Patients’ drugs

We are trying to encourage patients’ to use their own drugs as much as possible, so could you advise all patients to take their regular medication into hospital with them on admission. These medicines help us form an accurate drug history, save time, improve patient safety and continuity of care. Green medicines bags are available to facilitate the transfer of medicines. For more information contact Adam Pattison Rathbone on 01642 854795 or adam.rathbone@stees.nhs.uk

First VATS thymectomy

Joel Dunning, cardiothoracic consultant surgeon at The James Cook University Hospital has performed what is believed to be the region’s first minimally invasive surgery for removing tumours from the thymus gland.

The video-assisted technique enables small cancers to be removed using three small incisions in the side of the chest rather than having to cut through the patient’s breastbone. Using this technique allows patients to recover much quicker, often going home the next day.

New podiatry service in Hambleton and Richmondshire

The trust has qualified to provide core podiatry service to patients living in Hambleton and Richmondshire. Services include treatment of:

• ingrowing / problematic toe nails by total or partial removal of the nail plate and phenol ablation of the matrix

• painful corns, callous fissures and verruca.

• symptomatic nail conditions including reduction of thickened, gryphotic toe nails

• vascular assessment of the lower limb, biomechanical assessments, and provision of corrective orthotics for non-complex cases

Monday to Saturday clinics, including early evening appointments, will be held in a range of community locations including the Friary Community Hospital, Friarage Hospital, Duchess of Kent, and Guisborough Primary Care Hospital.

We aim to treat all urgent referrals within five working days and non-urgent referrals within six weeks of receipt of referral. Referrals can be made via chose and book and paper referral forms have been sent out to practices. Referrals can be returned by post, emailed to podiatry.clinic@nhs.net, faxed to 01642 732351 or telephoned to 01642 737807.

This regular briefing aims to keep local GPs up to date with the trust’s new services and developments.

If you’d like any further information about any of the items in this issue contact Caroline Parnell on 01642 835592, email caroline.parnell@stees.nhs.uk or go to our website www.southtees.nhs.uk

GP briefingJULY2013

Advanced heart valve surgery for 100th patient

The 100th patients has benefited from an advanced heart valve replacement procedure at James Cook. The trust was one of the first in the UK to offer the minimally invasive procedure for replacing the aortic valve, which means patients recover much faster, spend less time in hospital, have less scaring and can be back at work in just six weeks.

Nine out of ten patients have no limitations and normal mobility back within six weeks and our latest patient survey shows a 100% satisfaction rate. Surgeons from across the country are coming to James Cook to learn how to carry out the procedure.

South Tees hypertension service

NICE guidance for hypertension is that patients who are not responding to usual treatments (typically three antihypertensive medications) should be able to meet a specialist1 for further investigation and treatment. Similarly, young patients in whom a secondary cause of hypertension may well be relevant are also identified as suitable for specialist assessment.

Clinical Indicators for 2013-2014 also recognise the importance of detecting and treating high blood pressure in the population. HYP002 and HYP003 in particular reward GP contractors who can demonstrate that patients have blood pressure under 150/90mmHg or 140/90mmHg respectively – something we can assist with, particularly in patients with hard to treat high blood pressure where NICE guidance are recommending specialist review.

To meet these needs we have brought together existing specialists with an interest in the condition to provide improved cross specialty working. This means patients with hypertension will be seen by South Tees hypertension service specialists who most fit their needs e.g. those with concurrent renal problems will be seen by nephrologists.

This team offers:

• A comprehensive assessment of patients’ high blood pressure with review of medications and other management

• All relevant imaging and other investigations to exclude or treat secondary causes

• Expertise in finding and treating the underlying causes of some hypertension, such as hyperaldosteronism, kidney disease or rarer hormone problems

• Complex and new treatments for suitable patients, such as renal artery stenting or renal denervation.

