1 October 2015 Welcome to the first edition of the new monthly GP newsletter for Chelsea and Westminster NHS Foundation Trust spanning our two hospital sites since our integration on 1 September 2015: Chelsea and Westminster Hospital and West Middlesex University Hospital. To reflect the new organisation, this newsletter is divided into three sections:

Trust News including upcoming GP education events

Chelsea and Westminster Hospital site specific news

West Middlesex University Hospital site specific news

If you would like to receive this newsletter direct to your inbox at the beginning of each month and to receive priority notification of our GP education events you can subscribe here: bit.ly/GPnewsletter2015 If you have any issues with making referrals or receiving clinical information from the hospital or if you have suggestions or comments about the GP newsletter content please contact: Justine Currie GP Relationship Manager T: 0203 315 6603 E: justine.currie@chelwest.nhs.uk or gpqueries.chelwest@nhs.net

In this edition (click hyperlinks below to

go direct to specific features) Trustwide News:

Patient pathways and tertiary referral routes to remain the same in new integrated organisation

New Chief Executive, Lesley Watts joins the organisation

Nursing uniforms have been updated across both hospital sites

Improving GP notification of patient deaths in hospital

Burns Management Education

My Medication Passport demand reaches 100,000

POPPY research study for the over 50s

Surgeon turned author ‘Going into hospital? A guide for patients, families and carers’ book released

Upcoming events

GP Bi-annual Education Day on 22 October 2015 – only a few spaces remaining

Research, Audit and Service Improvement event on 12 November 2015

St Stephen’s AIDS Trust Education Calendar – October and November 2015

Chelsea and Westminster site specific:

New Craniofacial Consultant Juling Ong covering Niall Kirkpatrick’s six month sabbatical

Good GP feedback for the Acute Diagnostic Oncology Clinic

MRI uploads – Chronic Pain referral reminder

Dermatology advice still available to GPs via cds.kcpct@nhs.net

Booking Paediatric blood tests

Modernised colorectal focus group

Annual Radiology GP Survey

A&E redevelopment update West Middlesex University Hospital site specific:

Experiencing issues with Discharge Summaries?

New Paediatric Assessment Unit

Pleural Effusion Pathway update

Maternity Day Assessment Unit

Ambulatory Emergency Care award

Women, pregnancy and mental health

West Mid hosts fun filled open day

Spotlight on: Ambulatory Emergency Care

Trustwide news

Contents

Patient pathways and tertiary referral routes to remain the same in new integrated organisation

New Chief Executive, Lesley Watts joins the organisation

Nursing uniforms have been updated across both hospital sites

Improving GP notification of patient deaths in hospital

Burns Management Education

My Medication Passport demand reaches 100,000

POPPY research study for the over 50s

Surgeon turned author ‘Going into hospital? A guide for patients, families and carers’ book released

Upcoming events

GP Bi-annual Education Day on 22 October 2015 – only a few spaces remaining

Research, Audit and Service Improvement event on 12 November 2015

St Stephen’s AIDS Trust Education Calendar – October and November 2015

Patient pathways and tertiary referral routes to remain the same in new integrated organisation Patient pathways and tertiary referral routes to remain the same in the new integrated organisation. There are no changes in established referral routes for patients cared for at West Middlesex or Chelsea and Westminster Hospitals. This applies equally to emergency and elective patients. For example, where the onward referral for patients with specialist needs has historically been from West Middlesex Hospital to Imperial Healthcare, these arrangements will continue as of 1 September 2015. Where patient transfers are based on available beds or managed across a network, such as critical and neonatal care, staff should continue to use the established mechanisms

for managing and transferring these patients. In short, you should not change your normal referral routes, as a result of the integration, by referring to West Middlesex or Chelsea and Westminster Hospital as an alternative to existing arrangements. Future developments As work on service integration progresses, there may be changes to patient pathways. These will be managed in a planned way and staff involved fully informed of any changes beforehand. This is necessary to ensure that both the required communication with clinical teams and any necessary changes in service capacity are in place in advance to ensure optimal care for patients. In the meantime, patient pathways and existing referral routes will remain the same as they were prior to integration.

