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Greenwich edition issue 4 

January 2012

Greetings! 

Welcome to the fourth edition of Fusion keeping you, our local GPs, up to date with what's happening in your local community health, mental health and learning disability provider, Oxleas NHS Foundation Trust. 

Despite the unseasonally good weather, winter is here and we are busy managing the extra winter pressures. As always, we aim to reduce the impact and to enable people to avoid A&E and hospital admissions wherever safely possible. We are working closely with practices to help support management plans for people most at risk of avoidable admissions, building on the risk stratification throughout the borough. In this edition, there's a feature on our Virtual Admission Avoidance Team, our multidisciplinary approach to treating people at home rather than in hospital.

If you have any ideas or specific information you want included in future editions, please let us know. We also welcome your feedback on the services we provide.

Yours sincerely

Stephen Firn

Chief Executive

Oxleas NHS Foundation Trust

Virtual Admission Avoidance Team

In collaboration with London Ambulance Service (LAS) and primary care services, this multidisciplinary team has developed clinical pathways offering GPs an alternative to ringing an ambulance for patients, preventing unnecessary A&E attendances and avoidable hospital admissions.

GPs can refer patients with the following health problems to the team:

• cellulitis
• UTI
• hypoglycaemia, elderly complex case management and heart failure (currently being reviewed by QE cardiologist)
• COPD - exacerbation, poor self management
• falls
• blocked catheter and palliative care
• necessity for multidisciplinary assessment including social crisis - Joint Emergency Team (JET) - see following article for more information

The team includes a wide range of specialists and links with other community health teams. The team has developed a portfolio of clinical pathways that are now being used by LAS as an alternative to automatic hospital attendance.

Benefits of referring to the team include:

• rapid assessment for your patients
• early decision making at a senior and expert level
• close liaison with other community teams and integrated care
• close liaison with social services for seamless care.

Routine referrals should be made via the Single Point of Access (SPA): 020 8836 8622. Enquiries about urgent care can be made through JET (see following article for contact details).

For more information about the Virtual Admissions Avoidance Team, please contact Giselle Broomes, Associate Director of Operations, Adults, email Giselle.broomes@oxleas.nhs.uk or call 020 3260 5175.

Joint Emergency Team (JET)

The team provides urgent preventative support and intervention to patients aged 18+ living in Greenwich, to avoid hospital admission (click here for details).  This may be via rehabilitation, coordinating care and or crisis intervention. The JET team work closely with A&E to facilitate discharges and liaise with community resources to ensure clients remain safe and independent in the community.  

Launched in April 2011, the Joint Emergency Team is a multidisplinary service resulting from merging Health (Rapid Response Team) and Social Services (Emergency Intervention Team) to provide continuity and a smooth pathway to clients.

Benefits of referring patients to JET team include:

• supports people at home if at risk of a hospital admission with the Intermediate Care at Home Reablement Team or can facilitate admission to one of our rehabilitation units, engaging other community services as required
• provides crisis intervention in the community
• provides medical, nursing and physical rehabilitation with intermediate care
• provides social crisis and safeguarding including emergency care packages
• offers multidisciplinary home visits: nurses, physiotherapists, occupational therapists and social workers
• provides advice and pathways to GPs in the community
• urgent visits can be prioritised within 2 hours following referral 
• patients will be contacted on the same day.

For exclusion criteria (click here for details) 

The team is based at Queen Elizabeth Hospital. Referrals can be made by calling: 020 8836 5031, Mon-Sun, 07:30 - 20:30  or if no reply, 020 8836 6000 Bleep 930. For any additional information or to arrange a presentation, please contact Ursula Dekker (click here for contact details)

Lower Limb Service - cellulitis

One of the key reasons for admission to hospital is cellulitis. The Lower Limb Service is currently working jointly with Queen Elizabeth Hospital to case find and facilitate early discharge and avoid inappropriate admissions for patients with cellulitis of the lower limb. 

The Lower Limb Service, part of the Integrated Complex Wound Care Team, provides treatment, education and advice about caring for and preventing cellulitis of the lower limb. Domiciliary and clinic appointments are available. To refer contact SPA team on 020 8836 8622. 

