Welcome to our March newsletter for GPs, practice managers and their colleagues and everyone working in Primary Care.

I hope you will find this interesting and useful. There is significant work going on to tackle some of our key challenges, requiring ever closer working with colleagues in primary care.

This partnership working is essential to our future and the local health economy, including areas such as implementing the STP for south west London and its goals for the population we all serve.

I am particularly pleased that we are continuing to be more proactive and outward-looking in working with GPs. For example, our Outpatients Transformation team has been out to meet and listen to groups of GPs at CCG-led locality meetings. Our medical education programme for 2017 is more focussed than ever on what you have asked for.

Consultants and GPs meet to consider new care pathways across a range of specialties that better serve our patients and both primary and tertiary providers. These interactions are hugely valuable and we need to do more. When consultants and GPs get together, innovation and best practice is usually a clear result.

Thank you for your support as we strive to improve throughout the year.

Professor Andrew Rhodes
Medical Director

First steps towards the Future of Outpatients – please give us your views and get involved

Genuine digital transformation; closer clinical-administration teamworking; innovation, more standardised operating processes; and a much greater focus on patient experience are among early themes to emerge from our Future of Outpatients project.

We are working on a long-term project to design a new-look, 21st century outpatients service, with operational processes that much better support GPs and patients. This is a long-term goal, and we are also continuing to focus on ongoing improvements.

Hospital clinicians, clinic and administration staff, GPs, patients and commissioners all came together to consider the issues and the priorities for an improved service at an event in December. Some key agreed principles included:

Patients must be at the heart, with more choice and control about their care, including how we communicate with them, including via an online patient portal. Services will be organised around patients’ needs.

·         Technology will drive transformation - achieving efficiencies and improving patient and GP experience. We need robust, quality data to help us to monitor and drive how we can best improve services for patients, with greater transparency so GPs can track their patients’ progress on the pathway and access useful information.

·         Within St George’s, clinical specialties and support functions should work more closely together in joined-up teams

·         We need to standardise more operating processes as well as improving overall service standards.

·         Innovation is key, incorporating new ways of providing services and care to patients

We are keen to hear from even more GPs and practice managers with their views, and feedback on specific proposed elements of the new Outpatients Service. Please contact us to find out more and get involved:

Outpatients.Transformation@stgeorges/nhs.uk

Kinesis boost for GP - consultant communications

We are aiming to increase use of the secure online Kinesis GP-consultant messaging system across Merton and Wandsworth by extending it across more St George’s specialties

GPs and CCGs have asked for better access to our consultants' expertise and guidance. Kinesis an easy-to-use system, allowing consultants to interact with GPs more regularly, answering queries and often prevent unnecessary referrals, and improving patient experience. It is currently being expanded across various sub-specialties within Cardiology, ENT, Gynaecology, Dermatology and T&O.

Dr Sarah Thurlbeck, Consultant in General Paediatrics, was an early adopter of Kinesis and has handled around 260 queries since April 2016. Sarah said: “It has certainly been a useful tool in paediatrics - reducing unnecessary referrals, and supporting GPs to care for patients in primary care. This helps the child and family’s experience because the child receives prompt, more expert care quickly and may not need to wait for a hospital appointment. GPs seem to value the speed and usefulness of responses.”

Wandsworth GPs already use the system and the other CCGs involved in the expansion initiative are delivering training to GPs on using the system. To find out more please contact

Outpatients.Transformation@stgeorges.nhs.uk

Innovative virtual clinic heralds drive to reduce follow-up appointments

We are aiming to reduce follow-up hospital appointments - freeing up consultant time and clinic resources, reducing unnecessary hospital attendances and improving patient experience.

This means developing innovative clinical-led approaches to reduce hospital outpatient attendances, and improve patients’ experience.

Our Vascular department is piloting a weekly telephone-based ‘virtual clinic’ for varicose veins patients. It aims to reduce waiting times for patients by four to six weeks, and replace unnecessary hospital visits for face to face follow-up appointments. The virtual clinic will be led and carried out by a Physicians Associate under the direction of the Consultant Vascular Surgeon. We will explain the process and provide information to patients when they first present. Appropriate, low-risk, patients will be called the week after their investigation to give them the results, and discuss dates if they require surgery.

