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PARTNERSHIP for HEALTH Davenport House Surgery & Patient Participation Group

The Joint Quarterly Newsletter www.davenporthouseppg.org.uk

Issue No 40 September 2008 www.davenportsurgery.demon.co.uk

THE PPG TAKES A LEAP FORWARD

It was heartening to re-ceive the unanimous sup-port of members present at the Special General meeting on 14 July for the proposal to raise the annual family subscrip-tion to £10 per annum from 2009. This will place the PPG in a much stronger position to con-tinue with its existing commitments and allow us to plan optimistically

for the future.

We aim to strengthen communication between Practice and Patients in a number of ways:

Ideally, more patients should have access to the information carried in the Newsletter, and we already have a small group from the Prac-tice and the PPG working together to see how this might be achieved.

The PPG website is up and running, but there is much that could be done to make this a hub linking Davenport House with other patient support groups both locally and nationally.

As part of this theme of teamwork, all the Practice Partners have agreed to attend the

AGM in February 2009, taking part in a medi-cal variation of „Any Questions?‟ with you the patients asking the questions. The December edition of the Newsletter will carry the details of this.

Representatives from Patient Groups in West Hertfordshire now meet on a regular basis. The number of Practices supporting patient groups is increasing, and Davenport House is consulted by patients from other Practices who plan to start similar organisations.

Davenport House PPG is by no means the only model for such groups, and there is much to gain by sharing ideas and activities. One ex-ample, which may appeal to our members, is the promotion of self-help support groups among patients with a particular chronic medical condition. Our „Small Group‟ meetings already bring together such patients and if it were seen to be helpful they could continue to meet infor-mally from time to time.

Do let us have your own ideas and suggestions for ways in which the PPG could improve its services to patients at Davenport House. In addition, may we ask you to encourage other patients of the Practice to join the PPG, so that we can be even more repre-sentative and influential in our liaison with the Prac-tice? Contact details for the PPG Committee are below.

Funding the Practice 2

NHS Reorganisation 3

District Nurse Team 4

Anthea Doran Award 5

Skin Problems 6

Holidays for Disabled 7

Surgery Snippets 8

Inside this issue:

PPG COMMITTEE MEMBER CONTACT DETAILS

Chair Roger Gedye 832374 roger.gedye@homecall.co.uk

Secretary Rosemary Horne 762620 rmh.harpenden@tiscali.co.uk

Treasurer Ian Drew 460597 drew1@hotmail.com

Membership Helen Hartley 767462 ahhartley@talk21.com

Newsletter John Harris 713246 j_harris@tiscali.co.uk

PCT Liaison Malcolm Rainbow 762590 malcolmrainbow@btinternet.com

Recruitment Pam Morris 620306 pamelamorris@amserve.com

Education Sheila Uppington 764230 suppington@hotmail.com

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HOW THE PRACTICE IS NOW FUNDED

A presentation by Dr Roger Sage, Chairman of Practice Based Commissioning (PBC) in St Albans, on 14

July at Fowden Hall Rothamsted

Dr Sage is a GP in St Albans and as Chairman of the PBC in St Albans is responsible for commission-ing services for the Primary Care Trust (PCT) to lo-cal GP Practices in the St Albans and Harpenden area covering 13 Practices and 130,000 patients. These new arrangements have been in formal exis-tence for 12 months with the PBC being responsible for some 10% of the substantial PCT budget with the remaining 90% taken up by secondary care through the hospitals.

The objective is that local GP Practices through the PCB decide on their priorities within the commis-sioning budget, with the PCT acting as their agent to procure services.

The PBC has a small executive board of 6 and has just appointed a Chief Executive Officer. All 13 Practices in the area have signed up to the PBC in order to improve services to their patients. Whilst the decision making process has been frustrated by lack of information, which is often received late, Dr Sage identified two areas of achievement over the first 12 months as follows:

CATS (Clinical Assessment & Treatment Schemes) in which patients are referred to a local GP with specialist training or to a consultant working for the PCB rather than to a hospital. 5 such schemes have been established with the general experience being satisfactory based on reduced waiting lists, reduced waiting times and improved benefits for the patient. In addition, there are sav-ings to the PBC which can be used to improve ser-vices elsewhere.

