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Monthly Archives: January 2015

MYTHS TO DISPEL

Last year a pair of 4th year medical students from Kings College, London carried out a study in the practice looking at myths  that women have concerning  cervical smears. They distributed this to patients: it was revealing how many misconceptions women had. Read this and see what you may learn. 

 Smear

Did you know that the statements below are ALL TRUE  

1) The main cause of cervical cancer is the Human Papilloma Virus (HPV)

2) All women, regardless of their sexual preference (heterosexual, bisexual, lesbian) are at risk of developing cervical cancer.

3) Every women should have a regular smear test, including women who have never had a sexual experience (virgins).

4) The more sexual partners you have , the greater risk your risk of cervical cancer.

5) You should still have your smear test even if you are no longer sexually active, as the cancer can develop long after sexual activity.

6) HPV is transmitted through vaginal sex, but also oral sex, and skin-to-skin contact ( of the genital area) with an infected person.

7) You should still attend your smear tests despite having your HPV vaccine, as the vaccine protects against the commonest type of virus, but not all types.

8) Early stages of cervical cancer may present without symptoms, screening enables detection before symptoms.

9) An abnormal smear test does not mean cancer – it indicates early changes, which if left untreated, could become cancer.

10) You should not feel any pain on having a cervical smear.

11) There is always an option for a female member of staff performing your smear test.

12) Though cervical cancer is uncommon in young women, they may develop changes in the cervix  that may develop changes in the cervix that may become cancer if not detected early.

13) The risk of cancer does not decrease with age – even after menopause it is important to attend your smear tests.

14) Smoking increases your risk of cervical cancer.

15) Cervical cancer is one of the most preventable cancers. The best preventions is attending smear tests.

Smear

All women aged between 25 and 64 are invited for cervical screening every three to five years.

The procedure is used to detect abnormal cells which, if left untreated, could lead to cancer in the cervix.

Screening coverage – the percentage of eligible women recorded as having been properly tested at least once in the last five years – has been falling.

On March 31 2014, the figure stood at 77.8%, down from 78.3% a year earlier and 80.6% a decade ago.

Across the UK, more than one in five invited to be screened don’t attend – one million women a year

Among 25 to 29-year-olds that figure rises to one in three.

Currently 33.7 per cent of 25 to 29 year-olds in and 22.3 per cent of 30 to 34 year-olds in the UK aren’t being screened.

The simple test can be carried out by practice nurses in local GP surgeries.

Every year in the UK, 300,000 women are diagnosed with cervical abnormalities.

Nine women are diagnosed with cervical cancer and three lose their lives, every single day.
Cervical screening saves around 5,000 lives a year.

But the Jo’s Trust research found that 20 per cent of young women see smear tests as unnecessary.

Other reasons given for not attending were concerns about pain (26.2 per cent) and embarrassment (26.6 per cent)

HAVE YOU BOOKED YOUR TEST OR ENCOURAGED YOUR

PARTNER / FRIEND / MOTHER / SISTER / DAUGHTERS / FEMALE RELATIVES TO BOOK THEIR TEST?

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Posted by on January 27, 2015 in Training and Advice

 

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IS BLOATING A PROBLEM?

This week I had an email reminding me it is Ovarian Cancer Awareness Week in March and to prepare for fundraising events and this brought to mind the tale of a dear aunt.

It was Easter 1969 when my aunt who was diagnosed with carcinoma of the ovary. She was the head teacher of a challenging junior school in Dagenham and aware of the surplus energy many of her pupils had and as no-one had volunteered to teach imagefootball she had decided to take on the task. However, that did create some problems as she was a Roman Catholic nun Sister Mary Ursula, who wore a full length habit and a stiffly starched headdress as seen in the comedy Sister Act!

I had only seen her when we as a family visited London as she was not allowed to stay anywhere other than a convent. We always had great fun as children when we visited as she always managed to produce a special meal usually afternoon tea and we were allowed to explore the convent grounds play with the animals they kept as well as have a singsong or dance to popular songs around the piano. We also helped to serve soup to the unusual people who came to the back door. I was always puzzled by these visitors but despite being as inquisitive as usual I never got any satisfactory answers to why these people came.

