Briefing: Update on LIVI and primary care access in North West Surrey
Sent on behalf of NICS – GP Federation
30 November 2022
Patients in North West Surrey will be able to access free LIVI video GP consultation services until 31 March 2023.
This follows information shared recently about a decision made by GP practices in North West Surrey to discontinue LIVI over time due to the rising costs of this service meaning it offers less value for money for patients.
As background to this decision, practices in North West Surrey have been reviewing how patients access services and are introducing some changes in response to patient feedback.
The key changes are:
- Providing more face-to-face appointments in the evenings and at weekends through acute illness hubs, based at Ashford Hospital, St Peter’s Hospital and Woking Community Hospital. These appointments are available now and can be booked via the patient’s GP practice (there is no walk-in facility for this service).
- Introducing a new service called Rapid Health that allows patients to directly book and manage their own appointments for a range of different practice services. In early 2023 Rapid Health will enable patients to initiate their own care for services such as first contact physiotherapy, immunisations and cervical smears.
Extending the availability of LIVI until March 2023 means patients can benefit from this service while the wider changes to accessing primary care services are embedded.
GPs and Consultants Networking evening
Save the Date:
Tuesday 13th December 2022 6.30pm for welcome drinks, speakers from 7pm onwards
Location: DoubleTree Hilton, Victoria Way, Woking, GU21 8EW
https://www.hilton.com/en/hotels/xwowodi-doubletree-woking/
Further information including finalised agenda to follow but please put the date and time in your diaries and share with any colleagues who would be interested in attending.
For any further information please call us on 01932 722420 or email on asph.gphelp@nhs.net
Radiology waiting times
Please note that waiting times for radiology are currently at around 6 weeks.
Duplicate Audiology Referrals
We are having increasing issues with GP’s re-referring Audiology patients to us via eRS when the patient has already had their triage appointment.
If a patient returns to your practice saying that they have not had an appointment, please check with them whether they have had a telephone consultation. If they have, they are on a waiting list for a test. This wait is currently around six months, although we do triage for red flags at the call, for example patients who really need to see an ENT surgeon and not an audiologist, or dual sensory loss.
If the patient has not had their triage appointment, then please chase the referral with us before sending a repeat request, so that we can check whether it has been received.
Please do not make a repeat referral, as this will only result in a wasted second triage appointment, and a longer wait for other patients.
Please remember that existing patients can contact the audiology team directly on asp-tr.hearing@nhs.net or 01784 884156. No repeat referral is required.
This message has also been emailed to all NW Surrey area practice managers on Friday 12/8/22.
Update re the Non-Specific but Serious Symptoms Clinic (NSSSC)
We are pleased to announce that the NSSSC has re-opened and referrals can be made using the updated referral form. Please search 2WW – Adult Non-Specific But Serious Symptoms in the document template finder on EMIS. Please note the patient information leaflet (PIL) has also been updated.
Due to current capacity issues the clinic is unable to operate under the previous model and certain changes have been made to the referral process. Please ensure that you complete ALL sections of the referral form and provide ALL supporting information. Any referrals received without the appropriate information will be returned to the referring clinician.
Please make special note of the following:
- Complete the QCancer score using the EMIS template.
- Send the full details of the QCancer score breakdown (this can either be drawn in to the referral form as a consultation or be sent as a separate document).
- Your patient will be contacted within TWO working days of receipt of the referral and they should be offered an appointment within the next week (including CT scan where appropriate). Please provide them with the new updated PIL.
- Please ensure that the patient has had ALL the requested investigations prior to referral since this will aid triage and appropriate further tests:
- FBC, U+E, LFT, Bone profile, HbA1c, TFT, CRP, coeliac antibodies, serum amylase, GGT, INR, CA125 (female), PSA (male), HIV, haematinics, serum protein electrophoresis
- FIT where appropriate
- Referral criteria include a QCancer score of 3% or greater with one or more of the following:
- Unexplained and unintentional weight loss (either documented > 5% or with strong clinical suspicion), not previously investigated.
- Significant generalised fatigue / malaise together with one or more other criteria on this list
- New onset or unexplained worsening breathlessness, where heart failure and non-malignant lung disease have been excluded, together with other criteria on this list (note that previously diagnosed cardiac or lung disease does not preclude referral)
- Suspicious but non-specific and non-resolving constitutional/abdominal symptoms, for 4 weeks or more (less if very significant concern), for example persistent nausea, loss of appetite, pain, steatorrhoea (in absence of chronic pancreatitis), abdominal distension, constipation. Please state symptoms and length of symptoms.