Service Re-design where the PCB is aiming to achieve more localised delivery of patient services. A project has been set up to establish a feasibility study for re-opening the Harpenden Memorial Hos-pital as a community asset. In addition, several working groups have been formed to look at estab-lishing units for the delivery of particular health care services, including mental health (the Cinderella of health services) and obesity.

It was clear that Dr Sage and the PCB committee are working very hard to influence real and immedi-ate changes, but are finding the decision making processes sometimes frustrating and often lengthy. At this stage he invited questions from over 100 Davenport House PPG members attending the presentation. The main points arising from a very lively session were:

There is currently one patient representative at each of the PCB meetings, but the aim is to increase this representation next year.

A report is being prepared for the use of Har-penden Memorial Hospital after various groups have been consulted where the future will depend on what is economically feasible. A patient suggested that it would make a good centre for the Harpenden GP Practices to share specialist support and admin services.

The new chief executive is responsible for supporting all the clinical groups, so progress would be looked for after 6 months. However, it is clear that the PCB received minimal ad-ministration support compared to the overall budget being managed.

In addition, the PCT is not always able finan-cially to support the PCB proposals even within the commissioning budget. On the other hand, a proposal from one PCB does not nec-essarily need to be shared across all the PCBs, provided it was clinically appropriate.

The PBC has no funds for mental health is-sues at present, but the current working group hopes to show that local services can be deliv-ered more cost effectively.

The PBC is trying to negotiate changes to the delivery of Care in the Home where there is a need to coordinate all the current services which are somewhat fragmented.

A newsletter from the PBC was available in the Surgery.

Several other questions were touched on such as-getting an appointment with your GP and other Practice issues, which are matters regularly taken up by the PPG directly with the Practice. This under-lines the value of as many patients as possible be-ing members of the PPG so that patient priorities can be reflected in how the Practice moves forward.

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The Darzi Report on Reorganisation of the NHS

The next chapter……….

By Dr Sneha Wadhwani MBChB DCH DRCOG DFFP MRCGP

In October 2007 Lord Darzi published his interim report

on the Government planned reorganisation of the NHS.

In it he introduced ideas of patient choice, development

of polyclinics or super Surgeries, ending the postcode

lottery, and allowing patients to carry their own “health

budget”.

June 2008 saw the publication of his final report consoli-

dating these ideas and developing new ones.

So let‟s look at each of the key areas:

Patient choice:

This idea has been around for some time, and was ini-

tially introduced as a result of the increased demand for

consumerism in the NHS. With the advent of the internet

and proliferation of healthcare resources for the public,

patients have become more educated about their health

and health problems and patient choice was introduced

to accommodate this change. Software has been intro-

duced to allow GPs to access secondary care clinic ap-

pointments and offer patients choice of hospital, clinic

and consultant.

Darzi proposes to develop this and allow patients choice

of GP and GP Surgery, but this has limitations which

have not been addressed in his report. For example, how

will we ensure adequate emergency care and home visits

to those living far away from the Surgery? What if pa-

tients chose to register at Surgeries near their work

place, how will they be cared for outside work hours?

Polyclinics or super surgeries:

Darzi has already pushed ahead with the development of

several large clinics which propose to house up to 25

GPs and provide some services currently offered in sec-

ondary care. In his final report he comments that patients

are “sometimes confused about which NHS service to

use” so why duplicate services to increase confusion all

the more.

With the government driven extension of current GP

opening hours, we will soon be providing the same dura-

tion of care, which polyclinics propose. In addition to this,

Davenport House Surgery and its community set up al-

ready provides the kind of services which he proposes

polyclinics will offer. Phlebotomy, anticoagulation, family

planning, women‟s health, leg ulcer clinics, asthma clin-

ics, vascular disease assessment, blood pressure clinics,

dietician, chiropody, health care promotion,

physiotherapy, minor surgery, acupuncture, osteopathy,

orthodontics, to name a few. So what will this promise

provide over and above what a good community Practice

already does? Darzi talks about patients needing

“personalised care” but how can this be provided by 25

GPs in a polyclinic on shift rotation where you‟ll be lucky

if you see the same doctor each time?

