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Greenwich edition - issue 9 

July 2013

Greetings! 

We are improving how we manage referrals to child and adolescent mental health services in Greenwich. See below for details. If you have any feedback on this or ideas or specific information you want included in future issues, please let us know. Feedback on the services Oxleas provide is always welcome.

Making our children's mental health services more responsive

We are improving our CAMHS services

We are making changes to improve our response to referrals to our child and adolescent mental health services (CAMHS). We are introducing the Choice and Partnership Approach (CAPA) which will mean that referrals will be seen by senior clinicians and then a decision made with the family about the next steps. Many families can be helped by a rapid response i.e. fast access to a specialist service which can assess their needs and 'match' these needs to therapies where appropriate. The eligibility criteria for secondary CAMHS services is not changing. However, we hope the introduction of this approach will mean that more families get the care they need quicker. Not all families will need ongoing intervention and the aim of the first appointment is to establish quickly where the child's needs can best be met. This work is in direct response to GPs' feedback about access.

We have begun this process with a 'blitz' on the waiting list in recent weeks and significant progress has been made. By September, the service will have moved to operating a four to six week wait from referral to the 'Choice' appointment. Recruitment of additional staff is underway and the whole team will undergo training over the summer period in the CAPA model. This change in response times should markedly improve the experience of accessing CAMHS by referrers and families.  

Support for parents whose children are affected by gangs

Liz Day, Dr Marcus Averbeck and Elisabeth Heismann

An innovative way of addressing violent, destructive and harmful behaviours in children and adolescents was showcased in the launch of three different projects in the Gallery at the Woolwich Centre on 21 June.

Dr Marcus Averbeck, Head of Family Therapy, introduced the Non Violent Resistance (NVR) afternoon. Elisabeth Hiesmann, Senior Family Therapist in Greenwich and Liz Day, Principal Family Therapist in Bexley, launched the new NVR DVD, a new booklet of testimonies by parents, children and supporters and a new programme designed for parents whose children are in or affected by gangs. 

Waiting times cut

Since winning the Integrated Children's Service contract in 2012, patients using two of our children's services have experienced huge cuts in waiting times. In a partnership between CAHMS and community health services, a new clinical care pathway for attention deficit hyperactivity disorder (ADHD) has seen waiting times reduce from 12 months to six weeks. 

The Integrated Children's Team acts as the single point of access for referrals. A triage system is in place to coordinate referrals to the appropriate team, the majority of children are able to be assessed within the integrated team.

In another waiting list initiative, a highly specialist psychologist was seconded into the Community Paediatrics Team and additional speech and language therapy provided to young patients with autistic spectrum disorder (ASD). This has resulted in the waiting time being reduced from more than a year to eight weeks.

Children toilet training sessions

GPs with patients who have children who have toilet training problems may be interested to know that we might be able to help.

Oxleas runs two drop in sessions each month where we offer advice about toilet training, concerns about constipation, bedwetting or toilet refusal. Continence trained nurses and nursery nurses will be on hand to talk to concerned parents. They will be happy to answer any questions and refer you on to other services if required.

Helping Greenwich GPs to treat body and mind

Integrated working by our health professionals in the Royal Borough of Greenwich is proving a great benefit to the area's patients. 

Left to right: COPD Matron, Paul Cullen; Sally Ranford, Oxygen Lead; Debra King, Oxygen Coordinator and Specialist Physiotherapist, Helen Jefford

Our chronic obstructive pulmonary disease (COPD) and pulmonary rehabilitation (PR) services in the borough work closely with Greenwich Time to Talk, our IAPT service.

According to Debra King, COPD and Home Oxygen Service Coordinator: "We can screen patients for anxiety and depression and signpost patients and doctors to IAPT should it be necessary."

Evidence in Practice in COPD

Lynn Orford

A pilot scheme is underway in Greenwich to identify people in the borough who either suffer from, or are at risk of developing, chronic obstructive pulmonary disorder (COPD).

The Evidence in Practice pilot is being run jointly by our COPD team led by Lynn Orford and MSD, a pharmaceutical company. Following a successful pilot in collaboration with us two years ago around diabetes, MSD and the COPD team are working with 20 GP practices across Greenwich. The first step is for MSD to visit practices and conduct a base-line audit to identify patients potentially at risk from COPD such as smokers aged over 35 or those frequently using inhalers or antibiotics but who have no diagnosis. For more information, contact Lynn Orford on 020 8319 5381.

Wide range of gynaecology services available from Oxleas

Dr Jane talks to Dr Sasha Abraham from Greenwich Peninsula Practice

Local GPs discussed with our Consultant in Sexual and Reproductive Healthcare, Dr Jane Dickson, how we are offering local women a wide range of gynaecological services in community clinics - many which women in the past would have had to have gone to hospital for. Women can be referred to the service by their GP for gynaecological conditions that do not require surgery. For more information see our Community Gynaecology Service.

