Summer Solstice Edition
The longest day is behind us – hard to believe! As I write this, Glastonbury is in full swing & the hayfever season is producing a lot of new first time sufferers. Eczema is harder to control than usual. It is the hottest summer since 1976 & the exam season is in progress. Those of you who work and juggle family commitments will be suffering more than usual too, so I am hoping that this summary of news, views and events will take some of the pressure off you.
We had a great meeting this month with Dave Edwards and the CPR training roadshow presenting the usual entertaining and informative session at the Shrewsbury Club. Supper was delicious and sitting around in the dining area was a great opportunity to chat to each other in a relaxed ambience before the meeting. It was lovely to catch up in a bit more depth. The focus of this year’s training was that of ensuring great team work and having someone in charge….apparently, that role will often fall to the doctor so we have to learn to sit back, relax and observe so we can coordinate the response. Dave has said he will share the colour posters for the different emergencies that Tim has produced and as soon as I get them I will pass them on.
Next month Dr Suman Kundu will be educating us about aspects of cardiology with a GP focus. The dates of future meetings are on the website, under the Information heading to the right of the page. In preparation for the meeting, you might like to review the update to QRISK (QRISK3) which includes a significantly wider range of inflammatory and vascular factors as well as mental health that need to be taken into account. Whilst it is a great tool for the public heatlh of the nation, I am not sure it is going to be useful for doctors as it will take considerably longer to fill in. See what you think!
Telford & Wrekin focus groups poster
I am completely out of touch with what is going on with Future Fit, but a newsflash from T&W CCG and Shropshire CCG organisation is making waves by discussing the transfer of some of the Women’s and Children’s Services back to Shrewsbury. The newsflash states:
“We are running some focus groups with the aim of talking to women, children, their family, friends and carers about the impact of moving some services currently delivered for them at the Princess Royal Hospital to the Royal Shrewsbury Hospital.”
The poster advertises two events in Telford asking for comments from people who have used the service in the past two years. It is likely that similar events are being held in Shropshire, though I can’t find any advertised dates. If you are interested in attending, Jenny Stevenson
‘Our Health Partnership’
Recently six Shropshire practices with a rough total of 38,000 patients joined forces with OHP. These practices are thought to be Bishops Castle, Craven Arms, Church Stretton, Drayton Medical Practice, Much Wenlock and Cressage and the Meadows Medical Practice. OHP employ their own salaried GPs and I have been told only use locums sourced through Network Locum. This will obviously affect some of you working in rural practices and we know that some of those practices have had difficulties recruiting permanent staff because of the reduction in attractiveness of rural medicine in the past 25 years. Some of you are likely to be better informed and it would be helpful to hear from you, especially if you know how your employment is likely to be affected.
It is worth bearing in mind, OHP was set up by after a small group of GPs who had just finished with the VTS had an idea about preserving general practice in a sustainable way. It has grown to involve 189 partners with over 279,000 patients and is the largest GP partnership in terms of patient list size. Just in case you thought that you might not be able to make a difference, think again!
BMA Update to Handbooks
If you are entering negotiations with a new or existing employer, you might like to know that the BMA has updated its GP Locum handbook and Salaried GP Handbook. This is particularly relevant to GPs newly starting out and if you know any please feel free to pass on this information as well as details about how to access our support network which they might value, particularly at a time of transition. There is information about practice obligations to you as a locum or salaried GP working with them.
Think Food First
Think Food and Food First are the iniatives of medicines optimisation/management in the two CCG areas. These are initiatives are part of a drive to reduce prescribing costs and are also part of raising awareness that nutrition is best provided by ‘real’ food. Acceptability has grown in the wake of the smoothie craze. There are wider issues around prescribing Ensure which were highlighted by two consecutive patients: a terminally ill woman and a new patient who was also addicted to opiates. The first declined nutritional supplements even though the district nurses felt she required them, the second demanded continuing prescription of supplements started in her previous practice. Does anyone remember being told that addicts were mixing heroin and other injectables with Ensure to reduce inflammation in the veins? Any references would be welcome.
Medicines Optimisation (previously the Shropshire CCG Medicines Management Team) will be focussing on working with care home and locality pharmacists to implement changes around prescribing and if you want any more information then you can email Shrccg.MOTqueries@nhs.net. In Telford & Wrekin, the Medicines Management Team, led by Jacqui Seaton, are doing similar work.
