Somerset and North Devon AAA Screening Programme. Annual Report April 2016-March 17

Transcription

1 Somerset and North Devon AAA Screening Programme Annual Report April 2016-March 17

2 1 Introduction The National AAA Screening Programme s aim is to reduce deaths from abdominal aortic aneurysms (AAA) through early detection, appropriate monitoring and treatment. The Somerset and North Devon AAA Screening Programme commenced in February 2011 and has its administrative and operative base at Musgrove Park Hospital, Taunton. The Programme sits within the Vascular Department, Surgical Directorate. The Programme covers the referring general practice populations (Appendix 1) within Somerset and North Devon. The Programme undertakes screening at 87 GP surgeries throughout the year, which range from quarterly to yearly visits. These are planned according to GP patient cohort size and the number of patients on yearly and quarterly surveillance to ensure we can always offer patients appointments locally. The Somerset and North Devon Screening Programme cover the North Devon area, and the rest of Devon is covered by the South Devon and Exeter Programme

3 The Programme has seen a change in staff over the year with the appointment of a new Programme Manager and Clinical Skills Trainer, both commencing in post in June The Team Andrew Stewart Adam Denyer Lorna Hewart Clinical Director CST/QA Programme Manager Hannah Baker Susie Lloyd Maureen Peddie Programme Administrator Screening Technician Screening Technician Jill Delacherie Celia Bellamy Moira Cook Screening Technician Screening Technician Nurse Practitioner 3 Establishment Role Clinical Director Clinical Skills Trainer Nurse Practitioner Programme Manager Programme Administrator Screening Technicians Establishment 0.2 WTE 0.2 WTE 0.1 WTE 0.91 WTE 1 WTE 2.14 WTE

4 4 The Screening Process A simple ultrasound test is performed to detect AAA. The scan itself is quick, painless and non-invasive and the results are given to the patient verbally at the time of the scan. A result letter is sent to GP s for all results and to patients with any result other than normal. Normal aortic diameter <2.9 cm Most men have a normal result and no further treatment or monitoring is required Small aneurysm aortic diameter cm Men with a small aneurysm are invited back for surveillance scans every 12 months to monitor the size of the aneurysm Medium aneurysm aortic diameter cm Men with a medium aneurysm are invited back for surveillance scans every 3 months to monitor the size of the aneurysm Large aneurysm aortic diameter >5.5 cm Men with a large aneurysm are offered an appointment with the Vascular Team to have more scans and talk about possible treatment, usually an operation. Non-visualised the aorta cannot be measured accurately These men are given a further appointment either with the screening technicians or with the clinical skills trainer.

5 5 Screening Pathway

6 5 2016/17 Activity* 100% of eligible subjects (4615) were offered an initial appointment. Of those patients, 3996 took up the offer of screening, which is an uptake rate of 86.59%. In 2015/16 uptake was 87.3% (compared with 80% Nationally). The uptake in 2015/16 was the highest across England AAA screening programmes. Men over the age of 65 can self-refer to the screening programme and this year we screened 478 self referrals. Tabled below are the results: Normal Result 2016/2017 Cohort 3996 (86.59%) 457 (95.6%) Self-Referrals (Screened 1/4/16 31/3/17) Abnormal (=> 3.0cm) 42 (1%) 21 (4.3%) 12 months ( cm) 30 (0.7%) 15 (3.1%) 3 months ( cm) 7 (0.2%) 4 (0.8%) Referral (=> 5.5cm) 5 (0.1%) 2 (0.4%) *Data taken as at 21/06/17 In addition to the 7 patients referred to the Vascular Team from cohort and self-referrals, a further 12 patients already under surveillance reached the 5.5 cm+ threshold this year and were transferred to the Vascular Surgeons, totalling 19 large AAA referrals from the Screening Programme. Once an aneurysm of <5.5 cm has been identified, the pathway standards require referral to the Vascular Team within 1 working day, an out-patient appointment within 2 weeks, and intervention for those deemed fit for surgery within 8 weeks. The AAA Screening Programme s performance for is charted below: Criteria Type % Acceptable Achieveable Subjects Referred within 1 working Cohort 100% >=95% 100% day Self Referrals 100% >=95% 100% Referrals for Specialist Cohort 100% >=90% >=95% Assessment within 2 weeks Self Referrals 100% >=90% >=95% Referrals Operated on within 8 Cohort 82.4% >=60% >=80% weeks Self Referrals 50% >=60% >=80% We missed the target of operating within 8 weeks for self referrals as there were only 2 patients in this category and 1 of the patients chose to wait over 8 weeks. There were 30 patients with non-visualised screens in (22 from cohort, 1 from selfreferral and 7 from surveillance). Of those 14 were rescanned by the Clinical Skills Trainer, 10 by the Screening Technicians, 4 declined further screening and 2 patients died prior to rescreen (non-aaa related).

