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Greenwich edition issue 5 

June 2012

Greetings! 

Welcome to the fifth 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. 

Thanks to everyone who attended the GP masterclass on 10 Minute CBT in April, it was really good to see so many of you there. For a number of GP colleagues, this was their first masterclass, and feedback was very positive. If you were unable to attend but are interested in further training, the 10 Minute CBT article in the next section provides more information. Our next GP masterclass is on 4 July - see dates for your diary section for more information and to book a place. 

If you have any ideas or specific information you would like about our services, please contact us. We also welcome your feedback on the services we provide.

Yours sincerely

Stephen Firn

Chief Executive

Oxleas NHS Foundation Trust

Community clinical teams: working in partnership with GP syndicates

Now that all Greenwich GP practices are members of one of the five syndicates established across the borough, our community health services have aligned staff from key services to link to each syndicate. This will help build relations and improve understanding between community services teams and GP practices.

In response to the syndicates' request, the Joint Emergency Team (JET), community matrons, district nurses, long term condition specialists and health visitors have estalished links to all syndicates. Names are listed here.  

The role of our syndicate links

Our syndicate links will:

• communicate with the syndicate leads, and attend syndicate meetings
• use these meetings to engage with practices and promote their services as well as understand the problems practices are facing with the service
• become the point of call for practices within the syndicates for advice or to deal with problems
• advise of other services which may be appropriate or of interest to the syndicate.

Through this process, practices can offer views and suggestions regarding systems and service provision.

New Integrated Children's Service

Oxleas will be launching a new Integrated Children's Service in Greenwich later this summer. The new service will work closely with existing services and provide a team of children's nurses working alongside other health professionals including dietiticians and psychiatrists in clinics and family homes. It will help prevent children having to go in to hospital unless they need to.

This will be an extension of some existing services currently provided by Oxleas and South London Healthcare NHS Trust (with some staff due to join Oxleas) and also three new specialist services for children with epilepsy, attention deficit hyperactivity disorder (ADHD) and a dietetics service. The service begins operating on 1 July and will develop to become fully operational over the course of the year.

This new service will mean better, more joined up care for children and young people with complex health needs and their families in the borough. It will establish a broad children's services network which will provide high quality child centred care. The team will work very closely with other services in Greenwich including schools, children's centres, Demelza Children's Hospice and local voluntary sector organisations. They will also work with specialist children's hospitals.

10 Minute CBT - training available for GPs

The GP masterclass on the 25 April opened with presentations from local providers including one by Katy Grazebrook, Oxleas' clinical lead for Greenwich Time to Talk (GTTT). Katy ran through the latest developments for GTTT and reminded GP colleagues of the service's impressive recovery rates and waiting times. With the latest statistics now released from the national IAPT organisation, GTTT has a lot to be proud of in its achievements as a wave-two IAPT site.

The main talk was from Danuta Orlowska, a clinical psychologist from '10 Minute CBT'. Danuta used a great range of video clips, and practical examples to distill the '10 minute CBT' concept with a very positive response from the audience. GPs learnt to formulate a patient's concerns in a cognitive way. They learnt to draw the links for the patient between the way they were thinking, their feelings, their physical symptoms, and the actions they decided to take. It left people with a lot to think about in terms of their own approach to patients, and many signed up for further courses in '10 minute CBT'.

For those people who were unable to come to this masterclass, but are interested in further training, this will consist of:

Four modules

• Introduction and communication skills
• Anxiety & panic/depression
• Long-term physical health conditions
• Medically unexplained symptoms (persistent health problems)

This can be delivered as half-day/full day training or on site.

Those signing up to the training will have the opportunity to discuss cases in supervision, including rating any recorded sessions against the Primary Care Practitioner Consultation Skills Scales if they would like.

If you missed the event, but are interested in training in 10 minute CBT, you can sign up by emailing: joe.ryan@oxleas.nhs.uk.