New Chief Executive Lesley Watts joins the organisation

Lesley became Chief Executive of Chelsea and Westminster Hospital NHS Foundation Trust on 14 September 2015. A nurse and midwife by training, Lesley has executive managerial experience at the highest level having been a Chair of an NHS Trust, a Foundation Trust Governor and a Director of Nursing and Operations at a major hospital. Prior to her appointment as Chief Executive, Lesley was Accountable Officer (Chief Executive) for East and North Hertfordshire Clinical Commissioning Group which has this

3

year been nominated for Health Education England Governing Body of the Year and the HSJ Patient Participation Award. Chairman Sir Thomas Hughes-Hallett said: ‘I am delighted that Lesley will be joining our team. Her leadership and obvious energy, empathy and enthusiasm will help us to continue to build an organisation with local, regional and world-class ambition. She has been pivotal to delivering successful mergers and acquisitions within the NHS and has a proven track record in delivering financial turnaround. She oversaw the merger of the Bedfordshire and Hertfordshire Health Authorities into a Strategic Health Authority, established and delivered an £84m turnaround project and led a programme to pursue clinical improvement in the redesign of local health services.’

Nursing uniforms have been updated across both hospital sites To reflect the new organisation, the nursing uniform across the two hospital sites have adopted the following nursing uniform. Work is also underway to roll out a patient facing administrator uniform across both sites.

Healthcare Assistant

Deputy Sister/Charge Nurse

Staff Nurse Specialist Nurse

Improving GP notification of patient deaths in hospital Discharge summaries (DSUMs) are an essential form of communication between the hospital and primary care. This is no less true when the patient passes away during their hospital admission. Despite this an audit in 2013 at Chelsea and Westminster Hospital NHS Foundation Trust revealed that only 1.7% of DSUMs were written and sent out within 24 hours for patients who had dies during their admission. This is in stark contrast to the national target for all patients’ DSUMs which the hospital ws meeting 80% sent out within the same timeframe.GPs and launched at Chelsea and Westminster this month. We recognise that timely notification to GPs of a patient’s death in hospital and the circumstances around it are essential for review of medical care, to support those close to the patient who are often also patients at the practice and to stop communication to the deceased patients. After raising awareness of this issue with clinical teams this was reaudited in 2015 and found that 22% of DSUMs were now being

Chief Nurse Cabinet

Sister/Charge Nurse

Lead Nurses/Matron

4

sent out within 24 hours. This represents an improvement but remains low so a further programme of education is now underway. Additionally a short template for DSUMs for deceased patients has been created with input from local GPs and launched at Chelsea and Westminster last month. This new template has been shared across both hospital sites and will be reaudited in 2016. The lead clinician for Palliative Medicine at Chelsea and Westminster, Dr Sarah Cox would be happy to hear your comments especially about the new DSUMs at sarah.cox@chelwest.nhs.uk

Burns Management Education Annette Kempster is the Burns Care Advisor/TRIPS Coordinator for the Burns Service at Chelsea and Westminster Hospital. Her role includes visiting Emergency Departments, Walk in Centres and General Practices within the M25 catchment area to provide up to date education on initial burns management. This includes first aid, burns depth assessment, total burn surface area, referral criteria and dressings. If you would like Annette to come to your practice to provide training please email annette.kempster@chelwest.nhs.uk or telephone 020 3315 2500.

My Medication Passport demand reaches 100,000 and provides real patient benefits

My Medication Passport is a small, easy-to-read, user-friendly booklet or app designed by patients for patients to hold a record of their medication. The My Medication Passport (MMP) is funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Northwest London. It supports patients to