Further pilot initiatives in different specialties will include digital technology, more patient self-assessment and self-management, and open access follow up appointments so patients have the choice to rebook an appointment if required.

The drive to reduce follow-up appointments also reflects intentions highlighted in the emerging Sustainability and Transformation Plan (STP) for south west London.

Overseas patients – pilot of new processes

We are piloting new processes to better monitor and collect payment from overseas patients who are not eligible for free NHS treatment. This will bring us into line with national NHS guidelines. Our new processes will enable us to properly assess whether patients are eligible for free NHS treatment.

The pilot will start in Maternity Services. All women who are non-emergency patients for Obstetrics will be asked to provide two forms of identification when they first present, and to complete – in advance – a Pregnancy Referral Form.

If a patient is not eligible for free NHS care, they will be charged for any treatment we provide to them. We will not turn away or delay treatment for any woman who cannot prove their identity, or are non-eligible for free NHS care. We will clearly communicate the Department of Health regulations and agree plans for payment. Our Overseas Patients team will work with patients to assess their eligibility, and to support them and discuss payment arrangements if they are not eligible

We are asking GPs to help us by telling women referred to St George’s Maternity Services about the new processes. Details can be found here:

www.stgeorges.nhs.uk/service/maternity-services/

We are also communicating directly through new appointment letters. If you have further queries, please do not hesitate to contact the Overseas Patients team:

020 8725 3439 or 020 8725 4693 or

overseaspatients@stgeorges.nhs.uk

Jacqueline Totterdell has been appointed as our new Chief Executive.  She was previously Chief Executive of Southend University Hospital NHS Foundation Trust, where she spent five years. She has also been Chief Operating Officer at The Hillingdon Hospital NHS Trust.

Avey Bhatia has joined as our Chief Nurse. She was previously Chief Nurse at Maidstone and Tunbridge Wells. After qualifying as a nurse, she originally worked in London at Guy's and St Thomas' and Hammersmith Hospitals, and St George's itself.

Marie-Noelle Orzel is our new Improvement Director. She is a nurse by background, and has previously worked as Improvement Director at North Cumbria University Hospitals and East Lancashire Hospitals NHS Trust. Marie-Noelle was also Director of Nursing at both Royal Devon and Exeter, and North Bristol NHS Trust, where she subsequently served as Chief Executive.

St George’s Vascular Institute (SGVI) is a specialist unit providing diagnosis and surgical treatment of disorders of the blood vessels.

The SGVI is the hub of the South West Thames Vascular Network, which has been established for 20 years, and provides emergency and elective services to people living across southwest London and Surrey. It is one of the biggest clinical networks in the country. Hospitals in the network include Epsom, St Helier’s, East Surrey, Kingston, Croydon and Queen Mary’s Roehampton. Clinics are offered at St George’s, at the district hospitals, and in the new Nelson Hospital. A further clinic at St John’s Therapy centre in Battersea, where we work with the tissue viability team to deliver ulcer care. Amputee rehabilitation is at the famous Douglas Bader Rehabilitation Centre at Queen Mary’s Roehampton.

The network provides world class care to patients with vascular surgical pathologies. These include aortic aneurysms and dissection, carotid artery atherosclerosis and stroke, peripheral vascular disease, multi-disciplinary management of the diabetic foot, varicose veins, and thrombosis. Rarer disorders such as thoracic outlet syndrome and popliteal entrapment syndrome are also managed.

The service has been designed to streamline the patient journey with consultants from the ‘spoke’ hospitals providing outpatient services, diagnostics and rehabilitation locally, with major elective and emergency surgery taking place at St George’s University Hospitals NHS Foundation Trust. 90 per cent of patients are seen at their local hospital. The outpatient clinics at St George’s University Hospitals NHS Foundation Trust offer a one-stop diagnostic service for people living near the hospital.