7 6 Governance 6.1 Risk Register The AAA Screening Programme s risks are recorded on the Taunton and Somerset NHS Foundation Trust s Surgical Risk Register. The risk register is reviewed at the monthly vascular specialty meetings, as well as at the monthly programme meetings and quarterly programme board meetings. Risk management for Timely replacement of AAA screening equipment Site related occupational hazards Delays in treatment due to hospital factors (eg ITU capacity) Single points of failure within a small team 6.2 Incidents The AAA Screening Programme encourage reporting of all incidents via the Trust s incident reporting system. These incidents are reviewed via monthly programme meetings and quarterly board meetings. Relevant incidents are also reported Nationally via the Screening Incident Assessment Form which is distributed to the Quality Assurance team and Screening and Immunisation Manager at Public Health England. For incidents were reported in the Screening Programme, 3 of which were also reported to the National Team. There were no serious incidents. 7 Achievements National Annual Report The National Annual Report for was published in 2016, reporting that the Somerset and North Devon AAA Screening Programme had achieved the highest uptake across England AAA screening programmes (87.3% compared to a National average of 80%). 7.2 Patient Surveillance Day The AAA Screening Team travelled to The Landmark Theatre in Ilfracombe on Wednesday 16 November 2016 to run a patient surveillance day. All patients under surveillance in the North Devon/South Somerset area were invited to attend the event, which was aimed to provide support, reassurance and guidance to patients, as well as an opportunity for patients to meet other patients with aneurysms. Speakers included Adam Denyer, Clinical Skills Training (speaking on ultrasound and quality assurance), Katy Darvall, Consultant Vascular Surgeon (speaking on the vascular surgery pathway and treatment), and Robin Croslegh (the patient experience). There was an extended coffee break to allow mingling and patients to approach various staff members for one-to-one discussion. Two patients kindly attended the event (one who had an EVAR and one an open repair procedure) to offer support.

8 A sample of feedback received regarding the event: Very informative and reassuring. Information presented very well It was most beneficial meeting other individuals with the same problem and listening to the team I have a much better understanding of what is involved 7.3 Pilot Scheme Targeting older men not previously screened The Somerset and North Devon AAA screening programme is in it s 6 th year and has screened the male population aged At risk male patients older than 71 have not been routinely invited to screening but may self refer. Following an initial approach by Essex House Medical Centre, the Screening Programme, in collaboration with two GP surgeries, trialled an initiative to promote the Screening Programme to older registered male patients. The information letter was endorsed by local GPs. Essex House Surgery Results: 248 patients were identified and of those 140 booked an appointment (56.45% uptake) 3 patients were identified with a small aneurysm and are now on yearly surveillance (2.14% incidence rate) Quantock Medical Centre Results: 95 patients were identified and of those 65 booked an appointment (68.42% uptake). 1 patient has been identified with a medium aneurysm and is now on quarterly surveillance (1.54% incidence rate) We are planning further work in 2017 to promote practice based self referral to this at risk group with prioritisation to lower social deprivation practices where there is some National evidence of higher incidence of AAA. 7.4 Nurse Practitioner Clinics All patients with identified AAA s are offered support by our nurse practitioner. Initially our nurse practitioner appointments were undertaken as telephone consultations with the opportunity for a further face to face consultation if requested by the patient. Following patient feedback 96% of our patients surveyed stated a preference for face to face consultation (this figure reduced to 75% if travel time was an hour or greater). As a result we have expanded the options for patients nurse practitioner review. This year we trialled a Skype clinic at West Mendip Hospital and face to face clinics at Musgrove Park Hospital and Litchdon Medical Centre. There was poor uptake of our initial trial with only one patient agreeing to a Skype consultation. Feedback was however positive and following this we have continued to offer Skype from home however uptake remains poor. Face to face clinics have been more popular. Feedback based on 11 patients responses were: 100% rated the quality of information provided as very positive, and 100% rated that questions and concerns were answered extremely well.