Ending the postcode lottery:

In this proposal Darzi focuses on the discrepancy in pro-

vision of certain treatment modalities from region to re-

gion in the UK. In tackling this problem, he has developed

the “NHS Constitution” which is set to ensure that all

drugs proven to be effective in the treatment of disease,

in conjunction with NICE „authorisation‟, will be available

to all who need them.

He hopes to achieve this by making local NHS bodies

more accountable, and empowering patients with regards

to their legal rights within the NHS.

Personalised health budgets:

Darzi proposes that by allowing patients to carry their

own personalised health care budget, they will achieve

greater control over their care. The hope is that with clear

safeguards, this will be piloted in certain patient groups

such as those with illnesses such as asthma or thyroid

disease.

Summary

While some of Darzi‟s proposals are to be credited, some

ideas seem fundamentally flawed. While he states that in

developing the report he has listened to the views of

more than 2,000 NHS staff and clinicians, we must re-

member that in his plans to develop a better service for

patients he has ignored a petition of more than 1.2 million

patients against polyclinics.

Some see his ideas as a drive for quality and a means of

ensuring the NHS is the best healthcare service in the

world, while others see it as a recycling of old commit-

ments with little to be delivered.

Fundamentally, the NHS always has been and still re-

mains a service provided by doctors, nurses and numer-

ous allied professionals, who care first and foremost,

while striving to deliver the best service they can offer.

This constant has remained, despite the continued ma-

nipulation of the NHS by politicians in exchange for their

short term electoral gain.

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THE DISTRICT NURSE TEAM REVERTS TO ITS “LINK” WITH DAVENPORT HOUSE

John Harris talks to Angela Price leader of the local District Nurse Team

After a period of uncertainty, manpower shortages and cost constraints the local District Nurse team, under the leadership of Angela Price, has restored its links with Davenport House Surgery. This team of 4 (Angela Price, Tracy Bennett, Mary Farrier and Sarah Grace) plus a nursing auxiliary (Carolyn Man-ley-Cooper) covers Davenport House and the Red-bourn Health Centre and is based in the Harpenden Memorial Hospital.

There are 3 other District Nurse teams based at the Memorial Hospital, two linked with other Surgeries and one responsible for residential homes in the area. This provides occasional overlap support for holiday and sickness cover.

Duty Times

Normal hours for the team are 8.00am to 4.00pm. In addition the team takes it in turns to provide occa-sional late duties 10.30am to 6.30pm, together with twilight evening shifts from 6.00pm to 10.00pm for urgent visits, which might for example be to sort out a blocked catheter.

There is an evening service provided by a separate team of nurses via the PCT. The aim is ultimately to achieve a 24 hour cover service.

Access

Patients are normally referred to the team by the GPs, Adult Care Services, Carers and Chiropody, although

direct access is available in case of need often iden-tified by a neighbour or family member/friend.

Services

The District Nurses provide a wide range of services to patients and the elderly in their homes with the following being examples:

Assessment of nursing needs post discharge from hospital after an operation or other treat-ment

Dressings, palliative care and removal of stitches/clips and/or catheter following surgery

Prevention of deep vein thrombosis medica-tion particularly post knee and hip operations

Leg ulcer care and assessment

Treatment of chronic problems for house-bound patients

Treatment of continence problems and educa-tion/help with a catheter

Crisis intervention in liaison with the GPs.

Contact

01582 460469

What is happening Beyond the Practice? By Malcolm Rainbow

I mentioned last time that we are looking at setting up a group to represent patients/users of health and social care services to work particularly with the Practice Based Commissioners for St Albans and Harpenden. (Roger Sage, the Chair spoke to us in July – See page 2)

We have received considerable support for the idea, (including from the PPG committee) and as result we have arranged a public meeting on Tues-day 23 September at 7pm in the St Albans Council Chamber. If you are interested in seeing what we can do together and how we can do it please come along.

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Davenport House Surgery’s Practice Manager of the Year

Anthea Doran

We are very proud to announce that on 2 July 2008 Anthea Doran, our Practice Manager, was awarded regional “Practice Manager of the Year”, by the Royal College of General Practitioners. We, of course, were not surprised, but are overwhelmingly pleased with her success.

