Winter News

Festive planning and Treatment room changes

I hope this latest article finds you looking forward to Christmas and the New Year. This is always a busy time of the year for the practice and we know that the Bank Holidays around these times can also be particularly challenging for the out of hours services. This year the surgery will be open on Friday 23rd December but then closed over the Christmas weekend, re opening on Wednesday 28th December. For New Year we are we are closed for the Saturday, Sunday and Bank Holiday Monday, re opening on Tuesday 3rd January. As per usual, if you need to access GP services out of hours, the best number to ring is our surgery emergency number: 0115 9652294, for whilst the surgery is closed, this does fast track you through the service and should be quicker than ringing NHS Direct! A common problem is patients running out of their routine medication. Whilst we would ask that people do not order 2 months of prescription this year, checking to ensure that you will not be running out of anything important over the holiday period would be sensible and we will of course do our best to help if you think you may have a problem in this area. We would though recommend stocking up with some routine ‘over the counter remedies’ which are of course often needed at this time of year. Many local pharmacies now stay open even in the holidays and most late night stores and garages stock a variety of such medicines.

So what should you do if you get a cold? Unfortunately these are common at this time of year. Your average toddler will get ten colds a year and most adults at least three. Many people get more and the lucky few less. It can come as a shock though if you are used to relatively few suddenly to get a bad year. Clearly as coughs and colds are viruses, antibiotics won’t work and all treatment is strictly for ‘symptom relief’. The old fashioned treatments work best – paracetamol, ibuprofen, steam inhalation & nasal decongestants during the day whilst at night a combination flu remedy can help with some having sedatives included. Remember not to use decongestants for more than a few days as after this they can actually make the problem worse. Also whilst many patients like cough medicines, there really isn’t much evidence they actually work and most health professionals don’t bother with them! Regular hand washing is probably the best way to reduce your chances of catching something over the holiday period and is particularly important after being in public places or in contact with someone who already has cold or flu symptoms.

Finally our practice nurse Mary Stansfield has asked me to let you all know of some changes to the hours and services available in the Treatment Room particularly on Mondays. Due to high demand, the Treatment Room on Mondays only will be extended from the current 11am to Midday. Also we will not be able to undertake ear syringing requests on Mondays from now on, though this service will continue to be available during the rest of the week. We are aware that our early morning appointments are particularly valued by those patients who need to get to work, so if your time is more flexible we would ask that you come along after 9.30 am if at all possible.

On which note it simply remains for me, on behalf of all at the Practice, to wish all of our patients a very happy festive period; a new year full of healthy resolutions; and to ask you to spare a thought for me contemplating my 50th birthday on Boxing Day!

Best wishes, Phil Rayner
 

Autumn News – Flu Clinics and Use of Resources

Flu Clinics: A timely reminder that the flu clinics are in full swing so please, if you haven’t already had one or made an appointment, and you are eligible for one, hurry and make an appointment. Remember that we know that flu jabs do genuinely save lives, particularly in patients ‘at risk’ (follow this link from the Dept of Health to get all the information you need about who is eligible and why you should have it http://tinyurl.com/639o7ec). For those who are not eligible to receive free flu jabs on the NHS, they are available for purchase at many of the larger pharmacy and supermarket stores. Remember to let us know if you are at risk and have had your jab elsewhere (eg an employer) so that we don’t keep ‘nagging’ you!

Home Visits: We know that many of our patients are genuinely housebound so will need a home visit for a flu jab or a blood test or long-term disease review. The problem arises when the visit is attempted and the patient has in fact gone out when the nurse or Doctor gets there, in which case we wonder if the patient could really have got down to the surgery. What we would ask is if it is at all possible to get to the surgery (eg by taxi, bus, neighbour, relative or friend) then please do so thereby saving us time so that we have a greater ability to devote that time to other patients who also need our services. Most things are better done in the surgery environment where we have access to medical records and any back up equipment that may be required. If you have a problem about transport (eg when a neighbour or relative is free to help) then please discuss with our reception team so that we can work with you to find a convenient slot.

Hospital appointments: Regular readers will know that times are hard in the NHS as well as elsewhere these days. GPs use of services is under increasing scrutiny and both prescribing and referrals are now regularly reviewed. The hospitals meanwhile are increasingly paid by a tariff system and needless to say, do all they can to extract the maximum fee from every referral and patient contact. This has resulted in some frankly bizarre practices (such as consultants now having to ask GPs to refer patients to a second consultant if they want their opinion; asking patients to bring hospital prescriptions to GPs to reissue and a very hawkish policy re missed or re-arranged appointments.

It always amazes me when I follow up these DNA (Did Not Attend) letters how frequently I find that the appointment never arrived, arrived too late or even went to the wrong address). And sadly it’s all about money. Occasionally, we do have to question some practices, for instance some drugs are for hospital prescription only and some requests for referrals may not actually be appropriate. So please bear with us if this occasionally crops up. We are not trying to be awkward or difficult but simply trying to ensure that our patients get the best and most appropriate care whilst also ensuring that the correct NHS budget is paying for those services (and not potentially paying for it twice). Also as I have previously mentioned, all budgets are now limited and it is expected that we ensure that every NHS pound is spent wisely.

