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GPLink Issue 1

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elcome to the first GP Link newsletter where we will be keeping you up-to-date with information on new services, how we are performing and where we are making improvements.

GP Minor Injuries Protocol

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he Radiology department operates a protocol whereby GPs can refer patients directly to the A&E Radiology department if a minor injury is suspected. Currently the service is only available to nine GP surgeries in the Norfolk area but the Radiology department is planning to roll this out to further GP practices. Advantages to participating in the service include the ability for GPs to refer patients directly for their radiographic examination without the need for patients to initially attend A&E, offering patient choice and ease of access to the right service. Immediate reporting of such investigations permits patients with fractures requiring urgent clinical review to be referred directly to A&E, and for negative reports to be available to the GP and patient on the same day. For surgeries who currently participate in the programme, referrals are requested electronically by the GP within certain strict criteria; for example, patients must have received the injury within the last 72 hours. Patients are provided with an information leaflet by the GP that explains how to contact A&E Radiology for an appointment and

the imaging pathway in detail. The NNUH Radiology department is keen to be a provider of choice for primary care referrals, and believes this referral pathway offers choice and efficiency to both the patient and referrer. We are looking for expressions of interest in participating in this service as well as feedback on its effectiveness so please send us an email to radiology@nnuh.nhs.uk

In this issue: • New cancer treatment facilities • New push to reduce DNAs • Memory Matters screening • More clinics at Cromer • Radiology ISAS accreditation • Expansion of Delivery Suite


New cancer treatment facilities

Work is well underway on the construction of the new radiotherapy centre at NNUH, due to open in autumn 2013, which will boost radiotherapy capacity by a third over the next five years. The unit will house two more linear accelerators, making a total of six ‘linacs’ at NNUH. The plans also include a new orthovoltage treatment room with equipment which can treat cancers which sit near the surface of the body. The new build will include a waiting area, office space and two consulting rooms. To help cancer patients avoid a hospital admission, there will be space for a new Acute Oncology Suite close to the ward area. The acute service provides rapid assessment and treatment for patients who are experiencing complications with their cancer or its treatment.

Brachytherapy service

We have launched the Targeted Radiotherapy Appeal which aims to raise £600,000 to provide state-of-the-art facilities for treating patients with prostate and gynaecological cancers using high dose rate (HDR) brachytherapy. Brachytherapy reduces treatment times and also means patients can be treated closer to home. Currently prostate cancer patients have to travel to London and Cambridge for this treatment. The money raised through the Targeted Radiotherapy Appeal will be used to build dedicated facilities so we can deliver this service to more patients. For more information on the appeal visit: www.justgiving.com/NNUHTargetedRadiotherapyAppeal

Fast Access Number

There is a fast access telephone number which GPs can use to contact the NNUH which is 01603 286666.

New push to reduce DNAs We see over 560,000 outpatients every year and we aim to keep ‘do not attends’ (DNAs) to a minimum in order to make the best use of our specialist teams. DNAs can be as high as 9% in some specialities and we have used systems such as text messaging to reduce these levels. Patients referred to NNUH are seen as part of the 18 week pathway which has tight deadlines in order to see the patient, complete all the necessary diagnostics and start treatment within the 18 week period. When a patient fails to turn up

for an appointment this can lead to a breach of the 18 week waiting time. There can also be extra work for the practice if the patient repeatedly misses appointments and has to be referred again. It also generates an extra cost for the NHS. To address this issue, we are working on improved patient information. Practices can help by asking patients about holiday plans on referral as this is one of the most common reasons for patients missing their first hospital appointment.

Advice for patients on referral: • Emphasise the importance of patients attending all hospital appointments throughout their treatment • Advise patients to contact the hospital as soon as possible if they need to rearrange an appointment • Encourage patients to plan ahead and not to cancel the day before an appointment.


