GP Matters is now available electronically. Our newsletter is emailed to all Practice Managers to be circulated down to GPs and other practice colleagues. If you would like us to send these to you directly, email gpmatters@nuth.nhs.uk and we will add you to our direct mailing list.

Update for GPs from The Newcastle Hospitals

Newcastle has been granted the first licence by the Human Fertilisation and Embryology Authority (HFEA) to offer a fertility treatment to mothers affected by mitochondrial disease.

The successful licence application means that from this year, women will be able to receive this treatment as an NHS service at the Newcastle Fertility Centre and the NHS Highly Specialised Service for Mitochondrial Disease.

Professor Mary Herbert who is based at the Newcastle Fertility Centre and works with the Wellcome Centre for Mitochondrial Disease at Newcastle University said: “The team here at the Newcastle Fertility Centre is delighted with the HFEA’s decision to grant our clinic a licence to offer treatments to prevent transmission of mitochondrial DNA disease. Many years of research have led to the development of pronuclear transfer as a treatment to reduce the risk of mothers transmitting disease to their children.”

Newcastle awarded world’s first mitochondrial licence

To find out more about this and other stories, go to the News section of our website www.newcastle-hospitals.nhs.uk

Issue Twenty three - August 2017

Also inside...

Plus

Newcastle acute oncology service

Urgent Access ServicesAdvice and Guidance @ The

Newcastle Hospitals

GP Communications - an update

Newcastle dermatology ‘self-funded’ treatments

Consultant First - Orthopaedic spinal e-Referral process

New plastics BCC clinic

2

In response to national reports, including NCEPOD and peer reviews nearly 10 years ago, Cancer Networks across the country set up Acute Oncology Groups to develop more systematic approaches to supporting patients presenting with acute problems caused by their cancer and its treatment.

The North of England Cancer Network set up a region-wide Acute Oncology Group which established comprehensive Cancer Clinical Guidelines and an infrastructure allowing all hospitals with emergency departments to introduce an Acute Oncology Service (AOS).

Newcastle’s AOS looks after: • Patients with a new cancer

diagnosis to give advice with regards to investigations, pathway and MDT referrals, complications of cancer and disease progression.

• Any patient presenting to emergency services if receiving, or within six weeks of finishing, systemic anti-cancer treatment (SACT) or radiotherapy, or who have participated in clinical trials.

• Patients receiving immunotherapy or within 12 months of completion of their treatment.

The team is led by three nurse specialists and two consultant oncologists who provide support and advice for patients being treated at

the Northern Centre for Cancer Care (NCCC) with acute cancer-related problems.

They are made aware of all patients receiving systemic anti-cancer treatment, radiotherapy, immunotherapy, and those who are partaking in clinical trials at NCCC, and have access to patient treatment details, so should they receive a call they can instigate rapid response care according to where the patient lives.

Dr Chris Jones, Consultant Medical Oncologist says: “There are a whole range of issues which can affect patients undergoing cancer treatments, some of which need immediate assessment and attention. “For example, myelosuppression is a specific issue we need to keep an eye on as development of neutropenic sepsis can be deadly and would require rapid administration of IV anti-biotics.”

Newcastle’s AOS is proud to have extremely low emergency admission rates and believe they have contributed to giving cancer patients a better quality of life during and immediately after their treatment.

Nurse Specialist Julie Huggan explains: “We spend a great deal of time providing advice to both our patients and GPs. We know from feedback that patients feel supported

and we very much hope our colleagues in primary care feel they have access to the expert advice they need so that we can collectively ensure the best possible outcomes for our patients.”

NCCC’s 24/7 helpline for patients on treatment or within the timescales specified, is for both primary healthcare professionals and patients and is staffed Monday to Friday 9am-5pm by the AOS. Other senior cancer nurses manage the system out of hours.

Newcastle acute oncology service

Leading authorities on infectious diseases and immunology at the Great North Children’s Hospital (GNCH) are taking part in an international EU funded mission to develop a rapid test to diagnose life-threatening bacterial infections.

