Chelsea and Westminster Hospital NHS Foundation Trust GP news - November 2015

4 November 2015 55 GPs attended our first GP Bi-annual education day last month. The event proved to be a great success and following feedback we are planning another GP Education Training Day in January 2016 where we plan to focus on Diabetes, Urology, Paediatrics

and Acute Assessment. GPs from all 8 local CCGs are welcome to attend and further details of this event will be circulated shortly.

Speaking of GP education updates, we are hosting a TIA study evening on 26 November at the Education Centre at West Middlesex site (see page 7) Cancer and Palliative Care Event on 10 December in our new Medicinema venue at Chelsea and Westminster Hospital site (see page 4).

We’d love to see you there!

In the lead up to HIV World Aids Day on 1 December, the Sexual Health team are running a roadshow of events in late November to encourage people to get tested.

Further information about this roadshow and details of exciting changes to sexual health care are featured on pages 3-4 followed by the Hospital site specific updates for the month.

Justine Currie GP Relationship Manager T: 0203 315 6603 E: justine.currie@chelwest.nhs.uk

In this edition: Trustwide News:

Spotlight on Sexual Health Services: What you need to know about PrEP Changes to Sexual Health Services at WMUH West London clinic move Sexual Health testing roadshow

ADOC update Cancer and Palliative Care Education Event, 10 December Carer’s Rights Day, 19 November Older Adults Support Team update Direct Access Colposcopy update2 24 hour blood monitoring service available Reminder to attach MRI results to chronic pain referrals

Local mental health and wellbeing service receives funding for innovative eHealth project Women, Pregnancy and Mental Health Building better Perinatal Mental Health services Who’s Who: Child Protection Team at West Middlesex University Hospital Message from the Endoscopy Unit Diagnostic Cardiology in the community TIA study evening, 26 November

Trustwide news What you need to know about PrEP PrEP, or pre exposure prophylaxis, entails the administration of Truvada (an antiretroviral licensed for the treatment of HIV) prior to and after sexual intercourse to reduce the likelihood of acquiring HIV. This strategy for HIV prevention is primarily based on two recent European studies both of which showed a reduction in HIV acquisition of 86% in participants: 1) PROUD - an open-label study in which half the participants had access to daily Truvada in the first year and half did not1 2) Ipergay - a placebo-controlled design evaluating an event driven regimen of Truvada (two tablets before sex, and one a day for two days after the last condomless anal sex act)2 In both trials the incidence of HIV in the control group was much higher than anticipated, 8.9/100 person years in PROUD and 6.6/100 person years in Ipergay. The HIV incidence in PROUD was eighteen fold higher than the estimated overall incidence in men who have sex with men (MSM) populations in England. The reduction in HIV infection was also the highest seen to date in intention to treat analyses (86% in both trials)3.

Target Population for PReP HIV negative individuals (predominantly MSM) who have had condomless anal sex with multiple partners in the preceding 3 months HIV negative individuals diagnosed with rectal STIs or syphilis in the preceding year HIV negative individuals who are likely to continue having unprotected anal intercourse HIV negative individuals who have engaged in “chem-sex” in the last three months Serodiscordant (one partner HIV negative, one partner HIV positive)

MSM or heterosexual couples who wish to continue having unprotected sex where the positive partner is not on treatment and wishes to remain off treatment

Who is not eligible?

Individuals who are already HIV positive Monogamous serodiscordant couples where the HIV positive partner is already on treatment and has an undetectable viral load

What we offer at 56 Dean Street Although the evidence is overwhelmingly in favour of PrEP as a means of preventing HIV acquisition in high risk patients, Truvada has not yet been licensed in the UK for this particular indication and is unlikely to be licensed until mid-2016. We feel strongly that for our high risk HIV negative patients in particular, PrEP, in addition to consistent condom use is an important and effective HIV prevention strategy.

As such, from September 2015 we have started a PrEP service for patients who wish to reduce their HIV risk. This runs on Saturday afternoons at 56 Dean Street, Soho. Patients pay for the Truvada (£400 for 30 tablets) but not for monitoring or consultation. The service is structured in the following way: Patients book an appointment via our call centre on 0203 315 6699.

Patients who choose to access PrEP at 56 Dean Street receive a baseline assessment of renal function as well as HIV and hepatitis B serology. They are also encouraged to have a sexual health screen.