British Heart Foundation award to establish Cardiac Rehabilitation Service

Greenwich Community Health Services, in close collaboration with the Cardiac Network and Greenwich Business Support Unit, have been awarded £100k to set up and deliver cardiac rehabilitation in the community in Greenwich.

Community Gynaecology Services

Our CASH (contraceptive and sexual health) medical team are now providing community gynaecology services. Many women's health problems can be helped without the need to be referred to hospital. If your patient's symptoms are not serious and do not require surgery, you can refer them for diagnosis and treatment by our specialist community gynaecology team. 

The CASH Community Gynaecology Service can assess and treat a wide range of symptoms and conditions such as: 

• heavy and painful periods
• premenstrual syndrome 
• problems with menstrual cycle which cause other medical conditions to get worse, ie migraines
• advice and treatment for the menopause
• irregular or abnormal bleeding (unless you suspect something serious)
• assessment of fertility
• hormone imbalance
• abdominal pain or pain or difficulty having sex
• pain or itching in the vagina or vulva
• 'lost' IUD
• help with prolapse.

Community Gynaecology clinics currently run at Market Street Health Centre in Woolwich. We will be opening clinics at Vanbrugh Hill Health Centre in Greenwich and Bungalow 3, Wensley Close in Eltham shortly.

GP referrals can be made through the Greenwich Referral Management Service (RMBS), through Choose and Book or by email to rmbs@nhs.net. 

For queries or complaints, please email fiona.dickson@nhs.net, for advice and information email greenwich.cash@nhs.net.  

Community Paediatric Audiology Service (CPAS)

This outpatient based service is responsible for the identification, assessment, diagnosis, management and rehabilitation of children with diseases of the ear and/or hearing loss. In addition, aetiological investigations are offered to all children following confirmation of sensorineural hearing loss. The rehabilitation of hearing impaired children is carried out jointly by local services (Advisory Teachers of the Hearing Impaired [Sensory] and Speech and Language Therapy) and the St George's Tertiary Audiology Satellite Service.

The service refers children with suspected/confirmed hearing impairment to St George's Tertiary Audiology Service (based at Murchison Clinic, Bexley) for final diagnosis and further management. The latter includes management of hearing aids and referral to the cochlear implant team. The CPAS has a close relationship with the ENT department at Queen Elizabeth Hospital. Children with middle ear problems (eg glue ear) are referred to ENT for further management and hearing assessments of younger/difficult children are carried out by the service when requested by ENT colleagues.

The service provides advice, liaises with other agencies concerned with the care of children with hearing impairment and offers teaching and training of staff involved in the identification of children with hearing loss in other health service providers (doctors, HVs, screeners etc).

Referral criteria/procedure

• Referrals are accepted for all children with a Greenwich GP.
• Referrals are accepted from all healthcare professionals (eg GPs, health visitors, community/hospital paediatricians, school/nursery nurses, speech and language therapists, etc)
• All children are to be referred if there are parental/professional concerns, difficulties with speech and language, behaviour and development
• Babies are referred for targeted screening from NHSP & St George's Tertiary Audiology Service
• Referrals are accepted for children who have failed two hearing screening tests in school
• Urgent referrals include children with history of meningitis, a family history of hearing loss or severe speech delay.

Referrals should be made in writing and sent to: 

The Community Paediatric Audiology Service, The Child Development Centre, 3 Wensley Close, Eltham SE9 5AB or alternatively, by downloading a referral form and sending this directly to the Audiology Service.  Alternatively, you can fax the completed referral form to 

020 8850 0087.

The referrals are prioritised according to the information provided in the referral letters/forms.

All new referrals are seen within six weeks of receipt of referral.

Click here for details of the Audiology Team and service locations.

Healthy start campaign

Recent policy, supported from evidence based research, has indicated that baby led weaning should not commence until six months. In response, we are running the healthy start campaign which is designed for babies aged five months. This includes healthy eating parties at children's centres and the healthy start packs containing evidence based information, meal planners, cooking tips and recipes, a bib, cup, spoon and bowl. Effectiveness will be evaluated at one year assessments. 

