CHAIRMAN’S COMMENTARY By Roger Gedye At last the trees are beginning to show a few green shoots and hopefully our immune systems are coming to terms with those winter viruses that seem to become more resilient every year. May I draw your attention to two key matters. SEPTEMBER HEALTH FAIR Planning for September’s ‘Health Fair’ is gathering pace. Please mark Saturday morning 28 September in your diaries. Dr Kirsten Lamb (Davenport House) and Mrs Pat Everett (Manager of the Harpenden Children’s Centre) are generously giving their time to provide the professional core of the working party planning the event. With its theme of You, your children and their health we are anticipating a party atmosphere of activities for and by younger children, with a range of informative stalls and talks for their parents and grandparents. Keeping active, eating well and staying healthy are challenges for parents and their children. We need our doctors, but we can and should be doing as much as possible to reduce our dependence on their services.
PREVENTION RATHER THAN CURE This will also be the theme running through the four editions of the Newsletter during this 20th Birthday Year. In April the responsibility for the financing of health care transfers from Primary Care Trusts, run by civil servants, to Clinical Commissioning Groups, run by consortia of GPs supported by civil servants. This will place an enormous responsibility on our doctors who are already heavily committed to their patients. Dr Sneha Wadhwani has written an authoritative article in which she outlines the significant priority areas for our doctors after the changeover. Emphasis is placed on the prevention of disease and the management of chronic illness – on staying well. (See below) As patients we have a responsibility to play our part. Promoting physical fitness through exercise and a proper diet is as important for parents and their children as it is for their grandparents – which brings me full circle to the theme of September’s Health Fair. Join me there!
THE GOVERNMENT’S PRIORITIES FOR GPs IN 2013 By Dr Sneha Wadhwani On 1 April this year perhaps the most radical change in the NHS since its creation will take place: the NHS Commissioning Board will take over day-to-day running of the health service, while GP-led groups will gain control of much of the budget. In November 2012 the Government issued the Commissioning Board with a mandate for patient care. The objectives in this mandate focus on areas which the Government consider of greatest importance. They include the following:
Disease prevention and early diagnosis and treatment of conditions such as cancer and heart disease. Managing chronic physical and mental health conditions such as dementia,
diabetes and depression – with more joined up care across GP Surgeries, district nurses and midwives, care homes and hospitals.
Rehabilitation following episodes of ill health such as stroke or injury.
Promotion of patient care in terms of compassion, dignity and respect.
Providing safe hospital and community nursing care with lower risk of hospital and nursing/residential home acquired infections, blood clots or bed sores.
These areas correspond to the five parts of the NHS Quality and Outcomes Framework which are target driven and considered as measures of GP performance and standards of care. The Government also identified priority areas where it is expecting particular progress to be made. Continued on next page.
Continued from previous page
Improving standards of care for older people and at the end of people’s lives
The diagnosis, treatment and care of people with dementia
Supporting people with multiple long-term physical and mental health conditions
Preventing premature deaths from the most common causes
Supporting those with health conditions to remain in or find work
In real terms for GPs this means more of the same but with higher targets. However, the detail of this plan is still not entirely finalised. Whilst GPs continue to address and deliver care in all of these areas, some are dependent on provision of supportive services in the community. For example, diagnostic services for dementia, extra funding for more chronic disease clinics and well person clinics, funding for more equipment in Surgery to identify those at risk of chronic disease, adequate numbers of district nurses and so on. This will be where local commissioning groups come in. It is hoped that they will use a localised budget to tailor local services to the needs of local populations. However, many GPs believe that some of the targets set by the Government in terms of real patient numbers to be unrealistic. Practices which are not able to reach these targets are likely to suffer financially and to be categorised as providing sub standard care.
