WALSALL LOCAL MEDICAL COMMITTEE

Transcription

1 WALSALL LOCAL MEDICAL COMMITTEE An open meeting of the Walsall Local Medical Committee was held in the Lecture Suite, Manor Learning and Conference Centre, Manor Hospital, Walsall on Monday 5 th January 2015 commencing at hours, which was attended by 25 people. Present: Dr.H.S.Syed Dr.H.Vitarana Dr.P.Dubb Dr.A.T.Askey Dr.A.J.Desai Dr.A.Ghosh Dr.S.Kaul Dr.A.S.Khan Dr.R.Kumar Dr.C.S.Lesshafft Dr.F.Mahmood Dr.S.Manthri Dr.A.S.Suri Dr.S.J.Vaid Chairman Medical Secretary Treasurer Also Present: Mr.Amir Khan Dr.N.Tugnet Dr.N.S.Sahota Phil Griffin Mr.Rajiv Pathak Mr.Andrew Garnham Tracey Bayliss Dr.A.Benjamin Dr.A.Muniyappa Dr.S.Siddiq Dr.R.Suri In Attendance: Carolyn Andrew Medical Director/Walsall Healthcare NHS Trust Consultant Rheumatologist and Clinical Lead for Rheumatology/Walsall Healthcare NHS Trust Assistant Director for Clinical Strategy/Birmingham, Solihull and Black Country Area Team/NHS England Associate Director - Strategic Transformation and Redesign/NHS Walsall CCG Consultant Vascular Surgeon/Dudley Group NHS Foundation Trust Consultant Vascular Surgeon/ Royal Wolverhampton Hospitals NHS Trust Abdominal Aortic Aneurysm (AAA) Screening Programme Manager - The Black Country LMC Executive Officer 1

2 The meeting was opened at hours by the LMC Chairman, Dr.Haris Syed, who welcomed speakers, guests and members to the first LMC meeting of the new year. WELCOME: Dr.Narinder Sahota Phil Griffin Mr.Amir Khan Dr.Nicola Tugnet Tracey Bayliss Mr.Rajiv Pathak Mr.Andrew Garnham 1) APOLOGIES: Dr.U.Ahmad Dr.A.S.Gill Dr.L.S.Nambisan Announcing an item extra to the published agenda, the LMC Chairman introduced Mr.Amir Khan, Medical Director Walsall Healthcare NHS Trust. 2) Pressure on Manor Hospital due to Emergency Admissions Mr.Amir Khan Mr.Amir Khan: Medical Director/Walsall Healthcare NHS Trust Amir Khan had requested time in the LMC meeting to speak to GP colleagues concerning the significant pressure from emergency admissions that the Trust had been facing. The last few weeks had been terrible, with the hospital operating constantly at Level 4. Over the holiday period there had regularly been 12 or 13 patients in A&E overnight waiting for beds. Amir added that currently there were around 118 medical patients not on medical wards, Consultants who were not abroad had been called back in from holiday and also some junior doctors. Amir asked GP colleagues for suggestions as to what the hospital might do differently to try to alleviate the situation. He said that formerly they would have diverted ambulances to other areas but this was not an option as neighbouring hospitals were in the same situation with more than one experiencing 12 hour breaches. Dr.Narinder Sahota, Assistant Director for Clinical Strategy/Birmingham, Solihull and Black Country, pointed out that primary care is also very busy trying to manage patients in the community as GPs try not to send patients into hospital. Amir was not sure whether the Stafford impact was part of this and wondered if much of the increase might be from Walsall itself. In addition, with Christmas and New Year bank holidays falling at the end of the week followed by the weekend, 4 day closure of GP surgeries might also have impacted on the situation, analysis of the figures may shed some light on this. In any event, this year had been the worst year ever and on the previous night the hospital had been forced to put beds into use that were usually used for clinical skills training. GPs had anecdotal examples of patients that had called NHS 111 recently, Dr.Puneet Dubb said that one of his patients had called 111 because they had chest pain after coughing and an ambulance had been dispatched. There were other similar examples involving NHS 111. It was generally felt that NHS 111 was making the situation worse, with 22% more people coming to A&E than previously and that the problem was mainly with the staff doing the triaging. 2

