National Health Service (NHS), PCT & Local Health Board News - June 2006

England - Local PCT News

Brent PCT - Diabetes Project

Brent has a higher than average incidence of diabetes, so most healthcare professionals deal with the disease every day. The Brent Emergency Care and Diagnosis Centre (BECaD) Single Point of Access Diabetes Project went live in March and the PCT is now hosting a launch event for GPs and AHPs. The decision of some of the newly formed practice based commissioning (PBC) groups to make diabetes a priority reflects and acknowledges the importance of this potentially serious condition.

The project will ensure that the majority of patients will have continuous screening and assessment in primary care, and that professionals there will be able to refer to the Single Point of Access (SPA). The SPA will act as an interface between primary care and the Acute Trust, and only one referral form is needed for all available services. There is a Rapid Access Clinic run by Consultants and other members of a Multi-Disciplinary Team, where patients can be seen within a week, and the SPA will respond to queries via phone, e-mail or fax within 24 hours. The Expert Consulting Centre in the Acute Trust will be reserved for specific groups of patients.

East Lincolnshire PCT - Contraceptive Services

It is reported that East Lincolnshire PCT is planning to close Family Planning Clinics across Lincolnshire, because this is a service which can be provided by GPs. However, Melissa Dear of the Family Planning Association has said that while general practice is a valued partner in contraceptive provision, it does not duplicate the services offered by family planning clinics - "Many practices do not provide all 14 of the different contraceptive methods and rely on referring women to clinics for the more specialist methods." The PCT has said that staff are currently being consulted on proposed changes to the family planning service, and that a three-month public consultation will be launched following an announcement later this month.

East Surrey / Crawley PCTs - Heart Failure

East Surrey and Crawley PCTs have expanded their Heart Failure Service by appointing two Heart Failure Nurses and four GPswSI. East Surrey PCT has also expanded its echocardiography service. The Heart Failure Nurses will be working in both primary and secondary care. They are now seeing patients who have been referred from the cardiac wards at East Surrey Hospital, but will soon be seeing patients referred from all wards, as well as GP referrals. They will also be establishing Heart Failure Clinics. A new GPwSI has been appointed for East Surrey to lead Heart Failure clinics with one of the Specialist Nurses, and three GPs from Crawley have attended echocardiography training. East Surrey PCT has agreed a contract with Echotech to provide open-access echocardiography services for its GPs.

Hyndburn & Ribble Valley PCT - New Health Centre

The PCT is developing the new £10m Darwen Health Centre to bring together practices in the Blackburn Road area. It believes that the new centre, which is to be built on land bounded by Blackburn Road, Lonsdale Street, Lower Antley Street and Leyland Street, is essential to replace outdated surgeries. However, so far only one practice out of a potential six has signed up, and the others are worried that they will not be given a fair price for their surgeries by the PCT. Director of Finance, Jeannette Newman, said the key problem was a "substantial variation" between two ways of pricing the existing GP properties. While a surgery might command a price of £732,500 when sold as a GP practice, the PCT will only pay the property value, which might be £540,000. Mark Wilkinson, the PCT's Chief Executive, has said that the development will continue, and that while he would prefer the centre to house all the GPs, other appropriate uses could be found for it. He also noted that other similar local schemes had full GP backing by the time they were ready to open. Another scheme, to accommodate practices in East Accrington, is planned for Paradise Street.

Lambeth PCT - Palliative Care

The PCT is aiming to increase the use by GPs of the Gold Standard Framework for palliative care, possibly with an enhanced service agreement. District Nurses are interested in commissioning home palliative care services via Practice-based commissioning.

New Foundation Trusts

Five new NHS Foundation Trusts have been authorised by Monitor, the independent regulator of foundation trusts:

- Salisbury Healthcare NHS Trust
- Royal Berkshire & Battle Hospitals NHS Trust
- Newcastle upon Tyne NHS Trust
- Southend Hospitals NHS Trust
- East Somerset NHS Trust

This brings the total number of NHS Foundation Trusts to 40. A further group of trusts is being considered for authorisation by 1st August, and this will complete the second wave of foundation trust applications.