A key factor in Practices attaining the targets lies with patients being motivated and proactive with regard to health promotion and chronic disease management. That is, attending Surgery for chronic disease checks when invited, getting your flu jab, being compliant with medication, adhering to lifestyle advice given by health professionals and much more. Whilst your GP can lead you to water, they cannot make you drink! With a community infrastructure tailored more to the needs of the local population, GPs should be able to offer their patients better access to rehabilitation services; for example, those for patients recovering from a stroke or serious injury as well as those with long term conditions such as chronic back pain. Currently the restriction with local physiotherapy services is for 6 sessions per patient, which may not be sufficient for all cases and thus fail to rehabilitate the patient to a functional level required for work. With the backing of local commissioning groups such rules and regulations could be changed according to population needs. SUMMARY It is clear that Government aims are to reduce the burden of chronic disease, promote well being, improve quality of life, and improve economic growth through a healthier population. Keeping the local population healthy has been the focus of primary care practitioners since the beginning of the NHS, and as such the Government priorities are not new to us. It is, however, how primary care is supported in delivering this care that is crucial.
SURGERY SNIPPET Anthea Doran, Practice Manager ELECTRONIC PRESCRIPTION SERVICE The Surgery has now started using the Electronic Prescription Service. As reported in my last Snippets the service allows prescriptions to be sent directly to the chemist of your choice via a secure internet connection.
problems with the system please let me know so we can address any concerns.
Please note that due to NHS guidance on safety we are unable to take any prescription requests over the phone. Requests can be made via the website, in Whilst most patients have found the change person, by post, by fax, or via seamless, some patients have reported a a request to your preferred problem with not receiving their prescription re- pharmacy. order form. This form is now printed by the pharmacy and you should ask for a copy if it is not routinely given to you. If you experience
MENTAL WELL-BEING By Dr Kirsten Lamb Research has shown that mental well-being is a critical component of health and that it interacts in both directions with our physical health. Our minds and our bodies are not separate!
5 STEPS TO MENTAL WELL-BEING Tools have been devised to score our mental well-being with a self-assessment tool and other information available on the NHS web site: http://www.nhs.uk/Conditions/stressanxiety-depression/Pages/improve-mental -wellbeing.aspx
This research from the World Health Organisation, UNICEF and other learned professional papers highlighting various relevant quotations can be found on the Patient Group web-site: www.davenporthouseppg.org.uk
Mental well-being can have a positive impact on our lives from our health to our productivity at every stage of life from birth to old age.
1. CONNECT – human beings are social animals and our interactions with those around us At birth we know that infants developing have big impacts on us but also on them. There is research evidence that shows that positive attachments with their parents are people who engage well with family and more secure and show better progress. friends, allocating enough time for it have better mental well-being. It’s interesting that We know that the first year of life is critical this is exactly what for all forms of development from physical to children wanted emotional, cognitive, social and moral when asked in a development – being brought up in a warm UNICEF survey! This supportive environment contributes might just mean positively. chatting to the person next to you In the pre-school years we know that on the train, positive parenting supports children, again switching off the TV in the evening and across the breadth of their development. playing a game with the children, phoning a friend, visiting a neighbour. Schools contribute by helping young people develop problem-solving skills, promoting 2. BE ACTIVE – physical activity is thought to positive behaviour, helping young people alter brain chemicals. ‘Runners’ high’ is develop skills at working with others believed to relate to the production of these constructively, encouraging mutual respect endorphins and allows runners to continue for and having robust anti-bullying strategies. longer despite physical pain. There are also psychological benefits to exercise including a In adult life the NHS lists the 5 steps to sense of achievement, greater self-esteem mental well-being which I explore next. and so on. There are all sorts of ways that we can use exercise for our benefit. It does not In the elderly there is evidence that staying have to mean pulling on the lycra and going active improves mental well-being. The to the gym if that is not your thing! So what melatonin effect of exposure to sunlight is the recommendation? All adults aged 19-64 helps. There is some evidence that are supposed to do 2 ½ hours of moderate befriending schemes also help. intensity aerobic exercise per week. This
could be walking. Locally we have Harpenden and Villages Health Walks - http:// www.walkingforhealth.org.uk/ walkfinder/east-england/harpendenhealthy-walking-scheme It could be going to the gym or having a swim. We are lucky to have a pool and sports centre in the town – ww.harpersfitness.co.uk/ harpenden-leisurecentre. We are also lucky locally to have a large number of sports clubs – tennis, football and rugby. But your activity could also be ballroom dancing, jive, zumba or gardening.