3 The LMC Chairman suggested that having GPs triaging ambulance calls had worked well in the past, reducing A&E attendance by up to 40% and asked whether it would be worth looking at this again. Amir agreed that this could be requested but said that another part of the problem was getting patients out of hospital if they required social services assessment this involved one third to one quarter of total number of patients waiting for discharge. The whole system is bogged down. Phil Griffin, Strategic Director for Service Transformation at NHS Walsall CCG, asked whether community services were working as well as they could be, district nursing, physiotherapy etc? Dr.Haris Syed, LMC Chairman, commented that Intermediate Care had never been set up as it was originally planned to be, there were not enough beds. LMC members also felt that Community Matrons were too small in number to practise effective prevention of admission to hospital for patients with long term conditions. Also GPs complained that there was no proper contact with locality teams since district nurses were no longer based in GP practices. The extended hours scheme in operation last year that enabled GP surgeries to open at weekends had not been commissioned this year LMC members wondered if this would have made a difference? Phil Griffin informed colleagues that an evaluation of the extended opening hours had been carried out, results were variable and it had not had the hoped for effect of reducing A&E attendance. New for this year is the over 75s LCS -over 5,00 patients have had a care review and a medication review as a result of this. In addition there is the vulnerable patients LCS and both of these services are contributing to prevent people from coming to hospital unnecessarily. Dr.Sohaib Siddiq recommended that data analysis needs to be done more regularly and pointed out that patients with co-morbidities will have to come into hospital at some point in their illness but if there is a lack of social services support then the hospital will be left with such patients occupying a bed for longer than is necessary. Dr.Sundar Vaid pointed out that patients are not always followed up and treated appropriately by the hospital before they become very ill. An example of this was given, where cancer patients had been seen by Dr.Vaid, found to be anaemic and referred to Oncology team. These patients were given repeat blood tests and sent home with no further follow up by hospital, only to require admission further down the line for severe anaemia. Another example given by Dr.Vaid was of a patient referred to hospital with chest pain who was sent home without cardiac enzymes being done. This patient later had a cardiac arrest. Amir replied that clinicians in A&E make decisions on clinical information available to them at the time. Clinical condition can change and individual could miss the diagnosis. He also reminded GP colleagues that there was an ambulatory care department at the hospital and urged them to use it, as a proportion of patients turning up at A&E could be effectively treated there. The contact number for Ambulatory Care is: Ext The LMC Chairman was hopeful that the discussion had been productive. 3

4 3) New Consultants in Rheumatology Dr.Nicola Tugnet and Dr.Muhammad Munir Dr.Nicola Tugnet: Consultant Rheumatologist and Clinical Lead for Rheumatology /Walsall Healthcare NHS Trust Dr. Nicola Tugnet expressed her appreciation for the invitation to LMC to meet and network with GP colleagues. She explained that her consultant colleague, Dr.Muhammad Munir, had been due to attend but due to a last minute difficulty he was unable to and sent his apologies. Dr.Munir hoped to attend on another occasion. Dr.Tugnet went on to say that she was a locally trained Rheumatologist, having completed her training at the QE in August 2014 and commenced in a full time post at the Manor Hospital at the beginning of September She added that she and Dr.Munir have broad general Rheumatology experience and clinical interests in connective tissue disease, osteoporosis and inflammatory arthritis in particular. The department has strong links with specialist centres to help in the management of patients with complex multisystem disease. Dr.Tugnet and Dr.Munir are aiming to restore stability to the Rheumatology service as there has been a high turnover of consultant staff. Both consultants are keen to work closely with GPs and would be happy to be contacted by or telephone for advice and guidance, particularly if it helps prevent admission to hospital or outpatient consultation. LMC members were advised that Rheumatology clinics are held daily (Monday Friday) and there is usually a consultant available for advice. Efforts will be made to answer queries and calls within 24 hours. This may be facilitated if the service is expanded in the future. Dr.Avi Suri requested that Dr.Tugnet and her colleague look at the Shared Care Protocol that is in place and to make sure it is used effectively. He also flagged up issues with TTO treatment. Dr.Tugnet commented that she was aware that some patients on disease modifying drugs may not have seen a consultant for some time and got lost-to-follow up, in view of the change in consultant staff and introduction of Lorenzo. She urged GP colleagues to refer patients back for Consultant review if they come across those who had not seen a Consultant Rheumatologist for some time. Contact details are: Nicola.tugnet@walsallhealthcare.nhs.uk Muhammad.munir@walsallhealthcare.nhs.uk Telephone: (secretary) Dr.Tugnet s attendance at the LMC meeting was appreciated it was hoped to welcome Dr.Munir on another occasion. 4

