Chelsea and Westminster Hospital NHS Foundation Trust GP News - March 2016

March 2016 In this edition: Trustwide news: Proposed Junior Doctors’ industrial action Burns management training offer Upcoming events: 16 March – Paediatric Services Showcase, Chelsea and Westminster Hospital 18 March – NW London Perinatal Mental Health Conference, Hammersmith 25 April – From Conception to Birth event, Chelsea and Westminster Hospital 26 April – Third Trans Health Conference, Coin Street Centre, Waterloo 12/13 May – Sexually Transmitted Infection Foundation Course, Hammersmith 19 October – Menopause Study Day, Chelsea and Westminster Hospital Chelsea and Westminster site specific: Update on improving NUCA 2WW referrals Spinal Cord Stimulator Service West London Centre for Sexual Health Older Adult Support Team (OAST) Female Genital Mutilation (FGM): Recognise, record, report, refer West Middlesex University Hospital site specific: Update on Surgical Assessment Unit and Emergency Surgical Ambulatory Care Service GPs can now order Non Obstetric Ultrasounds through Sunquest ICE Is your patient fit for referral surgery?

Hounslow wellbeing group for mums For more information on this edition of GP news or for any GP issues or queries please contact: Justine Currie GP Relationship Manager T: 0203 315 6603 E: gpqueries.chelwest@nhs.net

Trustwide news Proposed Junior Doctors’ industrial action Last month the British Medical Association (BMA) announced three further 48-hour periods of proposed industrial action for junior doctors during March and April.

The first strike will begin at 8am on Wednesday 9 March and last until 8am on Friday 11 March. The 48-hour action only affects non-emergency care.

During the proposed strike, emergency care will be prioritised and we expect to safely run all urgent and emergency care services including A&E, UCC and maternity, as well as cancer appointments.

Walk-in radiology services will be available during the strikes but there may be an additional delay in reporting on scans.

To enable safe emergency care, we have made specific arrangements for patients with planned appointments scheduled to take place during the strike action as follows: Patients that have been prioritised based on consultants’ clinical decision-making have already been notified by letter or telephone that their appointment will proceed even in the event of strike action and they should attend their appointment as detailed in their hospital letter Patients not in the priority cohort have been notified by letter that their appointment will only proceed if the strike is called off. If the strike goes ahead these patients will not be seen and should not come to the hospital.

We will contact these patients to reschedule their appointment.

If patients have any questions about their appointments during the industrial action, they can get in touch with us: Chelsea and Westminster PALS: 020 3315 6727 West Middlesex Appointment Office: 020 8560 2121 We apologise for any inconvenience caused, but our focus during the strikes will be to ensure that we continue to provide safe emergency care for patients. Thank you in advance for your assistance and support during the upcoming industrial action.

Burns management training offer Annette Kempster is the Burns Care Advisor for the Trust, covering training and education needs across the complete catchment area for Chelsea and Westminster Hospital and West Middlesex University Hospital.

Annette provides the latest information on initial burns management, including first aid, burns wound assessment and referral criteria.

18 March – North West London Perinatal Mental Health Conference The Plenary Lecture on Friday 18 March 2016, 9.30am – 4.30pm at St Paul’s Centre, Queen Caroline Street, W6 9PJ will be given by Dr Margaret Oates OBE, Consultant Perinatal Psychiatrist and Clinical Director for East Midlands Strategic Clinical Networks, NHS England. She will be speaking on: Lessons for maternal mental health – UK confidential enquiries into maternal deaths The programme for the day includes: • Keynote speeches from Clare Dolman (Vice Chair, Bipolar UK) and Dr Lucinda Green (Consultant Perinatal Psychiatrist, Guy’s and St Thomas’) • Interactive breakout sessions on Tokophobia and Birth Anxiety, Medications in Pregnancy and Lactation, Screening and Communication in Pregnancy, and collaborative working practice To register your attendance, please click here: https://www.eventbrite.co.uk/e/north-westlondon-perinatal-mental-health-conference2016-tickets-20698087537

If you would like Annette to come and provide some training locally at your GP practice, please email annette.kempster@chelwest.nhs.uk or call her on 020 3315 2500.

Upcoming events 16 March – Paediatric Services Showcase On Wednesday 16 March from 6.30pm-9.00pm we are hosting a Paediatric Services Showcase in our new MediCinema. The event will focus on day surgery, endocrinology and paediatric diabetes.

Mr Simon Clarke, Service Director for Paediatric Surgery and Dr Kingi Aminu, Clinical Director for Chelsea Children’s Hospital will host the session.