Patients are counselled about which PrEP regimen is best suited to their sexual behaviour – the PROUD 2

regimen (i.e. daily Truvada) or the Ipergay regimen (Truvada taken prior to and after sexual risk). In depth information is provided about each.

We offer drug level monitoring to patients who are already on PrEP having sourced Truvada elsewhere to assess integrity of the drug (cost of this service is £230).

All patients accessing PrEP at 56 Dean Street are offered three monthly follow up consultations for renal function monitoring and HIV testing.

For further information please visit our website - www.getprep.uk and submit any questions through the online query form.

References available on request

Changes to Sexual Health Services at West Middlesex University Hospital On 1 September 2015, Sexual Health Hounslow joined a larger family of sexual health services, including 56 Dean Street, West London Centre for Sexual Health and the John Hunter Clinic. The acquisition of West Middlesex University Hospital will not see any changes to the Sexual Health Hounslow service delivery but it provides the opportunity to share best practice across teams and sites.

Kiss service is rebranded as the ‘Young People’s Clinic’ Following feedback which indicated that young people were not familiar with the KISS service, it has been rebranded as the Young People’s Clinic across three sites in Hounslow: Heart of Hounslow Centre for Health, Feltham Centre for Health and Chiswick Health Centre. Additionally, the age limit has been reduced from ‘under 25’ to ’19 and under’ to increase individuals’ comfort levels in attending sexual health services.

More information about this service is available at www.sexualhealthhounslow.org.uk

Do you work with foster carers?

In March 2016, the fostering team and Sexual Health Hounslow will be holding joint training on promoting positive sexual health and sexual identity for foster carers in Hounslow.

If you are interested in attending the course, please contact Kam.Severin@hounslow.gov.uk or call 0208 583 3452.

West London Centre for Sexual Health moving in 2016 West London Centre for Sexual Health is moving in early 2016 from its current home in Charing Cross Hospital to 10 Hammersmith Broadway for improved patient access.

Sexual Health Testing Roadshow In the week preceding Worlds AIDS day (1 December 2015), we are running a number of events to mark National Testing week. Local testing events currently planned are as follows: Hounslow - The screening bus will be located in Bell Square from 11am – 3pm on Monday 23 November 2015.

Central London - Pop-up clinic at Halve-it, House of Parliament from 1-5pm on Wednesday 25 November 2015.

Hammersmith and Fulham - The screening bus will be located on Hammersmith Broadway from 11am-3pm on Wednesday 25 November 2015 before going to Shepherd’s Bush Market from 11am-3pm on Thursday 26 November.

West London - The screening bus will be located on Portobello Road from 11am to 3pm on Friday 27 November 2015.

On World AIDS Day, 1 December, events are being planned at GAY Bar, Soho and Chelsea and Westminster Hospital foyer.

If you have any questions about these events or you would like a poster for your patients’ waiting area, please contact: Gary.Whitlock@chelwest.nhs.uk 3

Chelsea and Westminster Hospital ADOC team win first place at inaugural National Acute Oncology Conference

Cancer and Palliative Care Education Event Dr Tom Newsom-Davis (consultant oncologist) and Dr Sarah Cox (consultant in palliative medicine) will be discussing the role and importance of rapid access to oncology and palliative care services, recent research in this area, the clinical situations in which this may be needed and the services available at Chelsea and Westminster.

This is free to attend and open to GPs and practice nurses.

When: Thursday 10 December 2015, 1-4pm Where: Medicinema, 3rd Floor, Chelsea and Westminster Hospital Spaces are strictly limited so please rsvp to justine.currie@chelwest.nhs.uk

The ADOC (Acute Diagnostic Oncology Clinic) team won best poster presentation at the first National Acute Oncology Conference held in Birmingham on 19 October. This event organised by members of the NHS England Acute Oncology Group and sponsored by Macmillan was attended by members who care for patients with acute cancer related problems in acute medicine, emergency care and primary care.

The (ADOC) is the alternative to referring to A&E for patients with urgent suspected new cancer. The clinic is for patients who are too unwell to wait for a ‘two week referral’. The service can see patients within 24 hours Monday to Friday.