St George’s University Hospitals NHS Foundation Trust Vascular Department has an international reputation in the treatment of complex aortic and carotid disease. It has a special interest in minimally invasive procedures, including:

·         Peripheral angioplasty

·         Endovascular aneurysm repair

·         Endovascular management of varicose veins

·         Endovascular treatment of popliteal aneurysms

Death rates from surgery carried out in the Institute are well below the national average, with patient outcomes improving year on year. St George’s University Hospitals NHS Foundation Trust Vascular Institute offers pioneering treatments for many conditions and has played a leading role in national investigations into new treatments for aneurysms and carotid disease.

The Institute has a well-developed research programme particularly focused around the health technology assessment, strategic service configuration models, and population health outcomes.

To refer a patient:

The Clinical Lead for SW Thames Vascular Network, is Mr Peter Holt

·         0208 725 0693

·         07968058988

Vascular surgical referrals and requests may be directed to the vascular registrar, 020 8672 1255 bleep 6640, who has full details of the service for each day. Depending on their condition, patients may be seen immediately, or sent to an urgent clinic or ward review.

The on call vascular consultant is also available for advice via the switchboard, 020 8672 1255, who can connect you to their mobile phone for immediate help.

GP Education session

Mr Holt will be presenting a free education session on Vascular Medicine/services on Wednesday, 26th April 2017 from 7-9pm, St George’s Hospital.

Please RSVP to dyhian.mckenzie@stgeorges.nhs.uk

St. George's Hospital offer a supra-specialist Paediatric Audiovestibular Medicine and Audiologist-led clinics. Please note there are no Community Paediatric Audiology clinics offered on the main St George’s Hospital site. 

Any referrals by GPs to Community Audiology (i.e. non-complex cases) should be sent directly to Queen Mary's Hospital. 

Examples of referrals that are appropriate for St. George's supra-specialist clinics include:

·         Assessment of children with complex medical needs

·         Initial assessment of children with risk factors for sensorineural or conductive hearing losses (e.g. meningitis, severe head trauma, ototoxic medications, metabolic disorders)

·         Children requiring aetiological investigation for a permanent hearing loss

·         Children with significant ongoing medical problems (e.g. blood disorder, immune disorder, treatment for cancer, epilepsy)

·         Children with problems with balance, dizziness, troublesome tinnitus and auditory processing

·         Difficult to test children including those with physical or sensory disabilities, significant learning difficulties, significant developmental delay and severe behavioural problems, as may be found in some children with ADHD or autism

All other referrals should be sent to the Community Paediatric Audiology clinic at Queen Mary's Hospital.

Referrals to the St. George's Supra-specialist Audiology services can be sent via the mail, fax or email using the usual channels

Just to reiterate, there is a new secure email service for primary care to use for fracture referrals and enquiries. Please email the inbox:

stgh-tr.fractureclinic@nhs.net

The nurse-led Blood Pressure Unit clinic has moved out of Knightsbridge Wing at St George’s Hospital to Morden Hall Medical Centre, 256 Morden Road, London, SW19 3DA.

As you will know, we have moved a number of outpatient clinics to other locations from both Knightsbridge and Lanesborough Wings at St George’s. Many of our buildings need renovation and refurbishment, so we are putting some buildings out of use, such as the Knightsbridge Wing, and moving affected services into new accommodation.

We are communicating with patients directly. There is no change to the referral process for GPs.

Patients with queries can contact 020 8540 0585 and choose option 6 for the Blood Pressure Unit.

Every year, our Emergency Department (ED) at St George’s treats 150,000+ patients.

Around 40% of these attendances are by patients who have attended at least once before in the same year. During 2014/15 and 2015/16, around 1,800 patients attended ED between six and 39 times. While most patients use the ED for its intended purpose – serious and life-threatening injuries or conditions only - a small but not insignificant cohort of frequent ED patients’ healthcare needs would be better met elsewhere.

The ED team is working hard to better understand the underlying issues and we have already introduced ways of supporting frequent attenders (more than one attendance per year). We have signposted patients to alternatives, such as a GP surgery or pharmacy, and sometimes helped patients book appointments with their GP while in ED. We are also looking to pool ideas and initiatives of healthcare organisations across south west London.