Chronic disease management

Community health services have teamed up with ProWellness to provide a new Chronic Disease Management System (CDMS) to support the management of patients with diabetes, chronic obstructive pulmonary disease (COPD) and heart failure in Greenwich.

This web-based tool means GPs will be able to access securely and share information with other healthcare professionals involved in a patient's care. It provides a holistic view of the patient's current condition and history, as well as enabling a better projection of how their condition is likely to develop.

ProWellness has been offering this system for the management of COPD and diabetes for some time, but it is the new partnership with Oxleas that will enable the introduction of a cardiac specific system (module). The system is being integrated into practice and is scheduled to be fully operational early in 2012.  

For more information, contact Richard Whittington, project manager on 07875 432918 or email Richard.whittington@gmx.co.uk

Wound care pilot

Within Greenwich, wound care spend is increasing year on year. This is caused by complex wound care requiring multiple visits by community nurses, expensive dressings, inappropriate prescribing of dressings and dressing waste. Current spend on wound care is in the region of approximately £1million per annum. 

An wound care three month pilot has started to supply and monitor dressings within two integrated community teams, using the current wound care formulary. The project is delivered through an electronic, web based ordering system. There is a potential 10-40% saving to be made on dressings alone, dependant on the outcome of the project. However, further financial savings will be met through increased productivity within community nursing, improved wound healing rates and reduced administration involved in requesting and producing prescriptions. 

The project will be fully evaluated in terms of patient outcomes, efficiency, productivity and patient satisfaction. If successful, GCHS will work with Greenwich Business Support Unit to transform the wound dressing budget across Greenwich.  

End of life care

Partnering with Greenwich and Bexley Community Hospice and Marie Curie Cancer Care, GCHS has a coordinated service for patients and their families and carers. 

GCHS provide a Rapid Response Service to support patients and their families/carers. The model has a key worker, usually the district nurse, who acts as the single point of contact for patients, families and professionals. The key worker coordinates services using the Gold Standards framework and Liverpool Care Pathway. 

A palliative care coordination centre has been established to coordinate packages of care for people nearing the end of their life. The rapid response service prevents inappropriate hospital admission during an emergency by providing responsive, out of hours support to patients and offers a triage and a helpline for patients, carers and professionals to seek advice on symptom relief and practical, emotional and psychological matters. In addition there will be personal care services.

GCHS community nurses provide the rapid response service 4pm-11pm on weekdays and from 8am to 11pm on Saturdays, Sundays and Bank Holidays. 

Access the service via: 020 8320 5794.

Podiatric Surgery

The Specialist Foot Service is available (via Choose and Book) for all foot problems which could be resolved via elective day surgery, freeing up some pressure from orthopaedics as well as the anaesthetic team at Queen Elizabeth Hospital. A local anaesthetic is used instead of a general, and patients are able to return home that same afternoon. An on-call service is offered for post-operative support, which is all undertaken by this community service, also reducing pressure on practice nursing.

To refer patients for treatment for bunions, arthritic joints, toe deformities and lumps and bumps, select the Specialist Foot Service at Garland Road, Plumstead via Choose and Book. Diagnostics are organised in house if necessary, although the service is able to access any imaging and diagnostics already undertaken at Queen Elizabeth Hospital. 

For further information please contact footsurgery@oxleas.nhs.uk or call 020 8305 7648.

Greenwich Intake and Liaison Team (ILT) and Short Intervention Team (SIT)

Greenwich Intake and Liaison Team (ILT) and Short Term Intervention Team (SIT) are based at the Ferryview Health Centre, John Wilson Street in Woolwich. The team, formerly the Assessment and Shared Care Team, has made several changes to improve the service for patients and referrers. These new teams came into effect on the 28 November 2011.