ADOC referral criteria

To refer: Call the GP advice line on 020 3315 5000 option 6 to discuss your patient with the CNS. All patients are reviewed by a medical oncologist at initial consultation.

Older Adult Support Team (OAST) Update OAST is a new rapid access clinic for elderly patients, set up as part of Ambulatory care in Chelsea and Westminster Hospital. OAST provides a consultant-led multidisciplinary assessement for older adults aged over 65 with acute or chronic issues and multiple comorbidities. The team consists of a Gertiatric Consultant, Pharmacist, Therapost and nursing support. OAST can see patients within 24 hours (Monday – Friday) via one of the following modes of assessment: - Phone Advice – for GPs needing advice from a Geriatrician consultant - Clinic (OP) – assessment in hospital, ideal if diagnostics required - Home Visit – domiciliary access for immobile patients To refer a patient, call the GP advice line on 0203 315 5000 and select option 5. Patients may be seen outside 24 hours of referral if hospital transport/bed are required.

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Carer’s Rights Event on 19 November Following a very successful Carers Day in June this year, we are hosting a Carer’s Rights Event on 19 November, 11am-1pm in the hospital foyer. Each year Carers Rights Day brings organisations across the UK together to help carers in their local community know their rights and find out how to get the help and support they are entitled to.

1. Making carers aware of their rights: Every year, more than 2 million people take on a new caring role. Many struggle to navigate the maze of services and entitlements, and miss out on financial and practical support as a result. Even people who have been caring for years sometimes are not aware of all their entitlements.

2. Letting carers know where to get help and support. Caring can bring all kinds of challenges. We want every carer to know where to turn for advice, information and support, whether in their local community or online.

3. Raising awareness of the needs of carers. Carers Rights Day raises awareness of the needs of carers with the public, decision makers and professionals, helping us realise our vision of a society that respects, values and supports carers.

Colposcopy Update Direct Referrals: To facilitate the processing of direct colposcopy referrals, we require the Direct Referral proforma (which is faxed to the GP surgery when an abnormal smear test result from the lab is received) to be completed fully – including past medical history and medication sections of the form – and faxed back to us ideally within 48 hours of receipt.

Please note: If your GP surgery is part of Direct Referral pilot then an additional referral letter is not required.

Cervical Screening Result: The majority of patients attend colposcopy without understanding what their cervical screening test result means. It is the responsibility of the smear taker to ensure the patient

understands the result, including HPV, prior to their colposcopy appointment.

Examples of incorrect information given to patients include:  They have type 16 or 18 HPV  They have a high risk for cervical cancer  HPV is not sexually transmitted  HPV will be treated at their colposcopy appointment  A negative smear in the past does not mean negative for HPV (as HPV can be present in the cervix but the cells continue to grow normally) We recommend the following source of information: https://www.gov.uk/guidance/cervicalscreening-programme-overview Increasing non-attendance for colposcopy appointments We aim to see all routine patients within six weeks of referral and patients with moderate abnormality or severe abnormality within 2 weeks. Unfortunately we have a nonattendance rate of 11-13% for new referrals and we are keen for your support in reminding patients of the importance of attending their colposcopy appointment.

Patients with a query about their appointment should contact the hospital’s centralised appointment office: 0203 315 6666 or via appointment.enquiries@chelwest.nhs.uk Susan Ogden – Advanced Nurse Practitioner

24 Hour Blood Pressure Monitoring Service available Blood pressure monitoring is available at Chelsea and Westminster Hospital.

Urgent referrals can be seen the same week, regular referrals only have a 2-3 week waiting period. To access this service, please fax referrals to 020 3315 2732 Vicky Reilly - Hypertension/Diabetes Specialist Nurse Tel: 020 3315 8132 5

West Middlesex University Hospital Local mental health and wellbeing service receives funding for innovative eHealth project The team behind West Middlesex University Hospital’s Perinatal Mental Health service has successfully secured £17,000 to launch their own eHealth project. The project aims to support women experiencing mental health issues immediately before and after giving birth, as well as the health professionals working in this area of care.

The funding has been awarded by the National Institute for Health Research: Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). The Perinatal Mental Health project was chosen as a worthy recipient; one which could encourage, support and promote innovation across North West London.

Is she on Priadel?

Is she on paroxetine?

