National Health Service, PCT & Local Health Board News - Nov 2006

England - Local PCT News

Bath - New Mini Hospital

Proposals have been announced for a new mini-hospital serving Bath, based at Peasedown St John. The new facility would be a co-operative, co-owned by all its staff,and it would treat both private and NHS patients. The new unit would specialise in day surgery, providing a range of treatments, including ophthalmology and orthopaedics, although a number of patients would be able to stay overnight. It would have four operating theatres, an endoscopy suite, 26 in-patient beds and radiology and physiotherapy departments, with a capacity to treat around 600 patients per week.

There are reports that support from local healthcare professionals is very strong, although a spokeswoman for Bath & North East Somerset PCT said it was still early days, and that the PCT had not yet been involved in any discussions over services. She noted that, in line with national policy, the PCT will be increasing the volume of activity from the independent sector over the next five years.

Bradford PCT - Self-Harm Pilot

An innovative new service is being piloted in Bradford to allow people who self-harm to be treated in GP Surgeries or Eccleshill Community Hospital rather than in Accident and Emergency Units. The 6-month project will initially provide a 24-hour, 7 days-a-week service for people aged 16 and over, who are registered with a GP in North Bradford (Shipley, Baildon, Wrose, Eccleshill and Leylands Surgery), but it is hoped that after evaluation it will be rolled-out across the district.

Patients will be seen within six hours of calling a phone number by staff who have been trained to understand why people self-harm and who will treat their injuries in a non-judgemental way. The team includes Practice Nurses, District Nurses, Nurse Practitioners, GPs and the Community Intervention Team. This scheme was developed by Dr Gillian Proctor, Clinical Psychologist with Bradford and Airedale tPCT's Mental Health Team, and Eleanor Longden, a Psychology Student and worker for the Early Intervention in Psychosis team.

Devon / Cornwall - Substance Misuse

The latest report from the National Programme on Substance Abuse Deaths shows that there has been a big rise in the number of drug-related deaths in Torbay and South Devon, from one in 2004 to nine in 2005. However, in Cornwall the number has remained the same for both 2004 and 2005 at two deaths. In the Exeter and Greater Devon area, which covers North, East, Mid and West Devon, Torridge and part of Teignbridge, the number went from 30 to 42 for the year between 2004 and 2005.

Dr Pat Riordan, Director of Public Health for the Exeter area of Devon PCT, said: "What we first need to establish is whether these increases are part of a new trend or if this is something that was just a glitch. But it is still early and we will need to work closely with the drug action teams in Devon to establish where the problem lies."

East Devon PCT / Bolton PCT - Nurse Prescribing Pilot

The two PCTs launched a 6-month Nurse Prescribing Project in September, which is part of NHS Connecting for Health's Nursing Development Programme. The project will initially consider how nurses currently prescribe and how technology could improve this.

Foundation Trust Status

The independent regulator, Monitor, has authorised three new foundation trusts from November: South London and Maudsley NHS Foundation Trust, Tavistock and Portman NHS Foundation Trust, and University Hospital of South Manchester NHS Foundation Trust.

Kennet & North Wiltshire / West Wiltshire PCTs (now part of Wiltshire PCT) Sexual Health Services

The two PCTs decided to discontinue the funding of vasectomies and female sterilisations before the new county PCT was established at the beginning of October. The two PCTs have a combined debt of approximately £30m, and this is part of their Finance Action Plan. The two PCTs have now joined South Wiltshire PCT to form the Wiltshire PCT. The PCTs decided to stop paying for the operations after looking at services which could be reduced without affecting people who are ill.

Paul Jakeman, the PCTs' Medical Director, said: "Other contraceptive services remain available and exceptional funding is available if alternative methods are not suitable for the medical or social needs of the patient."

