Local CCG Research Articles

331 Improving Equity of Access in a Post-Covid World: A Closed Loop Audit of the Varicose Vein (VV) Referral to Treatment (RTT) Pathway

Abstract Aim Restrictions in clinic, investigations and theatre capacity following COVID-19 led to a change in local CCG VV referral criteria meaning those with advanced venous disease were seen. However, it was noted that many patients attending clinic didn’t meet these new CCG criteria. Method Following a change in CCG criteria in April 2021, all VV referrals to vascular surgery between 01/04/21-28/02/22 (AC1) were audited and differences between the consultants’ acceptance practice was reviewed. Results were presented at clinical governance in 09/03/22, with change implemented and referrals between 01/04/22-31/07/22 (AC2) re-audited. Results 250 VV referrals were made in AC1, 43.5% Male, mean (±SD) age 54.8 (16.9) years, by GPs (82.8%), other HCP (11.6%). 158 (63.2%) failed the criteria and should have been rejected. However, the actual rejection rate was 44.9%, with significant differences (P<0.001) in consultant practice demonstrating inequity for patients’ acceptance to be seen in clinic. 62.9% of ineligible patients attending clinic had subsequent investigations, increasing the waiting list time for all patients. 153 VV referrals were made in AC2, 43.1% Male, mean (±SD) age 55.3 (17.7) years, by GPs (86.3%), other HCPs (12.4%). 96 (63.7%) failed the criteria. However, in AC2 there was a 15.5% improvement (p = 0.02) in consultants appropriately rejecting outright and no significant differences in consultant practice (P = 0.46). Conclusions There is now less variation between consultants and a greater adherence to CCG criteria in AC2 demonstrating improved equity of access. There are fewer inappropriate clinic attendances, therefore less investigations and treatment booked, decreasing overall wait time and unnecessary downstream costs.

The impact of the ‘Community Refocus Project’ on the Community dietitians service at Western Sussex Hospitals NHS Foundation Trust (WSHFT)

The Chichester community dietetic team offer a domiciliary service for housebound individuals. During 2014 to 2015 total patient contacts increased by 27% without any increase in service funding. The team felt that not all the referrals for dietetic input were appropriate, complete or timely which made prioritisation difficult and impacted on the effective use of clinical resources. This abstract outlines the service improvements undertaken to address the above concerns. A review of referrals received in January and February 2015 showed frequent omission of relevant information and inadequate identification of malnutrition. Most referrals were received from GPs and community nursing teams/allied health professionals. The majority of referrals (61%) were for care home residents. Following assessment 26% of referrals were deemed inappropriate by the Dietitian. From March to July 2015 the dietetic team established the ‘Community Refocus Project’. The community nursing teams and allied health professionals highlighted a lack of awareness of referral criteria, the use of outdated referral forms and patient information literature, a lack of weighing equipment and a perceived lack of effective multidisciplinary working between Dietitian and community staff. The key objectives for the project are shown in Table 1.Table 1Key ObjectivesRevise ‘Malnutrition Universal Screening Tool’ formDevelop community dietetic referral criteria and triage processRevise community dietitian referral formDevelop working links with community healthcare professionalsRevise patient information leafletImplement and evaluate training package Open table in a new tab The local community malnutrition screening tool was revised in consultation with our community healthcare teams and based on guidance from British Association for Parenteral and Enteral Nutrition (BAPEN). Triage criteria for referrals were revised to base prioritisation on the ‘Malnutrition Universal Screening Tool’ score and dysphagia risk. The referral form was updated to reflect information required for appropriate triaging and a standard response letter was developed for incomplete or inappropriate referrals. An information leaflet was developed for healthcare professionals to use with patients requiring first line food fortification advice. GPs and community healthcare teams were informed of the new processes. An education package including a teaching session and resource pack for healthcare professionals was developed covering all aspects of malnutrition management in the community. Training sessions were attended by more than 50 community staff and 100% positive feedback received. All resources developed were made available on the WSHFT public facing website and some were also included in the local CCG Adult Oral Nutritional Supplement Formulary. To date, the team report that the new referral and triage process is more robust and that having up to date resources available is beneficial. This work has also led to improvements in working relationships with community nursing teams and the medicines management team. Initial findings from a repeat review of referrals in January and February 2016 showed that the total number of referrals remained the same and that these continued to be predominately for care home residents (68%). There was a decrease in referrals from community staff from 25% to 11%; however, there was an increase in referrals coming from GPs. These initial findings highlight potential key areas for development, although further evaluation of the project within the wider community is required.

Integrating children's services - between aspiration and reality

Integrating children's services - between aspiration and reality

MELATONIN – WORKING IN COLLABERATION WITH THE CCG TO REDUCE COSTS

AimTo reduce the overall expenditure on melatonin for the local health economy by working collaboratively with the CCG's. To ensure that all paediatric patients prescribed melatonin have been clinically assessed...

G321(P) Fix freddie!