She had been to see her team play in the schools cup final and was overjoyed that they had won. She had run up and down the pitch cheering them on like any other football coach but in full nuns habit!
Unfortunately, shortly after this she was admitted to hospital with pneumonia and incidentally found to have advanced Ovarian Carcinoma. She like many others showed very little in the way of symptoms.

Coincidentally, I had applied to do voluntary work in Dr. Barnado’s children’s home in Barkingside, Essex, helping with spins bifida children who had been taken into care and was accepted. They provided free accommodation and meals and this gave a country girl a chance to be able to explore London. What’s more I would be near Upton Park Hospital where she was having frequent admissions for treatment.

It wasn’t long before she made her mark there with frequent colourful visitors ranging from high ranking priests to ex-pupils. There was never a dull moment especially as she took it upon herself to visit the male wards (bearing in mind that in those days many patients were in hospital for weeks on end) equipped with mouth organ to orchestrate singalongs usually the old cockney pub songs or football songs especially as she was a keen West Ham supporter!

Needless to say it was appropriate that she was the first person I told when I received my A level results and full acceptance to Medical school. Sadly she died the day I left to go home to prepare to start my career in medicine. This was my first experience of being with someone so ill and eventually dying. She was only 41yrs of age and died within months of being diagnosed. She was so open about how she felt and what gave her the most comfort. Her insights, her humour and her fears along with her many words of wisdom formed a good base as I embarked on my medical training.

It is sad that even after 45yrs only 3% of women can very confidently pick out a symptom 

Carcinoma ovaryIf ovarian cancer but if diagnosed the prognosis has improved considerably. 

The disease is the fifth most common cause of cancer deaths in women and experts fear the lack of awareness may contribute to low survival rates in the UK compared with elsewhere.

Ovarian cancer

We as doctors are increasing our awareness and  vigilance  about investigating women when presenting with suspicious symptoms. We need you to come to us if you have suspicious symptoms.

    image          It  may simply be persistent bloating don’t assume it is Irritable Bowel Syndrome –  GET CHECKED

http://www.targetovariancancer.org.uk

 
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Posted by on January 25, 2015 in Training and Advice

 

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HEART – FELT TRIBUTE TO A SPECIAL PERSON

Rosemary Palmer In October 2014 I had the usual animated conversation with an energetic, enthusiastic 89yr old lady who as usual was in the throes of organising yet another event for dyslexia, so that it came as a great surprise when I heard she died a week later.

I knew Rosemary Palmer for many years and was well aware of her passion for helping and teaching children and Adults with Dyslexia and other Autistic Spectrum Disorders (ASD) such as dyspraxia. I first knew her when her son was very ill and when he died at the young age of 45yrs she as a mother felt sad that he had struggled through life not reaching his full potential as he was so disabled with severe dyslexia. Subsequently, she  became even more intent in helping those with this condition.

I remember > 10 yrs ago being invited to her house one evening  along with other interested parties,  as she was having ‘a grand opening’ of the studio she had created in her garden. This was to be where she taught many pupils aswell as being a resource centre.

Rosemary Palmer in her studio

Rosemary Palmer in her studio

Ealing dyslexia  She was an active member of.  Ealing Dyslexia Association             and

was the chairperson for many  years.

http://www.ealingdyslexia.org.uk

She raised funds and set up the Adult Dyslexia Group : it is the first of its type, running  evening classes, offering support and practical advice. She was an invaluable teacher at the Insight Scools and Skills Academy, Alexandria Road, West Ealing where she taught many adults and children aswell as train staff and will be sorely missed.

What is Dyslexia?
Dyslexia is a specific learning difficulty that results in significant and persistent problems with reading, spelling, writing and sometimes arithmetic. It uoccurs in spite of normal teaching and is independent of socio-cultural background or intelligence.