Memory Matters Screening

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ince September 2012, we have been working on the achievement of a national scheme to screen all patients admitted as an emergency and aged 75 and over, for memory issues. This work has been part of a CQUIN (Commissioning for Quality and Innovation) for all acute hospitals. It enables us to highlight those patients with dementia on our systems and ensures that all staff are made aware of patients who have memory problems. We are now able to confirm that we are screening most people at the hospital front door and that where indicated, this initial question regarding problems with memory will generate the need for a further more detailed assessment to assess the seriousness of a patient’s memory problems. As a result of this assessment, some patients will require a review by their GP and some will need to be considered for onward referral to the mental health services. As a GP, you are likely to see a gradual increase in the number of patients who need to be reviewed and considered for on-going support. Currently, the mental health services are also receiving copies of these assessments but need referral information from you, following your review of the patient. We also write to patients to tell them of the screening and that we have written to you to consider referral. This CQUIN will be on continuing this year and clinical forms will be posted or emailed to you.

Cromer Hospital Update More clinics at Cromer

Extra out-patient clinics will be offered at Cromer Hospital this summer in general surgery, vascular surgery and upper GI and dermatology. Additional endocrinology and pain management clinics have already been introduced. We also hope to be able to offer some simple chemotherapy treatments and new treatment for some forms of macular degeneration, and continue the roll out of our static mammography and bone density scanning services.

London hospitals hold first ever specialist outreach clinic at Cromer Great Ormond Street Hospital (GOSH) and Guy’s St Thomas’ Hospital (GSTT) held their first ever outreach clinic for young patients with a rare skin condition at Cromer Hospital last month. The clinic, which was organised in conjunction with the NNUH dermatology department, was for young people with Epidermolysis Bullosa (EB). Consultant Dermatologist Dr Jemima Mellerio from GSTT and Consultant Paediatrician Dr Anna Martinez from GOSH liaised with the NNUH dermatology clinical director, Dr Nick Levell, to set up the clinic at Cromer Hospital.


NEWS IN BRIEF NNUH tops national research league table

A new league table published by the National Institute for Health Research Clinical Research Network shows the NNUH is the top large acute Trust in England and in the top twenty hospitals in the country for the number of clinical research studies it conducted last year. There were 182 research studies were carried out by NNUH in 2012 to 2013, compared to 158 in 2011 to 2012.

Patients waiting for treatment lowest ever

Shorter waits for ambulance handovers

For the second month running we have continued to improve ambulance handover performance resulting in fewer patients waiting for long periods to be handed over from ambulances to the A&E department. During May, 16 patients waited over 60 minutes, compared to 109 patients who waited over 60 minutes in April. 102 of those in April were in the first half of the month, during which time emergency care nationally was under intense pressure, with a significant increase in very sick patients, particularly in older age groups. At NNUH there was a 10% increase in the number of patients over 85 years old who were admitted in this period. There were 3343 ambulance arrivals at NNUH during May and the average handover time was 16.55 minutes. This compares to 3029 ambulance arrivals in April when the average handover time was 23:38 minutes.

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he number of patients waiting over 18 weeks from their GP referral to treatment at the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) has been more than halved in a year and is now at the lowest level ever. At the end of May 2012, 533 patients were waiting over 18 weeks for treatment after seeing their GP, which is the maximum waiting time permitted by the NHS. That figure has been reduced by almost two thirds and of the 5078 patients currently waiting for treatment, only 185 are waiting over 18 weeks. Anna Dugdale, Chief Executive at NNUH said: "This is a testament to the hard work of our administrative, clinical and management teams, who together,

have made this possible. With the agreement of our commissioners we have been booking in longest waiters first, because we believe it’s the right thing to do for our patients. This is a remarkable achievement, even more so given the challenges presented by a huge surge in emergency admissions between mid-February and midApril. We have never before had less than 300 people waiting over 18 weeks. “Waiting for treatment can be a worrying time for patients and we intend to build on this achievement and bring these numbers down ever further so that our patients receive the best quality treatment as quickly as possible.�


ISAS Accreditation for Radiology

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n November 2012, the Radiology Department at NNUH became one of only 10 accredited imaging services in the UK. This process involves inspection and feedback and requires the imaging service to meet a range of patient-centred standards of quality. These standards are clinical; facilities, resource and workforce; patient experience and safety. It covers all departmental work except breast screening and nuclear medicine. All aspects of departmental work are covered from patient changing facilities and dignity or contrast reaction

Improved Waiting Times

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emand for radiological investigations continues to rise across all imaging modalities and from all referral sources. One area of prominence has been musculoskeletal (MSK) ultrasound. In response the hospital has appointed a Consultant Sonographer with a specialist interest in MSK ultrasound, the first such appointment in the NHS. The charts opposite illustrate the substantial reduction in the number of outstanding cases and waiting time achieved on a background of increasing demand for the service.

management to maintenance of equipment or appropriate protocols for research activity. The radiology department has shown evidence of meeting standards in these areas and of having processes in place for audit and improvement in these areas. This evidence is all documented electronically. This accreditation is awarded by the UK Accreditation Service (UKAS). UKAS is the only national accreditation body recognised by government and can grant Government recognition of an accreditation process. UKAS manages an Imaging Services

Accreditation Scheme (ISAS) on behalf of The Royal College of Radiologists and the College of Radiographers. A follow up inspections will take place in September and continue every two years to maintain this accreditation. We are proud to have achieved these objective standards of quality and we will continue to focus on improving the quality and patient centric ethos of our service.


NEWS IN BRIEF

Expansion of Delivery Suite

Improving patient meals

Over the next few months the Delivery Suite at the NNUH will be refurbished as part of the hospital’s regular programme of maintenance. The hospital has been successful in gaining £272,000 of funding from the Department of Health to improve the environment for patients and this resource will be used to create six additional bathrooms so that all birthing rooms will have en-suite facilities.

More parking

During the refurbishment, which started in early June, the Delivery Suite will be relocated to Cley Ward which will have birthing rooms with all the relevant equipment and en-suite facilities. The hospital is also taking this opportunity to increase the overall capacity of the delivery suite and adding three new delivery rooms to the current complement to help the service cope with the predicted increase in the birth rate. The Midwifery-led Birthing Unit (pictured above) is unaffected by these changes. The birth rate has increased from 4929 births in 2003 to 6352 births in 2012. The Midwifery-led Birthing Unit has helped to address the increasing birth rate after being opened in August 2011 with 1187 births during the first year the unit was open. The unit offers women who are healthy with a straightforward pregnancy a home-from-home environment in which to have a natural birth.

Richard Hughes, local chef and owner of the Lavender House restaurant, is working with NNUH and Serco, which runs the hospital’s catering service, on a project to improve hospital food. The aim is to increase patient satisfaction of meals as well as nutritional uptake, following feedback from the Trust’s patient experience surveys. A new 310-space visitor car park opened at NNUH in May and will make it easier for patients and visitors to park at peak times. The new car park has been built by developer Bullens as part of the expansion of the Norwich Research Park. The charges are the same as the existing hospital car parks. There will also be lighting, security patrols and CCTV for the safety of car park users.

Consultant appointed as new Chair of BMS

Mr Edward Morris, consultant in obstetrics and gynaecology has been appointed as the new Chairman of the British Menopause Society (BMS). Mr Morris has a particular interest in pelvic pain, endometriosis, fibroids, the menopause, urogynaecology and leads the laparoscopic gynaecological surgery and endometriosis services.

NNUH announces new chairman

John Fry, former chief executive of both Johnston Press and Archant, the company which publishes newspapers including the Eastern Daily Press and Norwich Evening News has become the new chairman of the Trust.

GP LINK Produced by the Communications Team at NNUH. If you have any feedback on this newsletter, please contact us at: Email: gplink@nnuh.nhs.uk Telephone: 01603 287634


GP Link Newsletter - Issue 1