It may be that if you’ve not heard from the hospital about an Outpatient appointment or if an operation is delayed or the date unknown, or you’ve had problems with a hospital encounter, that the hospital’s own Patient Advice and Liaison Service (PALS) is the best port of call. We hear they have a lot of clout in the hospital and can often ‘make things happen’ and sort things out. Contact details for them are:

City Hospital - Freephone 0800 0521195
QMC – Freephone 0800 1830204
Email – pals@nuh.nhs.uk
By post – NUH NHS Trust, c/o PALS, Freepost NEA14614, Nottingham NG7 1BR

There are also PALS offices at both QMC and City Hospital campuses

Phil Rayner

September News - It's time to think about Flu

Writing an article in the middle of summer it seems strange to be thinking about flu, however in the practice we are busy planning our flu immunisation clinics for this coming autumn. As always vaccinating at risk individuals is a key component of the Government's health prevention strategy and we are hoping this year to persuade a few more of you than usual to attend. We actually do quite well in vaccinating our patients at Calverton but know that quite a few who should be receiving this do not attend. Some common myths are that the vaccination makes you ill - NOT TRUE! All the research done shows that as this is an inactivated vaccine, statistically any post flu jab illness would have happened anyway. 'I never get colds so I don't need one' - NOT TRUE! - most of us get flu very rarely, but when we do it knocks us for six. The flu jab doesn't protect against coughs and colds but if in our 'at risk group' flu could kill you and the vaccine does prevent against this. SO WHY TAKE THE RISK?

I am very grateful to our senior nurse Shirley Wragg for the following facts and figures. Influenza killed over 500 people in the UK last year. Vaccination is a proven way of preventing these deaths. The at risk groups are defined every year by the Department of Health and currently include anyone over 65 years of age plus anyone over 6 months with Cardiac, Respiratory & Immune Disorders or Diabetes. Our computer system automatically codes those patients who are eligible for a flu jab so if in doubt please contact our reception team for further advice. This year the flu vaccine will contain California H1N1, A/Perth & B/Brisbane strains. These are selected by the World Health Organisation based on known strains circulating and change every year as the flu virus is very adept at mutation and changing its protein structure as it evolves. After vaccination, immunity takes 7 to 10 days to develop and lasts about 12 months, hence the need for giving in the autumn and repeating every year.

Our Saturday clinics are on 1st October and 15^th October and we have midweek afternoon clinics as well on Mon 3^rd, Tues 4^th, Wed 5^th, Fri 7^th, Tues 11^th, Thurs 13^th, Fri 14^th, Mon 17^th, Tues 18^th and Fri 21^st October for those who can’t make those dates.

Last year we gave over 2100 jabs which sounds impressive but we know this is only 77% of those who are eligible aged over 65. Nationally the average is 73% but this year we would like to vaccinate over 80% if possible. In the 6 months to 64 age range the figure falls to 55% (vs 50% nationally) and we would really like to get this over 60% if we can. One group of patients we would particularly like to attend are our pregnant ladies. Whilst pregnant the immune system is suppressed so flu like illness is more common and the risk of a more severe infection is also greater. Again our statistics of 47% vaccinated are better than the national average (38%) but we would like to do better!

Finally to some patients we also offer a second injection against the bacteria pneumococcus (a cause of serious pneumonia), this though is given every 5 years. There are some slight variations in the patient groups who require this booster vaccination, for example it is recommended for patients with no spleen and some with kidney impairment. Again our computer system prompts us when this is required so if in doubt you can check with our reception team.

                                                                       Best wishes, Phil Rayner

NHS funding of Procedures of Limited Clinical Value: A guide to the policy & why your doctor has to observe it

NHS funds

• NHS Nottinghamshire County and NHS Nottingham City buy healthcare on behalf of the local population. The money for this comes from a fixed budget. By law, we are required to keep within this budget.
• Demand for healthcare is greater than can be funded from this fixed budget. Unfortunately, this means that some healthcare which patients might wish to receive and which professionals might wish to offer cannot be funded.
• This has always been the situation since the start of the NHS.

Assessing what the overall population most needs

• Our approach to this situation is to prioritise what we spend, so that the local population gets access to the healthcare that is most needed.
• This assessment of need is made across the whole population and, wherever possible, on the basis of best evidence about what works. We also aim to do this in a way that is fair, so that different people with equal need have equal opportunity to access services.
• This approach is not new. It is consistent with other NHS organisations who buy healthcare for their local populations.
• One result of this kind of assessment is a list of some of the treatments which can only be paid for by the local NHS in certain restricted circumstances, and also a number of treatments which don’t work well enough to justify any use within the local NHS. A similar list has been drawn up for medications, to ensure that the local NHS gets the greatest possible value for the local population. We aim to review these lists to ensure that they reflect the best available evidence and are affordable and fair.