Leeds PCT - Dermatology Pilot

The PCT is recruiting a Nurse Specialist in Dermatology to work in the Leeds Tissue Viability Department on a Department of Health pilot project: “Care Closer to Home”. This is a one-year pilot project to establish and assess an Intermediate Care Facility, integrating Primary and Secondary Care for Dermatology Services.

The Dermatology Nurse Specialist will work within a multi-professional team, including a GPwSI and Dermatology Consultant, to deliver nurse-led outreach clinics for adults with Psoriasis, Eczema and Acne, and children with Eczema. These clinics are an extension of the secondary care dermatological nursing service, and the intention is to move appropriate dermatological conditions into a primary care setting for first line intervention.

North Hampshire PCT - Virtual Wards

North Hampshire PCT has supported the principle of Virtual Community Wards, a concept which is being piloted by Croydon PCT. Patients are selected for the virtual wards based on their predicted need, using computer software newly developed for the NHS. Nationally, the number of people aged 65 and over is predicted to increase by 53% by 2026. In Basingstoke and Deane, that rise is expected to be by 75% and the number of over-85s is set to double.

Helen Clanchy, Director of Primary & Community Care at the PCT, said: "Looking at Croydon, we believe we would be able to move quite quickly to community matron posts through this model." Once the software has suggested those patients who are at most risk of emergency hospital admission, they can be admitted to the "virtual ward", and cared for in their own homes using similar organisation, timetable and staffing to a hospital ward. A Community Matron will be in day-to-day charge and will liaise with the patient's GP. There will be an extensive consultation and a detailed implementation plan will be drawn up before any changes are introduced.

North Yorkshire PCT - GP Services

A GP mini-surgery is to be established within the Accident and Emergency Department of Scarborough and North East Yorkshire Healthcare NHS Trust, in an attempt to divert patients for whom the services of a GP would be more appropriate. The A&E Department suffers backlogs of patients in winter and summer, because of the large elderly population and the high number of tourists, and the PCT hopes to station GPs, Nurse Practitioners and other medical staff within the department this autumn.

Northampton PCT - Prescribing Budget

Measures to achieve savings of £40m at Northamptonshire PCT include advising GPs not to prescribe nicotine replacement therapy, two anti-obesity medicines, head lice treatments and some gluten-free foods. The Trust said that the measures were preferable to staff redundancies, and Dr Kamal Sood, Chairman of the LMC, said: "If we don't make these cuts, then other areas would bear it, and that could hit vulnerable and sick people more."

Nottingham University Hospital NHS Trust - Haematology

Nottingham City Hospital's new £10m Clinical Haematology Centre has been officially opened. The unit is one of the largest in the UK, and it has combined expertise from both the City Hospital and Queen's Medical Centre under one roof. It is also the first unit in the UK to receive European accreditation as a Centre of Excellence in Bone Marrow Transplantation.

The building houses:
- 40 inpatient beds
- A day case unit including outpatient chemotherapy
- A stem cell harvesting suite
- A haematology outpatients' department
- Two rooms for teenagers

Selby & York PCT - Choose and Book

Selby & York PCT has announced that its controversial Referral Advice and Clinical Assessment Service (RACAS) will no longer be used to scrutinise all referrals, and GPs are now expected to use the Choose and Book Computer System. RACAS was set up to streamline which patients could be seen in hospital after they were referred by GPs - only those patients who met required criteria were referred on, and those who did not were sent back to their GP. The service was operating in orthopaedics, dermatology and gynaecology, and will still be in operation for orthopaedic referrals until the end of this year

Dr David Geddes, Primary Care Medical Director at the PCT, said: "I am concerned that the development of RACAS has created unnecessary complexity to the referral pathway for the majority of referrals. "Choose and Book software is increasingly being used by practices to manage referrals, it allows patients to be tracked and will increasingly become the method of referral." It will now be up to GPs to refer patients according to guidelines laid down by the PCT, and for hospitals to refuse to treat patients for operations that are not being funded.