Here is the current definition from the British Dyslexia Association:

Dyslexia is a specific learning difficulty which mainly affects the development of literacy and language related skills. It is likely to be present at birth and to be lifelong in its effects. It is characterised by difficulties with phonological processing, rapid naming, working memory, processing speed, and the automatic development of skills that may not match up to an individual’s other cognitive abilities. It tends to be resistant to conventional teaching methods, but its effects can be mitigated by appropriately specific intervention, including the application of information technology and supportive counselling.

If you are concerned that you or someone you know has dyslexia or a similar disorder use the Ealing Dyslexia Association website and it will also provide other useful links. 

 
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Posted by on January 24, 2015 in Training and Advice

 

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WHAT IS OUR MISSION STATEMENT

As we prepared for our CQC visit we felt it was important to stop and think about what our purpose is, what we are providing for all our patients and what we would like in return in order to run a safe, effective, caring, responsive and well led surgery.

Mission statement

Each of our patients matters to us!

Our promise to our patient is to:

v Treat you with respect and courtesy at all times

v Provide you with advice and treatment in a timely manner

v Help you make decisions about your health.

v Treat you as an equal and with dignity at all times

v Discuss your treatment with experts and refer you when necessary

v Guide you through the health and social services

v Ensure we maintain confidentiality with what we discuss and keeping your records secure and safe.

v Keep up to date with development in health care by continuing to learn and ensure our staff are trained to optimum levels to provide you with high levels of care and support

v Treat you with compassion and to enhance your care while you are with us

In return we ask you the patient to:

v Keep your appointments and let us know if you cannot attend an appointment

v Use the out of hour’s service only for an urgent medical condition which cannot wait until the next working day

v Be courteous to our staff who do the best they can for you. “Please” and “Thank you” would be the perfect way to support them

v Talk to us about complaints, suggestions, compliments to ensure we can develop as a surgery.

Patients

We will use this mission statement to reflect upon on a regular basis to maintain a high standard of care. 

 
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Posted by on January 22, 2015 in Training and Advice

 

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WE HAVE SURVIVED A CQC INSPECTION!

On January 10th 2013 The surgery at 102 The Avenue as a service provider were registered by the Care Quality Commission under the Health and Social Care Act 2008.

  • CQC

We were aware that one day we would be having an inspection and since that time we have been working together to improve the environment, train our staff, formulate policies such as how to act in the event of a fire, bomb alert, infection control, staff employment, needle stick injury etc

Initially, when inspections were performed they seemed intrusive and a negative experience and were heavily criticised. We faced the thought of an inspection with fear and intrepidation so that during this time we have been working hard to meet the requirements.

Subsequently, they have set out a new vision and direction for the Care Quality Commission in their Strategy for 2013- 2016, raising standards and putting people first and in their recent consultation ‘A new start’, which proposes radical changes to the way they regulate health and social care services. The changes were developed with extensive engagement with the public, CQC staff, providers and key organisations. They has  been strong support for the introduction of Chief Inspectors; expert inspection teams; ratings to help people choose care; a focus on highlighting good practice; and a commitment to listen better to the views and experiences of people who use services. They also claim there is strong support for the new framework, principles and operating model that they will use, which include the five key questions they will ask of services:

Are they safe?

 Are they effective?

Are they caring?

Are they responsive?

Are they well-led?

Two weeks ago we were informed that the day had arrived for our inspection. On Tuesday January 20th  3 inspectors arrived, a GP, a retired Nurse Practitioner and an Administrator greeted by both doctors : firstly , I was asked to give a summary of what I felt we did best and they listened intently, making notes. Following this they sat together to formulate a plan of action and then soon after infiltrated the surgery individually talking to all members of staff and patients who attended by request but also to patients waiting to be seen by clinicians. The atmosphere in the surgery remained calm and they remained unobtrusive. The staff were interviewed but still continued to deal with patients in their usual caring, efficient manner. We, as doctors were fired with numerous questions from their prompt sheets as were Mary, our practice nurse and Sangeeta, the practice manager.

At the end of the day Dr Livingston and myself were summoned to their presence and we are very pleased to say that the overall assessment was extremely favourable except for a few minor comments, such as the fact that patients did not know how to complain ( despite the fact that is written on out practice leaflet and on our website) hence we need a poster!