Implications for you

• This may mean that your doctor is not able to offer you a certain treatment because it would not be funded by the local NHS.
• Although most doctors recognise the need for some kind of policy like this, she/he may be uncomfortable because of its implications for you as an individual.
• Even so, your doctor has to observe the policy because it is the policy of the local NHS, and is the best way to ensure that local NHS funds are spent on the things that will bring greatest overall benefit to local people in a way that is affordable and fair.

There follows a brief summary of what is included in this policy and in the related policy covering cosmetic treatments.

Examples of treatments which are not funded by the local NHS

The following list contains examples of some of the treatments that are not funded or are restricted, and are most relevant to patients in a primary care setting.

• Dental implants for cosmetic purposes
• Surgical treatment of varicose veins – strict criteria apply
• Surgical or laser treatment for a range of benign skin lesions except in specific circumstances set out in the Cosmetics policy, e.g.
  • viral warts, seborrhoeic warts, molluscum contagiosum, spider veins, cherry angioma, skin tags, papillomas, naevi, haemangiomas, xanthelasma, epidermoid cysts
• Complementary therapies including acupuncture (except acupuncture for low back pain up to 12 months duration, for which criteria apply)
• Grommets, tonsillectomy, adenoidectomy, surgery for sleep apnoea – strict criteria apply
• Surgery for snoring
• Hysterectomy for heavy menstrual bleeding – strict criteria apply
• Caesarean section (elective) – criteria apply
• Cataracts – criteria apply
• Labial reduction – except for dyspareunia
• Circumcision – except for medical reasons
• Haemorrhoidectomy – strict criteria apply
• Inguinal hernia repair – strict criteria apply
• Tests for confirming diagnosis of Irritable Bowel Syndrome in adults
• Reversal of sterilisation
• Back surgery and injections – strict criteria apply
• Surgery for Dupuytrens, Ganglion, and Joint injections – strict criteria apply
• Cosmetic treatments except in the very specific circumstances set out in the Cosmetics policy. List of treatments not funded includes (but not limited to):
  • Excision of excessive skin from thigh / leg / hip / buttock / arm / forearm, facelifts, fat grafts, liposuction, phalloplasty, chin implant, cheek implants, collagen implant, cranial banding for positional plageocephaly, earlobe repair, botulinum for wrinkles / frown lines / aging neck, resurfacing by laser for skin conditions causing scarring, correction of nipple inversion, breast uplift, hair depilation, electrolysis

August News - ‘Phew it’s hot’ and ‘What to do about warts’

Last week’s helpful PCT email read ‘Please see attached Met Office heat wave alert for Sunday – there is a 60% chance of a heat wave, please advise all your vulnerable patients what to do’. Needless to say this caused some scratching of heads but it seems a sensible thing to write about today. So what is a heat wave? The Met Office very helpfully gives the following health watch information on their website - www.metoffice.gov.uk/weather/uk/heathealth

'A Heat-Health Watch system operates in England and Wales from 1 June to 15 September each year. The Heat-Health Watch system comprises four levels of response based upon threshold maximum daytime and minimum night-time temperatures. Essentially these are 30 °C by day and 15 °C overnight and the four levels are graded from green to red depending on the temperatures expected and for how long.'

What they say is that ‘Heat waves can be dangerous, especially for the very young, very old or those with chronic diseases. If you want more information about hot weather and your health please visit www.nhs.uk

In practical terms patients with heart, respiratory and serious health problems are at risk as heat can make these problems worse. Some medication can affect the body’s ability to cope with heat excess. Also babies and young children can be vulnerable to heat extremes. Symptoms to watch for include dizziness or faintness, breathlessness, vomiting or increasing confusion. Milder symptoms can include cramps, tiredness or problems sleeping. Exertion, a temperature (e.g. from infection), alcohol and age over 75 can also be factors putting people at greater risk. However once we get to the ‘red alert’, illness and death could occur even among the fit and healthy and not just in the so called ‘high-risk groups’.

So what can you do? Best advice is to – stay out of the heat during the day (11am -3pm is suggested); avoid excessive exertion; keep cool by finding shade; drink cool fluids; wear a broad brimmed hat and light loose fitting clothing. Windows should be closed if it’s cooler inside than out but open once the outside becomes cooler again. A cool moist cloth, cool water sprays or even tepid showers or baths can all be helpful. Fluids should be water or fruit juice; alcohol and caffeinated drinks should be avoided and cool light meals are best. If you do know someone living alone, a daily check on their well being at such times is recommended. If in doubt, NHS Direct can give advice on 0845 4647.