Background Facing higher than average unscheduled care use in a busy inner city paediatric unit, with a significant proportion of low acuity conditions, a need to become proactive in tackling the pressure was recognised. Collaborated as part of new innovative integrated paediatric care model with puppet company to produce Fix Freddie! Pilot tour Spring 2014. Objectives Better understanding of how local community accesses children’s unscheduled care bringing together communities and professionals across the whole system, to support families in feeling confident to navigate system and care for their children’s health needs reduce pressures on the local emergency and urgent care system Methods Explored different settings and workshop styles (Table 1). Parents/carers asked to complete a pre show questionnaire. After the show, explored issues with: small parent focus groups classroom-based discussion and picture drawing fete style event with informal conversations with professionals Feedback obtained with Post-It comments on “Freddie Feedback” poster. Information leaflet distributed with advice about where to seek advice, self management, and information about local services. Filmed to capture impact of events on children, parents and professionals. Results Pre show questionnaire Completed by 46 parents of 85 children. 53% white british; 47% diverse ethnic mix. Chart A how seek child health advice – 85% GP, 21% ED, 42% family and friends, 37% internet. Chart B services use when worried – 89% GP, 52% ED Parents most consistently worried by fever, 52% would seek GP review 41% would go to A&E. Other concerns included cough, vomiting, diarrhoea, abdominal pain. Attended ED and the GP with similar illnesses. 26% reported issues in accessing care, primarily lack of same day GP appointments. Key themes surfaced from Fix Freddie! Feedback (Table 2) Better understanding of local services available, notably about 111 Improved knowledge and confidence about self managing minor illnesses and injuries Additional awareness raised about safety at home General positive feedback for puppet show and events Conclusion Fix Freddie! has provided a fun and engaging way to make new connexions across the whole system, facilitating co-design of local solutions to problems of healthcare accessibility and confidence in self management. Local CCG commissioners are now funding a wider local tour and we are working on next steps to broaden reach of the events.

FIX FREDDIE! – PULLING STRINGS TO REDUCE PRESSURE ON MINORS

Objectives & BackgroundEmergency and urgent care workload is becoming unsustainable.1 2NW London has higher than average use of unscheduled care;3significant proportion with low acuity conditions.2 4 5As a paediatric emergency care provider, Imperial College Healthcare (ICHT) recognise a need to become proactive in tackling this challenge. ICHT collaborated with a professional puppet company to produce Fix Freddie!6A pilot tour ran in NW London March and April 2014. Objectives included:better understanding of how local community accesses unscheduled caregathering professionals across the whole system to support families in feeling confident to navigate system and care for their children's health needsreducing pressures on unscheduled care systemMethodsPilot tour explored different settings and workshop styles. Audience 484 children, 134 adults(image1)Parents and carers asked to complete pre show questionnaire about child health and services. After the show issues raised explored in various ways:small parent focus groupsclassroom-based discussionfete style event promoting conversations with professionalsFeedback obtained with Post-It comments on “Freddie Feedback” poster(image 2).Filmed to capture impact of events on children, parents, professionals.Leaflet distributed with information about how to seek advice, self management and local services.Results:Pre show questionnaireCompleted by 46 parents of 85 children. 53% white british; 47% diverse ethnicies.Chart A -How they seek child health advice(image 3)Chart B -Services use when worried(image 3)Parents consistently worried by fever: 52% would seek GP review 41% would go to ED.Attended ED and the GP with similar illnesses.26% reported issues in accessing care, primarily lack of same day GP appointments.Key themes surfaced from Fix Freddie! Feedback(image 4)Better understanding of local services, notably 111Improved confidence managing minor ailmentsPositive feedback for puppet show and eventsImmediate impact captured on film, currently being analysed. Short documentary being produced by June 2014.ConclusionFix Freddie! has provided a fun and engaging way to make connections across the whole system, facilitating co-design of local solutions to problems of healthcare accessibility and confidence in self management. Local CCG commissioners are keen to fund a wider local tour and we are looking at next steps to broaden the reach of events.

PTU-160 So You Requested Coeliac Serology; What Next?: A Seven Year Review Of Outcome After Requesting Anti-tissue Transglutaminase

IntroductionCoeliac disease is common in the UK with a prevalence of 1 in every 100–200 of the population. Individuals may go undetected for many years, despite presenting numerous times to...

The right to die peacefully

The editorial1 and accompanying article2 in the October edition of the BJGP highlighted the problems of advance care planning in older people. We detail below the tragic consequences of failure to have these conversations. A review of case notes of patients registered with a local CCG, who were over 75 years of age and died after spending …

CCGs must do more to engage GP members, finds survey

Leaders of clinical commissioning groups need to work much harder to reach out to their GP members if they are to prove that these new organisations are not just a rehash of primary care trusts, concludes a joint report from the Nuffield Trust and the King’s Fund.1 The report—which is based on interviews and surveys with GPs at six representative sites in England—highlights a considerable gap between the views of those in charge of these GP led member organisations and GPs without formal roles. Many GPs don’t have a strong sense of ownership of their local CCG …

Practice nurses ruled out

Practice nurses have been ruled out of the registered nurse post on their local CCG governing body. Ana Selby suggests alternative ways that nurses can exert their influence on commissioning