PCT Reorganisation

The Department of Health has announced the new configuration of PCTs in England. The number of PCTs will be reduced from 303 to 152, and more than 70% of the new PCTs will mirror Local Authority boundaries. The changes will be effective from October 2006. In the east of England, Great Yarmouth and Waveney PCTs have merged to form one small cross-border PCT, rather than being separated and placed within the new Norfolk PCT and Suffolk PCT. Bassetlaw PCT has not been merged into the Nottinghamshire County Teaching PCT and has kept its original boundaries. The PCT has historical health links with south Yorkshire. Huntingdonshire PCT has merged with three other Cambridgeshire PCTs, despite its protests, although the two Peterborough PCTs have remained separate.

Morecambe Bay PCT has been split in two: the southern part of the PCT (Lancaster) has joined with the new North Lancashire PCT, while the northern part (South Lakeland) has been merged with the new Cumbria PCT. Two new PCTs with the largest populations are in the south: Hampshire PCT has a population of 1,253,000, and Surrey PCT has 1,055,000. No other PCT covers a population of more than 800,000.

Southern Norfolk PCT - Emergency Contraception Service

The PCT Board has asked the PEC to suggest which of three recent proposals for pharmacy enhanced services should be prioritised. The PEC has now reviewed the proposals and agreed the top priority as the emergency hormonal contraception enhanced service. The other two proposals involved smoking cessation and medication review. The PEC felt that a new smoking cessation service was unlikely to increase the number of quitters, and noted that the PCT was meeting national smoking cessation targets, already having a service at Levels 2 and 3. Considering medication review, it thought that while studies show this to be a cost-effective intervention, recent trials indicate the picture might be more complex.

Finally, figures show that the PCT has some areas where the teenage pregnancy rate is higher than both the PCT and the county average. The PEC thought it unlikely that this could be influenced without the development of existing services. The service will be available from community pharmacies in a limited number of areas where the teenage pregnancy rate is above the PCT average (Thetford and Dereham for 2006/7). The PEC recommended that the next areas for consideration be Wymondham, Diss and Watton, although these would also require the development of further sexual health services for young people.

Sutton & Merton PCT - Diabetes

The Diabetic Retinopathy Screening service at south Wimbledon's Nelson Hospital was introduced in 2004, and has now been extended to include three new clinics in Sutton and Merton. Sir Muir Gray, Programme Director for the UK National Screening Committee, has praised the programme, saying: "In its first year of operating, the programme has succeeded in offering over 90% of its patients screening, and over 70% have taken up the offer. This is a good performance for any programme and exceptional for such a new one." Dr Nadeem Khan is the PCT's Programme Manager for the service. He said: "It is very important for people with diabetes to have regular screenings and our patients have said that the new service makes this easier for them to do. They prefer to have their eyes tested somewhere local and convenient, rather than having to travel to a large hospital."

Swindon & Marlborough NHS Trust - Spare Capacity

The Chief Executive of Swindon & Marlborough NHS Trust is considering leasing empty beds in the Great Western Hospital's Treatment Centre to the private sector if there is no increase in demand by 2008. The Trust has been told that there will not now be the anticipated demand for beds from its main commissioning PCTs (Swindon PCT and Kennet & North Wiltshire PCT) and currently 36 of the 108 NHS beds in the Brunel Treatment Centre stand empty. The centre opened in April 2005.

The Great Western Hospital already earns £4m a year from its private ward, and still has to clear £2.2m from its £12m deficit. Kennet & Wiltshire PCT also currently has a large deficit, and Swindon PCT is trying to treat more patients in the community.

