NHS Trust

University Hospitals of Leicester

GP Newsletter

November/December 2013

Happy Christmas! Welcome to the Winter edition of the newsletter

In order to further aid your communication with UHL Consultants we are piloting Choose & Book - Advice & Guidance. During the pilot phase this facility will be FREE.Advice & Guidance in CaB allows GPs to ask a consultant a clinical question (including attaching photos, letters, tests etc) and the consultant will reply (through CaB) within five working days.

Use Advice & Guidance facilityReferrals for FREE*!

*For a limited period

choose and book

So far four services are available:

Advice and Guidance Requests:

•ColorectalServiceClinic-colorectalsurgery-LGH

•AdultGeneralDermatology-LRI

•GeneralHaematologyClinic-haematology-LRI

•AdultGeneralHepatology-medical-LRI

Examplesinclude:

•Rashes,equivocalbloodtests,ECGsetc

•Routine/non-urgentrequestsi.e.therewouldbenodetrimentalimpactonthecareofthepatientwhilstwaitingforaresponse(althoughtheturnaroundtimeiswithinfiveworkingdays)

Overleaf is a list of actual referrals made over the last month through Advice & Guidance in CaB

Search By:*Request Type: *Priority:

▼AppointmentAppointmentAdvice

▼-- Select --

Please book all radiology requests through ICE.

Access the link below for the latest information regarding

clinics and sevices run in UHL to aid admission avoidance.

www.leicestershospitals.nhs.uk/professionals/potential-admission-

avoidance-services/

Admission Avoidance Services & Clinics

Advice & Guidance facilitychoose and book

Potential Benefits Benefit to Primary Care Benefit to Secondary Care

Historically advice and guidance has been provided by UHL consultants although in an ad hoc way for a long time. For example, through the GP Hotline, letters, text messages etc. The process is often not auditable so it is difficult for secondary care to quantify the workload involved. There is also no standard system within primary care to check that Advice and Guidance requests have been responded to.

The purpose of the ‘Advice and Guidance’ system is to facilitate a clinician to clinician ‘conversation’. Your request will be responded to by an appropriate clinician working on a rotational basis with their colleagues. Queries are sent to the service rather than a specific consultant so response times are met and the workload is distributed equally.

A turnaround time of a maximum of five working days is proposed.

The guidance www.leicestershospitals.nhs.uk/professionals/choose-and-book/ provides a step by step process of how to use Choose and Book ‘Advice and Guidance’.

Better quality patient preparation for an outpatient appointment e.g. right bloods, right investigations prior to a consultant seeing a patient.

Early active management of patient by GP with consultant advice which may negate need for an appointment

GP education/reassurance

Potential reduction in outpatient referrals

Auditable electronically

Electronically secure for transmission of patient identifiable information

An advice and guidance request can be quickly converted to an appointment booking

Potential to reduce follow-up appointments

Patient care started earlier

GPs more confident to manage conditions in primary care

Wait times reduced

System for tracking responses - query can be sent at a convenient time rather than trying to telephone a consultant when they are busy

Better clinical governance

To minimise delays for patients

Potential to reduce follow-up appointments and consultant in better position to provide a course of action

Reduces unnecessary appointments

May reduce pressure on appointments such as two week waits

Wait times reduced

Able to quantify workload and distribute equally amongst colleagues Reduces time wasted trying to contact a GP when they are consulting/home visit

Standard patient data provided e.g. current medication, medical history

-

If you require training or support in the use of Advice & Guidance please call 0116 295 1190

The CaB facilitators may be able to visit practices if need be.

For CaB queries email: Cabfacilitators@leics.nhs.uk

Leicestershire Health Informatics Service deal with all technical Choose and Book related queries as well as training. Contact: 0116 295 3500.

For further information regarding this pilot please email: Charlie.Carr@uhl-tr.nhs.uk

Process: How it will work

The list of possible benefits are:

Training & Support

Advice & Guidance facilitychoose and book

choose and book

Actual referrals made over the last month through Advice & Guidance in CaB

Advice It is important to be clear in

the history whether this is a primary incontinence type problem or a diarrhoea

problem (if you see what I mean) if the latter, I would start her on mesalasine orally and by

foam enema to see if this helps. If it doesn’t, she should be seen in a gastroenterology clinic.

Essentially it is all symptomatic treatment. If you want to discuss further ring

me on **********.

AdviceI note the GGT is normal and the

Bone ALP is very high and therefore as a consequence I think he doesn’t have any liver

problem. I note a vitamin D level is normal. If he has inflammatory joint disease or Paget’s disease

of a bone this might explain the ALP rise. It might be worth ruling out myeloma by looking for BJP. I note

also on one of his blood tests it says he had leg pain. I do not think I need to see him in a

Hepatology clinic. Many Thanks

RequestI referred this lady with an 8

week history of bowel frequency on the 2 week wait for exclusion of cancer. A colonoscopy showed a few diverticuli

and biopsies have revealed a likely diagnosis of collagenous colitis. I have

now had a letter asking me to refer for routine OPD for clinical

correlation.