5 4) Screening Men for AAA in the Black Country Mr.Rajiv Pathak/Mr.Andrew Garnham/Tracey Bayliss Mr.Rajiv Pathak: Mr.Andrew Garnham: Tracey Bayliss: Consultant Vascular Surgeon/ Dudley Group NHS Foundation Trust Consultant Vascular Surgeon/ Royal Wolverhampton Hospitals NHS Trust Abdominal Aortic Aneurysm (AAA) Screening Programme Manager - The Black Country Mr.Rajiv Pathak introduced himself, Mr.Andrew Garnham and Tracey Bayliss to LMC members, adding that the AAA Screening Programme was based at Russells Hall Hospital, Dudley. Their aim was to encourage GPs to offer space in their premises to hold screening sessions and to promote the service to patients. Mr.Pathak said that all GPs were likely to come across Abdominal Aortic Aneurysm (AAA) at some point and it is a condition that, if undetected, can cause major morbidity/mortality. Background 2% The proportion of deaths in men aged 65 and over that are caused by ruptured AAA 6,000 The number of deaths from ruptured AAA each year in England and Wales 80% The mortality rate from ruptured AAA 0-6% The post-operative mortality rate for planned AAA surgery in high quality vascular services 95% of ruptured AAA occur in men aged 65 and over Case for Screening Mr.Pathak reminded GP colleagues that AAA is generally asymptomatic and simple ultrasound scan of the abdomen is the easiest way to check whether a man has an AAA. Research * shows that screening men aged 65 should reduce the death rate from ruptured AAA among men aged by around 50%. UK National Screening Committee assessed evidence and decided that screening men aged 65 and allowing men over 65 to self-refer could deliver benefits and be cost-effective. * The Multi-centre Aneurysm Screening Study (MASS). Lancet 2002 Phased roll-out of screening programme across England began in Spring 2009 and was completed in Spring 2013, Black Country screening programme began in Spring AAA screening programmes will also be rolled out in Scotland, Wales and Northern Ireland. Screening operates separately to the Vascular Risk Management Programme. Main AAA risk factors are: Age Being male Smoking High blood pressure Close family history 5