West Gloucestershire PCT - Respiratory Nurse Specialist

Kathy Campbell has been appointed as Respiratory Specialist Practitioner at the PCT to work in pulmonary rehabilitation and respiratory services. It is hoped to pilot a new service model demonstrating clinical and cost effectiveness in a locality in the Forest of Dean. Last year, the PCT and Dr White, Consultant in Respiratory Medicine and COPD Lead at Gloucestershire Hospitals NHS Trust, met to discuss which patients currently being seen in secondary care, could be seen in primary care, and it was decided to recruit a Respiratory Nurse Specialist (RNS) for all of West Gloucestershire except the North Forest locality.

Initial thoughts were for the RNS to run respiratory clinics in primary care for approximately 16 patients per week. This could be done in conjunction with Practice Nurses (who will risk-assess), and District Nurses (who will care for the housebound). A mapping exercise still needs to be completed, to identify what services are available to respiratory patients, and a patient journey also needs to be mapped, to identify individual health care needs.

West Norfolk PCT - Mental Health

West Norfolk PCT has decided that its mental health services will join the Foundation Trust application of Norfolk & Waveney Mental Health Partnership NHS Trust, rather than become part of the new norfolk-wide PCT in October. The PCT wanted to make a decision on the future of the mental health services as there were fears that they might be overlooked as a priority under the new PCT.

Staff felt this was the "least worst" and "safest" option, as the partnership is in financial balance and views mental health as a priority. It was also felt that previous experience of working with the Partnership would minimise disruption. Other options had included:

- the formation of a Specialised Personal Medical Service, independent of the NHS
- being taken over by one of the new NHS Foundation Trusts, or
- transferring to Social Services

Wales - Local Health Board News

Ceredigion & Mid-Wales NHS Trust - CHD

The Welsh Assembly has promised £1.7m to help fund a new Coronary Care Unit at Aberystwyth's Bronglais Hospital. Every District Hospital should have had a dedicated unit by the end of 2002, and Bronglais is currently the only hospital in Wales without one

Neath Port Talbot LHB - Specialist Practitioners

The board's Medical Directorate has announced that the LHB has been successful in its bid, with Bridgend LHB and Bro Morgannwg NHS Trust, for a BHF Heart Failure Nurse, and is looking for funding to enable a GP to begin training as a GPwSI in Diabetes.

Scotland - Local NHS News

Argyll & Bute CHP - Out-of-Hours

Port Appin practice, one of the few remaining mainland GP practices in Britain which still provides an out-of-hours service, is planning to transfer to NHS 24 cover later this year. The practice covers the Isle of Lismore as well as mainland Appin, and will opt out of providing out-of-hours services provided that "a safe and sustainable alternative" can be put in place. Argyll & Bute CHP is confident that safe alternative cover can be arranged by the end of this year, but islanders on Lismore believe the timescale for change is "grossly optimistic", and that the only way of providing a reasonably reliable emergency response to Lismore would be by air. It is anticipated that out-of-hours GP cover to the practice area will, in the future, be provided from the established Primary Care Emergency Centre, based at Lorn ands Islands District General Hospital, where a GP is available on a shift system. Port Appin practice has agreed to offer an "on-call back up" while the new system is introduced.

NHS Highland / NHS Shetland - Heart Failure Nurses

The British Heart Foundation has agreed funding for a Specialist Nurse in NHS Shetland to deliver training in early coronary care and resuscitation management. The funding will last for three years, and although there is a possibility that it might continue, the board will be preparing an exit strategy in case it cannot afford to continue. BHF is also funding one full-time and four part-time Specialist Nurses in NHS Highlands. These nurses will offer essential care and support for patients and carers in Inverness, Lochaber, Skye & Lochalsh, Caithness & Sutherland, Nairn, Badenoch & Strathspey, Ross-shire and Inverness-shire.

NHS Lothian - Smoking Cessation

Following advice and funding from the Scottish Executive, NHS Lothian has launched a £1.2m Smoking Cessation Campaign which will ensure that all smokers admitted to hospital will be approached by a new, dedicated member of staff employed specificially to help them quit. Once discharged, patients will be referred to community services who will continue the programme. Young people, pregnant women and those on low incomes will be the main target of this initiative, with an expansion of youth work and the roll-out of the West Lothian Stop4Life scheme in which midwives help expectant mothers to give up smoking.

