In December 2011, Ashford and

St. Peter’s NHS Foundation Trust

established an Acute Oncology

Service in line with a nationally led

directive.

The service is nurse-led by Dr

Barry Quinn, Macmillan

Consultant Lead Nurse for Cancer

and Palliative Care, in

collaboration with Consultant

Oncologist Dr Maria Drzymala and

a team of cancer nurses. The

service consists of a senior cancer

nurse who is available between

8.00am and 4.00pm Monday to

Friday, and a Consultant

Oncologist who is available each

weekday morning. Outside of

these hours the Trust can get

advice from an on-call registrar

and consultant at Royal Surrey

County Hospital. The benefit of

the service is that patients with

cancer related problems admitted

to A&E and to the wards can be

seen more quickly and feel more

reassured that their care and

correct treatment is being planned

and delivered.

The service is aimed at patients

who may have treatment related

toxicities or who may have

symptoms relating to disease

progression needing unplanned

and sometimes emergency

treatment. It also aims to ensure

that those admitted with a

suspected cancer undergo the

correct investigations in a timely

manner. The service is not

designed to replace the 2WW

referral procedure and this should

be followed for the majority of new

referrals where the GP is

suspicious of a cancer diagnosis.

Currently between 5 and 9 cancer

patients requiring unplanned/

emergency treatment are

benefitting from this service.

For patients in the above

categories the service is designed

to compliment and enrich the

existing A&E services by:

allowing the patients to be seen

much more quickly,

providing targeted care and

treatment in a timely manner,

reducing unnecessary

investigations by providing

advice and support to non-

specialist doctors or doctors in

training,

providing education and

training to A&E and ward based

nursing and medical staff

improving care and facilitating a

better use of services.

On leaving hospital patients are

given the pager number for the on-

call senior cancer nurse. Patients

already undergoing treatment will

already have access to their key

worker, and the Acute Oncology

Service aims to provide an

additional level of support.

This team aim to provide

additional advice and support in

patient management to help

ensure that the patient gets the

correct treatment in the most

appropriate environment. Working

together the GP, community

teams and Ashford and St Peter’s

can continue to strengthen our

working relationship in striving to

achieve the best outcome for the

individual patient.

April 2012

Introducing The Acute Oncology Service

The Acute Oncology Team L-R Registered Nurse Emma Bond, Registered Nurse Claire Johnson, Dr Barry Quinn, Dr Maria Drzymala and Registered Nurse Fiona Power.

Overview

The Trust has undertaken an

Enhancing Quality programme in

four areas which has demonstrated

increased clinical quality and

potential to improve outcomes for

patients, according to the first year

of official data. This is summarised

in SEC Annual Report. The

Programme is closely linked to

NICE Quality Standards, the

Commissioning Outcome

Framework and NHS Outcomes

Framework. It supports both

commissioners and providers to

deliver their Duty of Quality.

The programme also supports the

consistency of care through the

collection and consistent use of

clinical process data and analysis

of outcomes. This focus on process

and outcomes delivers reduced

variation in care, better outcomes

and improved costs. It is an

evidence-based improvement

programme that delivers rapid

spread and adaptation of existing

knowledge to multiple settings

through clinical sharing and

collaborative learning.

Clinical engagement in quality improvement and collaborative learning has been a major success of the Programme. Events have been well supported by clinical teams and they have attracted national speakers and experts in their field. There has been a positive response to the sharing of comparative quality data and clinical teams have been keen to take the opportunity to describe in detail how improvements have been made. This has been a key component in the rapid pace of performance improvement. This year ASPH FT

was one of three Trusts in SEC to be recognised with an award for their contribution to collaborative events.

Programme design and

implementation

The Enhancing Quality (EQ) Programme began data analysis with patients discharged from hospital in July 2010. Year One of the Programme is defined as July 2010 to June 2011 patient discharges. ASPH was one of 10 South East Trusts who took part in focused work in four areas. The four clinical conditions for which quality measures exist are:

Acute Myocardial Infarction (AMI)

Heart Failure (HF)

Hip and Knee replacement surgery (H&K)

Pneumonia (PN)

Quality Measures Doctors, nurses and clinical staff across Kent, Surrey and Sussex agreed a number of key things should happen for every patient, which are referred to as clinical process and outcome measures. There are 21 measures described in Figure 1 (enclosed) for four conditions - hip and knee surgery, heart attack, heart failure and pneumonia and their associated outcomes are described overleaf.

Physiotherapy

Departments Enforce

Trust DNA Policy

Whilst the telephone

reminder service introduced

in August 2011 has gone

some way to reducing DNAs

in the Physiotherapy

Departments at Ashford and

St. Peter’s, the DNA rate is

regrettably still high in that

area.

Part of the reminder service

is a function which allows

patients to change or cancel

appointments which they are

unable to attend or which are

no longer required.

We would be grateful if you

could encourage your

patients to make use of this

service and allow another

patient to take the unwanted

slots, which will help us to

reduce waiting times and

improve the service.

Please also make sure that

patients are aware that if

they do not attend their

physiotherapy appointment

they will be discharged and

will require a new referral

should they wish to be seen

at a later date.