UNICEF baby friendly status

Following assessment for UNICEF Baby Friendly status in December 2011, our Public Health Community Nursing team (PHCN) met 38 out of 43 criteria (with over half of the criteria scoring 100%), narrowly missing achieving Level 3 status. Oxleas was the first community trust to be assessed in the country and we will be reassessed in three to six months on the five outstanding criteria. 

Oxleas' Greenwich community health services was commended for its work, with particular reference to the diversity and complexity of the community and the intensive work of the breast feeding advisors, the infant feeding advisors and health visitors, saying that Greenwich Community Health Services should be held up as a beacon of good practice. Previously, the service was also the first to achieve Stage 1 and 2. 

Looked after children (LAC)

Sally Devincenzi is our new Designated Nurse for Looked After Children, focussing on improving the health and wellbeing of some of the most vulnerable children in the borough. Sally joins Assumpta Coleman, Named Nurse working with the school aged child and Sew Lan Ooi who has joined the trust as Nurse for Care Leavers. 

Assumpta has been with the LAC team for four years and was working across all the age ranges from 4+ until April 2011. She has a wealth of knowledge especially with children who have complex needs and acts as advocate for both child and carer. She trains foster carers and other professionals in the health needs of LAC. 

Sew Lan works with the 15+ age group and has already made a huge difference to some of the most hard to engage adolescents, to ensure the transition to adult life is as smooth as possible. Sew Lan focuses on developing relationships with young people, engaging on their terms whether that is over coffee or early evening clinics using texting. 

All the nurses work in partnership with care homes, schools and children's services. Nurses perform annual health assessments and will see approximately 70% of our own children no matter where they are placed to ensure continuity with their nurse. 

The LAC team work closely with many professionals and are happy to support GP colleagues with queries relating to LAC placed by Greenwich Local authority, such as immunisation status and health concerns.

Please feel free to contact us as detailed below

Sally, tel: 020 8301 8940, email:sally.devincenzi@nhs.net 

Sew Lan, tel: 020 8301 8954, email: sew.lan.ooi@nhs.net 

Assumpta, tel: 020 8301 8955, email: assumpta.coleman@nhs.net

LAC admin, tel: 020 8317 8079, email: greenwich.lac@nhs.net  

Alzheimer's disease shared care agreement - Donepezil, Galantamine, Rivastigmine and Memantine

The above shared care agreement has been developed by NHS South East London Bromley, Bexley and Greenwich Business Support Units and Oxleas.  

The shared care agreement outlines suggested ways in which the responsibilties for managing the prescribing of the above drugs for the treatment of Alzheimer's disease can be shared between the specialist and GP. GPs are invited to participate. If GPs are not confident to undertake this role, they are under no obligation to do so. In such an event, the total clinical responsibility for the patient for the diagnosed condition remains with the specialist. If a specialist asks a GP to prescribe this drug, the GP should reply to this request as soon as practicable.  

This agreement formalises the structure that enables GPs to work with our services to provide the most effective way of treating people with dementia, with medicines that preserve abilities and skills for as long as possible. It is important that GPs share prescribing with our services as almost all our patients are on several medicines and it is essential that both services always have a complete list of all medicines being given. It will also allow some increase in the capacity of the Memory Service to see more new referrals for assessment and diagnosis of memory problems.  

To download the new Alzheimer's disease shared care agreement, please click here.     

Integrated healthcare services in prisons and forensic units

Oxleas is now providing integrated healthcare services to West Kent prisons and forensic units in Maidstone and Dartford, taking over the role in December 2011. 

Community learning disability team move

Greenwich community learning disability team, previously based at Civic House, have moved to the Woolwich Centre. Contact numbers remain the same (click here), however patient appointments will be at the outpatients building at Memorial Hospital in Shooters Hill. This is a temporary move until clinical space is secured nearer to the Woolwich Centre. 

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.