Newsletter – September 2011

 Advice Letter Listing or ALL goes live on 3 October for IHT

ALL is a new way to make every outpatient referral to Ipswich Hospital – and West Suffolk Hospital in a few months.  It uses a simple pre referral checklist/referral form, developed by consultants and primary care, to ensure patients are fully worked-up prior to referral. Guidance covers an initial 7 specialties with more later.

Referral are sent by secretaries, via C&B, to IHT.  A consultant will review the referral within 72 hours and responds either with a management plan back to the GP or the patient is booked straight into a clinic by the hospital.

For specialties not yet covered by the pre-referral guidance referral letters are sent via C&B and IHT will book the patient in.

As part of the roll-out John Havard, who developed it, is available to practices to answer any questions on how it works and the benefits for GP and patients.

If you have any comments or feedback please send them to David Pannell and John Havard.

Karen Blades has joined the East Fed executive

Karen is a GP at Leiston and will lead on improving our use of diagnostics and pathology. She is starting with some pathology quick wins and will move onto the use of pathology in chronic disease management and the requirements of QoF.

End of life project and training event 5 October

This project seeks to reduce the number of care/nursing home patients who are admitted to hospital at the end of their life.  The LES involves practices being paid to complete an end of life plan and notifying the ambulance service, OOH etc for each resident coming to the end of their lives.  The fee is £50 per patient and details are with your PM.

We have organised a training event, open to all GPs, on 5 October 2011 from 7pm to 9pm at Trinity Park.  Where Dr Kelvin Bengston, Palliative Care Consultant from St Elizabeth’s Hospice, Dr Paul Driscoll from Haven Health and members of the Advance Care Planning team will lead a discussion on how to start these difficult conversations.   To book places please contact lorrain.parr@nhs.net.

For those already using the DNACPR forms, the Ambulance Service report they are easier to spot when printed out on the red header/border. However, this isn’t imperative so black and white forms or photocopies will suffice.

Helping practices to achieve the QoF prescribing, outpatients and admissions

East Fed is helping practices to achieve the 97 QoF points available for these areas. This has included organising workshops, templates and detailed instructions for GPs and PMs. This is a good example of the Federation helping practices to maintain their income in difficult times.

Invoice validation by practices has helped to save nearly £1m at IHT

The PCT and practices are jointly checking a sample of charges made each month by the acutes. So far this has saved £918,000 or 2% of total invoiced amounts. The work has also confirmed that 95% of A&E and inpatient discharge summaries are being sent within one working day – which is a significant improvement from last year.

Post ‘pause’

We now have detailed instructions for how Clinical Commissioning Groups (CCGs which replace GP consortia) will work. The target date is April 2013.  Priorities include:

• Deciding the future configuration e.g. a single group, East & West or the three existing groups.
• Preparing for authorisation e.g. Board development, strategy development and engagement with patients, providers and practices.

We are also talking with the LMC ton ensure a smooth transition. Its long experience of service change and national links will be useful.

Reducing pressure on practices

We are aware of the pressure on practices caused by the number of initiatives being launched. We now have a plan for the rest of the year which takes into account these pressures and have postponed a couple of projects. Our main priority is to ensure that new initiatives are fully thought through and the systems work from day one – thus reducing the impact on practices.

24 hour ECG

We are aware that the turnaround time at IHT is longer than the agree two weeks. We are arranging a private company to help clear the backlog. From January, IHT will have a new cardiologist which should allow them to deliver the ten day target.

Our financial position is excellent

Thanks to the work by practices we are in a really good budgetary position.

• Prescribing – At July we are 5% under-budget with a saving of £0.6m to date.  Ipscom are 3% over and the West 5% over.  The star performers are Framlingham which has gone from 12% over-budget to just under and Martlesham which is now under budget.  All but one of our practices has a lower over-spend than last year.

• Referrals – GP referrals are as expected (Ipscom and the West’s are both above budget). According to practice data referrals are down year on year in all specialties apart from colorectal, cardiology and respiratory. Consultant to consultant referrals remain the problem with strong growth. 

• Electives – These are still well above budget but reflect the endoscopy backlog.

• Unplanned admissions GP admissions continue to fall (-5%) and non-GP continue to rise (+9%). 

Changes to the Total Care Team and MDT meetings

We have rejigged these in response to your feedback. For example, any patients discussed at the monthly MDT meetings do not need a separate referral form, unless the professionals present from the TCT need additional social information.  Some things are more challenging such as the lack of a community matron in the Woodbridge area while Emma is on maternity.

Can we remind practices that to meet the LES terms a GP, practice nurse and administrator are required to attend the MDT meetings and a minimum of 10 are required by the 31 March.

OA Hip pathway

The pathway is for patients with established or advanced osteoarthritis of the hip (or other conditions leading to the need for a total hip replacement procedure). The aims are to improve pre-operative information and preparation to help patients manage their condition and to improve post-operative recovery.

The new service has two elements:

• A scoring system that ensures that patients are listed for surgery in order of clinical need.
• A physio-led programme to support patients to manage their condition and prepare for surgery.

Ten practices are now using the service and it will be rolled-out to everyone else over the next couple of months.

EAU triage

The EAU consultant scheme has been running for nearly four months.  30% of all calls have resulted in an alternative outcome to admission, rising to 45% in August.  The figure falls to 20% when you analyse subsequent admissions for up to seven days after the initial call. 

There is a fairly equal split in referrals from A&E and GPs, and the weekly outcomes have been broadly similar since the scheme started

• 1/3 being seen by Admission Prevention Service in the community
• 1/3 ward attender or urgent OPA
• 1/3 advice only

East Fed and the PCT are going to undertake a formal review of the service and if you have any experiences, particularly if a patient has been adversely affected, can you send the details to David Pannell as soon as possible.

John Havard, Billy McKee, John Flather and Paul Kaiser