So on to warts. One of my practice roles is manning the wart (or cryotherapy) clinic which I have dutifully done for the past 16 years. Interestingly there is a lot of conflicting evidence as to how best to treat warts and many people believe they should be left to go on their own (as they are viral colonies and the body eventually becomes immune to them). In fact a recent research paper in the British Medical Journal concluded that there was no convincing evidence that treatment of warts or verrucas actually works! Indeed many GP surgeries have now stopped cryotherapy sessions altogether. Our clinic though remains popular so here are a few pointers. Firstly do initially try over the counter treatments, most work by dissolving thin layers of skin so that the wart or verruca may eventually go (though perseverance and persistence is, I am afraid, required). Covering warts with duct tape can help and we have information on this technique if needed (or try Google). Freezing verrucas generally doesn’t work well as the skin on feet is quite thick and hard. Soaking the foot in a strong antiseptic solution can sometimes help though. Freezing small warts, skin tags and moles on stalks can work though so if in doubt you can always book into the cryotherapy clinic and I will see what I can do. The clinics are held on a Tuesday, with a morning and afternoon session. We try to run one about every 3 weeks to keep up with demand.

Finally this month we say farewell to Dr Qamar after his year in the practice. He is replaced by Dr Jonathan Graham who will also be with us for a 12 month spell. Whether he will match Dr Partington’s exotic holidays and Dr Litchfield’s exotic ties remains to be seen!

                                                                       Best wishes, Phil Rayner

July 2011 - 'Hot Topics and Fond Farewells'

Hot Topics

As always I am writing this article several weeks before publication. This means that last week was half-term and the Rayner family duly de-camped to Cornwall. Luckily we got some sun, but as camping, also surprisingly cold nights. In addition the tuneful dawn chorus was less appealing starting at 4.30am at this time of year.

This brings me on to the topic of sun creams for as usual I under-estimated the strength of the English sun on a windy beach and have duly got sun burnt. We also know from research that most of us are pretty inconsistent at putting sun protection on, which means that in general only the 30 or 50 strengths provide any useful skin protection. A broad brimmed hat is also a good idea though not necessarily a great fashion accessory!

The other big hot topic this week is the German E coli outbreak which has been linked to something called Haemolytic Uraemic Syndrome or HUS. This is where a particular strain of the E coli produces a toxin which affects the kidneys and can result in reduced function or even failure. Fortunately these outbreaks are rare but a food source is the usual culprit and seems likely with this one also. (Some of you may remember something similar in Scotland a few years ago linked to uncooked meat from a butchers shop.) So what can you do – clearly good food hygiene and washing all fruit and vegetables is sensible. Re-washing your hands after this is also being suggested. Fortunately as GPs we now get regular e-mail updates from the Chief Medical Officer when serious medical problems are around and the main symptom to report is bad diarrhoea particularly with blood present in the motion with poor urine production despite a reasonable intake of fluids. At the time of writing there have been 11 UK cases and all had recently returned from Germany. Fingers crossed this is all done and dusted by the time of publication!

Other news relates to a service of which we have recently become aware called ‘There for You’. This is particularly aimed at people over 50 and is provided by the charity Age UK. They describe it as a ‘sign posting’ service but offers a home visit for assessment and also follow up if needed. It is particularly for those who are isolated from goods, services, help, advice, information or social interaction for any reason and is free to access. More information can be obtained from Adele Walker (who covers our area) on her mobile 07872 839624 or e mail adele.walker@ageuknotts.org.uk

Our ‘comings and goings’

We are sorry to report the departure of Dr Jane Turrill at the end of July. Jane has been with us now for 3 years as a salaried GP and took over the list of Donna Smith when she took up a GP partnership position. As Dr Litchfield will be increasing his hours in the surgery and as we will also be welcoming back Dr Emma Sherwood for 2 days a week we will be re-allocating Dr Turrill’s patients to the existing doctors in the practice. In the past we have done this using the first letter of surname but we do like to keep families with the same doctor and will endeavour to continue this practice. If you do have any questions or concerns about this please contact our Practice Managers or Reception team.

Finally I am delighted to report some very positive feedback about our new on-line prescription re-ordering service, so if you haven’t given it a try why not take a look via the Calverton Practice website!

                                                                       Best wishes, Phil Rayner

June 2011 – ‘Pesky Pollen’ & ‘Healthy News’

As always I am writing this article some weeks prior to publication. The last few weeks have been particularly sunny which can only mean one thing – Hay fever is imminent! Of course some of your will have been sneezing for weeks already and the likely culprit is Birch pollen. This starts in March & April usually, (whereas grass pollen generally gets going in about June). Later in the year fungi are the problem and if your symptoms are year round then House Dust Mite may be your nemesis! Of course this begs the question – what should I do? The key message is start your treatments early. The mainstay of treatment is anti-histamines and we would recommend either Loratadine or Cetirizine. For most people these are non-sedating, once daily and easily available either over the counter or on prescription. Cetirizine has the advantage that a second dose can be taken later in the day if needed. Both can be safely taken long term and indeed work best if taken regularly. For people with more troublesome symptoms adding a nasal steroid spray and/or Chromoglycate eye drops can be helpful. Again these are best used regularly and started before symptoms become too established, they are also available now direct from a pharmacist. Occasionally and particularly with grass pollen, symptoms can be severe – avoiding pollen helps (e.g. sleeping with windows closed at night & avoiding grassy fields) but sometimes a few days of a steroid tablet help to settle things down. These can be particularly useful for example for teenagers with exams or crucial engagements but do need a prescription. Steroid injections (Kenalog) are not now recommended, though there is some evidence that a daily dose of local honey provides a form of immunotherapy. Finally for those of you who are sensitive to Birch there is an associated food allergy syndrome and some uncooked fruits and vegetables can produce local irritation and swelling. Potatoes, tomatoes and apples are common suspects!