Whilst on the subject of medicines and optimisation, there is more than usually relevant information in the MHRA update for June concerning patients on denosumab and brimonidine.
Safeguarding and Deprivation of Liberties
The Safeguarding session this year, which will be in the autumn, and will be around DoLs. This is because a lot of change is happening and DoL is being updated to Liberty Protection Safeguarding. The Law Commission have outlined suggestions to changes in the Mental Capacity and Deprivation of Liberty and legislation is likely (if it survives the ramifications of the outcomes of the recent general election).
Until recently, it was felt that all patients in care homes, especially those with dementia, were effectively detained and so all deaths were being reported ot the Coroner. This produced an upsurge in workload unsurprisingly. There has been an update to the legislation on the advice of the Chief Coroner which you may not be aware of (thanks to Jenny Stevenson for sending us the Shropshire CCG newsletter which outlines this). I am quoting directly:
“With effect from 3 April 2017, there has been a change to the definition of “state detention” introduced by the Policing and Crime Act 2017. The new Chief Coroner has issued new guidance – 16A – to accompany (and then supersede) the existing guidance. The guidance makes clear that “deaths under DOLS” are not automatically to be considered as being under state detention where the death occurs after 3 April. Conversely, the guidance also makes clear that: “Of course, there may be a requirement for an investigation on other grounds (e.g. that death was unnatural, or indeed the person was in police custody). Furthermore, a person who dies while subject to restrictions amounting to “state detention” in a hospital or care home, but without there having been a deprivation of liberty authorised under the MCA 2005, will still have to be the subject of an investigation and inquest on “state detention” grounds.” So, if the DOLS has not yet been granted then an Inquest will still be required.
New Chief Coroner’s Guidance on DOLS, Mental Capacity Law and Policy – 28 March 2017
Audrey Scott-Ryan shared a link about Modern Day Slavery
Telford & Wrekin CCG have shared a link to raise awareness of Child Sexual Exploitation (thanks to Jo Leahy for this). The vimeo link Know the Signs (password is ‘chatback2016’). There is a download button just beneath the video and it is recommended to download the HD 1080p file as this the full HD version.
0-25 Emotional Health & Wellbeing Service
South Staffordshire & Shropshire Healthcare NHS Foundation Trust are very pleased to have been awarded prime provider the for delivery of the 0-25 Emotional Health & Wellbeing Services across Telford & Wrekin and Shropshire starting on 1st May 2017. In a statement, they outlined their plans:
“In order to provide an innovative and modern service which meets the needs of local residents, our model will be delivered in partnership with The Children’s Society, Kooth and Healios.
- The Children’s Society – Fight for change, supporting disadvantage children to have better lives. Building a country where children are free from disadvantage. Running drop in sessions, participation leads, scoping availability of resources in the community, working with young people to aid transition to other services.
- Kooth – To lead the way in using digital technology to remove barriers to achieving emotional and mental health. An anonymous 24 hour online service offering peer support, self help and trained counsellors to talk to.
- Healios – To transform how care is delivered to help patients, families and carers effectively move forward to achieve their goals providing a better quality of life. An online service delivering NICE accredited therapy.
We have come together to form an innovative partnership which offers a unique combination of established local services, specialist expertise and flexibility which will improve emotional health outcomes for residents.
The clinical service will continue to be delivered on a hub and spoke basis and, in the short term, there will be no changes to clinic locations. Access to the service is via Family Connect (Telford) and Compass (Shropshire). This will be reviewed and further communications will take place.
If you would like any further information, please contact Carolyn Gavin, Carolyn.gavin@sssft.nhs.uk
While you are at it, and so you are confident in managing all aspects of a case, the new guidance on aspects of confidentiality produced by the GMC came into force on 25th April 2017. There is a good summary of the changes so you don’t have to wade through the full document. Both are available on the same page of the GMC webiste. It’s a bit dry, but worth a CPD point and easy to demonstrate impact.
I hope that as many of you as possible are attending the T&W PLT meeting on Safeguarding on Tuesday. If you are going, I will see you there.