Does she have PTSD? What do you do? The Hounslow Perinatal Mental Health Service are available to help via email: wlm-tr.pnmhwmuh@nhs.net Want to know more about mental health and pregnancy? The Perinatal Mental Health Community Education Provider Network [PNMH CEPN] project is the place to find out more. Please do not hesitate to email PNMH-CEPN@chelwest.nhs.uk

Building better Perinatal Mental Health services

Louise Page, Consultant Obstetrician at West Middlesex University Hospital and project lead explains how they plan to use the extra money: “We want to develop and expand our existing maternity website to provide even more information for women on the services we offer. This will also include a more extensive list of local contacts who can provide further help and support to the women who need it.”

The extra funding will also enable the Perinatal Mental Health team to share best practice by producing a wide range of electronic learning materials for fellow health professional across North West London.

The eHealth project is planned to be completed by March 2016.

Women, pregnancy and mental health Is she planning a pregnancy?

Is she pregnant?

Is she psychotic?

Can you help improve Hounslow’s mental health services?

Hammersmith and Fulham CCG are working in partnership with Ealing CCG and Hounslow CCG to plan and redesign mental health services across the three boroughs.

A key priority is perinatal mental health – services for mothers and their families from conception until their child is one year old. To ensure that these services meet the needs of the local residents, we are keen for their current service users to share their knowledge and expertise by emailing hf.ccg@inwl.nhs.uk.to help with the redesign process.

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Who’s Who: Child Protection Team at West Middlesex University Hospital Queen Mary’s Maternity Unit Twickenham Road, Isleworth, TW7 6AF 020 8560 2121 Paediatric Department Consultant Paediatrician responsible for Child Protection: Anne Davies T: 020 8321 5743 E: anne.davies@wmuh.nhs.uk Named Nurse based on the paediatric ward: Daisy Dhloo T: 020 8321 5361 E: daisy.dhloo@wmuh.nhs.uk Both Daisy and Dr Davies are contactable via the switch board T: 020 8560 2121 A&E Health Visitor Liaison: Katie Muggeridge – T: 020 8321 6819 or 07960 139 433 E: katemuggeridge@nhs.net Maternity Named Midwife: Tonie Neville T: 07876 590 621 tonie.neville@wmuh.nhs.uk Safeguarding Midwife: Teresa Driver T: 020 8321 5564 or 07920 757 360 E: tdriver@nhs.net Perinatal Mental Health Midwives : Julia Lidderdale and Louise Nunn T: 020 8321 6333 or 07920 751 234 julia.lidderdale@wmuh.nhs.uk louise.nunn@wmuh.nhs.uk Wards Starlight Children’s Ward – 020 8321 6172 Special Care Baby Unit – 020 8321 5944 Antenatal Clinic 020 – 8321 5950 Labour Ward – 020 8321 5946 Postnatal Ward – 020 8321 5978 Community Midwives – 020 8321 2581 For out of hours emergency child protection concerns please contact the Paediatric Registrar via the switchboard

A message from the Endoscopy Unit We are currently experiencing a high DNA rate for endoscopy. Please support us by highlighting the importance of attending their endoscopy appointment and including up-todate patient demographics, including patients’ mobile numbers, in the referrals to allow us to send appointment text reminders.

Thank you.

Diagnostic Cardiology in the community West Middlesex’s Cardiology department now provides two community services, offering Echo and Holter monitor procedures at the Chiswick Health Centre and the Feltham Health Centre.

Chiswick Health Centre

Feltham Health Centre

Echocardiograms – every Monday, 1pm – 3pm 24 hour Holter monitors – every other Thursday, 1pm – 3pm Echocardiograms – every other Tuesday, 1pm – 3pm 24 hour Holter monitors – every other Wednesday, 1pm – 3pm

eRequest forms can be found on SystemOne and should be emailed to the Referral Centre at Hounslow.hrfs@nhs.net

TIA study evening, 26 November, 7.00pm-8.45pm You are invited to a TIA study evening on 26 November at 7pm in the Education Centre at WMUH. The full programme is accessible here: http://www.chelwest.nhs.uk/professionals/gpstudy-evening-tia-nov-2015.pdf Places are limited so please RSVP via ahlam.wynne@wmuh.nhs.uk or call 0208 560 2121 bleep 413.

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