GPLinkIssue 2

Welcome to our second edition of GP Link, the newsletter where we keep you up-to-date with information on new services, how we are performing and where we are making improvements.

In this issue:

• Endoscopytraining• TherapyServicesexplained

• Patientreferralpathways

• InvestmentinRadiology

Are your patients fit to refer for elective surgery?The NNUH has a pre-operative assessment clinic running every day with nurses, physiotherapists, occupational therapists and anaesthetists. The team assesses each patient’s fitness and helps people to prepare for their operation, explaining what will happen and arranging for mobility aids and equipment to be made available.

If you would like to check if your patient is suitable for day surgery before referral, please call the team

health problems that could be identified at the time of initial referral.

At NNUH, recent work has shown this to be approximately one patient every day. This results in in-convenience and distress to the patient and additional costs for the surgical pathway due to wasted operating time and repeated investigations and assessments.

A simple three point assessment to determine whether your patient is “fit to refer” could detect the most common problems and avoid these delays and additional costs. This assessment could include• BP check- which should be <180/110 at time of pre-op assessment• Pulse check for new AF- which should be rate controlled at <90• HbA1C check for known diabetics - which should be less than 69mmol/mol

on 01603 287819 or e mail the lead for pre-operative assessment, Dr Anna Lipp on: anna.lipp@nnuh.nhs.uk

It can be difficult to know how fit a patient has to be to have an operation and it will depend on the type of surgery and anaesthesia proposed. However there are a few common problems that regularly cause patients to have their booked surgery delayed or cancelled.

These are usually pre-existing

Day Procedure Unit Update

The East of England Endoscopy Training Centre at NNUH has become one of only three sites to offer a new practical colonoscopic polypectomy course to trainees across the UK.

The NNUH is one of ten regional centres of excellence in the UK for endoscopy training accredited by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG). It offers a range of courses for consultants, specialist registrars, nurse endoscopists and GPs with preference given to those from the Eastern region.

On the colonoscopic polypectomy course, trainees are taught the complex skills required to remove polyps from colons on realistic models. This provides

NNUH centre of excellence third site to offer new training

a safer and more controlled environment to practice techniques that otherwise could result in injury if not done correctly. The first course was facilitated at NNUH by leads Drs Richard Tighe and Ian Beales and nurse training lead Jane Cook.

Dr Beales, Consultant in Gastroenterology and General Medicine at NNUH, has also recently been elected to take over the prestigious role of Chair of the trainees section of the National Endoscopy Training Body. In this role he will help lead further initiatives and oversee the governance and implementation of Endoscopy training nationally.

Referrals to the Breast ClinicAt present, we prioritize patients with suspected breast cancer (i.e. on the two-week-wait pathway) to appointment times early in the day to ensure that appropriate imaging is performed on a one-stop basis.

A small number of less suspicious referrals are not currently able to undergo same-day imaging, and it can cause a significant amount of distress if patients arrive in the clinic expecting have all their tests on the same day.

Using the cancer pathway for these cases can mean that more worrying cases do not receive same-day imaging. Please note that as all symptomatic breast clinic referrals are seen within two weeks, whether they are on the suspected breast cancer pathway or not, it is safe to use the routine referral pathway when suspicion levels are low.

We hope to achieve same-day imaging for all referrals in the future. Until then, we ask for your support in helping patients to understand the timing of their investigations.

Fast Access Number Remember, there is a fast access telephone number which GPs can use to contact the NNUH which is 01603 286666.

New proceduresWe are always looking at new techniques and innovations to offer patients the option of day surgery where appropriate. About 20,000 patients are seen annually for a range of procedures and in Norwich now:• 70% of Laparoscopic Cholecystectomies are performed as day cases • Prostatectomy using a laser technique can be performed as a day case • 30% of mastectomies are performed as a day case

Saturday working meets demand for day surgeryFor the last nine months, the Day Procedure Unit has been running theatre lists on a Saturday as part of its normal working week. Saturday surgery suits many working patients who find it easier to organise their lives around a weekend procedure. The six day working week has helped the unit to keep up with the demand for surgery and make the best use of the facilities.

Texting patients before surgery reduces cancellationsFor some years, we have been sending SMS text messages to patients before their outpatient appointment. Now the system has been rolled out for all surgery with patients being contacted a few days ahead of their operation. This helps to reduce cancellations as patients are encouraged to contact the hospital if they are unfit for surgery or not able to attend on the day.