Health Club Membership Offer from Nuffield Health
The probity issues around the Nuffield Health and the gym membership offer is akin to the issues of sponsorship by pharmaceutical companies, especially when they start offering patients registered with GP Members a reduced discount. Having said that, discounted gym memberships are available to RCGP Members. The nearest Nuffield Health Fitness & Wellbeing Centre is Telford Forge Retail Park, Colliers Way, Old Park, Telford, TF3 4AG. The discounted rate seems to be the same as the Summer Sale rate and the advert states:
“20% discount on memberships for all RCGP members and their partners. Book your free trial or join online using code RCGP011216 at nuffieldhealth.com/royal. Find out more at nuffieldhealth.com/rcgp *Access is to any of our 111 Fitness and Wellbeing Clubs. RCGP members’ partners must reside at the same address. †Terms & Conditions apply. Code is unique to your company. Proof of employment must be given to the club within 14 days of joining online or you will be converted onto a full rate membership. Nuffield Health reserves the right to withdraw the offer at any time.”
Inappropriate Hospital Work Devolved to Primary Care – Your Opportunity to take Action
The LMC are keen to represent sesssional doctors in the way in which they would like to be represented. Ian Rummens is working very hard to ensure that we are copied into any relevant work and I try and forward on anything that fits this bill. I am sending out his annual letter, mostly drafted by me this year!
Dr Zoe Norris is now Chair of the Sessional GP Subcommittee and she is well known for her blogs and her work with NB Update and since she has taken over the role of Chair, there appears to be more outward sign of getting GP engagement especially in the regions. One example of this has been the increase in interesting (and free) GP Education sessions on aspects of personal wellbeing as well as update training days such as the recent one on Clinical Immunology in Birmingham.
I am also sending out the letters that the BMA have drafted for practices to use where there is inappropriate hospital work being sent out to primary care. This is going to be a very interesting debate! I sent out two such letters last week, though omitted to copy it to the CCGs and the LMC. I will be better prepared next time. Ian Rummens says,
“Letters should be sent to the relevant consultant/hospital with copies please to your CCG and to me. In SC CCG please send to Michael Whitworth, Interim Contracts Manager. In T&W CCG please send to the TRAQs team. The relevant person is Sharon Clennell, Senior Commissioning Manager. It might be worth copying her in as well as sending to TRAQs.”
Resilience in the Light of the Recent Events
In a BMJ Blog, the authors outlined that resilience is caused by trauma and that managing the resilience is dependent on an adequat infrastructure being in place – I would also argue that the press do not help as they go in search of the most badly affected victim or the most strident detractor of the provision of care. Spare a thought for those on the front line who have witnessed the most appalling injuries and pushed themselves to the limits of their endurance.
Public Health – Vitamin D – a message from Dr Andrew Cowley, Consultant Paediatrician
Since Vitamin D is the sunshine vitamin, the message from Dr Cowley, sent out via Alison Jones, is topical.
Dr Cowley reminds us that:
“As clinicians we need to ensure that any patient at risk of vitamin D deficiency is offered advice and supplementation. This NICE guidance has recently been updated. Initial guidance was in November 2014 and it has recently been updated in May 2017.
Population groups at higher risk of having a low vitamin D status include:
- All pregnant and breastfeeding women, particularly teenagers and young women.
- Children under 4 years.
- People over 65.
- People who have low or no exposure to the sun. For example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods (I reckon that this puts most doctors and other medical staff in the high risk bracket!! -AG).
- People who have darker skin, for example, people of African, African–Caribbean and South Asian origin.
At risk groups are currently advised to take a supplement that meets 100% of the reference nutrient intake for their age group. This is 8.5 micrograms/day (340 international units, IU) for infants aged 0–6 months, 7 micrograms/day (280 IU) for older infants and children up to the age of 5 and 10 micrograms/day (400 IU) for adults.
All infants and young children aged 6 months to 5 years are advised to take a daily supplement containing vitamin D in the form of vitamin drops. But infants who are fed infant formula will not need them until they have less than 500 ml of infant formula a day, because these products are fortified with vitamin D. (‘Vitamin D – advice for supplements for at risk groups – letter from the UK Chief Medical Officers’ Department of Health).
This is a public health issue and the updated guidance will be reviewed by the CCGs and Primary Care, but every clinician seeing children has a responsibility to offer advice on Vitamin D supplementation. Many thanks”
Public Health – The Elderly
On the subject of public health issues, Age Uk have produced a 16 page document A Summary of Wellbeing in Later Life. David Sandbach forwarded it to us as potential interested parties.