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

11 January 2016 Happy New Year!

In this edition:

West Middlesex University Hospital site specific: Emergency Surgical Ambulatory Care Unit (ESAC)

Trustwide News: Women, pregnancy and mental health Arrangements during proposed Junior Doctors’ strike action

Free perinatal mental health training – 2016 teaching dates

Chelsea and Westminster site specific: Importance of internal examination , including speculum, for a suspected cervical cancer for ALL GYNAECOLOGY NUCAs (New Urgent Suspected Cancers) Poppy Research Study Safe Place Scheme

North West London Perinatal Mental Health Conference Rapid Access Chest Pain Clinic Justine Currie GP Relationship Manager T: 0203 315 6603 E: justine.currie@chelwest.nhs.uk or gpqueries.chelwest@nhs.net

Trustwide news Arrangements during proposed Junior Doctors’ strike action

10 February 2016: Full withdrawal of labour between 8am and 5pm on Wednesday 10 February

The British Medical Association has written to all trusts across England informing them of Junior Doctors’ intention to take industrial action on the following dates:

During the proposed strike on Tuesday 12 January 8am to Wednesday 13 January 8am which affects Non-Emergency care.

12 January 2016: Emergency care only between 8am on Tuesday 12 January and 8am on Wednesday 13 January (24 hours) 26 January 2016: Emergency care only between 8am on Tuesday 26 January and 8am on Thursday 28 January (48 hours)

Emergency care will be prioritised and we expect to safely run all urgent and emergency care services including A&E, UCC and maternity To enable safe emergency care and based on learning from the previous proposed strike action, the following arrangements have been made for planned appointments scheduled for 12 January:

o Patients that have been prioritised

based on consultants’ clinical decision making have been notified by telephone that they will not have their appointments called off in the event that the strike goes ahead. These patients are to attend their appointment on Tuesday irrespective of the strike action. o Patients not in the priority cohort have been contacted to confirm that their appointment will only proceed if the strike is called off and they have been asked to check the media or the Trust website to confirm. Confirmation about the strike situation will be made available by 8pm on Monday 11 January at the latest. If the strike does go ahead, these patients will not be seen on Tuesday and should not come to hospital. If the strike goes ahead we will be contacting patients to reschedule their appointment. However if the

strike action is called off, their appointment will run as normal.

Walk-in radiology services will be available during the strikes but there may be a short additional delay in reporting on scans Patients who have any questions about their appointment during strike action can contact CW PALS Tel: 020 3315 6727 or WMUH Appointment Office Tel: 020 8560 2121.

We apologise for any inconvenience caused but our focus during industrial action is ensuring that we continue to provide safe emergency care to patients. Thank you in advance for your assistance and support during the upcoming strike action.

If you have any additional queries about the upcoming strikes, please don't hesitate to contact Justine Currie, GP Relationship Manager on T: 0203 315 6603, E: gpqueries.chelwest@nhs.net

Chelsea and Westminster Hospital The importance of an internal examination, including speculum, for a suspected cervical cancer for ALL GYNAECOLOGY NUCAS (New Urgent Suspected Cancers) Patients are informing us that they are often not examined prior to an urgent two week wait referral for a suspected cervical cancer.

Please note, particularly for suspected cervical cancers, the guidance below: Women presenting with symptoms of cervical cancer, such as post coital bleeding (particularly in women over 40 years), inter menstrual bleeding and persistent vaginal discharge should be referred urgently only if on examination, the cervix is consistent of a cervical cancer (ie looks abnormal or suspicious).

If there is a benign cervical polyp, a routine gynaecological referral will suffice.

If the cervix looks normal, the recommended action is a pregnancy test and testing for cervical infection (e.g. Chlamydia, N Gonorrhoea, Herpes), which could be performed in general practice, family planning clinics or GUM clinics.

Any positive tests for sexually transmitted infections would need to be appropriately treated.

We have included link for the new guidance, published by NICE June 2015 below.

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Recommended resources:

michelle.anthonipillai@chelwest.nhs.uk or st ephen.fletcher@chelwest.nhs.uk

http://www.nice.org.uk/guidance/NG12/cha pter/1-recommendations#gynaecologicalcancers https://www.gov.uk/government/uploads/sy stem/uploads/attachment_data/file/436924 /doh-guidelines-young-women.pdf If you are unsure and wish to discuss the criteria for NUCA referral, please contact either: Sue Ogden, Advanced Nurse PractitionerColposcopy sue.ogden@chelwest.nhs.uk Emma Mathurine, Clinical Nurse Specialist Gynae-oncology emma.mathurine@chelwest.nhs.uk

POPPY Research Study Are you or your patients over 50?

The POPPY study is looking into the effects of ageing on the general health and fitness of people over 50. It offers participants the opportunity to have investigations that you may not regularly have.

Inclusion criteria : participants to be of caucasian or black ethnic background.

Safe Place Scheme The Trust has been working with our local Community Support Officers from the Metropolitan Police to support the ‘SAFE PLACE’ scheme.

The scheme helps vulnerable people who have some form of independent living, by identifying premises e.g. shops, banks, hospitals as a ‘ Safe Place’ in which to display the ‘Safe Place’ sticker. These places are for those who have been given ‘I need help’ card and who may feel vulnerable, threatened or lost.

People who need help and support can identify the sticker and request help from a member of staff( Security/Pals ) who can call the nominated person on their card or the Police in the event of an emergency or crime committed.

Staff at each site would then ‘keep an eye’( location to be agreed) on the vulnerable person until the nominated person/police arrive or arrange for support.’

For further information about the safe place scheme you can contact kathryn.mangold@chelwest.nhs.uk

The study will monitor participants’ health over 2 years with a total of 3 visits. Visits will include a bone density scan, cognitive tests and blood tests.