6 Screening Process All men in the Black Country (Dudley, Walsall and Wolverhampton) are invited for screening in the year they turn 65 by the Screening Programme Men over 65 can self-refer (Posters displayed in GP Practices, press articles etc) Ultrasound scans carried out by the Screening Programme at suitable locations: GP Practices Health Centres & Community Hospitals locations across the Black Country. Result provided verbally to man (and in writing if AAA detected) Result sent in writing to man s GP Possible results Normal less than 3cm discharged from screening programme Small aneurysm 3 to 4.4cm offered appointment with Joy Lewis, Vascular Specialist Nurse, and yearly surveillance appointments Medium aneurysm 4.5 to 5.4cm offered appointment with Joy Lewis, Vascular Specialist Nurse, and 3-monthly surveillance Large aneurysm 5.5cm or above referred to Consultant Vascular Surgeon within local programme s defined vascular network (not all aneurysms will be operable) Medication and lifestyle advice It is recommended that patients with AAA should: Commence/continue aspirin and statin therapy unless there are contraindications Eat a healthy balanced diet and reduce intake of fatty foods Stop smoking Maintain a healthy weight Take regular exercise Summary and Key message for GPs GP colleagues were advised that the Screening Programme will be responsible for inviting all eligible men and for service provision. Mr.Pathak urged GPs to please encourage men to attend for screening by displaying posters and leaflets in waiting rooms etc and to promote awareness and benefits of the screening programme. He also asked practices to consider hosting a screening session if possible by providing a standard consultation room or to suggest an alternative location for screening their patients. National statistics show that screening men in their own GP Practice has the best attendance rate. Each scan takes 7.5 minutes and around 15 scans are performed in each screening session. Screening already takes place at the following venues in the Walsall area: Pinfold Health Centre, Bloxwich The Keys Family Practice, Willenhall Brace Street Health Centre, Caldmore Sai Medical Centre Harden Health Centre, Bloxwich Bentley Medical Practice Blackwood Health Centre, Streetly Anchor Meadow Health Centre, Aldridge Additional offers to host screening programmes had also been received from practices at Moxley Medical Centre, Holland Park Surgery, St.John s Medical Centre and Rushall Medical Centre. 6

7 Mr.Pathak showed slides containing screening figures For small aneurysms the rupture rate is 1% per annum. The following issues were raised: Phil Griffin - Is the uptake rate better from some parts of Walsall than others? A piece of work has been done on this and we are actively going into areas where uptake is low. Moving screening closer to home usually improves uptake. Mr.Garnham added that Black Country man is not very good at looking after his health and needs encouragement. Dr.S.J.Vaid - What about women? Incidence is much higher in males than in females but it is possible that at age 70 women may well get invited for screening in the future. Dr.AJ.Desai - Do you screen out-of-area patients? No, we can only screen men registered to GP Practices in the Black Country. However, as the screening programme is complete national, we will be able to give patients the phone number for their allocated screening programme. Dr.H.Vitarana - What is the repair method? Most are stented but around 20% are still open repair. Dr.S.Siddiq - Is there any variation among ethnic groups. We have been looking at how to improve breast screening uptake in Asian women as it is very poor. The use of a mobile unit seems to be improving uptake could a similar idea work for AAA. We are already going round surgeries wherever accommodation is offered more locations always welcome. Tracey added that she could flag up patients who DNA to their GP. Dr.S.J.Vaid - What about other issues detected during aneurysm scan? One patient had a tumour in the liver picked up, two week referral was made but the patient sadly died. Scanning is deliberately very focussed and not intended to pick up problems in other areas of the body. Dr.F.Mahmood - A patient with inoperable AAA could be described as a ticking time bomb. How does a GP best support such patients and should they be regarded as terminal? Even large aneurysms can go a very long time without rupture. This has only happened to 2 patients so far in the 3 years that we have been screening. Those patients should be kept under review by hospital surveillance and the local Vascular surgeon. Contact details: Tracey Bayliss Abdominal Aortic Aneurysm (AAA) Screening Programme Manager - The Black Country Russells Hall Hospital, Dudley, West Midlands DY1 2HQ Telephone Extension: 1125 Direct Line: Tracey.Bayliss@dgh.nhs.uk Visit the NHS AAA Screening website for more information: The LMC Chairman thanked Tracey and her colleagues from the Screening Programme and urged GPs to promote the service to their patients. 5) Any Other Business NONE. 7

8 6) Date of Next Meeting Monday 2 nd February 2015 in the Lecture Suite, MLCC, Manor Hospital Start time: hours The open session of the LMC meeting was concluded at hours by the LMC Chairman. Committee members were requested to remain for the In-Committee meeting. 8