Also, had we thought of installing a defibrillator ?

We want to express our heart- felt thanks to all our loyal staff, who always work hard and deliver an excellent service to our patients and this was noticed by the inspectors. Also, a thank you to those patients who showed their support by talking to the inspectors on the day or writing positive comments on the CQC cards.

Thank you

The final completed report will be available in about two months time and will be posted on the following website

http://www.cqc.org.uk/content/doctorsgps

 
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Posted by on January 21, 2015 in Training and Advice

 

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GO THROUGH THE STAGES OF LOSS WITH THIS GIRAFFE

Candace also passed on this video as she found it helpful in describing the feelings she has gone through. It illustrates what anyone goes through when experiencing loss, albeit a serious illness, a bereavement or even the break up of a partnership. I am sure many people will identify with this giraffe and perhaps be able to raise a smile at the end!

 

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WE ARE MORE THAN OUR DISEASE

Several months ago I wrote a blog promoting a book written by one of our patients ‘Prescription for Disaster’ by Candace Lafleur It is a very personal report of what a disease can do to someone, but the way Candace deals with it, is amazing. She shows us that even in the worst conditions like hers, life is worth living and how you can keep on laughing. Reading it makes one laugh from the belly and cry from the heart as it has that underlining sadness that we as doctors are aware of when treating patients with chronic illnesses but her attitude inspires us as doctors to be hopeful and inspired.

She also made this video to emphasise the importance of attitude when dealing with a chronic illness and admits to all the normal emotions besides laughter. She would like to think by showing others how she has hung on to her personal hopes and aspirations and achieved success in her life with the disease she has not allowed it to dominate and prevent achievement.

 

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DO YOU WORRY ABOUT CANCER?

NHS England has ordered an independent taskforce to develop a five-year action plan with the aim of improving cancer survival rates and services.
The taskforce includes cancer specialist doctors, clinicians, patient groups and charity leaders, who will collectively look at ways to improve cancer prevention, first contact with services, diagnosis, treatment and support for those living with and beyond cancer and end of life care.

Early diagnosis of cancer:

The problem UK has relatively poor track record when compared with other European countries. It is estimated there are probably an additional 5-10,000 deaths each year most of which can be attributed to diagnostic delay.

Later diagnosis due to mixture of

  • late presentation by patient (alack awareness)

  •  Late recognition by GP

  • Delays in secondary care

In the last 18 moths new research from the National CANCER Intelligence Network has published the startling findings that in England 25% of cancers are diagnosed as emergencies. The figure rises with age implying that older people with symptoms are less likely to be investigated or referred early. More easily diagnosed cancers such as breast, uterine or melanoma are less likely to present in A&E but more difficult ones such as brain or pancreas are more likely to present in A&E .

58% brain tumours

39% of lung cases

25% colorectal cases

present as emergencies. Older women, women and people from ethnic minorities were more likely to present late.

If if a patient presents to their GP with symptoms we have the facility to refer under a 2 week rule which the patient is informed of at the consultation and an immediate referral is made to secondary care and they are contracted to see the patient within 2 weeks. However, it has been found that under half of current cancers are diagnosed with the 2 week urgent referral system.

For many years we as GP’s have used a risk stratification tool to establish a patient’s risk of a cardiovascular event( heart attack or stroke) and high risk patients are seen and treated and given relevant health education and this has resulted in a significant fall in cardiovascular events. One tool which is started to be used for cancer is QCancer  based on the QResearch database and pioneered at Nottingham university

It is a single tool to look at multiple cancers.

It has asymptomatic based approach but also takes into account risk factors such as age, smoking, alcohol, family history and weight.

