alyn Morice runs
clinical trials into chronic coughs at Castle Hill Hospital, Cottingham, and is
currently looking for people with smoking-related breathlessness or a recent
chest infection which has left them with a cough for more than 2 weeks.
Hull tPCT - Home Monitoring Systems
The PCT has
introduced the Doc@Home system for 10 patients with long-term conditions. The
hand-held portable device allows the remote monitoring of pulse, blood pressure
and weight and can alert the Community Matron to potential
problems.
Leicester City PCT - GP Commissioning
Two
GPswSI in Musculoskeletal Conditions have been held up by the PCT as good
examples of how practice-based commissioning can enable GPs to use their
clinical knowledge and experience to re-engineer services and benefit local
people. Most patients referred to hospital with musculoskeletal problems do not
require an operation, so the two GPs were commissioned to provide a variety of
services for patients with musculoskeletal disorders.
Dr Patrick
Wheeler runs a Musculoskeletal Sports and Exercise Medicine Clinic at his
practice in Astill Lodge Road, and Dr Newley runs a Musculoskeletal Medicine
Service at his surgery at The Maples, Evington Road. The services particularly
aim to make services more accessible for patients from nearby practices, but
are open to all practices in the city. Negotiations are currently taking place
with other GPswSI with the aim of providing further local musculoskeletal
services in the community.
Northamptonshire tPCT - Practice-based
Commissioning
As part of the national move towards PBC, almost 60
GPs in Northamptonshire are investing in the Nene Healthcare Limited Liability
Partnership (LLP), a new organisation which will enable patients to have minor
operations and treatments closer to home.
Nottinghamshire County
tPCT - Independent Pharmacist Prescriber
Beth Hird, Senior Practice
Pharmacist for Notts County tPCT, has successfully completed the Independent
Prescribing Conversion course and will be able to practise as an independent
prescriber once she registers with the Royal Pharmaceutical Society. She said:
"It is an exciting step forward for the profession to take on the professional
responsibility of independent prescribing. It should lead to new roles for
pharmacists, especially with the advent of practice-based commissioning,
resulting in a more patient-focused NHS.”
Mrs Hird already runs a
weekly asthma clinic at a local medical practice. She will now be able to
prescribe independently for these patients, and will be able to extend the
clinic to include patients with acute exacerbations and those referred by their
GP for a diagnosis. She also plans to take on Statin prescribing within the
practice.
Wiltshire PCT - 24hr Community Teams
Wiltshire
PCT is planning the establishment of 11 new 24-hour Neighbourhood Community
Teams across the county, working closely with GPs and comprising community
matrons, nurses, therapists and rehabiliation staff. The lack of 24-hour
community care means that some patients, whose condition could best be managed
at home, have to be admitted to hospital.
The teams will be supported
by new primary care centres in Trowbridge, Devizes, Salisbury and Malmesbury,
and the replacement of some hospital departments with upgraded community
hospitals in Chippenham, Warminster and Marlborough. There are plans for minor
injuries units in Trowbridge and Chippenham.
Worcestershire PCT -
Cervical Screening Provision
Worcestershire PCT has awarded the
contract for cervical cytology screening services to Gloucestershire Hospitals
NHS Foundation Trust. Screening services have been provided by the
Worcestershire Acute Hospitals NHS Trust for over 30 years. The new
out-of-county service was commissioned from Gloucestershire Hospitals after the
submission of five competitive bids. The PCT is hoping to introduce liquid
based cytology to the county by December 2007 - the deadline for implementation
nationwide is October 2008.
Wales - Local Health Board News
Gwynedd / Anglesey LHBs - Proposed
Partnership Working
Both LHB boards have proposed a new structure
for collaborative working across the areas of Clinical Governance, Medicines
Management and Patient/Public Involvement. The first meeting of the Joint
Medicines Management Sub-Group should be held this
month.
Monmouthshire LHB - Prescribing Report
The LHB's
Prescribing Team has visited all local GP practices and has reported on
progress towards achieving the All Wales Medicines Strategy Group (AWMSG)
prescribing indicators. Now that the budget element has been removed from the
prescribing incentive scheme, the Prescribing Team focuses on encouraging audit
and education, and uses the AWMSG comparators to allocate points. There is a
wide variation in the levels of achievement. The Chippenham surgery has
championed the repeat dispensing process, and have worked with the LHB to roll
this out to other surgeries in Monmouthshire. Only three practices have not
achieved the generic prescribing target of 78%.
With regard to statin
prescribing, Vauxhall surgery has championed the statin switch in
Monmouthshire, with a simvastatin prescribing rate of 78%. Dr Jarrett's (Usk)
has been asked to consider switching to Simvastatin 40mg, but has expressed
concerns over gastric side-effects - a small trial is underway. Wye Valley
surgery has not adopted the statin switch, and also has the lowest generic
prescribing rate in the LHB. Old Station surgery was targeted for the statin
switch because it has a large number of patients on statins and could save
around £37k pa. Mount Pleasant surgery uniquely prescribes Rosuvastatin,
and the LHB is currently working with the practice and Gwent LMC on this
issue.