Home Oxygen Assessment Service

The referral form for the home oxygen service is available on Knowledge Management and on our website www.nnuh.nhs.uk/TrustDoc.asp?ID=600&q=oxygen

• Referrals are accepted according to the following criteria:

• Confirmed clinical diagnosis of a disorder associated with chronic hypoxaemia

• Optimal medical and pharmacological management

• Evidence of hypoxaemia/exercise desaturation when clinically stable based on pulse oximetry:

• Resting saturations of ≤ 92% on room air

• Desaturation on exertion of ≥ 4% to below 90% on room air

Changes to pathology services Norfolk’s three acute hospitals have teamed up to form the Eastern Pathology Alliance which will be providing pathology services to local practices.

The Norfolk and Norwich University Hospital, the James Paget University Hospital and the Queen Elizabeth Hospital at King’s Lynn have been working together for the last two years to form a merged pathology service which will provide all GP pathology services from the NNUH laboratory, with all 3 Trust laboratories being managed by the NNUH. The Eastern Pathology Alliance has been recommended to operate pathology

services in Norfolk following a tendering process run by NHS East and Midlands. This follows the publication of the Carter Report which assessed how pathology services were run and managed across the UK and recommended that a more efficient service could be provided from larger laboratories.

Discussions are taking place with representatives from HealthEast, (NHS Great Yarmouth and Waveney CCG), on behalf of all Clinical Commissioning Groups, to manage the roll out to GP practices over the coming months. See the next edition of GP Link for more details.

Therapy Services ExplainedThere are a broad range of Therapeutic Services provided to in-patients and out-patients, adults and children across the hospital and community.

Professionals within therapeutic ser-vices support the Consultant led medical assessment, diagnosis and treatment of patients during their in-patient stay and assess and treat patients in out-patient clinics across the hospital. Dietetics and paediatric physiotherapy provide com-munity services as well as hospital based services.

The range of services provided ensures that children, adults and older people receive holistic assessment and support. Professionals work together as a multi-

professional team, all working to assist the patient to improve or maintain health and wellbeing, or support end-of-life decisions. The team facilitates discharge

to the most appropriate environment to meet ongoing health and care needs. Onward referral to other services and agencies is made according to patient need.

Future articles will introduce the individual services, roles and responsibilities. For any general enquiries regarding the services within the Directorate please contact Tracey Fleming, Head of Therapeutic Services Directorate on 01603 646082 or contact the individual services.

Patient Feedback: The Friends & Family Test

Surveys have been used to gather patient feedback on the wards at NNUH for 18 months and now the feedback programme is set to expand across the whole hospital. Patients who visit one of the Trust’s clinics or who visit the Accident and Emergency Department now also have the opportunity to answer the Friends and Family Test (FFT) question, “How likely are you to recommend our ward to friends and family if they needed similar care or treatment?”

Currently five clinics and A&E are offering patients the opportunity to feedback by Freepost postcard, online through a quick response code found on posters or by downloading an App. This patient feedback programme will be rolled out across ten more clinics in the next few weeks.

New Medical Research building The NNUH has entered into a £19 million joint venture with the University of East Anglia to provide state-of-the-art facilities for both medical research and teaching on the Norwich Research Park.

The new Norwich Medical Research Building is due for completion in September 2014. It will contain facilities for researching prostate cancer, nutrition and health, and microbiology including NNUH’s Tissue Bank. The tissue bank is being funded by the BBSRC (Biotechnology and Biological Sciences Research Council) with some charitable support.

The new building will also house the Norfolk Bone and Joint Centre, dedicated to re-searching and finding new treatments for chronic bone diseases. A £1m fundraising campaign has been launched to support the development of the centre. To make a donation, go to http://www.uea.ac.uk/boneandjoint

Clinicians from NNUH and academics from the UEA believe that this important project will enable Norwich to remain at the forefront of medical research for years to come as well as enabling Medical Students to benefit from the clinical expertise on-site.

Patient referral pathways

£2 million programme grant to improve dementia care. A new five year research study is being hosted at NNUH to investigate how better standards of care can be implemented across the NHS to improve the outcomes of hospital admission for people with dementia.