90% of patients with cancer present with symptoms

Symptoms that  can be significant 

Key symptoms in model (identified from studies including NICE guidelines 2005)

 coughing up blood  vomiting blood  blood in the urine(painless)

Rectal bleeding  Unexplained bruising  Constipation, cough for >l 3 weeks

Vaginal bleeding (women) after intercourse or after menopause

  Testicular lump (men)  Loss of appetite  Unintentional weight loss

 Indigestion +/- heart burn  Difficulty swallowing

 Abdominal pain or swelling  Breast lump, pain, skin  Night sweats

Neck lump  Urinary symptoms (men)

We have started to use this in the practice and some of you may be aware of being handed a questionnaire in reception if not please ask for one. We will then create a score in the format of Cates Plot and relative risk which is entered in the records.

An example of a result showing an individual’s risk of having a cancer and a further breakdown of the results demonstrates which is the most likely cancer at risk – in this example it is a colorectal cancer. 

image
image

If the score suggests  you have a risk of cancer  you will be asked to make an appointment to discuss this to arrange appropriate referral and investigations.

 It will also be updated if new symptoms occur. 

Hopefully during the next 12 months this will be fully integrated into our computer system rather than relying on paper questionnaires so that alerts can be triggered during regular consultations.

The following 12 types of cancer will be considered :-

Cancer

 

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EBOLA

When anyone hears this name they immediately associate it with death and tradegy. It is not surprising that on several occasions I have seen a child in surgery with a fever and they have been unusually fearful because they are frightened they have contracted Ebola.
We can reassure, act appropriately and educate our children in so many ways:-

* Remind our children that we live in a country that has clean running water and an excellent sewage system which saves countless lives especially from infections. Did we not see the adverts on the TV at Christmas asking us to contribute to a provision of a pump in a bush village which had no running water?

* Educate our children to wash their hands before meals and after using the toilet and put our hands to our mouths or turn away when we have cough?

* Make sure you are up to date with immunisation and seek advice when travelling for recommended immunisations and health care with the practise nurse or local travel clinic

Travel clinichttp://www.globetrotterstravelclinics.com

* Encourage healthy living especially with regards diet and exercise.

* Appreciate and treasure our health service and not take it for granted that we have a service which is accessible, free and can offer a comprehensive range of treatments comparable to any country in the World.

Expectations are high – I can be sure that at least 50% of patients attending on Monday morning will have minor ailments which could be treated with Over The Counter remedies or just reassurance. If I sit in out of hours clinics the story is much the same!
Nevertheless, when I have had to admit or refer a patient with a serious illness for the most part I am pleased with the prompt response and standard of care. Moreover, if the outcomes are not satisfactory as a GP I have a voice to be able communicate dissatisfaction and facilitate change and as a patient there is also the same opportunity through PALS our Patient Liaison Service (details obtained at the surgery or on the website NHS choices)

More about Ebola
Nearly 40 years after Peter Piot was first dispatched to investigate a mysterious new virus.

Ebola
He was 27 and still in training, he had one of the greatest opportunities an aspiring microbiologist could dream of: the chance to discover a new virus, investigate its mode of transmission and stop the outbreak. It all started when his laboratory at the Institute of Tropical Medicine in Antwerp received a thermos from what was then called Zaire. It contained the blood of a Flemish nun who had died of what was thought to be yellow fever.

From that sample, however, his lab isolated a new virus, confirmed by the Centers for Disease Control in Atlanta and subsequently called Ebola, after a river about 100km north of Yambuku, the centre of the epidemic. It turned out to be one of the most deadly viruses known.

In early September 1976, Mabalo Lokela, the headmaster of the local school, had died with a high fever, intractable diarrhoea and bleeding. His death sent a shockwave through the small mission community. Soon the hospital was full of patients with a similar illness and nearly all died within a week.
There have been several outbreaks since that time but the present outbreak is the worst.

How is it transmitted?

It is believed that the virus originates in fruit bats. It circulates in populations of wild animals including gorillas, fruit bats, monkeys, antelopes and even porcupines.
It is transmitted through contact with bodily fluids. Eating fruit collected from the forest floor, that an infected fruit bat had bitten, could spread it. So could contact with the blood of an infected animal that had been butchered for bush meat.

Ebola

Monkeys, apes and antelopes are commonly eaten in the areas where the outbreak began. If someone were handling the raw meat and had an open cut on their hand, that could transmit the virus.