- Persistently abnormal laboratory tests which are not readily explicable including:
- thrombocytosis (> 400 x 109/l) (persistent for >6 weeks; infection and inflammatory disease thought clinically unlikely)
- alkaline phosphatase more than twice the upper limit of normal
- significantly raised CRP (or ESR corrected for age) and infection/inflammation thought clinically unlikely
- hypercalcaemia
- Unexplained new or progressive pain (including bone pain for four weeks or more)
- Persistent dyspepsia ongoing for 8 weeks despite normal UGI endoscopy
- Painless jaundice without apparent cause
- Significant GP concern/ GP “gut feeling” regarding a possible cancer diagnosis where there is no clear urgent referral pathway (for example unexplained thromboembolism, paraneoplastic syndrome, new onset diabetes without weight gain; please confirm details in free text box below)
- Referral is due to clinical concerns that do not meet the above criteria (GP must give full details in the ‘additional clinical information’ box at the time of the referral)
- Please note only referrals with a QCancer score of 3% or greater will be accepted. Should you have concerns about a possible malignancy with a value less than 3% then use the closest TWR referral route detailing why you are referring and what your suspected diagnosis is.
- Please consider the Rapid Access Older Person Clinic or the local hubs for frail elderly patients if appropriate.
Please contact Ishbel Davis, NSSSC Coordinator, with any questions.
Telephone: 01932 723105
Email: asp-tr.nsssp@nhs.net
Please ensure the previous version of the NSSSC referral form is deactivated & archived within your practice EMIS.
Please contact NWS RSS (syheartlandsccg.wrss@nhs.net) if you require any support regarding referral forms
Update on Ultrasound Services
Due to the current increased demand for ultrasound we have commissioned some additional activity through Diagnostic World. This will reduce the waiting time for patients who have been referred for a routine ultrasound by yourselves. We would be grateful if you could highlight to your patients when you refer for an ultrasound that they may be contacted by Diagnostic World and have their diagnostic test at a community site.
Please note the activity that Diagnostic World are delivering is over and above the activity that you have commissioned with the provider and you should continue to utilise their community capacity as normal.
Ashford and St Peter’s Specialist Menopause Clinic
Most women with menopausal symptoms can be managed in primary care. Patients can be referred to Miss Sadiya Hussain- a gynaecologist and menopause specialist for management in Ashford and St Peter’s Hospitals.
https://thebms.org.uk/clinic/menopause-clinic-6/
They will need to meet the following criteria:
- Primary care management has been proficient but failed to provide sufficient relief in symptoms. Management to-date needs to be adequately documented in the referral letter OR
- Management is too complex to be undertaken in primary care. Reasons for this need to be carefully documented in the referral letter
OR
- Where there is Premature Ovarian Failure (<40y) and the patient would like to conceive.
In this case use:
| Menopausal | – Age 45 or over
– Symptoms significantly affecting quality of life |
| Multiple treatment failure | – 3 or more regimens tried
– List types of HRT attempted and detail problems experienced |
| Venous Thromboembolism | – Personal history/FMH in a 1st degree relative
– History of event |
| Osteoporosis | – Confirmed or high risk eg POI, steroid use
– Positive FMH in a 1st degree relative – Low body mass index – History of traumatic fracture |
| Previous or high risk of hormone dependent malignancy | – Eg. Breast/ovarian/endometrial cancer |
| Other | – Eg. Patient or GP directed
– Multiple comorbidities |
POI / Hypothalamic Amenorrhoea
| Premature Ovarian Insufficiency (POI) |
Note: Included results for LH/FSH, TFT, and BMD. Shared care agreement with GP required |
| Hypothalamic Amenorrhoea |
|
Tinnitus Referrals – New pathway for referrals.
For patients under our audiology service who wished to see the Tinnitus and Hyperacusis team at the Royal Surrey, previously we were required to ask GPs to refer to on our behalf. To reduce your workload and streamline the patient pathway we are now able to do this directly. We will advise you when this has been done in our clinic letters.