 ‘Healthy News’ – Notts County tPCT produce a regular newsletter called ‘Take a Healthy Interest’. This is full of useful information and the latest edition has articles on how to stop smoking, how to keep fit for free and simple ways to eat more healthily. The latter is part of the Change 4 Life programme and is encouraging ‘snack swaps’. Also there is an update on the ‘Big Healthy Debate’ (which I wrote about a couple of months ago) and a quick guide to local NHS changes, with information about how you can have a voice in shaping the new services planned. So why not take a look at www.nottspct.nhs.uk or phone 01623 673125 for a copy of the magazine! Change 4 Life also have their own website – www.change4life.co.uk. where you can fill in a simple questionnaire and receive a tailored Swapathon plan. What are you waiting for?!

                                                                        Best wishes, Phil Rayner

MAY 2011

At last the weather is warming up, however as previously discussed on these pages a cold wind is blowing through health service finances. As of April 1^st we have re-joined the NNEC (Nottingham North & East Cluster) in readiness for fully fledged GP led commissioning starting in 2012. At that time Primary Care Trusts (our current masters) will have gone and a ‘brave new world’ will have emerged. Unfortunately as we are all aware, the public coffers are empty (or at least looking rather strained) and one of the key expectations our government has from GP led commissioning is that it provides ‘good value for money’. This has led to the identification of services felt to be of ‘limited clinical value’ and in future they are likely to be drastically restricted. Some of these are fairly obvious e.g. cosmetic surgery, sterilisation reversal & treatment of benign skin lesions, but some may be less so. Thus for example, minor hernias, routine varicose veins, nuisance haemorrhoids will all be deemed of LCV. Other procedures such as grommets, tonsillectomy, adenoidectomy, snoring treatments, hysterectomy, back surgery and others will be subject to much more stringent criteria before being approved. Some of this checking will be done by us GPs at the time of referral, however we also expect referrals deemed ‘inappropriate’ to be returned. We are aware that this is likely to be extremely frustrating for some of our patients but as health budgets are now fixed and demand for health care will always exceed funds available, what is in effect prioritisation of use of resources seems inevitable. More information on this is available from our website. 

Last week we got a very interesting phone call from 2 researchers working on GP practice data. It seems we are in the top 1% of practices with regard to facilitating patient access and avoiding attendance at A&E. (Just 29 practices nationally and 7 in the E Midlands Strategic Health Authority are in this group) These are both felt to be markers of ‘good practice’ so they rang us up to see what we do. The answer it appears is Triage. Many practices do this but it seems it works best if done by GPs themselves and operates throughout the day. Of course we told them we have been doing this for many years, that it seems to work particularly well with our personal list system and that we like it, you (our patients) on the whole seem to like it and we now discover it actually saves the NHS money. Of course it’s probably the latter reason that has attracted most interest but we were delighted to be told that our model is to be presented at a national conference to try to encourage other GPs across the country to adopt it!  

Finally our comings and goings: we sadly say farewell to Wendy Magyar, one of our two Health Care Assistants, has now left. Wendy has done a fantastic job alongside Gerry Dawson supporting the role of our nursing team in BP monitoring, occasional phlebotomy and assisting with the INR (warfarin monitoring) service. Trina Lilburn is expanding her dispensary role to replace Wendy and appears to be looking forward to her new challenge. Dr Partington, having survived sharks in Egypt, will be braving leeches and Orang-Utans in the wilds of Borneo. Our ‘newby’ Dr Litchfield is dazzling us all with his particularly vivid collection of ties, though those of you without a head for heights should avoid his recently installed mountaineering photo collection. One of Matt half way up a frozen waterfall in the Alps is definitely not for the faint hearted!        

           Best wishes, Phil Rayner

Easter and Bank Holiday Opening times

Thereafter as normal until Monday 30th May Closed for Spring Bank Holiday

SPRING 2011

Writing this latest article it’s March 1st, the mornings are getting brighter and spring feels like it might be on the horizon. Clearly my purchasing a snow shovel has guaranteed no further deluges of the white stuff for the foreseeable future and England are even winning at rugby! This month I am delighted to welcome contributions from other members of the practice team. Firstly Robert our INR and travel nurse guru, then Marie, our Practice Manager.

Bugs, Beasties and other things

Travel

So what about Travel? We know that the world is shrinking and increasingly our patients are choosing exotic destinations for their holidays. Some of these destinations our surprisingly accessible but as Robert would like to point out there are a few issues to be aware of. Firstly there are a host of exotic diseases to consider once you stray outside Britain and Europe. Mosquito borne Malaria, Yellow Fever, Japanese encephalitis and dengue fever, water borne cholera, typhoid and dysentery and rabies from that unsuspected animal bite in a rural location. Fortunately many of these illnesses can be prevented by sensible precautions (sensible clothing, mosquito nets, insect repellent etc) plus pre travel planning and vaccinations. But, it takes time to sort these things out and generally travel medicines and vaccinations are not covered by the NHS (and can be quite expensive particularly for some destinations).