Spaces are limited to 40 places, so if you are interested in attending, please RSVP to: caroline.pooley@chelwest.nhs.uk

25 April – From Conception to Birth event On Monday 25 April from 6.30pm-9.00pm, Mr Dimitrios Nikolaou, Mr Nigel Borley and Miss Gubby Ayida invite you to a 'From Conception to Birth' event in our MediCinema. This session will cover male and female infertility and provide an inside look at how we, in partnership with GPs, can optimise recovery for caesarean section patients.

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You will also have the opportunity to view our maternity suites.

12/13 May – Sexually Transmitted Infection Foundation Course

Spaces are limited to 40 places, so if you are interested in attending, please RSVP via to: to caroline.pooley@chelwest.nhs.uk

The next St Stephen’s Aids Trust /Chelsea and Westminster Hospital Sexually Transmitted Infection Foundation course will be held on 12/ 13 May at St Paul’s Centre, Hammersmith. The course is aimed at GPs, hospital doctors and specialist nurses working in the field.

26 April – Third Trans Health Conference CliniQ, the UK’s only trans-led sexual health and wellbeing service is holding its third national conference Trans Health Matters.

For details please email linda.connor@ssat.org.uk or visit the website www.ssat.org.uk

This is the only UK event to specifically address sexual health, HIV and trans populations. It will include a range of speakers and will host the UK launch of the WHO’s Trans Implementation Tool, as well as provide updates from Public Health England on trans HIV surveillance, PEP and PrEP.

19 October – Menopause Study Day

The conference will be held at the Coin Street Neighbourhood Centre, SE1 9NH on 26 April. For more info see www.cliniQ.org.uk.

If you would like a copy of the programme or to sign up for the study day, please call 020 3315 3168 or email claire.bellone@chelwest.nhs.uk

Claire Ballone, Clinical Nurse Specialist, is hosting a menopause study day in partnership with the British Menopause Society on the 19 October 2016 at Chelsea and Westminster Hospital.

Chelsea and Westminster Hospital Update on improving NUCA 2WW referrals As mentioned in the last edition of GP news, we have seen an increasing number of inappropriate Gynaecological 2WW referrals and we recognise that it’s in everybody’s interests to increase 2WW referral appropriateness and to minimise any unnecessary distress to patients.

We are keen to work with our local GPs to ensure that 2WW priority slots are used appropriately, that the criteria for referring patients with suspected cancers are better understood and that all the necessary details are included in all Gynaecological 2WW referrals.

To this end, we have launched a 2WW referral feedback template which will be sent back to the referring practice, accompanied by the original referral, as and when required.

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The template is designed to be a teaching and learning aid for the GP and practice concerned to help inform future clinical decision-making around 2WW referrals – all GP NUCA referrals will still be processed as per usual guidance.

If you have any questions about the feedback process, please contact us as follows:

Services provided from the new site include: A walk-in sexual health screening service Sexual health/contraception treatment and care, including sessions for under-19s and clinics for complex cases such as FGM HIV treatment and care

For gynae-oncology queries (i.e. endometrial, ovary, vulval) – Emma Mathurine, Clinical Nurse Specialist: emma.mathurine@chelwest.nhs.uk For cervical cancer and colposcopy queries – Susan Ogden and Vanessa Dand, Nurse Colposcopists: colposcopyclinic@chelwest.nhs.uk

Spinal Cord Stimulator Service Do any of your patients with chronic pain suffer from any of the following?

Persistent sciatica Refractory angina Failed back surgery syndrome (FBSS) Complex regional pain syndrome (CRPS) Peripheral neuropathic pain Or has your patient tried and not responded to conservative treatments – e.g. analgesics and physiotherapy.

Why not refer these patients to the Spinal Cord Stimulator Service at Chelsea and Westminster?

The new clinic has excellent transport links and is close to Hammersmith tube and bus station. For further information, please call: 020 3311 1224.

Spinal Cord Stimulation is a neuromodulation therapy, which delivers small electrical fields to the spinal cord to mask areas of pain.

To find out more, download the leaflet or contact us on 020 3315 8000 via the switchboard.

West London Centre for Sexual Health – we are moving to Hammersmith Broadway!

In early April 2016 the West London Centre for Sexual Health will be moving from Charing Cross Hospital to 10 Hammersmith Broadway, W6 7AL. As lead clinician Rachael Jones says: “The move will help to make our services more visible and accessible to those who really need our input.”

Older Adult Support Team (OAST) – Elderly Acute Medicine Clinic OAST is our new rapid access clinic for older patients and part of the ambulatory care service at Chelsea and Westminster hospital. Our main goal is to reduce preventable A&E attendances and hospital admissions.

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We provide consultant-led multi-disciplinary assessments for adults aged over 65 with acute or chronic issues and multiple comorbidities. Our opening hours are 9am-5pm, Monday to Friday and we are based in the Medical Day Unit (MDU).