Action Being Taken on Long Waiting Surgical Patients
Currently the Trust has long waiting lists for surgery, as a result of the initial COVID-19 response and therefore in line with national protocols and agreements we have made arrangements for your patient to have their procedure at one of the local private hospitals. Together with Surrey Heartlands CCG we have made arrangements to transfer surgical care for around 800 patients to the Woking Nuffield, Circle Runnymede, Spire Ashtead or EpsoMedical (Cobham Day Surgery). This will enable patients to have their surgery much faster than if they waited for surgery at Ashford Hospital or St Peter’s.
In the majority of cases the surgical team will remain the same as if they had their surgery at St Peter’s or Ashford Hospitals. The discharge information will be provided by the hospital where their surgery is undertaken and will follow the discharge protocols of that particular organisation.
All patients will be asked if they want their care transferred.
If you need any further information or clarifications then please use the GP helpline email address (asph.gphelp@nhs.net) and either Emma Jackson or Debbie Beesley will respond to you.
Reminder of regulations for chargeable fertility services for patients who have paid the NHS surcharge
Following changes to the ‘Immigration Health Surcharge’ coverage and the removal of Assisted Conception/Fertility treatment from August 2017, we are seeing an increase of patient who are unaware they will incur costs for this treatment path.
Therefore could we request that when referring patient for this service you have made them aware that if they paid the ‘Immigration Health Surcharge’ (HIS) as part of their Visa application they will be required to pay full estimated costs in advance of attendance.
The full guidance can be found here.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/864481/(chapter 5 p36, 5.15).
Please can you highlight this to your patients prior to referral for fertility services.
Direct Access ECGs
The ECG service at Ashford Hospital is still running but we are not accepting walk-in patients as we need to control the number of patients in the department at any one time. All referrals are being triaged. Please send your referrals to asp-tr.CardiologyDiagnostics@nhs.net
Ultrasound-Guided Injections
Under Covid-19 National Guidance ultrasound guided injections have been paused. Until this guidance changes it has been recommended that referrals are sent via the MSK pathways so that Consultants can triage the referral and consider if an alternative pathway is available.
GP Blood Tests
Due to Covid-19 all GP patients must now book online for blood tests, the walk in service is limited to patients attending consultant appointments.
This decision is to decrease the volume of patients on site at any one time to reduce the risk of cross infection
To book appointments please visit www.ashfordstpeters.nhs.uk/bloodtests
For ALL appointments please remember to put in the details of the patient and not the person making the booking. If it is impossible for you to gain access online please phone 01784 884565 between 09.00 – 15.00
Thank you for your cooperation.
New NICE Guidance on Planned Care Pathways for Covid-19
NICE has recently published some new guidance on planned care pathways for Covid-19. This has been ratified for use by our Clinical Reference Group. The headlines are that patients are no longer recommended to have 14 day pre-op isolation. Instead they are being asked to follow social distancing/hand hygiene best practice for 14 days prior to surgery, have a Covid swab up to 3 days before, and self-isolate from the day of the test until admission.
Change of E-Mail Address for Gastroenterology
Please be aware that the e-mail address for Gastroenterology has been changed. Details of the change and an updated contacts list have been emailed to practice managers this morning (16/7/20).
TIA Covid Update
Our Stroke TIA service is continuing to accept referrals for both high and low risk patients. Please continue to refer appropriate patients promptly.
All referrals are now reviewed by our consultant team and patients are offered face to face or virtual appointments based on their clinical risk. We would be grateful if you could provide us with as much information as possible about the clinical events leading to the referral. This will help the consultant triage the referral correctly and in a timely manner.
Our Specialist Stroke Nurses, in cooperation with the consultant in charge for the day, are available to advise on all high risk referrals and any queries you may have. They can be contacted via ASPH switchboard bleep 5828
The goal of the TIA clinic activity is to identify and prioritise the treatment of patients that may have sustained a transient cerebrovascular event in order to minimise their risk of stroke. We would be grateful therefore only to use this service for patients who you suspect have suffered a “a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia” TIA. Neurology conditions, even if presenting subacutely, should be referred to our Neurology Department and can be discussed via consultant connect.
Amendment to Ultrasound Referral Protocols
In response to the concerns expressed by GPs regarding the new criteria for requesting US scans which was previously agreed with the CCG, we have decided to return to the previous US referral protocols with immediate effect whilst we review this current vetting system.
If we have any concern regarding a request we will contact the referring GP to discuss further. This was a process we used previously.
Please convey my apologies for any inconvenience we have caused.
If you require a reminder of the previous protocols please contact Alanna Marvin alanna.marvin@nhs.net