The study is called ‘PERFECTED’ (Peri-operative Enhanced Recovery hip FracturE Care of paTiEnts with Dementia).

At present, one quarter of acute NHS hospital beds are occupied by people with dementia. But rehabilitation of sufferers is difficult due to acute confusion “delirium” and other complications

The study will be hosted by NNUH where initial re-search will take place. A further 10 hospitals will also be involved after three years. After the programme has ended, it is hoped that the guidelines will be rolled out under a four-year trial across the NHS.

As you are aware the Choose and Book System has been in place at the Norfolk and Norwich University and Cromer Hospitals for several years and is well supported by GP practices. Once a referral is created through this system patients can book their appointments via one of the following options:-

(i) TAL (national telephone appointments line)(ii) Through their surgery (if this service is available at the surgery)(iii) OnlineOnce an appointment has been made the trust sends out a letter of confirmation to

the patient when their referral has been accepted by the consultant. It is important that the patient receives either written or verbal confirmation of their appointment before arriving at the hospital.

When creating a Unique Booking Reference Number (UBRN), Choose and Book guidelines indicate referrals for two week waits and urgents should be attached within one working day, and routine referrals should be attached within three working days.

For the trust this is the preferred route for patient referrals as it offers the patient choice in booking their appointment, assists the departments in managing their outpatient activity more efficiently and ultimately supports the trusts aim to become paperless in the future.

As an alternative to the Choose and Book system we also process written (paper) referrals which need to be sent directly to our Outpatients Booking Services Department located at Level 3, 20 Rouen Road, Norwich, NR1 1QQ. Emergency referrals must be directed to the speciality via telephone or fax.

For both types of referral to be processed without delay it is imperative that pertinent information directly relating to the patients’ health status is provided and where appropriate, a concise past medical history included, in addition to a list of current medications.

When referring patients to the trust it would be extremely helpful if the following information could be relayed to the patient:-

(i) The patient is aware they are being referred to the hospital for a second opinion, particularly those patients being referred via the 2 week wait route

(ii) Patients are aware of the trust Referral To Treatment (RTT) pathway (iii) Patients need to indicate to the GP whether they require an interpreter or

transportationIf you have any queries please telephone Bridget Whitworth, Out-patients Booking

Services Manager on 01603 287982.

£300,000 investment in advanced Radiotherapy services Hundreds more cancer patients every year will benefit from the expansion of state-of-the-art radiotherapy at NNUH, thanks to a £ £312,776 grant from the Radiotherapy Innovation Fund.

The hospital has purchase new equipment and software which will enable the hospital to treat up to 500 more patients with Intensity Modulated Radiotherapy (IMRT) which varies the intensity of radiation aimed at a cancerous tumour. In August 2012, fewer than 14% of patients receiving radiotherapy nationally were given IMRT. By April 2013 that figure had risen to over 22%. Whilst not all types of cancer can benefit from IMRT, it is suitable for a variety of different cancers including many breast and prostate tumours. Currently 34% of all patients having curative radiotherapy at NNUH

are offered this treatment and this investment will mean even more patients will be able to access this advanced treatment.

GP LINK

ProducedbytheCommunicationsTeamatNNUH.

Ifyouhaveanyfeedbackonthisnewsletter,pleasecontactusat:

Email:gplink@nnuh.nhs.ukTelephone:01603287634

Big C Cancer Support & Information CentreFor those who are not familiar with the Big C Centre based at the NNUH, it is a drop-in centre for cancer patients and their carers, funded by Big C charity (covering Norfolk & North Suffolk). Staffed by three healthcare professionals and volunteers, the Centre offers a warm and welcoming environment for local cancer patients at any stage of their cancer journey; they do not have to be currently undergoing treatment at any of Norfolk’s hospitals.

The Centre is open Monday to Friday 09:30-16:30 and until 19:30 on the first Wednesday of each month.

The Centre offers complementary therapies, counselling, relaxation groups, Healthy Matters programme (advice from dietician, Physio, OT), CAB/financial advice, carers’ club, pamper sessions, headwear workshops (for those with hair loss) and bereavement support.

For more information go to www.big-ccentre.co.uk or telephone 01603 286112 (Big C also offers information/support at its Gt.Yarmouth Centre, Millennium Library and Louise Hamilton Centre)