RequestI would be grateful for your advice

regarding the above old gentleman who has had a raised alk phos since 2008. His recent vit,

GGT, alt, bili are all normal. He had a BONE ALK PHOS level done which was very high at a level of 121 (upper

limit being 44). I would be very grateful if you may kindly advise me whether you felt he needed

a formal referral to yourselves due to his elevated alk phos.

haematology

hepatology

Search By:*Request Type: *Priority:

▼AppointmentAppointmentAdvice

▼-- Select --

The following information is intended as a guide to GP referral into UHL for all plain film Radiology examinations. In all instances of referral full relevant clinical information is required and requests that do not give sufficient information or fall outside College Guidelines may be rejected. For Open Access referrals the patient may have to be sent away.

Radiological guidelines are available on the following website: www.irefer.org.uk/The scope of the guidelines is broad. Providing robust clinical detail or discussing complex cases may allow a more patient focused investigative pathway making the most of imaging resources.Advice for individual requests regarding appropriateness and suitable modality is available if required by ringing the GP hub at Glenfield on (0116) 256 3689

during normal working hours.Referral Routes

Requests should be sent using ICE, but written requests will be accepted where ICE is not

available.

Open Access• Patients requiring plain film

examinations can be referred under the Open Access scheme into Glenfield Hospital (flyer attached).

• Patientsunder17yearsorthosehavingminortraumafrom48hourspostinjuryto3weeks,mustbesenttoLeicesterRoyalInfirmary.

Results• For plain film examinations, reports are

usually available within a maximum of three working days.

• Where acute chest conditions and fractures are detected at attendance, urgent results are rung through or faxed the same day and referred to an MDT where appropriate.

• Results are viewable through ICE where this system is used, immediately on completion.

Radiological Investigation Access for GPs

For further information email: nicholas.clark@uhl-tr.nhs.uk

Consultant update

Dr Edwina Scott Oncology

Dr Premkumar Children

Dr Michael Williamson Children

Dr Aparna Deshpande Imaging

Dr Moinuddin Hoosein Imaging

Dr Gareth Lewis A&E

Dr Yee Tang Anaesthetics

Dr Usman Puar Anaesthetics

Dr Luis Aznar-garcia Oncology

Dr Viktor Zlocha Cardiology

Dr Riyaz Somani Cardiology

Dr Simon MacDonald Paediatric Cardiology

Dr Praiakia Pinglay Imaging

Dr Lakshmi Sundaram Imaging

Dr Khawar Ansari A&E

Dr Fouzia Jabeen Pathology

Dr Matthew Ronnie General Surgery

Dr Ian Patchett Sexual Health

Starters

The system is now LIVE and actively interfaces with the hospital iLab (pathology) and HISS systems.

It will flag up abnormal blood results as well as missed blood tests, enabling us to

promptly liaise with patients and GPs with appropriate actions.

This system will ensure our patients on immuno-suppressants and potentially toxic drugs are safely monitored as per departmental protocols and national guidelines, thereby enhancing the Shared Care process.

Dr. James Francis Consultant Rheumatologist & Head of Service

Rheumatology blood monitoring system launched

Email: mscdiabetes@leicester.ac.uk or visit the link: http://www2.le.ac.uk/departments/health-sciences/PG/pgt/diabetes

The Rheumatology Department has established a dedicated, state-of-the-art monitoring system (4S DAWN Clinical Software) for our patients on Disease

Modifying Anti-Rheumatic Drugs (DMARDs) and Biological Agents (Anti-TNF therapies).

If you have any specific queries, please contact Hinesh Patel, our dedicated DAWN administrator:

Hinesh.j.patel@uhl-tr.nhs.uk or 0116 258 6029

Farewell to Dr Andrew St JohnDr Andrew St John will be sadly retiring from UHL on Tuesday 31 December 2013.

After a full career in general practice, Andrew was appointed as Assistant Medical Director at UHL in 2006 – the first GP to be appointed to this post within a hospital.

Andrew chaired Cancer Care and Enhanced Recovery Programme committees and for three years also chaired the Collaborative Clinical Interface Group.

His biggest contribution to patient care was his work in changing the way

discharge letters were created, centrally stored and transmitted electronically. Changes made to the ICE system also allowed further enhancements, such as ordering diagnostic tests online and the ability to review all tests regardless of who ordered it in the first place.