Once the virus is in human circulation, it becomes far harder to contain. Health care workers have been at particular risk because they have come into direct, close contact with victims.

Traditional burial ceremonies among many of the communities affected involve direct contact with the body of the dead, and this is believed to have been a major factor in the early spread of the virus, before public safety messages began to get through to people.

The virus can also be transmitted through sex. The WHO says that even men who have recovered from the virus can still transmit it through their semen for up to seven weeks after recovery.

Signs and Symtoms of Ebola

Fever
Severe headache
Muscle pain
Weakness
Fatigue
Diarrhea
Vomiting
Abdominal (stomach) pain
Unexplained hemorrhage (bleeding or bruising)
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years.

The latest advise from NHS England is illustrated below:-

Ebola

 

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ARE WE IMPROVING WHOLE PATIENT CARE?

Visiting doctorAs a GP for many years if I visited an elderly person on a Friday or after 3.30pm in the afternoon and although their illnesses could be treated in the home if they were living alone I would often have to admit them into hospital.
Social services would often need 48hrs notice or more to implement social care in the way of carers or meals on wheels etc. We relied on the goodwill of neighbours or relatives dropping everything to travel long distances to the rescue.

Earlier in my career and sometimes latterly there have been occasions when I have made a meal, waited for relatives to come, the neighbours to return from work, rung the Cat Protection League to get the cat sorted out, hung out the washing, visited several times a day and night all simply to keep a person out of hospital. This is what many older GP’s did and in some areas of the country probably still do.

Alas, the situation has changed considerably, in that more older people are isolated with neighbours working longer hours and keeping to themselves and close relatives often scattered around the world as well as people living longer and with more complex medical needs.

Doctors have an increased work load and the consultations needing to encompass health prevention and screening and there an increased need for documentation by computer to record every aspect of the consultation. Also, with the introduction of more medications  and patients surviving severe medical illnesses longer GP’s are now responsible for their management. When the final year students are attached to the practise for 2 months each time they express their surprise of how many complex cases are managed in Primary Care.  Lloyd George fileGone are the days of a scribbling remark in a handwritten file in a packet – the Lloyd George file and the rest of the information being retained in the doctors head and if a patient’s condition became in anyway complex they were whisked away to experience a prolonged hospital admission.

It is a long time since I wrote the following abbreviations in patients notes!

  •       GOK ( God Only Knows)
  •        TEETH – Tried Everything Else; Try Homeopathy
  •        PIN (pain in the neck)
  •        SALT – Same As Last Time.
  •         FLD – Funny Looking Dad.
  •         ATSWWT – Always Thinks Something’s Wrong With Them.
  •         VIPIA – Very Important Pain In the A**.
  •         FFFF – Female, Fat, Forty and Flatulent.

These changes have resulted in more ‘social’ admissions which are often prolonged and can lead to a decrease in a persons independence when they are ready for discharge as the ward they are admitted to does not have the multidisciplinary team to avoid this.
Incredibly health and social care have worked totally independently. I remember when I was a junior doctor (SHO – Senior House Officer – the old nomenclature ) the consultant at the time commented that if I wrote letters for the patient they were rehoused very quickly and what was my trick. “Sir, (as we addressed our seniors in those days) could it be that she signs herself as the Senior House Officer, piped up the Registrar!”

At last this is being addressed and following the formation of the Ealing Clinical Commissioning Group (ECCG) in April 2011 plans implement patient-centred plans to provide the right care at the right time and at the right place for the residents of Ealing.

The ECCG launched these plans on 16.05.2012 in a document:-

Better Care, Closer to Home (2012 – 2015)

http://www.ealingccg.nhs.uk/media/633/NHS%20Ealing%20CCG%20-%20Out%20of%20Hospital%20Strategy.pdf

A three-year strategy for coordinated, high quality care out of hospital
Our objective is to provide the right care at the right time and at the right place for the residents of Ealing. This was carefully thought out by a comprehensive team of people from all social and health disciplines lead by Dr Mohini Palmer an experienced GP
In their document they quoted:-
“Our vision is to ensure that our health care system keeps patients well and at home and, when patients do become unwell, provides cost- effective, evidence based and timely care at the right place appropriate to their needs.
As demand rises with increasing health needs and the development of new treatments, we need to respond to the challenges while delivering the highest quality of care. We need to build and preserve what we do well and continue to look for new developments to deliver the best standards of care.

