Shropshire Sessional GP Network

With the passage of the equinox, autumn is officially here and it promises to be a colourful and busy one.

The first of the SSGPN autumn meetings is on Wednesday 11th October – see the calendar – and please note the change of venue. We are meeting at Sparrows Cafe on the Battlefield Farm Shop Site (see calendar for more information).  This is going to be a really interesting evening with Cathy Smith from the Kaisen (Japanese for “Continuous Improvement”) Office at SaTH. Intrigued? Come along, find out more and about how your patients and you can expect the improvements to benefit you.

Food available, please assist the catering and let me know you are coming!

Feel free to edit the calendar with any information you have about meetings that are of interest to you as they are likely to interest other members too – it is relatively easy and a great way of keeping the rest of up to date.  Anyone can blog, so let others know what you are feeling about being a sessional GP in Shropshire and how the current NHS climate is affecting you.  The important thing is that you are not alone.

We had a brilliant meeting last month which at which Dr Peter Taylor shared with us the importance of having Terms and Conditions of employment.  He gave us a lot of food for thought and we all went away determined to produce our own. Peter has very generously shared his talk with us in the slides from clinical meetings section – if there is anything you want clarity on then Peter is at virtually every SSGPN meeting so it would be a good place to meet him and ask!

After a bit of a hiccough, Telford and Wrekin CCG are continuing to fund a mentoring service for any doctor who would like to access mentoring/coaching.  There are 14 active mentors out there and all are keen to engage with you and encourage creative solutions to life’s conundrums in the workplace.  The mentors update training this year is about to take place at Nottingham University with Dr Gordon French, a consultant anaesthetist working at NHS (E).   Check out the Paean website. Mentoring is amazingly powerful and you will never know until you try.

What’s going on in and around the area?

• Two Week Rule Referrals – In 2014 SaTH produced a patient information sheet to help people who were being referred under the two week rule to understand the process.  I confess that I had not seen this before nor had I used it.  However, the good news is that it has recently been updated.  It might be a good idea to ask in your practices where you can find it on the computer. The two week wait office has suggested that it should be on everyone’s desktop for quick and easy access.  They say “It is important that patients are given information about why they are being referred at the time of referral – from experience the hospital trust finds that patients who read this leaflet are better prepared when contacted to be offered an appointment, and are more likely to attend their appointment.  From a patient point of view, this information also aims to help their understanding and reduce anxiety

• On 1st June 2017 the Community Ophthalmology Service changed provider. The new provider Community Health and Eye Care (CHEC) is in the process of receiving patient records from the previous service provider (The Practice Group).  I am not sure what this means for patients and have no idea why the change was deemed necessary – does anyone have any information?  If GPs, or practices, have any questions about the service they are invited to contact Bethan Emberton at Bethan.emberton@nhs.net

• Safeguarding – Sessional GPs were invited to join the Shrewsbury PLT session on Wednesday 27th October.  I went along. The afternoon was packed, both literally and figuratively and covered both child and adult safeguarding to Level 3. The two half day training sessions had been condensed into three hours.  St Barnabas’ church hall was much like the first part of its name and in comparison the car park was tiny and the roadworks provided added difficulties.  The presenters were kind enough to share their slides which cover all you need to know so you can “tick the box” for your own training.  A big thanks to Jenny Stevenson for pulling it all together and it was great to see many of you there.

• Following another highly successful CPR training evening from Dave Edwards’ team, Dave has sent through the promised emergency action cards which I have uploaded into the reference section – I hope you find them useful, or at least reassuring!

• Improved access and service delivery for adult community mental health services provided by South Staffordshire and Shropshire Healthcare NHS Foundation Trust.  There is a letter from Cathy Riley, and the access information in the Reference Material section.  The biggest plus for us is that self referral and referral by concerned others is possible to this service

• BURSARY AVAILABLE   Health Education England, working across the West Midlands, is pleased to be able to offer a contribution towards course fees for medical and dental staff undertaking an Education, Simulation or Career Development award/qualification. They are also looking to support doctorate level study in Medical Education with the overall aim of further improving the quality of clinical education for medical and dental trainees and ultimately the safety of patients.  Please use the link below for further information & the application form.  Please send any queries to: educationbursary.wm@hee.nhs.uk or visit their website.