understand the impact of their medications and is particularly useful for people using multiple medications. In addition, it supports improved interactions between patients and healthcare professionals regarding their medications. Since its launch in April 2013, 100,000 pocket booklets have been ordered by pharmacies, hospitals, charities, GP practices, nursing homes, libraries and by patients and carers across England, Wales, Ireland and Scotland. Additionally, over 5,000 iPhone and 4,263 android apps have been downloaded, in at least 37 different countries worldwide. My Medication Passport was developed by patients and healthcare professionals based at Imperial College Healthcare NHS Trust. It was part of a wider project designed to improve the review of medicines for older people. However, it was soon seen that the passport was useful for anyone taking multiple medicines. My Medication Passport is highly relevant as the number of people living with one or more long-term health conditions increases and the medicines they take increases also. Errors can occur when medicines are changed, and as people move from one care setting to another such as being discharged from hospital to home; or their care is managed by multiple clinicians in hospitals or in the community. My Medication Passport is used as a good practice example in the Royal Pharmaceutical Society ‘Keeping Patients Safe’ a 2012 report on ensuring accurate medication management when patients transfer between care providers. Professor Derek Bell, Director of NIHR CLAHRC Northwest London said: “This is a fantastic milestone and shows very clearly that this simple but effective patient aid is having a really positive impact. MMP is a tool for anyone to use, designed by patients for patients. Medicines mismanagement can be a real challenge, particularly when patients transfer between different care settings and My Medication Passport helps patients to keep a record of their medications and aids dialogue about their medicines with family, carers and health care professionals.”

5

The benefits of the My Medication Passport have been evaluated and documented within a number of NHS organisations and, as the concept becomes better known it is believed it will become accepted practice for all patients. Anyone can order copies of My Medication Passport by visiting www.bit.ly/CLAHRC-mmp

POPPY Research Study Are you or your patients over 50? The POPPY study is looking into the effects of ageing on the general health and fitness of people over 50. It will offer you the opportunity to have investigations that you may not regularly have. The study will monitor your health over 2 years with a total of 3 visits. Visits will include a bone density scan, cognitive tests and blood tests. If this sounds like something you would be happy to take part in, or just want some more information do not hesitate in contacting us using the details below. If you know someone who may also be interested please feel free to pass on our details: T: 020 3315 6138 or 07592 784 983 E: michelle.anthonipillai@chelwest.nhs.uk orstephen.fletcher@chelwest.nhs.uk

Surgeon turned author: ‘Going into hospital?’ A guide for patients, families and carers’ book released

Mr Oliver Warren, Consultant in Colorectal Surgeon has written a book called ‘Going into

Hospital? A guide for patients, families and carers’. The two co-authors are Professor Bryony Dean Franklin (Pharmacist, Professor of Medication Safety, ICL) and Professor Charles Vincent (Psychologist, Professor of Clinical Safety, Oxford University). The book is a guide to the ‘foreign land’ that is the hospital. It aims to explain to patients and their families how hospitals work, how to make informed choices, how better to navigate their way through the myriad of different departments. It tries to translate the complex difficult language and make it easier to understand. We are proud of the book, and hope it will make a difference to patients. Mr Oliver J Warren MD FRCS (Gen.Surg.) Consultant in Colorectal Surgery

Upcoming events GP Bi-annual Education Day on 22 October 2015 – only a few spaces remaining Sixty GPs and Practice Nurses are already signed up to the first Chelsea and Westminster Hospital NHS Foundation Trust bi-annual GP education day and the remaining few spaces are going fast. If you are interested in attending this GP education day please rsvp by emailing caroline.pooley@chelwest.nhs.uk Please note we have limited morning and afternoon half day slots if you are unable to make the full day. Full details of the agenda are included below. When: Thursday 22 October 2015, 9am-5pm Where: Chelsea Football Club, Stamford Bridge, Fulham Road, SW6 1HS Parking is available and a buffet lunch will be provided Programme for the day: 9.00am: Registration 9.15am: Introduction and welcome – Prof Simon Barton 9.30am – 11.00am: Cardiology – Dr Julian Collinson

Hypertension

6

Heart Failure

AF

Examples of inappropriate referrals 11.15am-12.45pm: Clinical Haematology – Dr Ian Gabriel,, Dr Francis Matthey

Haematology in the elderly population – Dr Ian Gabriel

Newer anticoagulants, low counts, high counts, haemochromatosis and the [mis]interpretation of biochemical iron studies – Dr Francis Matthey