There are times when we use hospitals to provide care for patients when that care could be provided closer to their home and in the community. Developing the right care outside hospital is a key part of how we will continue to maintain the provision of quality and cost effective care for the residents of Ealing.

This is our three-year strategy to design and deliver out of hospital care.

To achieve this, our out-of-hospital initiatives will be:​

  • Inclusive: We want our services to be inclusive and for this to happen we will involve patient and public groups in our proposals. As we develop our initiatives it should be clear to all users how we are developing our plans.
  • Integrated: We will work with all our stakeholders who provide out of hospital care e.g. primary care, community services, social care, nursing homes, voluntary groups to provide joined up care.
  • Sustainable: Our approach will be sustainable and we will invest when we need to deliver the care.

Our strategy aims to improve quality and efficiency across the system, the experience of all patients, and make the best use of our resources.
We recognise this is a different and substantial shift from how we deliver health today. In the coming months we will be meeting with patient and public groups to explain our plans and to fully involve you as we develop our initiatives.
We need to continue to respond to the challenges we face and to evolve to deliver the best sustainable health care for the residents of Ealing.”
As demand rises with increasing health needs and the development of new treatments, we need to respond to the challenges while delivering the highest quality of care. We need to build and preserve what we do well and continue to look for new developments to deliver the best standards of care.

There are times when we use hospitals to provide care for patients when that care could be provided closer to their home and in the community. Developing the right care outside hospital is a key part of how we will continue to maintain the provision of quality and cost effective care for the residents of Ealing.

We need to change the way we deliver care. At present access to care and the quality of care are variable across the borough. Improving the access, quality and scope of out of hospital services will require new ways of coordinating services, investment and greater accountability. Exhibit 1 sets out reasons for transforming out of hospital care.”

Further details are found in NHS North West London’s Shaping a Healthier Future programme in the following document:-

 

http://www.healthiernorthwestlondon.nhs.uk/sites/default/files/documents/Factsheet_for_Ealing_residents_0.pdf
How have we delivered better care, closer to home?

The examples of the initiatives:-

*Urgent Care Centre: this is already providing 24 hour urgent care to patients at Ealing hospital
*111 and single point of access
*Improving access to GPs – at our surgery we have cooperated by
– providing extra slots for emergency appointments
– providing a later surgery ( Wednesday evening until 8pm)
– introduced by Ealing CCG. If you feel unwell on Saturdays and Sundays, you can call NHS 111 for medical help and advice. If the trained adviser thinks you need to see a GP, they will direct you to the practice in your area that is open. We are part of the rota of GP’s

*Integrated Rapid Response Service: started in July 2012 and provides a response to patients to provide care in their home and to support them on discharge from hospital.

*A new service started in October 2012 called ICE (or Integrated Care Ealing) which cares for patients at home if they are not sick enough to be admitted to hospital but are too unwell to stay at home without extra care. The service provides nurses, physiotherapists, and health care assistants, under the clinical leadership of Ealing Hospital Consultants. In 2013/4 there has been an increase in the number of staff and types of clinical conditions that the service manages.
Dr Livingston and I have used this service on many occasions and proved it to be extremely useful and helped in avoiding unnecessary hospital admissions.

*We also have a GP wards – Rosemary and Magnolia Wards at Ealing hospital totally geared to manage the acute condition eg urinary tract infection, which although treatable in the home can present with confusion, which settles after 24-48hrs and admitting a patient for 1-2 days and then discharging with a care package saves a prolonged admission. We also have the ICE team who are a multidisciplinary team with nurses, physiotherapists again linked to social services.

