Planned care news
Welcome to this weeks Planned Care information page. Every two weeks we will be bringing you up to date information on a range of subjects, this newsletter includes a focus on the Adult Hearing (Audiology) Service, the e-RS service Trust update on the best services to refer to using e-RS, e-RS guidance and support, Lambeth Cancer Support Team, update on Faecal Calprotectin, new treatments for hepatitis C survey and the new geriatric & acute helpline. The link to this page can be found every week in the GP Bulletin. To read pervious bulletins, please click here.
We always welcome feedback – please let us know LAMCCG.firstname.lastname@example.org if you have any ideas or suggestions for the newsletter or on the content.
Spotlight on: Adult Hearing (Audiology) Service
What is it?
The Adult Hearing (Audiology) Service is for adults aged 50 years or over experiencing hearing and communication difficulties, and who may benefit from a hearing assessment and rehabilitation, including the option of trying hearing aids with aftercare support.
There has been an Adult Hearing (Audiology) Service in Lambeth for a number of years, however, Lambeth CCG and Southwark CCG have jointly recommissioned the service and there are now six providers (Specsavers, Inhealth, The Outside Clinic, Lewisham and Greenwich NHS Trust, Hearbase Limited and Scrivens) with multiple locations across Lambeth and Southwark. Home visits can be arranged for housebound and care home service users with The Outside Clinic provider. The existing service continues until the end of June and new service begins on 1 July 2017.
Who can be seen by the service?
The service is for adults aged 50 years or over experiencing hearing and communication difficulties and who may benefit from a hearing assessment and rehabilitation, including the option of trying hearing aids with aftercare support.
There are a number of exclusion criteria for the service:
- Complete or partial obstruction of the external auditory canal preventing full examination of the eardrum
- Abnormal appearance of the outer ear and/or eardrum
- Persistent pain affecting either ear (pain in or around the ear lasting more than 7 days in the last 90 days)
- History of discharge (other than wax) from the ear within the last 90 days
- Sudden (within 72 hours) or rapid (90 days or less) loss or deterioration of hearing
- Fluctuating hearing loss (other than associated with colds)
- Unilateral or asymmetrical, or pulsatile or distressing tinnitus lasting more than 5 minutes at a time e.g. causes sleep disturbance or anxiety and depression
- Abnormal auditory perceptions (dysacuses)
- Vertigo which has not fully recovered or which is recurrent
- Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds
- Altered sensation or numbness in the face or observed facial droop
- Unilateral or asymmetrical sensorineural hearing loss
- Patients who meet any of these exclusion criteria should be referred to ENT acute services, if applicable.
- Please note that ear wax removal is not part of the service and MUST be removed prior to attendance.
If your patient is under 50 years old and could benefit from a hearing assessment and rehabilitation, please refer them to the ENT acute services.
How to refer:
The new referral form will shortly be available on DXS (search: Adult Hearing (Audiology) Service) when the contract starts on the 1st July 17
In the first three months (i.e. until the end of September 2017) GPs can refer to the service either via e-RS or email. From October 2017 all referrals to the Adult Hearing (Audiology) Service should be made via e-RS. Details of providers, where to send referral forms (both via email and on e-RS), locations and opening hours are included on the second page of the referral form.
For housebound patients, GPs should refer patients on e-RS by searching The Outside Clinic or Outside Clinic (Service ID 7278812) or by e-mail directly to: email@example.com
GP support is available on 0800 95 49 101.
Where can patients be seen?
Below is a list of participating providers. Lambeth patients can be seen by providers in Southwark as well. Home visits can be arranged for housebound patients.
Hearbase and Scrivens both provide the Adult Hearing (Audiology) Service from local Health Centres and/or General Practice. Both providers are looking to set-up this service in Lambeth GP practices in the borough. If your GP practice is interested in hosting either providers, please contact firstname.lastname@example.org or the Providers direct
Electronic referral system (ERS) - (formerly Choose and Book)
National Commissioning for Quality and Innovation (CQUIN) targets have been set to help achieve e-RS utilization. Providers (the Trusts) are expected to publish all of their services on e-RS in line with the following schedule:
- Q1 2017/18: submit baseline plans to ensure all services are available for referral via e-RS.
- Q2 2017/18: 80% of referrals to 1st outpatient services can be received through e-RS.
- Q3 2017/18: 90% of referrals to 1st outpatient services can be received through e-RS.