Anthea Doran is a psychology graduate who moved from Marks & Spencer‟s into practice management. She had been living in Harpenden commuting to London when she noticed our advertisement, and recognised that she could manipulate her new bosses into providing her with a post that could ac-commodate raising a family whilst continuing in a stimulating and reasonably well paid post.

Realising that our previous Practice Managers had been a little disappointing, the Practice had em-ployed the services of Kathy Appleby, a practice management consultant and ex VAMP training man-ager, to oversee the selection process. She sternly warned us that we should not let Anthea‟s youth or appearance sway us when considering the finalists and, of course, we didn‟t!

She has been, quite simply, magnificent. She ar-rived at a time when the Practice had been bedev-illed by change over the preceding few years. The „new contract‟ of 1990, health promotion clinics and fund-holding, we had weathered them all, but we had no conception of what the future would bring. From FHSA to FPC to PCG to merging into a new PCT which then merged twice into our current PCT, and now commissioning, she has managed our business with quiet good humour and patience. Lloyd George to Windows, memos to e-mails and consultants to counsellors, she has steered the changes, allowing us to continue consulting in peace and quiet. Her skills are such that the local VTS regularly invites her to hold sessions on Prac-tice Management, and I know her handouts at these sessions have been filched by trainers who surrepti-tiously sneak them home for further study!

The partners may be very good doctors, some spe-cialising in certain medical fields, others preferring

IT or teaching or some such. However Anthea is the generalist par excellence. She can read the balance sheet, support a distressed receptionist, explain the computer‟s misbehaviour („you do need to log on with your own password, Dr!‟), negotiate with a pharmaceutical company, sort out the hospital... and that‟s before coffee!

But above all this, tran-scending the manage-ment of the business, and the personnel manage-ment, she supports the partners. As one would expect in any partnership, the years have provided highs and lows, stresses and anxieties, births and bereavements. Quietly and efficiently she antici-pates the issues and ac-commodates. She‟s

there. She manages.

We should all, patients, partners and staff alike be very proud of Anthea‟s accolade. She truly is more than deserving of it.

EDITOR’S COMMENTS

This edition has been designed by the editor using Microsoft Publisher, with support from Media Print Ltd, in order to reduce the costs of producing the Newsletter.

As this is a new learning experience any help which PPG members could provide, particularly if they have expertise would be appreciated.

Please contact John Harris on 713246.

Explanation of the various acronyms

VAMP Name of our old computer sys-tem now called Vision

FHSA Family Health Services Authority which transferred into

FPC Family Practitioner Commit-tee which changed into

PCG Primary Care Group which is now the PCT!

Lloyd George The A5 envelopes in which the pa-per copies of patient's records are kept and used before everything went on computer

Local VTS Vocational Training Scheme All

trainee GPs are attached to a VTS that oversees their training

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Skin Problems

Led by Dr Chas Thenuwara

A report of the Small Group Meeting by Sheila Uppington

Dr Thenuwara proved himself to be a real expert on a wide range of skin conditions as he patiently an-swered all our queries after an initial presentation on common dermal problems.

He gave us many excellent tips, some of which are listed below –

Avoid too much sun, especially between 11-3pm, as it is a major risk factor in skin dis-ease.

Always apply sun cream (more than SPF 15) before going out in the sun and remember its protection does not last long. Sun cream itself has a shelf life of no longer than 2 years.

When rubbing in any cream rub with the grain of the skin – i.e. around the legs and arms, not up and down.

Wet clothes absorb more UV light than dry ones. Sun hats and clothes-covered skin are sensible on bright days.

ABC to help think about whether skin blem-ishes need fast diagnosis. The danger signs are: A, if asymmetrical, B for border if irregular or a bit stretching out at an odd angle and C for colour when it is dark and not uniform. But any worrying mark that changes or doesn‟t go away after 2 months should also be checked out.

All skin, but particularly ageing skin, needs

moisturising. Lotions contain the most water, creams in the middle and ointments the least but most „grease‟. So the drier the skin the more „grease‟ is needed to keep the water in the skin and thus moisturised.