9 A sample of comments below: Overall a good, positive experience which made me feel confident that I was being dealt with in a professional caring manner I feel better for the appointment. Good advice given. I feel more confident about the future I always like to understand the implications related to any issue. This was explained totally satisfactorily. I can carry on as normal with no worries. The AAA Screening Programme now offers patients face to face consultation alongside Skype from home and telephone contact. The face to face appointments are either booked at Musgrove Park Hospital, West Mendip Hospital or Litchdon Medical Centre depending on the demand. 7.5 GP Surgery Visits The Programme Manager has visited 24 of the 87 surgeries since commencement in post in June 2016 with a plan to continue thse visits throughout We are extremely grateful to these sites for hosting our local programme and it has been fantastic to meet the surgery staff who have facilitated this service locally for their patients. Our ability to offer patients local appointments is undoubtedly a major factor to the high uptake of AAA screening in our region. It has enabled further promotion of uptake and self referral, a collaborative approach to booking of clinics and an opportunity to update surgeries with new developments within the programme. 7.6 Patient Feedback Patient feedback was obtained throughout one week of screening clinics in August 2016, November 2016 and March The results are documented below: Total Surveyed Percentage Completed Definitely Would Recommend the Service Probably Would Probably Not Definitely Not Mar % 91.60% 8.40% 0% 0% Nov % 95.50% 4.50% 0% 0% Aug % 93% 7% 0% 0% A sample of comments from the feedback sessions below: The information explained clearly the reasons to have the scan and I felt proud that our NHS could offer such a service This being done at my local surgery was so much easier than having to travel the 50 mile round trip to the hospital. Thank you! Ladies were brilliant I cannot fault this service in any way

10 7.7 30,000 th Patient Screened On the 20 January 2017 our Programme screened our 30,000 th patient at Taunton Road Medical Centre in Bridgwater. This milestone was celebrated by a publicity shoot and an article which was published in a variety of newspapers/broadcasts across Somerset and North Devon. We experienced a sharp rise in self referrals over February and March due to this additional publicity (52 self referrals in February and 79 self referrals in March)*. This is against an average self referral rate of 25 per month. Pictured (left to right): Dr Harry Smallwood (GP at Taunton Road Medical Centre), Hazel Priest (reception team leader), Robert Elston (30,000 th patient to be screened for AAA), Maureen Peddie (screening technician Musgrove Park Hospital) *This data excludes self referrals received for Essex House Surgery and Quantock Medical as we were running additional promotional work with these surgeries as mentioned above. 7.8 Audit An audit relating to the type of bed used at screening clinics was undertaken this year. The results showed that 39% of clinics were undertaken on a fixed bed. The audit is ongoing and we are hoping to see a reduction following work with the GP surgeries raising awareness of the need for height adjustable beds. 7.9 Equipment The Screening Programme were successful in updating all 3 ultrasound machines this year. Therefore the risk timely replacement of AAA screening equipment has now been archived.

11 8 Objectives 2017/18 During the Somerset and North Devon Screening Programme will continue to strive to ensure the programme is delivered to a consistently high standard. Specific objectives for the year include: Patient Surveillance Day we plan later in the year to organise a repeat surveillance day to the one undertaken in November 2016 for the Somerset patients under surveillance. GP Surgery Visits The Programme Manager will continue with the GP surgery visits, with the aim of completing over half of the GP practices by the end of Audit Planned audits for include review of the prior notification list process and a DNA audit/review. Promotional Work Targeting Older Men Not Previously Screened The Programme plans to continue working with GP surgeries to invite older patients who have not previously been screened. Quality Assurance Visit we will incorporate any learning/goals set by the Quality Assurance Visit on the 6 July 2017 into our objectives for this year.