So, plan ahead, research your destination and any likely health risks, consider whether you have any pre existing illnesses which could be a problem (e.g. if pregnant or immuno-suppressed you should steer well clear of malaria affected countries). Some patients are not able to be given the Yellow fever vaccine which can be tricky if it is required for your intended destination. So our advice is to consult Robert well in advance (and at least 4 weeks before travel to allow time for vaccinations and malaria prophylaxis to take effect) and if in doubt about whether a travel destination is safe for you, take advice from Robert, your GP or travel adviser.

Confidentiality

Next - Confidentiality. Here at the Practice, we take our duty of care towards our patients very seriously. This includes not only the medical care we offer, but also how we treat the ‘information’ that comes with the patient. All our records are held securely but that is not where it ends. Unless you give us specific, written permission to talk to a non-medical person about you or your care, we will not enter into discussion with anyone. This means for instance, that if your health insurer wants a GP to provide information about you, they have to provide us with a copy of the consent form they will have asked you to complete. Any ‘official’ third-party request will always be treated in this way.

So far, so obvious; it is the not so obvious requests which sometimes may lead patients or their relatives to think we are being a little unreasonable. For example, a mother rings the surgery to ask if her 16 year old daughter has an appointment booked, or a spouse rings for their partner’s results. Under the rules by which we work, we cannot tell them: we cannot make the assumption that they have included someone else in their health plans and we are duty bound not to tell. If you feel that you would be happy for your son /daughter /husband /wife, indeed anyone else to be involved in any discussions about your health or the care we give you, just drop us a line with the name and contact details of the person and a statement to the effect that you are giving us your consent to talk to that person and we can put the details into your notes – please make sure you sign the letter to make it legal! Remember – without your consent, what happens here, stays here, simple as that!

Marie Cooper & Phil Rayner

New Year News 2011

Team changes

As many of you are already aware, Dr Challen took the difficult decision to retire on health grounds and it is with great sadness that we say goodbye to her from the Practice. We know she has received good wishes from many of you and she would like to thank everyone for their expressions of good will. We would also like to thank Dr Challen’s patients for the understanding that has been shown during the last few months.

We now welcome Dr Matthew Litchfield to the team and he will be taking over responsibility for Dr Challen’s patients from now on. Dr Litchfield came through the selection process (some outstanding young doctors were interviewed and choosing between them proved extremely difficult) and accepted our offer to join us. He is another graduate of the Nottingham GP training programme and has worked for the last couple of years in two local practices, one of which was the student medical centre in Nottingham. He obtained his MRCGP with distinction and also has a diploma in Mountain Medicine. His hobbies include climbing (including Himalayan expeditions), road cycling and walking (he recently undertook the challenging Inca trail in Peru).

We also welcome back Dr Stuart Alexander who returns for another few months. Dr Jo Emmanuel has now left us to continue her GP training in a hospital post.

From the housekeeping department we say farewell to Jacqui Leek and welcome Sheila Wood in her place.

PCT news

The days of Nottinghamshire County Primary Care Trust may be numbered however we still receive guidelines on good practice from them. The latest relates to patients wishing to access private health care. Whilst this is always an option, at times the boundary between what is private and what is NHS has been blurred. For instance if following a private consultation a certain treatment is recommended, should this be private or issued on the NHS?

New guidance states that ‘a patient will be expected to pay the full cost of any treatment they receive in relation to care provided privately’ also ‘any investigations, medication or treatment provided by a clinician in the course of a private consultation will be at the patients expense.’ We are aware that many private insurance policies do not cover medication which can be a very expensive component of private treatment. We advise all our patients with private health insurance or wishing to purchase private health care to consider this and discuss with their GP at the time of referral.

Patients are allowed to opt back into NHS care after an episode of private care is completed; however any ongoing treatment or follow up required, is expected to be in keeping with the normal NHS referral and care pathways currently in place.

If anyone has any questions regarding this issue please feel free to contact either Mr Alan Selden our practice Chief Executive or Mr Adrian Kennedy our practice Pharmacist who can provide more information regarding this matter.

Summer News 2010

Staff Changes

No doubt many of you are already aware of the very sad news that Dr Challen has suddenly and unexpectedly been taken ill and it seems that she is going to require a prolonged absence from the practice. We all wish her and her family the very best over what is undoubtedly a difficult time for them in the coming months.

For the next few months Dr Jo Emmanuel is returning for another spell as Registrar and will be dealing with many of Dr Challen’s patients.

Dr Imran Qamar has also joined us for his final year of GP Registrar training, replacing Dr Asmita Maharaj who was with us for four months.

Dr Jonathan Hickinbotham has now left after a few months with us and Dr Jon Mead will be coming to replace him starting in late August.