The aim is to develop a simple, two hour blood test which can determine whether a feverish child has a common virus or a life-threatening bacterial infection.

Currently, a scoring system helps staff identify which children may be at higher risk of a bacterial infection.

They are given a test to confirm bacterial infections which can take up to 48 hours. Because of this antibiotic treatment is automatically started in some children.

Dr Marieke Emonts-le Clercq, consultant paediatrician specialising in infectious diseases at GNCH said: “We have been able to identify two genes, one which becomes activated by the child’s immune system when they have a bacterial infection and the other when they have a viral infection.

“If the condition of the genes can be tested rapidly through a blood test,

we can be confident of getting the right treatment started immediately.

“Patient inclusion has already started in our hospital so parents and their children attending A&E might be asked if they are willing to take part in this exciting research.”

Childhood experts in bacterial infections mission

Newcastle upon Tyne’s emergency helpline for oncology patients is: ( 0191 213 9302

Dr Marieke Emonts-le Clercq

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All NHS organisations across the North East and beyond are continuing to experience high levels of urgent care activity, even during the spring and summer seasons.

Once again we would like to emphasise the range of clinical services available to GPs when making urgent referrals to the Newcastle Hospitals.

Last year we sent out an A5 laminated, ‘quick at a glance’ sheet of useful contact details which aims to help our primary care colleagues to seek alternative admission services for urgent patients at the Newcastle Hospitals.

It was produced with the intention that you carry it with you at all times and have it to refer to, whether in your practice, or in a patient’s home.

These key services can be contacted when you need to arrange rapid referral to specialist care in one of our community or secondary care based services, and can be an excellent alternative to emergency admission for some patients. They include:

The Ambulatory Care Unit – for patients who are ambulatory and would benefit from urgent assessment or investigations which can be booked for the same day or following morning;

Our Emergency Medical Opinion Line – direct communication with a Consultant in Acute Medicine about a potential admission;

Community Response and Rehabilitation Team (CRRT) – providing community based responses for patients who are frail and vulnerable, often with complex health and social care needs;

Rapid Assessment in Care of the Elderly (RACE) – rapid MDT assessment for early stage concerns.

Making use of all these services will help us to free capacity in our Emergency Department.

Urgent Access Services @ Newcastle Hospitals

GP Communications - an update

Improving communications between ourselves and colleagues in primary care remains a key priority. In recent months we have been working hard with all clinical leads for health informatics to implement improved electronic clinical documentation

The benefits of doing so are multi-faceted including prompt communication of clinical information following a hospital episode, so that GPs have up to date information regarding their patients’ conditions and management plans.

At the current time we are routinely sending electronic discharge summaries from wards and our Emergency Department at the RVI, as well as notification of both elective and emergency admissions via e:Record. This is working well.

We have now also rolled out electronic ‘Notification of Serious Diagnosis’. GPs will notice new cancer diagnoses in the main but you should start to see notifications for serious, non-malignant diagnoses as well.

If your Practice does not use ICE, you will continue to receive paper documentation.

Discharge SummariesWe are now in a position to produce new electronic discharge summaries in a slightly different format to what you are used to seeing. We hope the new layout, which complies with the Academy of Medical Royal Colleges’ guidelines, is more helpful. Medication details will now be incorporated, rather than added to an additional document. This will start to be introduced for the new junior doctor induction in late July.

Clinic LettersOur plans to send out clinical letters electronically are also progressing and will start soon for two of our haematology clinics, expanding to all haematology and oncology clinics, followed by dermatology. All being well, we will expand this roll out to send electronic clinic letters from all areas across the Trust by the end of the year. We will let you have specific dates before these documents are sent electronically.