Contact Details

If you have any feedback on this

publication or the Trust in

general, require any further

information about the Trust or

require this document

electronically please contact:

Debbie Beesley, GP News

Editor, 01932 723511

debbie.beesley@asph.nhs.uk

Enhancing Quality Outcomes

During the first year of EQ, the data on individual quality measures within each clinical area was used to create an aggregate score representing overall quality. This score is referred to as the Composite Quality Score (CQS). Another score called the Appropriate Care Score indicates at a patient level those that have received all the measures they were eligible to receive, additionally, outcomes for the same populations are tracked to monitor change over time. KEY FINDINGS FROM EQ Looking at the results for Ashford and St Peters over the last 18 months we can report improvements in all pathways:

Significant improvements are reflected in:

Heart Failure

Following a Rapid Improvement Event in July 2011, improved integration of services with Community Heart Failure Nurse Services Using a change to our electronic discharge process systems, a prompt alerts and reminds clinical staff to give tailored patient information relating to Heart Failure– improvement from 18% in Jan 2011 to 37% of patients receiving discharge information in Dec 2011

Pneumonia Education programme strengthened to improve understanding of local antibiotic guidance and process for taking blood culture prior to administering antibiotics Improved advice and counselling to smokers – from 20% in Jan 2011 to 75% in Dec 2011.

Hip and Knees

Improved process for assessment and

monitoring of VTE prophylactic antibiotics

received

EQ is prepared to innovate where there is appetite and support from clinicians and others for intervention to facilitate quality improvement. The strength of clinical support has seen it expand into new clinical areas where there is no existing model of systematic quality measurement. Two new whole system pathways were initiated in 2011; Dementia and community Heart Failure, with Acute Kidney Injury planned for implementation in 2012, results for these will be released at a later date. These new work streams have required measure development as well as development of new methods for data collection.

Baseline Jan -Dec % Improvement

AMI 94.85% 97.44% 2.5%

Heart Failure 41.08% 56.37% 15.29%

Pneumonia 76.71% 89.88% 13.17%

Hip and Knees 77.52% 91.10% 13.58%

Pneumonia (No CURB)

Jul to Dec

2010

Jan to Nov

2011

Oxygenation Assessment 95.37% 98.69%

Initial Antibiotic Selection for CAP

82.08% 95.93%

Blood cultures performed prior to

28.81% 57.02%

Initial Antibiotic Received Within 6

72.85% 77.50%

Adult Smoking Cessation Advice/

24.44% 60.27%

Composite Process Score

76.71% 88.30%

Appropriate Care Score (ACS) 56.60% 75.72%

Hip and Knee Jul - Dec

2010

Jan -Nov 2011

Prophylactic antibiotics within one hour prior to surgery

78.92% 93.68%

Appropriate antibiotic regimen 71.50% 78.41%

Prophylactic antibiotics discontinued within 24 hours

92.80% 90.87%

VTE prophylaxis Ordered 73.66% 97.38%

VTE prophylaxis Timely 71.56% 96.91%

Composite Process Score (CPS) 77.52% 91.45%

Appropriate Care Score (ACS) 45.74% 72.78%

Heart Failure Jul - Dec

2010

Jan -Nov

2011

LV function evaluation 72.87% 86.00%

ACEI or ARB at discharge 81.48% 85.25%

Discharge instructions 3.25% 20.48%

Adult smoking cessation advice/

counselling 11.11% 37.50%

Composite Process Score (CPS) 41.08% 56.37%

Appropriate Care Score (ACS) 6.62% 20.54%

In the past, Ashford and St. Peter’s NHS Foundation

Trust has issued parking permits for GPs to park in

staff parking areas when visiting the Trust for patient

visits, lectures or meetings.

The revision of parking areas and the introduction of

barrier-controlled patient parking has led to a great

improvement in provision of patient parking, which

has proved very popular with the patients who no

longer have to arrive early for their appointments in

order to find a space to park.

In addition, from 1st April 2012 staff will be asked to

pay to park, either via an annual permit or by

purchasing scratch cards alongside a supporting

permit.

As staff parking areas are now at a premium and are

generally full, new arrangements have been made to

allow us to continue to provide free parking for GPs.

The process will be as follows:

GPs should now take a ticket and park in the

public car parks (which now have spaces

available). The ticket can be exchanged for a

free release ticket from Security between

9.00am and 5.00pm, or from the Post Graduate

Education Centre. They will be required to show

their ID, and numbers will be logged in order to

allow the Trust to keep track of the demand. GPs attending out of hours meetings should go

to the barrier and buzz. The car parking

managers are on site until 8.00pm and the

security team is available 24 hours a day.

Another alternative would be to collect a release

ticket during office hours or at a previous visit if

possible.

Revised Parking Arrangements for GPs.

Dates for Your Diary

Date Venue Topic Speaker

20/04/2012 Hazel Room, SPH GP Resuscitation Training Day*

Paul Wills, Senior Resuscitation Officer, ASPH

08/05/2011 PGEC, SPH Diabetes Management Dr Safdar Naqvi, Consultant Endocrinologist

09/05/2012 Education Centre, ASHFORD

Osteoporosis & Vitamin D* Mr Chris Schofield, Dr Gulam Patel and Dr David Cartwright

15/05/2011 PGEC, SPH Obesity Management TBC

18/05/2012 PGEC, SPH Dermatology Study Day* Dermatology Department

22/05/2011 PGEC, SPH Ambulatory Care Pathways Dr Gulam Patel, Consultant Rheumatologist & Divisional Director for Ambulatory Care

29/05/2011 PGEC, SPH Safeguarding Children Dr Tara Jones, PTC lead GP for Safeguarding Children

30/05/2012 Education Centre, ASHFORD

Family Planning & Women's Health Update*

Dr Tina Peers, Consultant in Contraception and Sexual Health and Dr Louise Carvalho, Specialty Doctor in GU Medicine, ASPH

* Please see attached fliers included in this publication for further information

More useful information is available on our new PGEC GP Website at: http://www.ashfordstpeters-pgecgp.org.uk/