The service began in April 2012, since this time we have seen 522 people. Of these, 402 were new patients and 120 were follow up patients. Our new follow up ratio is only 1:0.3. This means we see only 21% of the 'follow ups' seen in hospital. Some of this relates to the fact that patients in hospital may be 'post-surgery' but much is due to the fact that we operate a 'one-stop shop'. We only have a 7% DNA Rate.

For informal information and advice about women's health problems, you can also tweet Dr Dickson on Twitter @TheGynaeDoctor.

End of Life Care

We are pleased to be able to announce the continuation of our End of Life Care service in Greenwich, working in partnership with Marie Curie Cancer Care and Greenwich and Bexley Community Hospice. The service supports GPs and district nurses in Greenwich 365 days a year, providing quality care and support for people with advanced illnesses.

The Greenwich Care Partnership enables more people to die in their place of choice by making sure appropriate care and support is available for patients and their families and carers. It was originally piloted in May 2011and received a lot of positive feedback. There was a large reduction in the amount of deaths of people with serious illnesses in hospital, as more people were able to die in their own homes or care homes.

Dr Hany Wahba, local GP and Chair of NHS Greenwich Clinical Commissioning Group said: "We are very pleased to be able to continue working with Greenwich & Bexley Community Hospice, Marie Curie Cancer Care and Oxleas NHS Foundation Trust. They have provided an excellent service to residents in Greenwich over the past couple of years and will continue to help people die with dignity in the best possible place for them."

Integrated cardiology service in Greenwich

Work is ongoing to develop an integrated cardiology service in the Royal Borough of Greenwich. Integrated care seeks to improve the quality of care for individual patients and carers by ensuring that services are well coordinated around their needs.

Greenwich Clinical Commissioning Group (GCCG), Oxleas and South London Healthcare NHS Trust have been exploring the possibilities of commissioning an integrated cardiology service and have set up a Strategic Integration Group (SIG). The group recently published an audit - most of which you can read here.

For more information contact Alison Stephens, Integrated Care - Project Manager (Cardiology Service) Oxleas NHS Foundation Trust. Tel: 01386 244559. Mob: 07790 130582. Email: alison@thehealthconsultancy.co.uk. 

London's first non-medical Approved Clinician

Dr Michael Witney

The first non-medical Approved Clinician has been appointed in London. Dr Michael Witney, our Director of Therapies and Consultant Clinical Psychologist, was recently confirmed in the role by the London Regional Approved Clinician Panel.

Read more

New lead for all our adult mental health services

Iain Dimond

We have streamlined the management for adult mental health services - the man at the helm is Iain Dimond. It will encourage innovations and new ways of working which will improve care and the patient experience.

Iain has recently taken up the role of Director of Adult Mental Health and Learning Disability Services - a new directorate was formed on 1 May. Iain is an occupational therapist by background. He joined Oxleas in 2009 as Service Director for Bromley Mental Health Services before becoming Director of Adult Complex Needs Mental Health and Learning Disability Services in 2012.

Meet our clinicians

Dr Jonathan West

In the latest of our series profiling Oxleas' clinical directors we talked to Dr Jonathan West, Clinical Director of Adult Complex Needs Recovery Service.

As well as his Clinical Director role across all of our adult community mental health services he is also a Consultant Psychiatrist specialising in treating patients that fall under the remit of the Early Intervention in Psychosis Team. These might typically be young people experiencing their first major breakdown.

He did his medical training at St. George's Medical School in Tooting. He specialised in psychiatry because he said: "Psychiatry has a holistic approach to patients and I like that. Psychiatry is a very decent part of the medical profession, where everybody involved seems to listen to each other. Patients and doctors listen closely to each other as do fellow professionals."

And Dr West isn't afraid of a challenge. In a previous job he worked in a deaf unit and had to learn sign language pretty quickly to function. Some staff at the unit were deaf too so it was an essential tool. Such experiences have helped him at Oxleas. Signing has he said helped him know how to use an interpreter to best advantage too. He said: "I always speak to a patient directly, not to the interpreter. The patient will still get the message and know you are concerned directly with him or her not the interpreter."  

Jonathan would welcome contact from local GPs. You can contact him on 020 8295 8060 or email: jonathan.west@oxleas.nhs.uk.  

Briefly

Our next GP Masterclasses

Free seminars for GPs

We continue to offer GP practices in Greenwich, Bexley and Bromley free 30 minute seminars on key health topics such as contraception and sexual health and assessing risk of suicide. Delivered by Oxleas' clinicians, these can be held in your practice at a time convenient to you. Click here  for the programme.