helping them with their shopping. However it could also be more than this, such as getting involved with a charity or volunteering. You can find out about what is available locally from the St Albans and District Centre for Voluntary Service www.cvsstalbans.org.uk We have a number of active charities locally such as Harpenden Helping Hand – this is the organisation that helps people get to hospital and doctor appointments, picks up prescriptions, helps people with shopping and other activities. They always welcome new volunteers Call us today to volunteer on 01582 460507 or email firstname.lastname@example.org
3. KEEP LEARNING – again we have research evidence that continuing our learning through 5. TAKE NOTICE – this is described as knowing what is going on inside and outside ourselves life makes us feel better. We can achieve from moment to moment, or mindfulness. things and boost our self-confidence. We Mindfulness programmes have been shown to often learn together with others thus reduce stress and anxiety. There are several enhancing our connectedness – the first of recognised ways to help us develop this. these 5 points. It’s felt that this learning does These include yoga – which also helps not have to be doing university courses or strength and balance and can be part of the getting qualifications but can be simply being active process. There are at least 7 developing new skills such as playing a different yoga classes available in Harpenden musical instrument, learning how to fix the – you can find out about them on car or your bike, or doing a cookery class. www.hertsdirect.org or at the Library. Meditation is another formal approach to Again we are very fortunate as mindfulness – classes are held on Wednesday a community to have access to evenings at the Quaker Meeting House on all sorts of learning Southdown Road from 7.30 – 9 pm. Tai-chi opportunities. Details of these also enhances this process of mindfulness. can be found at the Library. There are also specific mindfulness We have an active WEA approaches – these can be part of cognitive (Workers’ Educational behavioural therapy www.bemindful.co.uk Association) for example. www.weaharpenden.org.uk – who run courses, go on trips to Bletchley Park for example. You can find out about the But what about one thing that covers all 5 steps : U3A (University of the Third Age) from www.hertsdirect.org . The Library also lists evening classes that are available. However learning can also involve visiting fascinating places of interest locally such as Verulamium Singing can really tick all the boxes. You Museum in St Albans, or reading a book, or doing on-line learning activities to improve IT too could be inspired by Gareth Malone! skills.
4. GIVE TO OTHERS – again we are designed as social animals. Scientists have discovered that ‘giving and co-operating with others’ stimulates the reward area in the brain! Again this can be simple acts of kindness such as helping a young mother with her child’s buggy to get off the train, giving up your seat on the bus or train to an elderly person, phoning someone who you know needs some support, visiting an elderly neighbour or
AT YOUR SERVICE—HARPENDEN CHILDREN’S CENTRE By Gillian Thornton Pat, who has worked at the Centre for five years.
Journalist and Patient Group committee ‘One of our resident experts may be able to help member Gillian Thornton starts a new series you instantly on the phone, but if not we make an appointment. Children’s Centres are funded by central Government so most of our services are free, although there’s a minimal charge for short courses such as behaviour management and first aid. But we’d never turn anyone away who needed our help but couldn’t pay.’ Some mothers struggle with bringing up boys and the Centre’s regular four-week course on managing mini-men is always well-subscribed. Also popular, particularly with families newly moved to the area, is help with finding childcare and negotiating the minefield of admissions to local schools. profiling local organisations, starting with Harpenden Children’s Centre. If you’re parent to one of the 30-40 babies born in Harpenden each month, you will receive information about Harpenden Children’s Centre as part of your ante-natal care. Take up their invitation to register and you’ll instantly have access to a wide range of free information and services based at their Batford and Southdown centres. But if you’ve newly moved to the area, you may not be aware just how much expertise and support is available to parents of Harpenden’s lively population of under-5s - around 2,400 of them at any given moment.
‘People are surprised by just how much expert advice is on offer here and how easy it is to access,’ says Pat. ‘And we’re completely non-judgmental too. We all know that parenting can be a challenging business! We run a number of drop-in sessions such as post-natal, where mums can talk to a health visitor about any concerns and they also get to meet other mums, which can be a support in itself.