If you require any additional copies contact: Lynn Watson, communications officer * lynn.watson@nuth.nhs.uk

We do hope this update is useful but if you have any queries or need further information please contact:

Dr Nick Thompson, consultant gastroenterologist * nick.thompson@nuth.nhs.ukGill Bewick, senior nurse, clinical informatics * gill.bewick@nuth.nhs.uk

4

In this issue we feature the allergy advice and guidance service:Newcastle’s immunology and allergy medical team now offer specialist advice for adult patients:

• experiencing episodes of spontaneous urticaria or angioedema • experiencing chronic spontaneous urticaria• who have experienced large local reactions to insect bites or stings• being considered for an adrenaline autojoiner• whose symptoms of allergic rhinitis are not controlled • interpretation of specific IgE results

In order to offer the most appropriate advice, please provide as much clinical history as possible along with a medication list including ‘as required’ medications where known.

We will respond within seven working days.

Our advice and guidance services on the NHS e-Re-ferral system offer great support for GPs with pa-tients who may not need a formal referral, but would benefit from specialist advice.

The benefits of advice and guidance (A&G) include:

• rapid opinion and management advice • better access to hospital appointments for patients who

need it • reduced inconvenience related to travelling to hospital • improved health service resource

Clinicians at the Newcastle Hospitals currently offer A&G in these areas:

• allergy• dermatology • haematology• neurology and neurology related Insomnia• ophthalmology

We are hoping to expand the number of specialties who offer advice and guidance in the coming months.

We are delighted to have appointed a further immunology consultant to the department.

Dr Shanti Mahabir, who was a trainee in Ireland, will be working alongside Dr Catherine Stroud (head of clinical immunology department), Dr Helen Bourne (head of laboratory immunology department) and Dr Gavin Spickett (consultant clinical immunologist).

Our team of nursing staff is now complete with the appointment of a new clinic sister, and an additional band 5 nurse.

This will allow our specialist nurses to further develop the services they offer including outpatient appointments for food and inhalant allergies as well as therapies such as inhalant and venom desensitisation, local anaesthetic allergy testing and training for patients with immunological therapies at home.

Immunology and allergy news

For further information please contact Dr Catherine Stroud, consultant immunologist ( 0191 282 5517* catherine.stroud@nuth.nhs.uk or catherine.stroud1@nhs.net

Advice and guidance @ the Newcastle Hospitals

Immunology and allergy team

5

How the system works:We require GPs to refer patients following the steps outlined below:

• Open e-Referral system in the normal way• Enter ‘Priority, Specialty = Orthopaedics and Clinic Type = Spine – Back Pain, Spine – Neck Pain, or Spine –

Scoliosis and Deformity’. • Press ‘Search All’• The ‘dummy’ service will be displayed as: ‘Orthopaedic - NUTH RMS Adult Spinal - Royal Victoria Infirmary -

Newcastle FT – RTD’ • Select the service and select ‘Appointment Search’• Select an appointment date and time (this will be from midnight onwards), then ‘Book’• Select ‘Submit’, then ‘Add Referral Letter’• Press ‘Close’ once the referral letter has been added

Once received, all referrals will be triaged in the normal way and the most appropriate appointment will be made for the patient as soon as a clinic slot becomes available. Details are sent directly to the patient.

Please note: In order to minimise any potential confusion for patients, NO documentation should be sent to patients relating to their ‘dummy’ appointment, ie. booked into the relevant clinic from midnight onwards.

We would ask that when booking the ‘dummy’ appointment, GPs inform their patient that whilst they do not yet have a booked appointment, they will receive a letter from the Newcastle Fracture Clinic in due course advising them of their true appointment or other recommended course of action.

In our last issue of GP Matters we introduced the new “Consultant First” service in dermatology. We now offer the same e-Referral process for orthopaedic spinal. The pressures on spinal services across the UK are well known, and for orthopaedic surgeons in the North East this is no exception. Due to the constraints of the NHS e-Referral system, the Newcastle Hospitals is unable to view referral letters if the patients do not already have an appointment. It is therefore not possible to triage these referrals in the usual way - a contributing factor as to why e-Referral has not previously been provided in the orthopaedic spinal department.

In an endeavour to tackle this problem and make electronic referring to the orthopaedic spinal surgeons available to GPs, we have introduced a new referral management service known as “Consultant First”. This approach enables GPs to refer patients in the usual way via e-Referral, but into a ‘dummy slot’.