The new teams will function as follows:

Intake and Liaison Team will

• take all new referrals into the mental health services
• signpost referrals to the appropriate service after the initial assessment.
• provide comprehensive assessments.
• contact all patients as soon as possible but not more than 10 working days after the referral.
• continue to respond to crisis referrals during the hours of 09.00 -17.00. 
• all out of hours assessments will be carried out in Queen Elizabeth Hospital Accident & Emergency Department. Referrals should be made to the Mental Health Liaison Team who are contactable on 020 8836 6000 bleep 373.

Short Term Intervention Team

Patients referred to the SIT team will receive targeted time limited care and support for up to a year. The possible interventions include psychiatric outpatient reviews and psychological therapies.

Service improvements

These changes mean there will be one central point of access for GPs and patients. Other improvements include:

• all assessments carried out within the team will be used to determine the most appropriate service to sign post a patient to. (SIT, Recovery, inpatients, etc)
• patients will be transferred to the most appropriate service for their care as soon as this is determined.
• to ensure continuity of care, one doctor will work with the patient in both teams.
• the service remains in Woolwich which is well known to most patients.
• where appropriate, psychological therapies will be offered as treatment with this service.

The contact number for the teams is: 0208 319 5500 Select option 1.

To download the adult mental health pathway in Greenwich please click here.  To download the older people mental health pathway (aged 65+) in Greenwich, please click here.  

Greenwich Recovery Service

From 28 November 2011, the Greenwich Recovery Service based at 68 The Heights Charlton has made a number of changes to improve the experience for service users and GPs. These are:

• outpatients seen at Ferryview Health Centre will get access to a wider range of professional interventions to assist their recovery
• the service now is arranged in three rather than five teams; East, West and Central with an increase in senior medical cover
• we are working towards aligning these with GP practice clusters
• we will be providing a direct re-referral route to the Recovery team for six months after discharge to further support service users and GPs. This will be detailed in the discharge letter.
• there is no change to the number of care coordinators for CPA clients, and we are minimising any changes of care coordinator as a result of the reconfiguration.

All new referrals to the service will need to be routed via the Intake and Liaison Team at Ferryview.

To download the adult mental health pathway in Greenwich please click here.  To download the older people mental health pathway (aged 65+) in Greenwich, please click here.

The Recovery Service works with mental health service users with more complex presentations likely to require interventions for more than one year.

New groups at Greenwich Time to Talk 

Greenwich Time to Talk (GTTT) is the primary care psychological therapy service for people who are stressed, anxious or low in mood.

Group cognitive behaviour therapy (CBT) is as effective as individual CBT therapy. So as well as individual treatment options (CBT self-help, CBT therapy and person-centred counselling), Time to Talk have a wide range of cognitive behaviour therapy (CBT) groups on offer.

Time to Talk understand that the idea of groups may seem scary at first. However, they can be extremely helpful for many people, for a number of reasons:

• they can meet other people with similar problems which can help people realise they are not alone.
• it can help people understand their difficulties and start making positive changes in their life.
• it is an opportunity to build skills and techniques to help people deal with their difficult emotions and experiences, and improve their quality of life.
• people can hear how other people have overcome similar difficulties.
• they have good outcomes in reducing the target problem.

Time to Talk offer a range of classes and group therapy treatment for the following problem areas:

• stress
• depression
• low self-esteem
• lack of assertiveness
• obsessive compulsive disorder 
• social anxiety
• worry
• coping with breathlessness (for people with lung problems / COPD)
• relapse prevention for depression using mindfulness-based techniques
• coping with chronic pain and low mood
• coping with chronic illness and low mood or anxiety

If you think your patients would benefit from this service please give them Time to Talk's number to self refer on: 020 3260 1100. Initial assessment is within 5 working days. If a group is agreed as the most appropriate treatment option, the person may need to wait for the start of the group. There are many groups starting this month. 

If you would like Time to Talk to come and talk to your practice staff about the treatments available, please contact Katy Grazebrook, email

katy.grazebrook@oxleas.nhs.uk or call 020 3260 1100.

Accessible health information

Easy-to-read and accessible information about health conditions and procedures, including accessible guides to cervical screening, hospital stays and ultrasound scans can be accessed and printed from Oxleas' website. They can be found here.