12.45pm-1.30pm: Lunch 1.30pm – 3.00pm: Gastroenterology – Dr Marcus Harbord, Dr Matthew Foxton, Dr Martin Benson, Dr Alan Steel 3.15pm – 4.45pm: Dermatology Urticaria update – the new guidelines – Dr

Chrystalla Macedo

Red flags in Dermatology – Dr Rishika Sinha

Benign skin lesions in dermatology – Dr James Shelley

How to diagnose skin cancer – Dr Louise Fearfield

4.45pm – 5pm - Close Research, Audit and Service Improvement event on 12 November 2015 Patients and the public are encouraged to attend the public showcase session of the audit and service improvement event When: 5.00-6.30pm on 12 November 2015 Where: Gleeson Lecture Theatre, Lift Bank B, Lower Ground Floor, Chelsea and Westminster Hospital This event is aimed at:

Promoting and publicising our reseach, audit and service improvement outputs across Chelsea and Wesminster and West Middlesex

Showcasing and celebrating current projects and recent successes to inspire future work that translates into improved patient care

Learn about the support available for those seeking to carry out research, audit and service improvements projects.

The event is being hosted by:

Dr Essam Ramhamadany, Assistant Director of Research, who will be discussing what we mean by research, audit and service improvement in healthcare

Dr Mark Nelson, Consultant in HIV Medication, who will be discussing about the progress made in his field of medicine, and how today’s research really is tomorrow’s care

Ron Grant, a patient at West Middlesex University Hospital, who will be discussing his experience of research and why it is important to be involved

Additionally, we will have a wide variety of staff presenting their work with opportunity to learn more about a wide variety of health conditions, staff on hand to speak about current opportunities for patients and healthy volunteers to be involved, details of national research opportunities and a forum to feedback your priorities for healthcare. Please email Mark Terry – Research Delivery and Operations Manager at mark.terry@chelwest.nhs.uk if you would like flyers to display in your practice. St Stephen’s AIDS Trust Education Calendar – October and November 2015 15 October: STImulate—all day event for GPs and practice nurses working in Hammersmith & Fulham. An update on sexual health focussing on local issues,STI rates, emerging and multi-systemic infections and how to spot them, testing for HIV, contraception update. Venue: St Paul’s Centre, Hammersmith Cost: Free 5/6 October: Sexually Transmitted Infections Foundation Course—2 days (Core and STIF) to equip GPs and practice nurses and other healthcare professionals working outside the GUM setter with the basic knowledge, skills and attitudes for the effective management of STIs including HIV testing, STIs in pregnancy and hepatitis. Venue: Chelsea and Westminster Hospital Cost: Core and PLUS: £225/Core only £125/Plus only £125

7

30 November: DFSRH Course of 5 (also available Diploma, LoC IUD, LoC SDI)—Course of 5 involves 5 intensive hours of workshops and assessments which must be passed before candidates move on to clinical training for DFSRH Diploma. Venue: Chelsea and Westminster Hospital Cost: £450 November: HIV: What You Need To Know—2 day course for all healthcare professionals to develop and update all

aspects of HIV including early diagnosis and primary infection, late diagnosis and AIDS, mental health issues, HIV testing in practice, HIV in pregnancy, a patient panel and ethical issues. Venue: Chelsea and Westminster Hospital Date: November 2015 to be confirmed Costs: £295 for NHS For more details on any of the above courses please visit www.ssat.org.uk or contact linda.connor@chelwest.nhs.uk.