*We have Community Matrons allocated to each network  and they coordinate the multidisciplinary team to attend patients with complex medical problems.
* All  patients older than 75years of age now have an allocated named GP who oversees their holistic management.
* In our practise we have seen many of elderly and formulated care plans which not only look at their physical and mental health needs but their social  aswell. These patients are reviewed at monthly intervals to note any significant changes in their status. It is also a chance to look at future planning particularly ‘end of life care’ so that whilst a patient is reasonably well they can have a say in their advanced care planning. Many people have welcomed this whilst others want to discuss it with their families or simply want to take life as it comes but at least they have a choice.

* Children’s nursing service: Ealing CCG have developed a children’s nursing service to provide care for children closer to and in a more convenient location for them and their families.

* Palliative care service: ECCG are working with the Marie Curie service to provide a rapid response team to assist and support those people who wish to die at home. We are able to get urgent access to McMillan nurses until 8pm so that a visits can bee arranged.

* Psychiatric liaison: ECCG have funded a psychiatric liaison service at Ealing hospital to provide a rapid response to patients who need this care. Dr livingston and myself have been working very closely with the appointed Community Psychiatric liaison Psychiatrists to achieve greatly improved outcomes especially with our complicated psychiatric patients – improving their care aswell improving our own learning needs in this challenging aspect of medicine.
We as GP’s have much improved access to psychiatric services aswell as a range of psychological services using:-
The Ealing IAPT (improving access to psychological therapies) service offers support for common mental health problems such as depression, anxiety and panic. Referrals can made by:-
– making a request to a GP or another health professional
– self referral by calling us directly on 020 3313 5660

How we are working together

The ECCG have identified better coordination of services as a priority in order to improve care. For example:
Ealing GPs now work in six Health Networks ensuring care is clinically led and consistent across GP practices
Within our six geographical multi-disciplinary groups, the Integrated Care pilot to provides integrated care across health and social care
We now work closely with partners in community and social services to support patients to use health and social care services effectively
A service providing coordinated and joined up care to Ealing residents who are in nursing homes evolved last year so that a group of GP’s take responsibility for their care and are accountable to the CCG.

We as practise and part of a network ( a group of nearby practises which are part of the commissioning group which includes Ealing, Acton ,Southall and Northolt have been actively taking part in many initiatives to improve patient care. Healthcare and social care professionals are working together much more closely.

We are actively seeking out patients that have complex medical/social problems and discussing how we can improve their care. We can now contact social services much more easily and over longer hours to effect urgent social care.

We are improving our liaison with hospital consultants including mental health and this has brought about an ongoing and active improvement in management of care as well sharing and educating each other about the management of common medical problems eg heart failure, anticoagulation, chronic obstructive pulmonary disease in the community.

We have a community diabetic team who liaise with GP’s to provide improved care for our large number of diabetics aswell as providing management they provide patient education.

We have increased our communication with social services gathering around a table to discuss these types of patients and share the problems and understand each other’s way of dealing with health problems with social issues.
Now we can access social services at weekends and late in the afternoon and it works! It is sad that it has taken an economic crisis and a need to save money to promote these changes. There have been many years of struggling, stamping feet and despairing to get social support to avoid hospitalisation of a patient who often took up an acute medical or surgical bed for weeks.

How has change been supported

* employing and having advice from experts
* peer to peer reviews – GP’s getting together in their networks for planning and using the expertise in a network to formulate initiatives.
* change of IT systems to to improve working together and monitoring progress of performance
* liaising with the public to establish needs of the geographical area by public meetings
* improving health education by liaising with Ealing council
* the right contracts and incentives to improve care, to underpin the new ways of working have been put in place.

These are many of the challenging initiatives that have been commenced in the last three years. Aswell as the superb work of our CCG governing body there has been a lot of work from many hard working GP’s and practice managers who attend meetings after their surgery’s in an attempt to improve our services.

As I wrote this I felt quite uplifted by what has been achieved and feel that in Ealing every effort is being made to shape a healthier future.

If you want to find out more about Ealing CCG and how it is evolving and to see what is in store for the future log in to website:-
http://www.ealingccg.nhs.uk

 

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