The orthopaedic spinal surgeons view the referral information and make a decision on the best way forward for each individual patient.

“Consultant First” Orthopaedic spinal e-Referral process

We do hope this is helpful but if you have any queries please contact our e-Referral Team:

Lawrence White, NHS e-Referral Service Manager((0191) 244 8632 * lawrence.white@nuth.nhs.uk or lawrencewhite@nhs.net

Rachel Beynon, Senior Application Support Officer ((0191) 282 0914 * rachel.beynon@nuth.nhs.uk or rachelbeynon@nhs.net

6

The Newcastle Hospitals’ plastic surgery department is now offering assessment of basal cell carcinoma (BCC) and other lesions, not including squamous cell carcinoma (SCC) via e-Referral.

Patients who should be referred• patients 16 and over • patients with skin lesions

Patients not suitable for referral • patients under 16• patients with suspected SCC

Very few skin conditions are now approved for NHS laser treatment and as a result, an increasing number of patients are considering a self-funded route in order to access treatment.

In response to this, Newcastle dermatology has developed a range of self-funded laser treatment packages for those services currently excluded from NHS contracts. Patients will be able to access high quality treatments from qualified and experienced practitioners, at a reasonable cost and in a safe environment.

The following services are now available to patients on a self-funded basis:

• laser hair removal • laser tattoo removal • skin rejuvenation • vascular lesions including facial telangiectasia, rosacea

vessels and spider naevi

Charges are calculated per session and the exact details of prices and the number of sessions likely to be required will be discussed with patients at their initial consultation.

For further information on the treatments available including costs please contact: * laser@nuth.nhs.uk

The Newcastle Hospital’s dementia care team has launched a Memory Café to support patients with dementia, their families and loved ones.

The cafe is held at the Melville Day Unit at the Freeman Hospital on the first Friday of each month and is aimed at newly diagnosed patients and their families.

Paula Coulson, associate nurse consultant vulnerable older adults said: “We are delighted to be launching the Memory Café at the Melville Day Unit.

“The purpose of the café is to provide patients and their carers with an opportunity to meet with one another in a relaxed environment to share their experiences.

“We hope patients and their carers will help us to shape future events and enjoy sharing their stories over a cup of tea.”

New plastics basal cell carcinoma clinicFor any queries or comments please contact Lawrence White, e-Referral service manager(0191 244 8632 *lawrence.white@nuth.nhs.uk or lawrencewhite@nhs.net Lorraine Ormond, appointments manager(0191 282 9514 *lorraine.ormond@nuth.nhs.uk or lorraine.ormond@nhs.net

Newcastle dermatology ‘self-funded’ treatments

To find out more please contact:(0191 213 7109

L-R: Susan Hall, Lynsey Drew and Gillian Crammen, nurse specialists dementia

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British Heart Foundation Cardiac Genetics Nurse, Julie Goodfellow, was recently presented with a prestigious Clinical Excellence Award from national charity Cardiomyopathy UK. The Award recognises her involvement with the charity in supporting and informing patients with the heart muscle disease cardiomyopathy, and follows countless nominations put forward by the many patients who have benefited from her care.

Julie’s role at the Freeman Hospital is to provide assessment and support to families and individuals with suspected inherited cardiac conditions, providing tailored education advice and support.

Of her award she said: “In my 30 years as a nurse, I have never been more chuffed with something that I have achieved. It is even more humbling to know that I was nominated for this award by my patients. It has made me feel truly valued for the work I do.”

The Newcastle Hospitals’ Prostate Cancer UK Survivorship programme provides support and practical help for men following treatment for prostate cancer.

The service has become a routine follow up for men who undergo surgery for prostate cancer and has now been extended to include men who have received any treatment for prostate cancer.

In collaboration with Maggie’s Newcastle, regular six-week courses run throughout the year offering one-to-one clinics and dedicated clinics for sexual function.

Each week a small group of men are given two informal talks on topics relevant to prostate cancer as well as providing education and information.

Alongside the six-week courses, the programme also runs one off education events, allowing those who live further afield, or who can’t commit to the six-week course to gain access to information and support.