Chelsea and Westminster Hospital

Contents New Craniofacial Consultant Juling Ong

covering Niall Kirkpatrick’s six month sabbatical

Good GP feedback for the Acute Diagnostic Oncology Clinic

MRI uploads – Chronic Pain referral reminder

Dermatology advice still available to GPs via email

Booking Paediatric blood tests

Modernised colorectal focus group

Annual Radiology GP Survey

A&E redevelopment update

New Craniofacial Consultant Juling Ong covering Niall Kirkpatrick’s six-month sabbatical Niall Kirkpatrick has played a leading role as a Consultant in the Craniofacial unit at Chelsea Westminster hospital for 12 years. During this time, the department has gone from strength to strength and now performs more craniofacial procedures that any other unit in the country. Over this period, Niall has been at the forefront of providing acute care for patients at Chelsea and Westminster as well as providing expertise in collaboration with hospitals in London as well as further afield. Niall is one of the founding members of the Craniofacial charity, Facing The World, and

his work has helped numerous children with severe Craniofacial conditions to live a better life. Although Niall has operated on numerous patients in the UK and abroad for the charity he recognised that a greater benefit could be achieved through education and over the last 8 years, Niall has been working to help develop a Craniofacial service in Danang, Vietnam. This endeavour has been awarded a Certificate of Merit by the People’s Party and the charity has been invited to develop a second unit in Hanoi and a third in Ho Chi Minh City. From August 2015 Niall will be on sabbatical leave for 6 months to assist with the expansion of the new Craniofacial units in Vietnam. We wish him well and look forward to his return to Chelsea in March. During this time, he will be replaced by Juling Ong, one of our new Craniofacial Plastic Surgeons.

Juling Ong completed much of his Craniofacial training at Chelsea and Westminster first as a Specialist Registrar

8

and subsequently as the Craniofacial Fellow and well as gaining further Craniofacial training at Great Ormond Street Hospital for Sick Children. Following completion of the specialty examinations in Plastic surgery in 2012, Juling was awarded the prestigious Ellison-Cliffe Travelling Fellowship undertook a 12 month Craniofacial fellowship in the United States at Dell Childrens Medical centre and Brackenridge Medical Centre in Austin. Aesthetics is as important as functional considerations in Craniofacial reconstructive surgery and last year, Juling was awarded a national interface fellowship to train in reconstructive and cosmetic surgery at the Royal Marsden Hospital. Juling and Niall have cared for many patients over this period and Juling will be a familiar face to many patients coming to Chelsea and Westminster. Juling is on the specialist register in Plastic Surgery and a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons, the American Cleft Palate-Craniofacial association and the American Society of Craniofacial Surgeons. His interests include:

Craniofacial trauma

Secondary craniofacial reconstruction following trauma and cancer surgery

Computer aided design and modelling for craniofacial reconstruction

Orthognathic surgery

Head and neck cancer

Skin cancer

Facial palsy

Congenital craniofacial conditions

Surgery for neurofibromatosis

Vascular malformations

To discuss any referrals to Juling you can contact him via email on juling.ong@chelwest.nhs.uk

Good GP feedback for the Acute Diagnostic Oncology Clinic (ADOC) ADOC has been opened and receiving referrals from GPs since May 2015. The feedback from GPs has been excellent – all

said that they would use the service again and have commented on:

Rapid investigations and diagnosis

Prompt and thorough communication

Excellent service

ADOC is a clinic for patients with urgent suspected cancer who we aim to see within 24 hours of referral. The clinic is for patients that are too unwell to wait for a ‘two week referral’ and is an alternative to referring the patient to A&E. In the ADOC outpatients clinic we aim to provide access to most investigations within three to five dats (and in practice many investigations are conducted on the same day) and work towards a preliminary diagnosis within 1 week. To make a referral – call the GP advice line 0203 315 5000 and select Option 6 for ADOC If you would like a member of the ADOC team to come and talk to you and your colleagues please contact our Project Manager joanne.simmons@chelwest.nhs.uk

MRI uploads – Chronic Pain referral reminder When referring patients to the chronic pain team, if MRI results are available, please include details of where the MRI scan was done as often patients cannot remember and it can slow down the patients’ treatment process. Carly England – Appointments Officer

Dermatology advice still available to GPs via cds.kcpct@nhs.net The dermatology email advice service cds.kcpct@nhs.net run by Dermatology consultants is still open and active to West London and Central London GPs for clinical advice on dermatological conditions. Dr Chrystalla Macedo – Dermatology Consultant

9

Booking Paediatric blood tests Please advise parents looking to book a blood test for their child (under 16) to contact the team directly on 0203 315 2019 rather than the call centre. The central call centre cannot directly book paediatric blood test appointments and it causes confusion and upset when they are transferred as the number was given to them by their GP surgeries.