‘Another popular service is our toy library. For a membership fee of only £6 a year, parents can borrow toys for two weeks for just 40p per toy. Details of all the toys – and the full range of services we offer – are on ‘We complement the care offered by GPs our website, or just and often work closely with them, telephone the office here especially the doctors at Davenport at our main centre in House,’ explains Centre Manager Pat Batford.
‘And please remember ‘Dr Lamb and Dr Wadwhani have both given post that whatever problem -natal talks for us, and the Children’s Centre will you are having with your under-5s and however be taking part in the Surgery’s Health Fair in unusual you think it is, September.’ the chances are that So whether your baby won’t sleep or your toddler we’ve heard it many times before. So do won’t eat, you’re struggling with behavioural please come and see us, issues or just need some general reassurance, staff at the Children’s Centre can help you – in a and then tell your friends – after all, that’s what we’re here for!’ group session, in a phone call or even a home visit by a member of the outreach team. And if Harpenden Children’s Centre, Holcroft Road, they can’t help personally, they always know Harpenden is located within Batford Early Years someone who can. Centre. Tel: 01582 713 872 or visit
‘All parents have to do is ask,’ stresses
PATIENT GROUP MEETING REPORT By Sheila Uppington Patients suffering a seizure/fit should have a cushion placed under their head, and when the fit has finished place the person in the recovery position and keep them warm. Choking can be dealt with by a blow between the shoulder blades with the heel of the hand. The Heimlich manoeuvre can also be used by a trained person.
An extremely informative evening held at the Surgery, led by Jill Hutchinson from the Red Cross, left us feeling a little more confident about dealing with emergencies in the home and knowing when to dial 999. Broken bones should be left but supported and the patient kept warm while awaiting help. Cuts should have direct pressure on them (unless glass in the cut) and the area elevated if Burns and scalds need plunging into cold water possible. If serious, do not give anything to eat for 10 minutes and covered with cling film to or drink. keep the air out. A medical check is needed if a large blister forms. Nosebleeds should be treated by leaning forward & pinching the nose just below the Hypothermic patients should be warmed up bridge for 10 minutes. This cycle can be slowly, while asthmatic patients need calming repeated twice more before summoning help if down, sitting up and taking their inhaler before bleeding won't stop. the ambulance arrives. A shocked person must be kept warm and legs raised to get blood to the brain. An unconscious person should have their airway checked when laid prone and the head tipped back. After calling an ambulance, if the patient isn't breathing, two chest compressions a second should be started. A heart attack can begin with pain, skin can show blue tinges, and nausea can be felt. Patients should be sat on the floor with their back against a chair with their knees pulled up. An aspirin under the tongue can be given but no water. Ring 999. Stroke patients should be assessed by 'FAST' - has the 'F'ace changed, can both 'A'rms be raised, is 'S'peech different - and if so ‘T’elephone dial 999.
SURGERY SNIPPET We often receive requests from patients to complete forms or write letters on patients’ behalf. These are many and various but examples include claiming back on a holiday insurance policy, confirming you are fit to take part in a sport, confirming you were unwell on the day of an exam. These types of requests do not form part of our NHS work and thus are completed by doctors outside of their NHS working hours. For this reason all forms and letters attract a charge and generally require a minimum of a week’s notice for completion. A full list of current charges is displayed in the Surgery, listed on our website and is available on request. All private letters and forms must be paid for on collection.
Head injuries need medical attention when the person is drowsy and/or confused, is vomiting projectile or more than once, has visual problems or has clear fluid leaking from facial orifices. If harmful substances have been swallowed don't make the patient vomit but give sips of cold water while getting urgent medical help.
So much to remember! And please be aware that this is only a brief overview. Full details should be obtained from Red Cross literature or their website www.redcross.org.uk
NEWS FROM THE L&D His Royal Highness the Duke of Edinburgh opens the L&D new cardiac unit— 19 February 2013.