Sister Jill Ferguson, Prostate Cancer UK survivorship nurse specialist said: “The service gives men the opportunity to ask as many questions as they like in a friendly, non-clinical setting, often sharing their experiences with others, which many men have found useful.

“It has been shown to lower anxiety, helping men focus on moving forward following a prostate cancer diagnosis.”

For further information contact Sister Jill Ferguson ( 0191 244 8280* Jill.ferguson3@nuth.nhs.uk

Putting patients at the heart of everything we do

Newcastle’s heart experts are pioneering new treatments for atrial fibrillation, the leading cause of stroke and heart failure. The Freeman Hospital is one of only 16 centres in Europe able to offer the cutting edge mapping system called the AcQMap, a basket-style wire that is placed directly into the heart chamber via the groin.

Once there, the wire expands into a spherical shape, studded with both electrodes, and tiny ultrasound crystals. These work in combination to measure the size and shape of the heart chamber, then simultaneously

record the waves of electricity that travel through the heart.

Recordings are made 5 times per second allowing the cardiologist to understand each individual’s abnormal rhythm and then go on to treat it, specifically to them.

Dr Stephen Murray, consultant cardiologist and rhythm specialist is leading the research at the Freeman Hospital. He said: “This system has the potential to design bespoke treatments for patients undergoing ablation treatment for persistent atrial fibrillation, and in doing so hopefully increase the chances of a successful outcome.”

The group meets at the Maggie’s Centre at the Freeman Hospital on the fourth Tuesday of the month: 1.30pm - 3.30pm

Julie Goodfellow

Dr Stephen Murray with the AcQMap

Sister Jill Ferguson

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NEW Consultant Appointments

Mr Richard Brady is the newest colorectal surgeon to join the Newcastle Hospitals. Specialising in laparoscopic colorectal surgery, inflammatory bowel disease, proctology and hernia and abdominal wall reconstruction, Richard says it wasn’t just the warmth and energy of the people of Newcastle that attracted him back to the City.

He said: “Newcastle Hospitals provides a colorectal service with great expertise and focus on progressive improvement and excellence. It has a national reputation for the quality of its surgical outcomes and I’m very proud

to join a team that delivers one of the best and most effective national services for patients with colorectal or inflammatory bowel disease.

“I will work within the wider service to provide fast, high-quality, open, engaged and approachable care management with a focus on providing the right treatment at the right time, and achieving the very best outcomes.

“We hope to bring in new ways of working in the future to facilitate joint decision making and ensure a strong network or support to our patients and the wider healthcare team in contact with them.”

Dr David Brass is the latest consultant to join the Newcastle dermatology team.

His specialist interests lie in the field of cutaneous oncology and dermatological surgery.

Originally from South Manchester, David joins the team at the RVI having completed a fellowship in Mohs micrographic surgery after obtaining his Dermatology SrP number and CCT here in Newcastle.

On joining the Newcastle dermatology

team David said: “I’m excited to be part of the dermatology team here at the Newcastle Hospitals.

“Although I have family ties in the North East, as my wife is from Stockton, I was primarily attracted to Newcastle based on the Trust’s reputation for training excellence in dermatology and dermatological surgery.

“I also enjoy teaching and aim to take an active role in postgraduate education.”

Consultant neonatologist Rob Tinnion has joined the Newcastle Hospitals from James Cook University Hospital

As well as working on the region’s largest neonatal unit at the RVI, Rob has been appointed as medical lead for the Northern Neonatal Transport Team (NNeTS) with overall responsibility for the North East’s newest clinical transport team.

On joining the neonatology team Rob said: “The department in Newcastle is the busiest in the region and is linked with the regional fetal medicine centre and

paediatric surgical services also based at the RVI, and so we deal with the widest range of perinatal and neonatal conditions possible.

He adds: “As a renowned centre of cutting edge research and pioneering practice, joining the team gives me to chance to practice neonatal medicine to the highest of standards.

“Over the next few years I hope to help develop the NNeTS team into one of the nation’s leading and most innovative neonatal transport teams.”