Patients are reviewed by our experienced team, which includes a geriatrician consultant, therapist and pharmacist. We also have access to nursing support and a liaison psychiatrist if required.

We aim to see urgent patients within 48 hours of referral through one of the following routes:

There are currently an estimated 60,000 girls aged 0-14 living in the UK who are at potential risk of FGM. Guidelines on how to protect young girls and how to care for survivors have now been introduced, together with a mandate on when to report FGM to the police.

GPs and practice nurses are very well-placed to recognise, record, report and refer suspected cases of FGM where appropriate.

How you can get involved:

Phone advice – GPs can receive advice on patients over the phone from one of our geriatrician consultants Clinic – Patients attend hospital for assessment, this is particularly helpful for diagnostics and treatments Home visit – domiciliary access is provided by our geriatrician pharmacist and therapist for immobile patients not requiring imaging

Identify women and children at risk of FGM Safeguard women and children in your area by ensuring a risk assessment is in place Understand and comply with the mandatory reporting duties for girls under the age of 18 Use a screening questionnaire for FGM Get to know your local FGM service and signpost survivors for support and advice

OAST referral criteria: Patients aged 65 and over from within the southern region of Kensington and Chelsea GP has immediate concerns and patient requires a rapid not routine appointment GP analysis is inconclusive and further consultation by geriatrician is required Medical emergencies should still be referred to A&E and not to OAST GPs can refer patients via the GP Advice Line – 020 3315 5000 (select option 5) – and we also require a GP letter to be faxed once the referral has been made.

Female Genital Mutilation (FGM): Recognise, record, report, refer Following on from the International Day of Zero Tolerance for Female Genital Mutilation (FGM) on 6 February, we need your input to help both prevent FGM and support survivors.

FGM is child abuse and is illegal in the UK. It can often cause significant lifelong psychological and physical complications.

We have a unique multidisciplinary FGM service within the West London Centre for Sexual Health.

The service is free, confidential and open access.

We can see patients aged 13 and over, and can help signpost younger people to other services.

The services we provide include: Sexual health screening Assessment of physical and psychological sequelae of FGM De-infibulation (‘reversal’) Support during pregnancy and safeguarding 6

We accept referrals from any health professional or self-referrals from across the whole of the UK. Get in touch with us: By phone – 020 3311 1579 (this line is manned by our health advising team) By fax – 020 3311 7582 By email – Dr Lazara Dominguez: Lazara.DominguezGarcia@chelwest.nhs.uk By post – Health advising team, West London Centre for Sexual Health, Charing Cross Hospital (South Wing), Fulham Palace Road, London W6 8RF

Please note: on Thursday 24 March, the FGM clinic will be closing and moving to our brand new premises at 10 Hammersmith Broadway, W6 7AL. We will reopen in this new location on Monday 4 April.

Further reading: https://www.gov.uk/government/publications/fe male-genital-mutilation-guidelines https://www.gov.uk/government/publications/m andatory-reporting-of-female-genital-mutilationprocedural-information

West Middlesex University Hospital Update on Surgical Assessment Unit and Emergency Surgical Ambulatory Care Service

and either admitted or discharged home, with follow up care if required.

Today, patients who need an emergency surgical opinion are referred to the SAU following an initial assessment by a triage nurse in A&E/UCC, or by their GP. A senior surgeon then carries out their expert assessment and makes a decision on the most appropriate way to treat the patient.

The SAU is open 24 hours a day, 7 days a week.

As you may know, in January West Middlesex University Hospital launched a new service to provide more streamlined and efficient care for General Surgery and Urology patients.

The service opened on 11 January and comprises a dedicated Surgical Assessment Unit (SAU) and co-located Emergency Surgical Ambulatory Care (ESAC) service with a fast access ‘hot clinic’. GPs and clinicians in A&E and the Urgent Care Centre (UCC) can directly refer patients to both services.

For patients requiring urgent surgical treatment on a number of common predefined conditions – for example, abscess, painful non-obstructed hernia, bleeding from the back passage, or postoperative and wound problems – they can now be referred to the new ESAC service.

In ESAC, patients receive a date for surgery and can return home the same day. The ESAC is open on Tuesdays and Thursdays from 8am-8pm.

The new team (pictured) is led by Mr Jason Smith, Clinical Director for Surgery, supported by Annette Lloyd, Matron for Surgery. The nurse in charge of the service is Áibhín Burke, Ward Manager for Richmond Surgical Centre.