The team includes:

Dr N Swanson (cardiology)

Dr J Louden (renal medicine)

Dr M Stewart (cardiology)

Dr J Murray (renal medicine)

Dr S Nag (endocrinology)

Dr M Kamruddin (endocrinology and general medicine, Friarage Hospital)

Dr A Sutton (cardiology)

Dr R Hartley (radiology)

http://www.southtees.nhs.uk/services/cardiothoracic-services/hypertension/

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Renal denervation

RDN is a promising new treatment option for resistant hypertension, where drug therapy has proven ineffective. It is an invasive procedure where the sympathetic nerve supply of the kidneys (which are strongly implicated in such resistant hypertension) is interrupted using radiofrequency ablation.

Tested in a small number of clinical trials, RDN has been shown to have a potent effect on blood pressure, with follow up available up to three years, showing sustained effects.

We have started performing this procedure in the cardiology catheter lab, using agreed protocols to carefully work up patients with truly resistant hypertension, with a view to performing RDN therapy.

RDN is supported by the North of England Cardiovascular Network and has been approved by NICE for use within strict limitations. The procedure has been identified as one needing specialised commissioning nationally and, although it is not routinely commissioned at present, is expected to be commissioned using the NHS England ‘commissioning for evaluation’ process shortly. Until this is confirmed, the procedure is currently only commissioned on an exceptional case by case basis.

Patients can be referred either through choose and book or by direct referral letter to any of the team or the respective specialties. Clinic staff will direct referrals for hypertension management to one of the team.

Exercise Smokescreen

On 4 September 2013, there will be a one-day multi-agency hospital evacuation exercise at Friarage Hospital, Northallerton. The aim of the exercise is to test the hospital’s evacuation arrangements, as well as considering the potential impact on the wider health and social care economy.

CQC inspection of Resolution Health Centre

The CQC made an unannounced Saturday morning inspection to check essential standards of quality and safety at Resolution Health Centre, North Ormesby, Middlesbrough. All of the standards inspected were met completely with no recommendations for improvement.

Malnutrition in the community

The Dairy Council has recently launched the “bring it back campaign” to increase awareness, recognition and treatment of malnutrition in the community. A useful set of resources including leaflets, postcards and posters can be downloaded or ordered for free at the following website: www.milk.co.uk/publications for use with your patients. Please note that localised under nutrition pathways should continue to be followed instead of the flowchart on the website.

New consultants

• Dr Hatim Taha has joined the trust as a consultant gastroenterologist replacing Dr Paul Cann

• Dr Thant Oo, elderly care consultant, replaces Dr Pei Loh

• Dr Stewart Pattman will join the trust on 2 September 2013 as a consultant chemical pathologist

All can be contacted via email firstname.lastname@stees.nhs.uk

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Perinatal mental health is a public health priority.

Mental disorders during pregnancy and the postnatal period can have serious consequences for the health and well -being of a mother and her baby, as well as for her partner and other family members (NICE Clinical guideline No.45 2007).

The trust in consultation with Tees, Esk and Wear Valleys NHS Foundation Trust has developed a set of maternal mental health pathways to provide a more structured systematic approach to improve the patient journey and assist practitioners in the prediction and detection of maternal mental health issues throughout the antenatal and postnatal period, up to one year following childbirth. Referrals should allow for assessment and formulation of individualised plans of care.

These pathways facilitate and support integrated care which promotes communication and collaborative care between primary care, mental health services, maternity and health visiting services in the Teesside and North Yorkshire and York areas. An aim of the pathways is to remind and enable health care staff of their on-going responsibility to comply and create an environment where more women are able to disclose their mental health issues and feel confident in the knowledge that they will be given support and information to enable them to make informed decisions about their care in partnership with their health care professionals, their partners and family members or carer. This may include the welfare of the infant and any other siblings or dependants (Children Act 1989, 2004).

The pathways will start with a six month pilot running from 1 August – 31 January 2014. A full evaluation will be undertaken throughout the pilot process.

Further information can be obtained from kay.branch@stees.nhs.uk

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