Allergic skin reactions are of 2 types. Irritant dermatitis (e.g. from chemicals) so stay away from the irritants once identified! Or allergic contact dermatitis. To isolate allergens try keeping a diary of food eaten, and activities, to see if any link with flare ups of eczema. Some-times a patch test is used to help identify aller-gens. There are various prescription prepara-tions that can help in treatment. But moisturis-ing is again important and can help to protect skin from irritants e.g. chlorine in a swimming pool.

To prevent skin irritation pat dry after washing rather than rubbing.

Athletes‟ foot can be treated but fungal infec-tions of the nail are much harder. Urea in foot creams breaks down tough skin.

Our sincere thanks must go to Dr Thenuwara for giving us such an informative evening. And don‟t do what I did afterwards, which was to take all the infor-mation to heart. Greased up with high factor sun-screen, wearing a long sleeved top, a wide brimmed hat, and then onto the allotment, where I got a red strip across my hips from where obviously the top came untucked while I was bending over weeding!

Paying Subscriptions in 2009

From next year beginning January 2009, the PPG annual subscription payment will increase to £10 per household. Members can choose to pay this by standing order, cheque or cash, but it helps us to restrict costs if as many members as possible pay by standing order.

The change in subscription rate means that we will have to ask every person who pays by standing order to complete a new standing order form. We will circulate these new forms to you with the December 2008 Newsletter and we would be very grateful if you could complete and return them to us as soon as possible thereafter.

To complete the new form, all you have to do is fill in the name and address of your bank branch, print your name, sort code and account number, then sign the form and return it to us via the PPG postbox in the surgery. This will automatically cancel your existing PPG standing order and establish the new one.

We will provide full instructions with the December Newsletter and we greatly appreciate your help in completing the new standing order forms.

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HAVE YOU HEARD OF HARPENDEN PHOENIX HOLIDAYS?

Harpenden Phoenix Holidays (HPH) is a local regis-tered charity, which is run by an active Committee, and a bank of volunteer helpers. We provide the opportunity for local severely disabled adults to take a group holiday to a suitable European destination, using specially adapted transport. The essence of these holidays is fun, fun, fun! And we have plenty of it.

Our travellers‟ medical conditions and disabili-ties are varied. They might be sufferers from MS, severe arthritis, strokes or indeed people with other life threatening conditions. The common factor is that they are not able to take holidays without the assistance of carers.

It is not easy to find a holiday venue where one can enjoy a relaxing break which includes safe, comfort-able transport, one to one 24 hour assistance from an able bodied helper, and at a reasonable cost to boot! So, Harpenden Phoenix Holidays provides ex-actly that! The holidays leave as a group of people and come back as one happy family!

Our trip to Lofer Austria 2007

An able-bodied volunteer helper accompanies each disabled traveller (we call them VIPs) day and night throughout the duration of their holiday. Any neces-sary medical and practical assistance that might be needed is on the vehicle, which remains with them during the trip and is used for excursions. Each ho-tel is selected for its suitability and facilities provided to ensure that great fun is had by all and a qualified nurse accompanies each holiday.

Whilst holidays are a major part of HPH‟s work, throughout the year various social events and day trips are also arranged, again utilising specially equipped transport. These trips are well suited for those people who believe that a trip abroad might not be ideal for them, and gives them a great

chance to meet the volunteers and make friends with other travellers. The Committee and Trustees go to great pains to select practical disabled-friendly destinations and suitable environments to make a day out a day to remember.

Some of the day trips we have enjoyed were to Wis-ley, the BBC, Houses of Parliament, Kew, London Zoo, The London Eye, just to mention a few. Thea-tre trips are also arranged and again these are all run on the same basis of one to one assistance from our volunteers.

At the end of the year, our VIPs and volunteer help-ers all look forward to getting together at our re-union meals to chat over the great times they have had with us, and are keenly discussing the plans for the forthcoming trips and holidays.

It takes a huge amount of effort behind the scenes to raise the funds to subsidise heavily each trip. But by continuing our efforts, we are able to pay half the costs of each trip, therefore making a holiday afford-able to each traveller.