In 2007, Andrew was instrumental in the development of the Urgent Care Centre at LRI, which replaced out-of-hours clinic working within Outpatients and provided daytime access to GP care for patients who chose not to go to their surgery.

Andrew has continued to provide a system for clinicians both inside and out

of UHL to raise concerns without resorting to the full complaints procedure, resulting in quicker resolutions.

Andrew said: “I offer an enormous thank you to all that have helped make the last seven years enjoyable, challenging and creative and most importantly have helped me provide solutions to problems.”

Since the GP hotline was launched in May 2012,it has received the following number of calls:

Below are three examples of the types of calls received by the GP hotline this month:

highlight report November/December 2013

GP hotline Tel: 0116 258 4858

GP hotline online

Total number of calls

200180160140120100806040200

Sept Oct NovDec

128

Jan

154

Feb Apr

114

Jun

114

May

10997

Mar

141

Aug

137

July

142 142

168

197

You can email requests to the GP hotline through our website. Your request will be actioned in real time between the hours of 9am – 6pm Monday to Friday.

The online form can be online at: www.leicestershospitals.nhs.uk/professionals/gp-hotline-online-request-for-help/

Alternatively, you can ring the GP hotline on 0116 258 48 58 and press option 2.

Dr Adam: Urology consultant or advice by

e-mail is fine. Thanks 32yr old female had a lumbar spine x-ray for

back pain which showed a calcified lesion around the left kidney. USS confirmed a

non-obstructive calculus in the lower pole measuring 9mm. No flank pain or

haematuria. Do we leave it alone?

I have an old lady who underwent a TAH + BSO in

March 2012. Subsequently developed menopausal symptoms and after discussion with

gynaecologist in 2102 was started on Evorel patches 100mcgs for symptom relief and prevention of

Osteoporosis. Her Current weight is 116 kgs giving her a BMI of 42.1. In view of the risk of VTE is it

safe to continue to prescribe HRT and for how long?

I have had a patient with a low wcc of

2.5, rechecked then 2.9 and most recently 3.4. She had a viral infection

when initially checked in August. She is otherwise well. Can I assume that the low

wcc was due to the viral infection and as it is rising nothing else needs

to be done?

GP Education

If you would like more information about any articles in the newsletter or have suggestions for future editions, please do get in touch.

Liz Sahu 0116 258 8598 / 07432 623 350 liz.sahu@uhl-tr.nhs.uk

Calendar of forthcoming GP education

GP education and evidence of our learning has never been at a more important stage. Here in Leicestershire we are working together as providers of GP education to support a good range of quality learning events. Through collaborative work we have created a new

web page that should provide you with all the information you will need for your appraisal and revalidation, plus a CPD calendar for the upcoming year. www.llrappraisal.co.uk

Dr Leslie BorrillLocality Clinical Lead, GP Beaumont Leys

Tuesday 19 Nov East Leicestershire & Rutland CCG (PLT)Dr Jay Banerjee Optimisation of Medical Care in the Community for the ElderlyDr Andrew Swann Prevention is Better than a Cure – Clostridium DifficileDr Richard Wong Funny Turns and FallsMr Emeka Oloto Sexual HealthWednesday 20 Nov Leicester City CCG (PLT)Dr Ian Scudamore Puerperal SepsisDr Pete Rodgers & Dr A Rickett Radiology requests

Forthcoming GP education events: 2013 GP events attended by UHL consultants:

For further information about our GP educational events programme, please visit:

http://www.leicestershospitals.nhs.uk/professionals/gp-education/

And finally…For general information such as referring to us, GP education and previous editions of the GP newsletter, you can find it all (home or at work) by clicking here:

www.leicestershospitals.nhs.uk/professionals/

PodcastsThe HIS firewall currently prevents practices from accessing Vimeo videos, which our Podcasts are. We are in conversation with HIS to find a solution to this issue. In the mean time, Podcasts can be viewed from the comfort of your own home!

To watch the podcast and to download (print/save) your CPD reflection form and certificate please click here:

www.leicestershospitals.nhs.uk/professionals/gp-video-based-education/

Please contact Liz Sahu with suggestions for future podcasts.

MSC Endocrinology module For further information please see: www2.le.ac.uk/departments/health-sciences/PG/pgt/diabetes

Joint Injection course Saturday 1 February 2014 or Saturday 7 June 2014

“What to inject, what not to inject and how to inject”Leicester General HospitalTo book a place please contact: Nichola Coleman on 0116 256 3016 Nichola.coleman@uhl-tr.nhs.ukFor further information about our GP educational programme, please visit:www.leicestershospitals.nhs.uk/professionals/gp-education/

The dates for the next module are:Thursday 23 January 2014 Friday 24 January 2014 Monday 10 February 2014 Tuesday 11 February 2014 Wednesday 12 February 2014 Thursday 10 April 2014