• Valproate and developmental disorders: new alert asking for patient review and further consideration of risk minimisation measures  From:  Medicines and Healthcare products Regulatory Agency (published 24 April 2017)  There is a lot in the press about this so I have uploaded the link again.

• From JAMA this month two opinion pieces which caught my eye The first challenges the claim that CBT is the gold standard treatment in psychotherapy (I wonder if they looked at the rapid training of non-psychotherapists to roll out CBT in the community -somehow I doubt it). The second challenges the increasing use of acid suppression for reflux in babies.  I think we should all be wary of extrapolating available evidence in a hurry to implement changes to accepted wisdom.

• Sad News – Dr Peter Bennett.  For the older readers, Dr Michael Dawson is coordinating the arrangements for any medical colleague who would like to attend his funeral service at Emstry Crematorium & Cemetery on Thursday 5th October at 11am. If you would like to attend please email Dr Michael Dawson.
• News from SaTH via Alison Jones and the GP Engagement Team.  The PRH has a new MRI scanner and RSH gets one later in the year;  there is a new consultant colorectal surgeon, Miss Kirsten McArdle; there is ongoing work about the recognition of sepsis (which I hope will include not over-diagnosing it) and there is a new Surgical Admission Lounge at PRH where “patients can wait in comfort” and have their pre-operative experience improved.
• Scabies in Telford & Wrekin Care Homes. I am not sure of the arrangement in Shropshire.  I have been telling the staff of one particular care home that treatment is a ‘homely remedy’ and they should manage the outbreaks themselves. This is perhaps a little harsh in the light of an email from Jacqui Seaton, Head of Medicines Management, this Friday, but was my interpretation of the Medicines Management advice that medication available for purchase over the counter should not be prescribed, unless quantities of medication (eg paracetamol or co-co-codamol 8/500) make their purchase a logistical nightmare for patients. Jacqui holds a stock of scabies treatment that can be issued to care homes under a PGD, so please contact her and she will deal with the homes direct.  Its always worth checking
• How effective is the flu vaccine?  This was a question posed by Dr Helen Willows on Resilient GP’s Facebook page.  The answers, including mine, were largely personal opinion and observation, but one GP, Wolfgang Walter, replied with data from the Cochrane Review, which was very sensible. To save you looking, or wondering, I have copied his response:
  • Clinical question: How effective are vaccines in preventing influenza in healthy adults (aged between 16 and 65 years)?
  • Bottom line: Inactivated influenza vaccines decreased the risk of symptoms of influenza and time off work, but their effects were minimal. In the relatively uncommon circumstance of the vaccine matching the viral circulating strain and high circulation, the NNT* to avoid influenza symptoms was 33. In average conditions (partially matching vaccine) the NNT was 100. There was no evidence vaccines affected hospital admissions, complication rates or transmission. Inactivated vaccines caused local harms (local erythema, tenderness and soreness), and an estimated 1.6 additional cases of Guillain-Barré syndrome per million vaccinations. * NNT= number needed to treat to benefit 1 individual.
  • Caveat: These results may be an optimistic estimate because company sponsored influenza vaccines trials tend to produce results favourable to their products, and some of the evidence came from trials carried out in ideal viral circulation and matching conditions; also because the harms evidence base was limited. Fifteen of the 36 trials in the review were funded by vaccine companies and 4 had no funding declaration.
  • Context: Over 200 viruses cause influenza and influenza-like illness (which produces the same symptoms). At best, vaccines might be effective against only influenza A and B, which represent about 10% of all circulating viruses. Healthy adults are presently targeted for influenza vaccination mainly in North America.” – www.cochraneprimarycare.org/pearls/limited-evidence-effectiveness-influenza-vaccine-healthy-adults.

• Rachel Clarke continues to use her experience as a junior doctor and her experience as a journalist to continue her attack on the political ‘football players’ using the NHS as their football. Her in the Telegraph is worth reading – here is the wording taken from her blog.

   

  So, that is a summary of recent posts to my inbox and of the meetings I have attended.  As always, if anyone has anything they would like to share, please let me know and I will endeavour to upload it to the SSGPN website.  Please remember the monthly meeting and help us further the improved communications between primary and secondary care, even if it is only on a small scale – every little helps and our contribution to the local health economy is growing as our numbers increase.

  Have a great fortnight!