Neath Port Talbot LHB - Respiratory Working Group
A Respiratory Working Group has been set up in Neath Port Talbot,
comprising healthcare professionals from both primary and secondary care. Neath
Port Talbot has the highest levels of respiratory illness in Wales. A local
practice nurse with a special interest in respiratory disease is spearheading
the joint LHB and Trust partnership, which is hoping to arrange Respiratory
Workshops every quarter. The first COPD workshop was held last
November.
Pembrokeshire LHB - Nursing Services
The
Director of Nursing at the LHB has reported on the new Anti-Coagulation Pilot
in GP surgeries, the Diabetic Link Project and the introduction of the new
Chronic Condition Nurse Practitioner. The Anti-Coagulation Pilot will involve
practice nurses taking a finger-prick blood sample and using a Coagucheck
device with INRstar software to calculate the Warfarin dose. Saundersfoot
Surgery is the first to start this service, with Newport Surgery to follow as
soon as staff are trained.
The Diabetic Link Project will be
co-ordinating practice nurse training in diabetes. Practice nurses will be
seconded to work one day a week at Withybush, where Diabetic Services are led
by Consultant Dr Paul Underwood. The nurses will work with the Diabetes Team
and the Diabetes Specialist Nurse and it is anticipated that this initiative
will improve the consistency in Diabetes Services across Pembrokeshire.
Fishguard is the first practice to take part in the scheme. Pembrokeshire
introduced two Chronic Condition Nurse Practitioners during the winter, in
partnership with Health & Social Care services. It is hoped that they will
help provide a more co-ordinated service for patients with long-term
illness.
Scotland - Local NHS News
NHS Highland - Heart Failure
Service
The NHS Highland Heart Failure Service will start in April,
with five BHF Heart Failure Nurses helping heart disease sufferers to keep
healthy and stay out of hospital. The nurses will work alongside the
Direct-Access ECHO service which helps GPs diagnose heart failure, and has been
funded for the next five years by the BHF and NHS Highland.
Mandi Smith
is Lead Heart Failure Nurse, and the five nurses will work with community staff
across the board. One part-time nurse will cover Caithness and Sutherland, two
nurses will cover Ross-shire and Lochaber, and one part-time nurse and a full
time nurse will cover Inverness, Nairnshire, and Badenoch and Strathspey.
Chronic Heart Failure is the most expensive cause of hospital admissions in
people over the age of 65 in the UK. In 2004, there were 6,083 bed days for
heart failure in the Highlands, 4,004 of which were in the acute hospitals.
Most patients are aged between 60 and 70.
NHS Lothian - Renal Website
The Royal Infirmary's Renal Unit has developed a website which
offers patients information about their condition, and has become recognised as
a valuable teaching tool for patients, staff and students. The website was
written and put together by members of the staff of the renal unit, and is
available at www.edren.org.
The unit
was also one of the first centres to pilot the national website
www.renalpatientview.org when it
was launched in 2005. This site provides online information to renal patients
about their diagnosis and treatment, and allows them to access individual
pieces of information, including their latest test results the day after they
are done.
Northern Ireland - Local NHS News
Northern Ireland - Regulation &
Quality Improvement Authority (RQIA)
The Regulation and Quality
Improvement Authority (RQIA) has begun a programme of review visits to every
health board and trust area - this is the first independent assessment of the
Quality Standards for health and personal social services in Northern Ireland.
In October 2006, each board, trust and agency completed a
self-assessment form to examine the first two themes of the Quality
Standards:
- corporate leadership and accountability
- safe and
effective care
and these themes will be examined in detail at the
review visit.
The RQIA was established in April 2005, and is
responsible for monitoring, regulating and reporting on the quality of care and
services, rather like the Healthcare Commission in England and Wales, and the
NHS Quality Improvement Scotland.
Nurse and Pharmacist Independent
Prescribing - Implementation Guidance
Guidance has now been
published on nurse and pharmacist independent prescribing, providing both
information and advice on good practice. Over 200 nurses are currently trained
in NI, and the first Pharmacist Independent Prescribers qualified this January.
Sperrin Lakeland Health & Social Care Trust - CHD
A
cardiologist at the Erne Hospital in Enniskillen has expressed doubts about the
Department of Health initiative to prescribe more generic statins. He said that
CHD patients in his locality tended to have very high levels of cholesterol and
may need more potent statins. He added that cost should not come into the
equation. Dr Mahendra Varma is also vice-chairman of the Northern Ireland
Chest, Heart and Stroke Association.
The Department of Health has said
that switching the one million patients currently on branded atorvastatin to
simvastatin "should have no effect on health" and would save the NHS
£1.1bn over five years. It also notes NICE's confirmation that generic
versions of statins are as effective for most patients as their more expensive,
branded counterparts.
Western HSSB - New Health Centres
The Western HSSB is preparing an outline business case for the
provision of new health centres across the region, involving 86 separate
projects. The aim of the programme is to provide healthcare as close to local
communities as possible, and in a modern setting. There is a particular
emphasis on improving existing GP practices, providing new facilities for
people with learning difficulties and mental health issues, and increasing
support services for children and older people.
Discussions in
Fermanagh involve new health centres in Lisnaskea and Irvinestown, a complete
refurbishment of the health centre in Belleek, and provision of new services at
Enniskillen, initially at the existing health centre but eventually at the Erne
Hospital site once the new hospital is built in 2011. A new GP surgery may be
sited at Derrygonnelly, and a practice may be re-positioned to cover the
Kinawley/Florencecourt areas.
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