Nurse Rachel Cansfield started on 1st April and joins the Practice nursing team helping with ‘birthday reviews’ etc.

Spring News March 2010

Easter Opening Times and arrangements
 

• Thursday 1st April Open as usual 08:30-18:30
• Good Friday 2nd April Closed
• Easter Saturday 3rd April Closed
• Easter Sunday 4th April Closed
• Easter Monday 5th April Closed
• Tuesday 6th April Open as usual 08:30-13:00 14:00-18:30

When we are closed emergencies will be dealt with by the Nottingham Emergency Medical Service, as usual. They are contacted via the surgery emergency number 965 2294. NHS direct can give advice and direct you to relevant services 0845 4647

Staff Changes
Dr Yvonne Burke has now left us to return to the Manchester area where her husband has a new Consultant post. We currently have Dr Jonathan Hickinbotham doing some locums both to replace Dr Burke and also to cover some of Dr James Hopkinson's clinics. Dr Hopkinson is currently combining General Practice with further training in his Sports Injury speciality.

Nurse Sue Bereznyckyj retires this month after twenty years working in the practice; prior to that she worked in the area as a District Nurse. Her contribution to the care of patients in the practice has been immense and she will be missed by staff and patients alike.

Nurse Jo Toomey left us in December and has emigrated to Australia with her family.

Nurse Clare Sampey has just started here and will be taking over much of the Women's Health workload, which is currently being covered by Nurse Mary Stansfield.

Nurse Rachel Cansfield will be starting on 1st April and will be helping with 'birthday reviews' etc We wish all them all well, whether departing or arriving.

Swine Flu Vaccinations
Update 09/03/2010
All children aged 6months to under 5 years group are eligible to have the vaccine and are strongly encouraged to do so as young children have been particularly at risk of suffering problems and possibly hospitalisation as a result of swine flu. It is one vaccine only except for immunosuppressed children (who need two vaccinations three weeks apart).
We still have supplies of swine flu vaccines to give to the other highest risk groups as defined by the Department of health. Please ring in and make an appointment if you are in one of the following high risk groups:

• Six months up to 65 years in the current seasonal flu vaccine
  clinical at risk groups
• All pregnant women
• Household contacts of immunocompromised individuals
• Aged 65 and over in the current seasonal flu vaccine clinical
  at-risk groups (not all over 65s)

If you are eligible, please contact reception to make an appointment on 965 7800.

There are leaflets explaining 'What you need to know' about swine flu vaccination at the surgery or they can be downloaded here.

As you may already be aware, the National Swine flu line has been suspended so if you are worried you may have Swine Flu, you should stay at home and contact your GP by phone.

Staff Changes

We are pleased to welcome Dr Yvonne Burke and Wendy Magyar, health care assistant to the team.

New Services Available

Warfarin monitoring.
Implanon contraceptive fitting.

Services for Teenagers at the Surgery

The national strategy for sexual health published recently states:
'We want our population to be in good sexual health and well educated in how to protect themselves against sexually transmitted infections and unplanned pregnancies. And to have services that meet their needs in a non-judgemental and supportive way.'

The practice is improving our services for teenagers in line with this national plan.

Nurse Jo Toomey will see teenagers for health checks and offer information on sexual health issues. In particular we are offering Chlamydia screening and treatment for 16-25 year olds. Chlamydia is common, often causes no symptoms and can cause long term damage so it is important to try and seek out and destroy this bug. We also participate in the C-card condom distribution scheme. This is a national scheme, where once a teenager has registered; they can obtain free condoms from any of the participation NHS organisations. As well as condoms we offer contraceptive services to all ages (not just teenagers, although condoms are only free to youngsters).

Of course, all of the doctors are happy to see teenagers in ordinary appointments but are aware that often teenagers are wary of seeing a GP who they think of as being their parents’ doctor. All consultations are completely confidential, which again is a common teenager concern. We would always encourage younger teenagers to involve their parents in their contraception and sexual health decisions but they have a legal right to confidentiality, as do all patients.

All our staff, including our receptionists, are also bound by confidentiality rules and teenagers should be assured that they only need to ask for the service they need to make sure they are given the correct type of appointment.

Travelling into town for contraceptive and sexual health services can be a problem for Calverton residents so we want to ensure that our teenagers have access to good services near to home. Please let us know if there are ways we could be improving these services.

Fatness and Fitness
Currently Britain is facing an obesity epidemic. Being overweight and inactive leads to heart disease and diabetes and there is huge concern amongst doctors about how we can deal with the expected health consequences of obesity. It is life expectancy is starting to fall after generations of improvement just because we are becoming fat and inactive at an alarming rate.

We have got used to most people being overweight and think it’s normal. Take a look at photo of the 1966 cup final crowd; you will probably think everyone is too skinny. They’re not: we have got used to being fat!

The government is trying to encourage change. The change4life campaign is government run and aiming to change our habits, targeting children first. The worry about children’s obesity is growing. Have a look at their website for ideas about how to help your gets get and stay healthy. We are happy to weight and measure children and give advice on what to aim for.