We are in particular need of male participants over 50.

If this sounds like something you or your patients would be happy to take part in, or you would like more information, do not hesitate in contacting us using the details below.

If you know someone who may also be interested please feel free to pass on our details.

Phone: 02033156138 or 07592784983 Email: 4

West Middlesex University Hospital Emergency Surgical Ambulatory Care (ESAC) Unit The West Middlesex University Hospital Emergency Surgical Assessment Clinic (ESAC) is a consultant-delivered clinic staffed by the on call Consultant of the Week, which is run each week day morning in the hospital’s Richmond Ward next to the Surgical Assessment Unit.

On launch the service will initially run on Tuesday and Thursday only.

Its purpose is to assess and treat patients rapidly and on an ambulatory basis providing a quick, effective and safe service for patients.

The consultant surgeons running the unit are: Mr Jason Smith (Clinical Director for Surgery & Head of the unit – GI) Mr Peter Dawson (Divisional Medical Director for Planned Care – GI) Ms Bubby Thava (Locum 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) Numbers of emergency admissions are increasing and are predicted to continue to do so, although it is well known that not all admissions are necessary. The traditional NHS system allows patients to often be admitted and unnecessarily occupy a bed whilst waiting for investigations.

ESAC has access to dedicated ultrasound slots, radiology and additional urgent theatre lists. The service is designed to be accessed directly by GPs, A&E doctors and in-house surgical teams.

The service runs a ‘hot clinic’ from 10.30am – 12.00pm on Tuesday & Thursday initially with a view to extend to 5-days a week after the pilot.

Surgery will take place in the afternoons on Tuesday & Thursday.

The aim is to provide a streamlined service to those patients suitable for the unit. The ‘hot clinic’ will give capacity to serially review patients where necessary in order to avoid unnecessary admission.

The service will utilise the emergency theatre slots in the afternoon and spaces on elective theatre lists to provide the ambulatory cover. Plans are in progress to develop additional ‘cold-emergency’ theatre slots separate to the emergency lists and to roll the service out to five days per week.

The following conditions are suitable to be seen in the ESAC: Abscesses-torso and peri-anal (not breast) Right iliac fossa pain Right upper quadrant pain Painful jaundice Small volume rectal bleed Mild diverticulitis Painful non-obstructed hernia Post-op problems Would problems The following patients are not appropriate for the ESAC: Evidence of sepsis or haemodynamic instability Pancreatitis Vascular problems Possible anastomotic leak or bile leak

Children under 16 years Large volume bleed Requirement for very urgent surgery Significant concurrent illness Reduced mobility No home input Lives alone or some distance away Cognitive or communications difficulties

Women, pregnancy and mental health Distress as a red flag

She was upset…

If you have a patient suitable for the ESAC or you would like telephone advice, please phone 07834 171825.

This phone is held by the on-call consultant surgeon between 8am and 8pm and the oncall middle grade surgeon out of hours.

You will be given a specific appointment time for the patient to attend the ESAC. Please try to ensure that any patient referred to the ESAC is nil by mouth from 2am on the day of their appointment.

If you require non-urgent advice, you can always use the unique West Middlesex Choose and Ask service (http://www.westmidcolorectal.org.uk/as k/) choosing the ‘Emergency Surgery’ option from the drop down list.

A patient information leaflet is available and downloadable from the above website.

Please advise patients that they are attending for assessment and not necessarily admission, but that they should bring an overnight bag and a good book just in case.

Rapid Access Chest Pain Clinic From Monday 1 February, no referrals will be accepted by the RACPC unless the latest referral form is used and completed correctly.

Haemoptysis in a smoker?

Painless jaundice in an old man?

Breast lump in a 50 year old?

Mental distress in the perinatal period?

It is a red flag just like the others – it has to be explored.

Want to know more about mental health and pregnancy?

The Perinatal Mental Health Community Education Provider Network [PNMH CEPN] project is where to find out more.

Email: PNMH-CEPN@wmuh.nhs.uk

The referral form can be accessed here

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Free perinatal mental health training – 2016 teaching dates

North West London Perinatal Mental Health Conference

For GPs, Health visitors, maternity and psychiatric staff or allied professions

Friday 18 March - St Paul’s Conference Centre, Hammersmith

One in 10 new mothers experience mental illness during pregnancy or in the first year of their baby’s life. We aim to provide teaching on the main aspects of mental health in and around the time of pregnancy:

First call for abstracts…

Mild to moderate perinatal mental health conditions Severe perinatal mental health conditions Management and medications Referral pathways 22 February, 10am – 4pm Meeting room B, 2nd Floor East Wing 26 February, 09.30am – 12.30pm Conference Room, Education centre 2 March, 10am – 3pm Undergraduate Training Room, Education Centre 11 March, 09.30am – 12.30pm Conference Room, Education Centre If you are unable to attend these sessions, we can arrange for teaching at your practice.

However, we only have funding from HENWL until 31st March 2016 so please book your session soon.

Please submit a 250 word abstract relating to perinatal mental health for consideration for presentation at this one day conference.

Interesting case reports, service developments, educational activities or research are all welcome. Nothing is too small to be considered.

Submissions from all healthcare professionals including those in training are welcome – we are keen to have representation from all the multiprofessional sections of the PNMH team.

Submissions are also welcome from third sector partners and women or their families.

Prizes will be available for the best abstracts.

Please complete this form and send your abstract to PNMH-CEPN@chelwest.nhs.uk by Saturday 13 February.

Authors selected for oral or poster presentations will be notified by Saturday 27 February.

To book your place on any of the above sessions, please email pnmh-cepn@wmuh.nhs.uk

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