Previously, patients needing unplanned surgical intervention were assessed by a doctor in A&E 7

The consultant surgeons supporting the unit are: Mr Jason Smith (Clinical Director for Surgery) Mr Peter Dawson (Divisional Director for Planned Care – GI) Ms Bubby Thava (Consultant Surgeon) Mr Musa Barkeji (Consultant Surgeon – Breast) Mr Siv Salaki (Locum Consultant Surgeon – Breast) Mr Rajiv Vashisht (Consultant Surgeon – Breast) Mr Razick Sait (Locum Consultant Surgeon – Breast) We are pleased to report that early outcomes from the first month of operation clearly indicate that both the SAU and ESAC are performing well: 38% of patients attending the SAU were discharged without admission – against a predicted forecast of 30% Breaches for General Surgery and Urology patients have fallen from an average of 3.4 to 0.3 breaches per day The average length of stay in the SAU is only 0.7 days The waiting time between A&E and surgical opinion for General Surgery and Urology patients has decreased from an average of 2.55 hours and 2.45 respectively, to 1.10 ESAC has also introduced extra services since its launch, such as our new fast access abscess drainage theatre sessions. These take place over four mornings per week and patients are seen and treated within 48 hours without the need to stay in hospital.

Together the SAU and ESAC set of services have dramatically reduced waiting times: Nearly 70% of patients are seen by a doctor within an hour Nearly 95% of patients are seen by a nurse within an hour We have also received excellent feedback from our patients: 88% of patients have rated the care and treatment as ‘very good’

94% of patients rated communication with doctors and nurses as ‘good’ or ‘very good’ If you have a patient suitable for the SAU or ESAC or you would like telephone advice, please call us on 07834 171825. The on-call consultant surgeon holds this phone between 8am and 8pm and the on-call middle grade surgeon out of hours.

GPs can now order Non Obstetric Ultrasounds through Sunquest ICE It is now possible for GPs to request Non Obstetric Ultrasound Requests using Sunquest ICE. This works in exactly the same way as for raising current requests.

Please remember to inform patients that they can contact the hospital directly to make an appointment, after you have printed out the request and handed it directly to the patient.

Alternatively, an appointment will be made within 2 weeks of the request being raised.

Is your patient fit for referral surgery?

Anaemia Anaemia is defined by the World Health Organisation (WHO) as a haemoglobin level of less than 130g/L in males, and less than120g/L in females. It is an independent risk factor for adverse perioperative events and also has an adverse effect on postoperative recovery and length of hospital stay.

Preoperative anaemia is a major predictive factor for allogenic blood transfusion and preoperative oral iron (if indicated), reduces perioperative allogenic blood transfusion.

Blood transfusion is associated with adverse effects such as immunosuppression, postoperative infective complications and increased tumour recurrence, in addition to well-known transfusion reactions and infective complications.

Therefore, all patients with anaemia should have a cause identified and their anaemia corrected, preferably prior to referral for surgery, unless risks of delayed surgery exceed those of proceeding with anaemia.

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Please note:

Hounslow wellbeing group for mums

Oral iron therapy (if tolerated) requires at least 30 days of treatment to increase Hb levels by 1g/dL. In some cases preoperative intravenous iron may be indicated / required. Note that the response to this also takes several weeks.

The Hounslow wellbeing group for mums is a free six-week group programme based on a cognitive behavioural model.

Patients referred for potentially major surgery should ideally have an Hb check within 3 months of referral and anaemia treated as appropriate.

In iron deficiency anaemia, oral iron should be commenced. In patients intolerant of oral iron, intravenous iron should be considered.

Patients with anaemia of chronic disease may benefit from iron therapy and/or erythropoiesis stimulating agents. Erythropoetin is licenced for use to optimise haemoglobin prior to total hip and total knee arthroplasty.

Do you know new mums who are: Feeling tired, struggling to adjust or unable to cope?

Finding it difficult to talk to people?

Interested in meeting other mums who are going through similar experiences?

To find out more, download the Hounslow wellbeing group leaflet.

As part of our Enhanced Recovery protocol and Blood Management Program, we aim to optimise iron stores for major surgery in order that patients are able to tolerate surgical blood loss easily and without need to resort to blood transfusion. Ferritin levels should be greater than 100 micrograms/L and Hb greater than 120g/L prior to undergoing major surgery.

References and further reading: Carson J, Duff A, Poses R et al Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996;9034:1055-60.

Musallam KM et al Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011 Oct 15;378(9800):1396-407.

Shander A, Javidroozi M, Ozawa S, Hare G What is really dangerous: anaemia or transfusion? Br J Anaesth 2011;107(Suppl 1):i41-59.

Wu W, Schifftner T, Henderson W et al Preoperative hematocrit levels and postoperative outcomes in older patients undergoing noncardiac surgery. J Am Med Assoc 2007;22:2481-8.

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