- Q4 2017/18: 100% of referrals to 1st outpatient services can be received through e-RS.
National guidance states that providers (the Trusts) will not be paid for any GP initiated appointments made outside of e-RS from October 2018. This means that all GP referrals must be sent via e-RS by this time.
Acute Trust Progress / Services to book
Both Guy's and St Thomas' NHS Foundation Trust (GSTT) and King's College Hospital NHS Trust (KCH) are working to the national CQUIN targets outlined above. Baseline plans clearly outlining which services are currently available on e-RS and plans demonstrating when all services will be published over the course of 2017/18 will be produced for the end of Q1.
Both trusts already have a number of services available to book on e-RS and practices are encouraged to utilise them whenever possible. The table below outlines some of the best services to refer to using e-RS at either trust:
|Orthopaedics||Two Week Wait Cancer Services|
|Pain Management||Breast Surgery|
| ||Elderly Care|
| ||General Medicine|
| ||Diagnostic ultrasound and MRI*|
*GPs need to book a dummy appointment when referring to this service.
System Development Update
Advice and Guidance Work-lists
There have been some changes made to the Advice and Guidance (A&G) work-list within e-RS. A new GP/Referrer work-list has been added called 'Advice and Guidance' work-list. This will allow all A&G requests and responses to be viewed on a single work-list. All items held on the current 'Advice and Guidance Responses' work-list will be moved to the new work-list and new A&G requests will no longer appear on the 'Awaiting Booking Acceptance' work-list. Don't forget to check the recent 6.4 release with information on new features such as the new column heading for some provider work lists.
Are you Ready ? Survey
Thank you to all of you who completed the e-RS: Are you ready? Survey, we really value your feedback. We are now processing the results and will develop an action plan to help best support Practices.
Keeping you informed - messages from the Trust e-RS Leads
Pleast book appointments when the patient is in the consultation and agree it with the patient. Our access policy states that patients will only be able to reschedule their appointment on ONE occasion - If they cancel and reschedule an appointment on more than ONE occasion they may also be discharged back to the GP. In these circumstances they may be required to start your wait again. We are finding a number of patients contacting us wanting to reschedule appointments which they have not booked. This has an impact on their RTT as the minute the GP surgery converts the UBRN the clock starts and in areas where we have capacity issues we are struggling to rebook these patients as the clock start is then skewed as we have to use the original dates.
When referring patients please only refer if they wish to engage with the service – we have seen a number of comments on ASIs saying patient away 3 months and can they have an apt after x date
For patients that do not meet the 2ww Skin criteria for pigmented lesions; changing lesions, moles, basal cell carcinoma, skin screening, etc
Please do not use our general service when referring patients as this is causing a lot of inappropriate referrals into this service and internal redirections. The general service also has the following alert "For routine skin cancer screening use clinic type "Basal Cell Carcinoma" to refer to correct clinic".
Lambeth Cancer Support Team
Have you met the Lambeth Cancer Support Team?
Lambeth have a team of healthcare professionals who have specialist knowledge and experience in cancer care including: prevention and screening; 2 week wait (2WW) pathways and referrals; early diagnosis through to treatment; and on to living well with cancer and palliative care.
Who are they?
The team of experts are, from left to right, Cate Barlow (Cancer Research UK Facilitator), Ann Courtness (Macmillan Nurse Facilitator) and George Pavey (Macmillan GP and Strategic Lead).
What can they offer your practice?
The team are offering tailored practice based visit(s) designed around the needs of the practice staff. One of the team will contact the practice to arrange an initial visit and agree the content of the visit(s). All practices will be offered at least one visit in the coming 12 months.
Why is cancer a focus for Lambeth?
We know that the screening rates for bowel cancer in Lambeth are 43.3%. This is lower than England 57.8% and London 43.3%. From 2014/15 to 2015/16 the cervical screening rate has decreased in England and London by 1% and in Lambeth by 2%. The 2WW conversion rate (i.e. number of patients diagnosed through 2WW compared to all routes for diagnosis) for Lambeth is 5.5%, this is lower than England 7.8% and London 5.5%, and Lambeth is ranked 21 out 32 CCGS across London.