Modernised colorectal focus group Did any of your patients of their children have bowel surgery during childhood? The team at Chelsea and Westminster Hospital are hosting a fun filled focus group at the Tower of London. When: Saturday 17 October, 10am-2pm Where: The Tower of London, New Armouries, Meeting Suite, London EC3N 4AB The focus groups is designed to share experiences and provide feedback of the service and what could be improeved. It is free to attend and lunch is provided. Each attendee is welcome to bring a guest with them. To register interest, patients can email Georgina.malakounides@chelwest.nhs.uk or call Stef Seal on 01733 392363.

Annual Radiology GP Survey As part of our on-going service evaluation we undertake an annual survey with GPs who refer patients to our radiology department. We have carried out these surveys periodically and find the comments insightful and have made several changes to how we run the service as a result. Our 2015 radiology survey is still available here: www.surveymonkey.com/r/CWradiology2015 Please do take a few minutes to feedback your views. If you would like any further information please don’t hesitate to email me at harriet.reid@chelwest.nhs.uk

Harriet Reid – Lead Superintendent Radiographer

A&E redevelopment update The opening of new facilities in Phase 1 of the Emergency Department redevelopment has been put back due to some of the works not meeting the quality standards we expect for our patients and staff. The majors area and fracture clinic had been earmarked for opening next week. The ‘go live’ dates have now been put back till November 2015 as we work through these issues with our contractor. We will keep you up to date with the new dates for opening once these have been confirmed. The A&E service itself will continue to run as normal for patients as these delays relate to our new Phase 1 facilities.

West Middlesex University Hospital

Contents Experiencing issues with Discharge

Summaries?

New Paediatric Assessment Unit

Pleural Effusion Pathway update

Maternity Day Assessment Unit

Ambulatory Emergency Care award

Women, pregnancy and mental health

West Mid hosts fun filled open day

Spotlight on: Ambulatory Emergency Care

Experiencing issues with Discharge Summaries? At the GP welcome event at West Middlesex University Hospital this week, a number of GPs raised concerns about the quality and timeliness of discharge summaries. We are committed to looking into this and we are conscious that there has been no central contact point for GPs to raise these and other issues with at West Middlesex and whilst we look into plans to create a more streamlined trouble shooting service for GPs who refer patients to the West Middlesex site, in the interim, please flag any issues you may be experiencing via email: gpqueries.chelwest@nhs.net or via phone: 020 3315 6603 Justine Currie GP Relationship Manager

New Paediatric Assessment Unit We are delighted to announce that the way we deliver acute paediatric care is changing. For some time we have wanted to provide a far more efficient clinical pathway, offering quick access to senior paediatric specialists and allowing for direct referrals from GPs, midwives, health visitors and out of hours services. Following productive discussions between West Middlesex University Hospital, our onsite Urgent Care Centre (UCC) and Hounslow CCG we are launching a new

Paediatric Assessment Unit (PAU) to be introduced in stages to ensure it is high quality, extremely effective and offers the best patient experience possible. The first phase of our new Paediatric Assessment Unit (PAU) launched on Monday 14 September 2015 and the overall ambitions for the service are to provide:

a 24 hour hotline for advice or referral

paediatric assessment in a family-centred environment

24 hour access to senior paediatric medical and nursing staff, led by a consultant paediatrician

improved clinical pathways to avoid A&E waits and reduce acute admissions

You can now discuss a clinical case or make a direct referral by calling 07901 008 688 or 020 8560 2121 and ask for bleep 355. We are committed to continuing service improvement by working with local healthcare professionals and welcome feedback and ideas for phase two of the project. Please contact Chris Kelly on 020 8321 6210 if you wish to discuss any element of this exciting new service.