It’s important for us to tackle this so we can ensure patients get the care and treatment they need without needing to come to the ED, reduce pressure on our available resources.

One area of focus for our Quality Improvement Plan, developed following last year’s CQC inspection, is end of life care – a vital service for many patients and their families.

It affects every part of the Trust, from the neonatal unit to the mortuary. It’s about helping people live as well as possible until death, with dignity, according to their wishes. Improved governance and operational oversight of end of life care means we can better see where things are working well, and where we can do better.

Key to this has been reinvigorating the End of Life Care Steering Group. Members of the group include a lead non-executive director, patient representative and Trust governor, as well as representatives from local commissioners, hospices and social services.

Alison Benincasa, Divisional Chair for the Trust’s Community Services Division and End of Life Care management lead, said: “We’re not just making changes to ensure we meet regulatory requirements - it’s about improving care for patients, their families and carers and about supporting and equipping our staff. The newly developed Trust End of Life Care Strategy and supporting implementation plan will mean better care.”

St George's has been rated as the best training unit for paediatric doctors in the Capital by the London School of Paediatrics, on behalf of Health Education England. This is a huge achievement, particularly given the high number of hospitals in London (32 units in London) which collectively help to train over one thousand trainee paediatric doctors each year. To come out on top is a significant achievement for the paediatric service, which provides a wide range of core and specialist services for children.

The wide range of paediatric services we deliver, says Dr Jonathan Round, our Director of Medical Education and a paediatric doctor in intensive care, provides a fantastic environment within which aspiring trainee doctors can succeed.  “The whole team has worked extremely hard to create a culture within which our trainee doctors can thrive. Our trainees play a crucial role in delivering a service for patients day in, day out – and, in return, we work hard to ensure they get the training and education opportunities they need.” 

Dr Elizabeth Boot (picture left), is a paediatric registrar and has been working as a trainee doctor on the Paediatric Intensive Care Unit (PICU) at St George’s since September last year. She said:
“I really enjoy working at St George’s. The staff are fantastic, but so are the training opportunities on offer. Given the wide range of services the Trust provides, we get to see and treat a wide range of conditions, including rarer disorders that you don’t get to see in every hospital. As a result,   I get to learn new skills, whilst also consolidating those I have already gained – and this is done through standard teaching, but also bedside input from consultants, which is as important.”

Our renal transplant team has recently been praised in two separate peer reviews of the service. They have been recognised as providing good care, clear pathways and access for patients with kidney disease requiring transplantation. The service carries out over 130 kidney transplants, with 480 patients attending the transplant clinic for care after surgery.

All kidneys from live donors are removed using state of the art keyhole surgery techniques. St George’s is also one of only a small number of centres offering a retroperitoneal surgical approach – which means patients usually only need to be in hospital for two days after donating a kidney.

The service was praised following an inspection by the West Midlands Quality Review Service (WMQRS), and an NHS England review of our outcomes for renal transplant patients.

Thank you for continuing to support our free monthly evening education sessions. The topics we have planned are based on your feedback from the evaluation forms that you complete at these sessions, so please continue to fill them in. I hope that these sessions will continue to be both interesting and valuable for you.

Please see below details of the upcoming sessions in 2017:

5 April 2017
Paediatric Asthma, Dr Richard Chavasse, Dr Richard Chavasse, Paediatric Respiratory Consultant

26 April 2017
Vascular Medicine, Mr Peter Holt, Reader in Vascular Surgery

17 May 2017
Neurology: headaches, Dr Niranjanan Nirmalanthan, Consultant Neurologist

28 June 2017
Haematology – blood test abnormality/anti-coag/anaemia, Dr Anna Cowley, ST6 Haematology

7.00pm: Buffet supper and refreshments
7.30 - 9.00pm: Presentations and Q&A

Venue: Hyde Park seminar room, level 1 Lanesborough wing, St George’s Hospital

Please email Dyhian.Mckenzie@stgeorges.nhs.uk or call 020 8725 2185 to reserve your place.

https://www.stgeorges.nhs.uk/gps-and-clinicians/gp-seminars/