12 Appendix 1 GP Practices Practice Practice Locality Practice Name Code L83003 Northern Locality of NEW Devon CCG Queens Medical Centre L83012 Northern Locality of NEW Devon CCG Bradworthy Surgery L83017 Northern Locality of NEW Devon CCG Waterside - Now part of Combe Medical Practice L83026 Northern Locality of NEW Devon CCG Torrington Health Centre L83035 Northern Locality of NEW Devon CCG Litchdon Medical Centre L83047 Northern Locality of NEW Devon CCG East Street Surgery L83050 Northern Locality of NEW Devon CCG Northam Surgery L83057 Northern Locality of NEW Devon CCG Fremington Medical Centre L83068 Northern Locality of NEW Devon CCG Lynton Health Centre L83069 Northern Locality of NEW Devon CCG Holsworthy Medical Centre L83073 Northern Locality of NEW Devon CCG Brannams Medical Centre L83083 Northern Locality of NEW Devon CCG Bideford Medical Centre L83096 Northern Locality of NEW Devon CCG Combe Medical Practice L83097 Northern Locality of NEW Devon CCG Caen Medical Centre L83105 Northern Locality of NEW Devon CCG Castle Gardens Surgery L83106 Northern Locality of NEW Devon CCG Wooda Surgery L83129 Northern Locality of NEW Devon CCG Hartland Surgery L83137 Northern Locality of NEW Devon CCG South Molton Health Centre L83139 Northern Locality of NEW Devon CCG Boutport Medical Centre L83663 Northern Locality of NEW Devon CCG Blake House Surgery L85001 Somerset French Weir Health Centre L85002 Somerset Wells Health Centre L85003 Somerset Exmoor Medical Centre L85004 Somerset Crewkerne Health Centre L85005 Somerset Buttercross Health Centre L85006 Somerset Crown Medical Centre L85007 Somerset Church Street Surgery L85008 Somerset Frome Medical Centre L85009 Somerset West Somerset Healthcare L85010 Somerset Highbridge Medical Centre L85011 Somerset Cheddar Medical Centre L85012 Somerset Wellington Medical Centre L85013 Somerset Quantock Medical Centre L85014 Somerset Blackbrook Surgery L85015 Somerset Preston Grove Medical Centre L85016 Somerset Burnham Medical Centre L85017 Somerset Penn Hill Surgery L85018 Somerset Cannington Health Centre L85019 Somerset Harley House Surgery L85020 Somerset Beckington Family Practice

13 Practice Practice Locality Practice Name Code L85021 Somerset College Way Surgery L85022 Somerset Hendford Lodge Medical Centre L85023 Somerset St James Medical Centre L85024 Somerset Polden Medical Practice (formerly Edington Surgery) L85025 Somerset Cranleigh Gardens Medical Centre L85026 Somerset Hamdon Medical Centre L85027 Somerset Wincanton Health Centre L85028 Somerset Springmead Surgery L85029 Somerset Vine Surgery (Da Cunha) L85030 Somerset Essex House Medical Centre L85031 Somerset Milborne Port Surgery L85032 Somerset Bruton Surgery L85033 Somerset Langport Surgery L85034 Somerset Wells City Practice L85035 Somerset East Quay Medical Centre L85036 Somerset Quantock Vale Surgery L85037 Somerset North Curry Health Centre L85038 Somerset Lister House Surgery L85039 Somerset Glastonbury Surgery L85040 Somerset Millbrook Surgery L85041 Somerset Irnham Lodge Surgery L85042 Somerset Taunton Road Medical Centre L85043 Somerset Park Medical Practice L85044 Somerset Queen Camel Medical Centre L85045 Somerset Westlake Surgery (Day) L85046 Somerset Mendip Country Practice L85047 Somerset Glastonbury Health Centre L85048 Somerset Ryalls Park Medical Centre L85050 Somerset Luson Surgery L85051 Somerset Redgate Medical Centre L85052 Somerset Warwick House Medical Practice L85053 Somerset Grove House Surgery L85054 Somerset Summervale Surgery L85055 Somerset Axbridge & Wedmore Surgeries L85056 Somerset North Petherton Surgery L85060 Somerset Vine Surgery (Vriend) L85061 Somerset Meadows Surgery L85062 Somerset Lyngford Park Surgery L85064 Somerset Oaklands Surgery L85065 Somerset Dunster Surgery L85066 Somerset Ilchester Surgery L85601 Somerset Brent Area Medical Centre

14 Practice Practice Locality Practice Name Code L85602 Somerset Brendon Hills - Merged with Dunster Surgery L85607 Somerset Somerset Bridge Medical Centre L85608 Somerset Porlock Medical Centre L85609 Somerset Creech Medical Centre L85611 Somerset Oakhill Surgery L85612 Somerset Victoria Park Medical Centre L85616 Somerset Victoria Gate Surgery L85619 Somerset Tawstock Medical Centre L85620 Somerset West One Surgery (formerly Crewkerne Surgery) L85624 Somerset Church View Medical Centre Y00189 Somerset Abbey Manor Medical Practice Y01163 Somerset Westlake Surgery (Smith) Y02778 Somerset Yeovil Health Centre