Pleural Effusion Pathway update The Pleural Effusion pathway was developed to improve the experience for patients presenting to hospital with pleural effusion. 20 patients have been referred to the pathway since it launched on 9 June 2015 and all received a respiratory outpatient follow up as part of the pathway.

Pleural Effusion Pathway document final version.docx

14 pleural drainage procedures have been performed in the Ambulatory Emergency Care (AEC) unit, enabling early hospital discharge in three cases and eleven avoided admissions.

11

Feedback has been excellent with an average overall satisfaction score of 9/10 and uptake of the pathway has been good. However, we want to increase uptake and are asking GP colleagues to consider using the procedure information and consent form (below) which has been developed to standardise consent for pleural procedures and improve documentation of procedures (in keeping with British Thoracic Society recommendations). Protein does not have to be present in an MSU in order for us to carry out a review.

Pleural procedure consent+documentation final.doc

Maternity Day Assessment Unit The West Middlesex University Hospital Maternity Day Assessment Unit is open from Monday to Friday, between 8:30am and 4.30pm. In addition to this, our Maternity Triage service is available 24 hours a day, 7 days a week. Friday, between 8:30am and 4.30pm. Our team are more than happy to see pregnant ladies who attend your surgeries with unexplained high blood pressure for a same-day review, and protein does not have to be present in an MSU in order for us to carry out a review. Contact our team on 030 8321 5953.

Ambulatory Emergency Care award In September the team behind the Ambulatory Emergency Care (AEC) unit at West Middlesex received an award for ‘most effective use of data to engage a whole organisation in understanding the impact and potential of AEC’. The award recognises the team’s effective use of data in order to influence the work of the whole hospital and enhance the AEC throughput. It is also a fantastic recognition of achievements made by the service in the short time it has been open.

As a result, the AEC team were invited to present at the AEC delivery network. Speaking on the topic of ‘From information overload to measuring what’s actually needed to support both acute and commissioners’ staff gave an overview of their AEC data since the service began.

Women, pregnancy and mental health With mental health higher on the health agenda than ever before, we have a real opportunity to help identify people at risk across the system – for example, woman planning or already experiencing a pregnancy. A few questions we can ask are:

Is she psychotic?

Is she on Priadel?

Is she on Paroxetine?

Does she have PTSD? These aren’t easy questions and can take some working out, but Hounslow Perinatal Mental Health Service are here to help. Email us: wlm-tr.pnmhwmuh@nhs.net or for more information on mental health and pregnancy you can contact the Perinatal Mental Health Community Education Provider Network (PNMH CEPN): PNMH-CEPN@chelwest.nhs.uk

West Mid hosts fun filled open day

West Middlesex University Hospital’s third annual open day took place on Saturday 12

12

September. Once again it proved hugely popular with the local community and was transforme4d into a sea of colour and activity as staff and volunteers came together to showcase the hospital’s broad range of services to eager visitors. With around 80 different stalls, free health checks and behind-the-scenes tours, the event was an opportunity for people to learn more about the site and chat to staff who deliver care to local people every day. From audiology through to X-ray, a huge range of services were represented, together with a many partner organisations with whom they work closely to provide a seamless experience for patients, including Hounslow and Richmond Community Healthcare NHS Trust and Hounslow CCG. There was also live music and entertainment throughout the day, including traditional African dancing and Zumba classes! Colleagues from Chelsea and Westminster Hospital were also on hand to provide information on the recent integration and explain the benefits that joining together will give patients at both hospitals.

Spotlight on: Ambulatory Emergency Care (AEC)

Under the ‘Shaping a Healthier Future’ (SaHF) programme for north west London, West Middlesex University Hospital was designated a major hospital, which in turn has led to investment and expansion in its acute services. The Ambulatory Emergency Care (AEC) unit opened in October 2014 and came about through close partnership working with Hounslow CCG and the local GP network.

The AEC ethos is that: “No patient should stay in hospital if they can be discharged safely” and the service uses a process-based model whereby AEC is an integral part of the emergency care system, with the direct acceptance of appropriate patients, determined by clinical conversations and by using AMB and NEWs scores. In its first six month of operation the service saw a total of 1,603 referrals; the monthly average is 267. The table below outlines the top AEC diagnoses by volume over the past three months, whilst the pie chart shows the overall analysis of discharge destinations.