Activity is very important: even if you struggle to get your weight down. Being fat but fit is much better than fat but inactive. In adults it is recommended that 30minutes for at least 5 days a week is the minimum for health. For kids it’s 60 minutes. Any kind of exercise that raises your heart rate and makes you feel like you have done a bit of work is good:, dancing, gardening, brisk walking, heavy cleaning: whatever fits with your lifestyle. You don’t have to wear Lycra to do exercise. To keep it up it needs to be part of you weekly routine and not just an occasional past-time.

In the surgery we are happy to see you to weigh and measure and advise on your ideal weight. There is no easy solution to weight loss; it always boils down to eating less and burning up more calories by being more active. Eating only more a calories a day than you need adds up to pounds on the waist by the end of a year. Organisations like weight watchers are helpful in supporting and guiding you too. Crash diets and extreme diets don’t work long term; it’s about making changes that you can keep up for years to come.

The problem is not something that the health service can tackle on its own, it has to be a much wider change, involving transport polices that get us out of our cars, safe places for children to play, leisure facilities, encouraging healthy eating, encouraging breastfeeding. At the surgery we are tying to may links with other organisations to try and make Calverton a healthier environment. Let us know if you have any ideas too.

Reprieve for our dispensary
After the consultation process the government has decided against changes to GP dispensing which is good news. We are pleased that we can continue to provide this service and relieved that the treat to certain jobs within our organisation has been lifted. Thank you to any of you who contributed to the government consultation.

Surveys, surveys surveys
Many of you will have an NHS/ MORI survey form dropping through your letterbox in the next few weeks. The government is posting these out to five and a half million people in England to see what they think of GP services. It’s rather a daunting 8 page document and is sent to a random selection of people including those who may not have had occasion to use GP services in the recent past. I do wonder if it is money well spent.

A lot of emphasis in this survey is put on access: how easy it is to get an appointment. This is always a thorny issue: demand is highly unpredictable. Many of you will be aware that we have made a big move to the use of telephone consultations in managing this challenge.

I thought I would explain a little about our telephone triage system and clarify that it should count as a consultation as far as the survey is concerned. We see the use of the phone as an important tool in working efficiently to the benefit of patients and enabling us to meet the demand for same day consultations. Anyone requesting a same day consultation will be phoned back by a doctor. The doctor has the full records in front of them as they talk and are consulting from the privacy of their consulting room exactly as in face to face visit. This allows the doctors to assess urgency and make a plan about when the best time for someone is to be seen. About 30 percent of our calls can be sorted out without the need for a face to face consultation. This means we can meet clinical priorities efficiently, we can avoid using non medically qualified staff to assess urgency and on the busiest days control the workload to make sure the standards of our consultations are maintained. Often any necessary blood tests can be organised before the appointment so the results are available when you see the doctor which can cut down on the total number of trips to the surgery. This method does require our patients to make they available during our telephone time so we can call them back, (answering machines and unavailable mobiles are a source of frustration for us!)

There has been another survey recently, administered by us, and is a contractual obligation on us at least for this year. Thank you to those of you who have taken the time to complete the patient satisfaction survey that we have been distributing to patients visiting the surgery. The results are currently being analysed by the poll company and we will publish the results on our website as soon as they become available.

Thankfully, in our contract for next year the government has reduced the emphasis on surveys and instead will award quality payments if we meet clinical targets. We will still welcome feedback on our services.

Kesten Challen

PATIENT SURVEY
Results of our annual patient survey 2007» ( PDF file 1.86MB)

New Year News from The Calverton Practice
Patient participation group
This is now up and running. There are seven patient members plus representation from the surgery. So far there have been two meetings. As with all new ventures it will take time to establish the relationship between the group and the surgery such that the group can become a valuable resource in our attempts to expand and improve services.

In order to make change it is important that we seek opinions from the users of our services and we hope that the group will be the conduit for those opinions. In the next edition of the Echo we will hope to publish contact details for group members so that concerns or ideas from patients can be fed back to us. We are still interested in hearing from anyone else who may have an interest in joining the group.

Our hope is that the group can help improve the health of the locality in ways beyond the traditional confines of general practice. One area that the group has already started work on is the area of healthy eating and exercise. We are in discussions with Gedling Borough Council about using some time at the leisure centre. We are talking to other bodies about cycle routes round the village and seeing if we can have designated walks marked out so that walkers can know how far they have actually walked. All of this would be part of an agreed exercise plan. Obesity and inactivity are major health issues and it is clear the health service cannot solve the problem by medical means. We have also signed a contract to put screens into the waiting rooms which will show health related content.

Liquid nitrogen
We have recently acquired a liquid nitrogen tank which means we have been able to resume offering on site treatment for a range of minor skin conditions. In years gone by we have obtained liquid nitrogen in small quantities from a local supplier but changes in safety rules mean we could no longer transport it without a special vehicle. The hospitals were not offering a replacement service as warts and skin tags are regarded as cosmetic problems. We have always felt this service has been valued and are pleased that we can now treat these problems again.