If you are a local person who is unable to take a holiday or day trip due to your medical condition and feel you might benefit from one of our holidays or days out, in the first instance you can contact John Favell on 01582 764179. Arrangements can then be made for one of our volunteers to arrange an infor-mal meeting with you to tell you more about what we do.

HELP!

Perhaps you are an able bodied adult and feel you are able to contribute by coming forward as a volunteer helper. We would love to hear from you. Even if you feel you could only ac-company a VIP on a day trip with our group, come with us and see what it’s all about. All you need is a caring, responsible attitude and a sense of fun! It is a good opportunity for school leavers entering medical/nursing careers to

gain first-hand experience!

We are also looking for volunteers to join our Committee and help behind the scenes, or join our fundraising team. If you feel you can help in any way, please again contact Mr John Favell

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FLU VACCINATIONS are offered at dedi-

cated flu clinics during the first two weeks of October to all those falling within the government identified “at risk” groups being patients who are:

Over 65 years at 31 March 2009

Have chronic diseases such as diabetes, chronic obstructive pulmonary disease, chronic liver disease, heart conditions and the immunosupressed

Carers

Bookings will be taken from the second week in September. Please phone after 11.00am when the lines are less busy. If you need a GP appointment during October let us know if you are an “at risk” category, so we can arrange for your GP to vacci-nate you to save a second visit.

Housebound patients will be immunised by the dis-trict nurses if they are on their caseload. Other housebound patients should contact the Surgery to request a vaccination where we will arrange for a GP to visit.

Pneumonia vaccinations are also offered, but can be undertaken at any time of the year for the same “at risk” groups, excluding carers.

TRAVEL VACCINATION ADVICE from the

Practice nurses for a family of four requires about an hour of nurse time so you should aim to book at least 3 weeks ahead. In addition, the recommended vaccinations for the more exotic locations can ne-cessitate a course of treatment over a period, so plan ahead to ensure that this can be completed. Further advice is on the PPG website

www.davenporthouseppg.org.uk

ALL CHANGE AT THE PRACTICE!

Dr S Ozturk who has been with us for the last year has qualified as a GP and is leaving to take up a salaried position in Southend.

Dr L Gosnell and Dr S Shaikh who joined us in February are retuning to hospital but will be back in February 2009 to complete their final year GP train-ing with us.

Dr H Wagstaff who has been with us as an F2 doc-tor for the last 4 months will stay with us for a fur-ther 6 months as she starts her GP specialism.

We welcome Drs T Haider and R Srivastava who will both be with us for 1 year whilst they complete their GP training and also Drs K Sangary and S Mirza who will be with us for 6 months as they start their GP training.

Finally Dr L Menozzi will be with us for 4 months. With so many learners in practice it is going to be a very busy 6 months!

We have also had some changes to our admin staff. Joanna Hogan has been with us for 3 months to help us get ready for all the new learners, but will leave us at the end of August to return to Australia. We also have a new prescription clerk Alison Weaver who handles up to 150 prescription re-quests each day.

APOLOGIES to all patients who have had prob-

lems when using our website to order repeat pre-scriptions, which have been caused by problems with our Internet Service Provider (ISP). This will be resolved by the time you read this Newsletter. Guid-ance on the repeat prescription service is also on the Surgery website.

PPG EDUCATION MEETINGS Monday 20 October 2008

Open PPG Members‟ meeting commencing at 8.00pm at Fowden Lecture Theatre, Rothamsted Experimental Station on “Pain Relief” covering pain generally and pain control if necessary towards the end-of-life. Speaker will be Dr Ros Taylor from St Francis Hospice, Berkhamstead.

This is an open meeting which is free for all PPG members. (Please separate notice)

Tuesday 4 November 2008

Small Group Meeting “A discussion on General Mental Health Issues” by Dr Kirston Lamb com-mencing at 7.30pm at the Surgery which may be attended by PPG members by application.

Please drop a note in the PPG letter box in the Sur-gery (or post it to the Surgery) quoting your name and address if you would like to attend. Otherwise contact Sheila Uppington.

NEWS FROM THE SURGERY

Anthea Doran, Practice Manager