1 Soft tissue disorders 158

2 Cellulitis 53

3 Headache 31

4 Pain in the limb 30

5 Anaemia and iron deficiency anaemia 18

6 Chest pain unspecified 15

7 Abnormal findings of blood chemistry 13

8 Phlebitis and thrombophlebitis 12

9 Ascites 11

10 Pleural effusion 10

The financial impact in the first six months of the AEC is estimated to be a net gain of £200,000 during the initial block contact. Whilst the yearly bed saving is projected as 5.3 beds per annum, saving £500,000+ against initial planned savings of £400,000. The service has since move to a full Payment by Results (PbR) system, based on diagnosis at presentation.

Examples of patient feedback “On attending the AEC it was very reassuring to be attended by C, receptionist, initially. She displayed excellent professionalism in

13

her work. Subsequently V, who then attended to us, displayed the same. I would like to congratulate them both; also the service from the nursing and medical staff was of the highest professionalism. Thank you.” “My mother has just returned from a full day in the care in the AEC unit at West Mid and we thought it was absolutely essential to pass on our deepest thanks and compliments in regard to the superb standard of care that she received. It is not every day someone attends hospital and can say at the end it was a hugely positive experience, however we can say that this was a great experience and a brilliant standard of healthcare.” “From the moment I walked in I was treated with respect and was seen very quickly by the doctor who then took me to the AEC where the staff were excellent and my case was handled by a doctor, a lovely lady, who kept me informed at every stage as to was being done. I must praise the management and all the medical staff for their hard work and putting people at ease when they are not well.” Examples of staff feedback “Patients enjoy being in AEC because they don’t have to hang around. I enjoy working on AEC more than the old MDU because the doctors and support staff are always available. We are a great team, and the doctors are very accessible. It makes you really want to come into work!” Khalida, staff nurse. “The AEC is a relaxing patient centred environment. It offers an excellent service to avoid hospital admission. There is great teamwork between doctors, nurses and the pharmacist. The work is interesting and varied.” Emily, junior doctor. “The AEC is brilliant for patients as they can be treated and discharged the same day!” Binu, staff nurse. “Thank you so much to everyone, such a fantastic team, I will really miss you all.” Sophie, exiting junior clinical fellow. AEC CQC visit

The CQC visited the AEC soon after its launch—feedback received (see below) was very encouraging. CQC view on responsiveness of medical services: The AEC is effective in reducing the number of inpatients and managing the increasing number of patients who require emergency admission following referral from sources including local GPs and A&E. CQC view on service planning and delivery to meet the needs of local people: The AEC had a range of consultant-led assessment clinics and a range of services including intravenous antibiotic treatments and blood transfusions. AEC patients were very positive about the care and treatment they received. One person told us: “It’s much better here than waiting in A&E—they have more time to look after me properly.” CQC view on innovation, improvement and sustainability: The new AEC has made an impact on both A&E performance and in reducing the number of admissions. More importantly, patients we spoke to were very positive about their care. What’s new in AEC? Nurse-led clinics: The AEC successfully incorporated the work and staff of the former Medical Day Unit from the outset. Referrals are made primarily from Rheuma-tology, Gastroenterology and Haematology. Patients who require regular infusions, injections and endocrine all-day blood tests can be directly referred to the team. A dedicated pharmacist is on hand to assist. AF and Venous Thromboembolic Disease: Most DVTs are diagnosed by the AEC with Tinzaparin administered in the unit or at home until an ultrasound proves conclusive. The AEC offers a bridging anticoagulation service for patients diagnosed with DVT, PE or AF. Anticoagulant counselling is carried out in the AEC by a pharmacist and INR monitoring is provided for patients taking warfarin until their care is taken on by the anticoagulation clinic. Patients are also offered a choice of commencing treatment on a dual oral anticoagulant (DOAC) after being counselled by AEC staff.