South Wiltshire PCT - Ambulance Service Partnership

Following a successful pilot, ambulance crews now have the ability to refer patients directly to healthcare workers. The initiative is a partnership between the NHS and social services which aims to avoid unnecessary hospital admissions. The pilot involved the Great Western Ambulance Service and South Wiltshire PCT, and has now been rolled across Bath and North East Somerset, and Gloucestershire. Crews have been trained to assess whether a hospital admission is needed and, if not (and with the patient's consent), the crew can then organise appropriate care from another health or social service. Once the Urgent Care Team is alerted, a nurse will call on the patient within two hours. The Nurse can then arrange for a package of support, which could include Occupational Therapy, Physiotherapy or a referral to the Falls Service.

Southampton City PCT / Hampshire PCT - Out-of-Hours Service

Hampshire's new Out-of-Hours Service, which is run by Southampton City PCT and the County Ambulance Service, handled more than 85,000 calls in its first year after taking over from Primecare. The service covers people living in Southampton, Eastleigh, Test Valley South, Mid Hampshire and the New Forest. Sheila Brooke, Head of Unscheduled Care at Southampton PCT, said: "We have seen the service go from strength to strength and have shown how well local NHS organisations can work together to provide a seamless service."

Wales - Local Health Board News

Monmouthshire LHB - Diabetic Retinopathy Screening

The Diabetic Retinopathy Service for Wales has launched a new mobile screening service across Monmouthshire in numerous locations such as GP surgeries, local hospitals and community health centres. The Diabetic Retinopathy Service for Wales is part of Cardiff & Vale NHS Trust, and is working closely with the LHB and GPs to ensure that all known patients with diabetes are sent invitations to attend for eye screening over the next twelve months.

The number of people suffering from diabetes is steadily increasing in Wales and is expected to double in the next five years from its current level of just under 100,000. The launch of the Monmouthshire service is part of the National Assembly for Wales’ Eye Care Initiative, and an important element of delivering the NSF for Diabetes in Wales. It aims to phase in additional facilities throughout the country to ensure that, by the end of 2006, all known diabetes sufferers will have been given the opportunity to have their eyes screened for diabetic retinopathy.

North Wales NHS Trust and LHBs - Substance Misuse

Responsibility for managing substitute prescribing services has been transferred form North West Wales NHS Trust to Gwynedd, Anglesey and Conwy LHBs. A new 3-tiered model of service for the shared care of substance misusers will be implemented shortly.

Wales - Out-of-Hours

It is reported that the cost of providing out-of-hours GP services in Wales is £6.5m more than the original estimates, and that some of Wales' 22 LHBs are having to use other parts of their budgets to offset this increase. Gwynedd and Powys LHBs had to find more than £600,000 each last year to fund out-of-hours services, and Ceredigion LHB has paid out an extra £700,000 over two years. LHBs were made responsible for out-of-hours services in 2004 following introduction of the new GP contract.

Scotland - Local NHS News

NHS Forth Valley - Dermatology

Waiting times for dermatology services in Forth Valley have been reduced by more than two thirds, despite a 30% increase in referrals in the past 18 months. This follows the opening this year of the new £290,000 Dermatology Centre at Stirling Royal Infirmary which is supported by satellite clinics in Balfron, Thornhill, Alloa, Stenhousemuir and Falkirk.

Two years ago, patients had to wait, on average, 54 weeks for a routine referral, but now 99% are seen in less than l8 weeks and anyone with a severe skin problem is given an appointment within two weeks. The community clinics are run by GPswSI in Dermatology, supported by the specialist hospital team, and these GPs now see around 30% of all new patients. Eleven nurse-led return clinics provide second line drug monitoring, and checks on the management of minor lesions and chronic conditions. The centre at Stirling Royal Infirmary provides specialist dermatology day treatment, investigations and outpatients clinics, and is complemented by the weekly community clinics, and a day treatment unit at Falkirk Royal Infirmary.