Lambeth Cancer Support Team, with Lambeth CCG, is available to support all practices to improve cancer care. The priorities for 2017/18 are:
- improving screening rates for bowel and cervical cancers. Improving the rate of bowel screening is in the recently agreed PMS contract. The team are able to provide evidence based support to facilitate increase in bowel screening and to raise awareness and knowledge of the test kit and Bowel scope
- early diagnosis. Supporting 2WW pathways, including use of pan London referral forms and raising awareness of warning signs of late diagnosis and highlighting where A&E diagnosis or attendance is high
- new pathways for rapid diagnostics for people with "vague symptoms" that support early diagnosis
How do I contact them?
Please contact the team through the service redesign email address
Are you aware of the changes in faecal calprotectin analysis?
Please be aware that the method we use for faecal calprotectin testing has changed from 22nd May 2017.
The method has changed from the Bulhmann EKCAL2 assay to the Diasorin Liaison XL faecal calprotectin method. Viapath are making this change to efficiently manage the workload. This change will also allow Viapath to maintain the turnaround time of 5-7 working days
What are the clinical consequences?
Given the lower calprotectin concentrations produced by the Liaison XL assay, guidance has been sought from the Gastroenterology team at King's College Hospital on referral pathways. Our joint recommendations are as follows:
- <50 ug/g faeces Normal
- 50 – 150 ug/g faeces Intermediate; please repeat test in 4 – 6 weeks' time (if this is a repeat test and/or there is clinical concern, consider referral)
- >150 ug/g faeces High; suggestive of IBD or other inflammatory pathology. Consider referral to secondary care.
All referral should be made in line with Lambeth CCG Inflammatory Bowel Disease guidelines. These can be found on DXS
If you require any further clarification or information, please do not hesitate to contact us.
Dr. Royce Vincent, Consultant Chemical Pathologist & Clinical Lead
Dr. David Taylor, Senior Clinical Scientist & Operations Lead
Are you aware of the new treatments for hepatitis C ?
Treatment for hepatitis C has recently become much easier with oral medications over a shorter time period. These oral medications are generally taken for 12 weeks, have very few side effects, are tolerated well and result in a cure for over 90% of patients. Waiting times have fallen dramatically and all patients are potential candidates for treatment
The main hepatitis C treatment centres for Lambeth are King's College Hospital and Guy's and St.Thomas' NHS Foundation Trust. Each centre is now able to offer treatments to an increased number of patients and eferrals for Hepatitis C investigations and treatment are encouraged.
To refer a patient from Lambeth, complete the local viral hepatitis referral form (available on DXS) and then use the e-referral system (ERS) to make the appointment. There are directly bookable slots for patients with viral hepatitis at local Trusts
If you have any comments or queries please contact Lizzie Smith, Hepatitis C Programme Manager:
Have you completed the hepatitis C education survey?
The link to the survey is: https://www.surveymonkey.co.uk/r/MXHDT2Z
The hepatitis C Network are seeking your views about the provision of education and training on Hepatitis C within south London.
The survey should only take around 5 minutes to complete. We would be grateful for your response by Monday 26th June 2017
The results of this survey will be used to develop a programme of events for the next 12 months, led by the Hepatitis C Operational Delivery Network. Please bear in mind that events will be open to all staff across south London, not just attendees at ODN management meetings. We encourage you to share this survey with colleagues where it would be relevant.
If you have any comments or queries please contact Lizzie Smith, hepatitis C Programme Manager:
Do you know about the new geriatric and acute general medicine helpline/ TALK - GP Telephone Advice Line ?
King's TALK Service is a new and easier way of contacting Geriatric Medicine, Acute General Medicine or a Consultant Paediatrician aiming to reduce unplanned emergency admissions to emergency departments and unnecessary referrals. GPs can discuss acutely unwell patients; discuss patient management or outpatient referrals with hospital specialists by calling the number below and selecting the appropriate option.
Tel: 020 3299 6613
Option 1 Geriatric Medicine (24/7 availability)
Option 2 Acute General Medicine (available Monday to Friday, 8am-5pm. Not available on bank holidays)
Option 3 Paediatric Consultant (Monday to Friday 8.30am-10.00pm, Saturday, Sunday & bank holidays 8.30am-5.00pm)
You need a smartcard to access e-RS, and all GPs (including locums) and administrative staff should be issued with a smartcard.
Locums can request a smartcard from the local Registrations Authority (RA) team. Once a locum has been issued with a card, the practice team can contact the RA team and ask for the locum to be given full access for that practice during their employment period.
Also contact the Lambeth GP IT Facilitation Knowledge-base for more information and updates from the IT Facilitator