There will also be an emphasis on one-to-one sessions and group work in places like working men's clubs and bingo halls. It is also hoped that more smokers will go to pharmacists for support while they are trying to stop, especially as many sessions can be booked at weekends and evenings when GP surgeries are closed. The Executive has asked all NHS Boards to reduce the number of smokers, and the target for NHS Lothian is 28,000 (almost one fifth of its population) by 2010.

NHS Shetland - Multiple Sclerosis

A new Multiple Sclerosis / Neurological Services Nurse Specialist, Ms Elizabeth Clark, has been appointed within NHS Shetland. The charity MS Scotland is providing much of the funding for the first 3 years, augmented by contributions from MS Shetland and NHS Shetland. NHS Shetland has confirmed that they will then continue to fund this post. The Chairman of MS Shetland said "The appointment of an MS Nurse has been the main thrust of the local branch's work for a number of years." Multiple Sclerosis is the most common disabling neurological disease amongst young adults, and it is particularly prevalent in Scotland where it affects around 10,500 people. In Shetland alone, the MS Society estimates that well over 90 people live with this condition.

Northern Ireland - Local NHS News

Craigavon & Banbridge LHSCG - COPD

The Outreach Spirometry Service for People with Respiratory Disease is the first project of its type in Northern Ireland, giving GPs the chance to refer patients to a dedicated primary care service from a hospital-based team. The service includes lung function tests, advice on smoking cessation, inhaler checks and guidance on inhaler technique. It is provided by a Senior Community Respiratory MTO who attends pre-booked clinics in central locations across the area as well as more remote practices and health centres. New patients are seen at these clinics and reviewed after 12 weeks. GPs are kept informed of procedings and follow-up sessions are taken on by Practices Nurses where appropriate. Improved links between primary and secondary care has resulted in early diagnosis, and consistency of service and treatment, which has also relieved the pressure on busy GPs. Patients also appreciate the convenience of the new service.

South & East Belfast LHSCG - Medicines Management

The LHSCG has funded a pilot Medicines Management Scheme to identify any problems with local patients taking medications as directed. The scheme identified 150 vulnerable elderly patients who were reviewed twice to ensure that their medicines were appropriate, had no adverse reactions, and had adequate instructions on the pack. As a result, the number of patients requiring interventions decreased from 92% at first review to 8% at second review. A number of issues were highlighted, such as:

POOR PATIENT KNOWLEDGE OF MEDICATION
70% of those piloted had no knowledge of the name or the purpose of their prescribed medication.

UNTREATED CONDITIONS
38% had medical conditions which were not being treated or had not been mentioned to their GP.

MONITORED DOSAGE
This needs to be used more extensively for at-risk patients who are living alone and have major compliance problems.

AWARENESS & SKILLS OF COMMUNITY PHARMACIST
There is a need to raise awareness of health professionals to the roles and skills of community pharmacies. Unfortunately, only about half of the pharmacies are trained in medicine management and more need to be encouraged to train.

Western HSSB - Strategic Commissioning Teams

The Board created three Strategic Commissioning Teams (SCTs) in 2005, and three new SCT Leads have now been announced to develop the initial work programmes.

SCT1 Children, Young People & Families (Lead: Dorothy Jeffrey)
Projects include:
- publication of the Children's Services Plan 2005/8
- extra services for Autism
- action plan to reduce teenage pregnancy
- "Teen Snapshot"

SCT2 Adults (Lead: Margaret Kelly)
Projects include:
- Mental Health development, including Forensic Services, Eating Disorders, Learning Disability
- work with the Regional Medical Services Consortium to fund cancer drugs, and establishment of pharmacy sub-groups to maintain better links with the Northern Ireland Cancer Network

SCT3 Older People (Lead: Bridget Bergin)
Projects include:
- Community Rehabilitation Team (Sperrin Lakeland Trust) preventing inappropriate hospital admissions
- COPD Early Discharge Programme, a joint project between Altnagelvin and Foyle Trust