NHS Greater Glasgow & Clyde - Mental Health

Three new mental health projects for the Glasgow area have been approved and are all expected to be up and running by spring 2007. ESTEEM is the first dedicated multi-disciplinary service to be piloted in Scotland for young people aged 16-35 years with first episode psychosis. The service will support the young person affected, and their family, for up to three years. Two consultants have been appointed and nursing staff are currently being recruited.

The second development is the creation of a dedicated service for adults with eating disorders. Individual and group therapy will be available through a day service and staff will be able to refer patients onto secondary inpatient services if necessary. The final project is the development of a new crisis service to provide intensive home-based treatment and therapy 24 hours per day. This service will offer an alternative to hospital admission wherever possible with locally based teams in each Community Health and Care Partnership area.

NHS Highland - CHD

The Cardiovascular Team at Lorn & Islands Hospital, Oban, has been shortlisted for a Hospital Doctor Award in award in recognition of its achievements developing a high-quality service for a scattered population; the service is patient-centred and uniquely locally-accessible.

The team helped to form a charity (ABCD - Argyll Beats Cardiovascular Disease) in 2000. In 2002, it used lottery funding to purchase a high-quality portable echocardiography machine, and provided an outreach service to the most remote communities on the islands of Mull and Islay, and to Campbeltown at the southern end of the Argyll peninsula. This service, provided by a Cardiac Physiologist, runs in parallel with outpatient clinics run by the Lead Consultant. It is based in the local community hospital and enables the team to provide direct access echocardiography for GPs in these communities.

NHS Lothian - Physician Assistants

Four Physician Assistants are joining GP practices in Edinburgh and West Lothian as part of a two-year trial. Physician Assistants are long-established healthcare workers in the US, and work under the direction of supervising GPs. At present, Physician Assistants will not be able to prescribe drugs but this is under review. Two will work in Edinburgh, developing and running an Integrated Chronic Disease Management Service for Diabetes and COPD. The remaining two will work in West Lothian under the direction of the West Lothian Community Health and Care Partnership.

Dr Charles Swainson, Medical Director, NHS Lothian, said: "These new roles will add value to our nurse and GP-led primary care clinics by increasing our capacity for looking after patients with chronic diseases. Our new colleagues will also help the efforts we are making to target people who we find are hard to reach with our current approaches." The trial is being run by NHS Education for Scotland and is part of national efforts to develop new modes of working in the wake of developments such as the European Working Time Directive and changes in training for doctors.

Northern Ireland - Local NHS News

Craigavon & Banbridge Community HSS Trust - Stroke

The Young Stroke - Moving On Project has been launched by the Trust in conjunction with Northern Ireland Chest, Heart and Stroke Partnership. It aims to help people aged 16-64, whose concerns following a stroke are likely to vary from those of older people. Stroke is the largest single cause of disability in Northern Ireland, and younger people who survive a stroke may have concerns regarding providing for a family, as well as social and employment issues. The project is a one-stop contact point, offering information and advice which is tailored to individual needs.

Craigavon & Banbridge LHSCG - Review of Public Administration

The work of the Craigavon & Banbridge LHSCG was celebrated at the end of September, as it stood down following the Review of Public Administration. Achievements include a Community Triage Pilot for people experiencing mental health difficulties (which is being rolled out in the Southern Board area), and a Minor Ailment Scheme involving local pharmacists (which has now been rolled out across Northern Ireland).

The Review of Public Administration (RPA) will mean a reduction in the number of HSS Trusts from 18 to 5, and the number of LHSCGs from 15 to 7 "Commissioning Groups". The new HSS Trusts were established in shadow form in August, Chief Executives have been appointed, and they should be ready to go "live" in April 2007.

Royal Group of Hospitals and Dental Hospital HSS Trust - Stroke

A new service has been launched in the Royal Hospital, in conjunction with the North and West Belfast LHSCG, to provide support and advice to the relatives of those who have suffered a stroke. Nurses will hold the sessions twice a month.