Primary care bulletin -19 October 2023
Bulletin:
Urgent mental health reminder; online consultation platforms; vaccination updates for practices and more


Welcome to this week's primary care bulletin


Key points this week include:
  • Urgent mental health reminder
  • Do you use PATCHs or eConsult online consultation platforms?
  • Vaccination updates for practices
  • New catalogue of resources available for maternity staff
  • NHS North West London cancer bulletin
  • New free fit note resources
  • C the signs North West London survey
  • Community eating disorders
  • Carbon footprint
  • Training, webinars and more

Urgent mental health referrals reminder 
When making urgent (6hr) and very urgent (1hr) mental health referrals to the Single Point of Access teams (SPAs) at CNWL and WLT NHS Trust, please remember to phone the relevant SPA to discuss the referral with them first to ensure timely management of these cases.

Contact: CNWL SPA (Kensington and Chelsea, Westminster, Brent, Harrow, Hillingdon) tel: 0800 023 4650 

WLT SPA (Hammersmith and Fulham, Ealing, Hounslow) tel: 0800 328 4444

Do you use PATCHs or eConsult online consultation platforms? 
Do you use these systems to help triage enquiries or manage sick notes?  

Are you looking to enhance your confidence when using these systems? 

Sign-up to our Digital First Action Learning Sets taking place in November. 

Details available on the Learning Hub: 

https://www.nwllearning.nhs.uk/course/view.php?id=338

Vaccination updates for practices 
1. Flu vaccine products for 65 years + cohort

This is a reminder to providers regarding the appropriate flu vaccine products for 65 years + cohort. 

Flu vaccines for the 65 years + cohort are:

· aQIV (Adjuvanted Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) Seqirus) or 

· QIVr (recombinant Quadrivalent Influenza Vaccine; Supemtek by Sanofi), with QIVc (Cell-based Quadrivalent Influenza Vaccine (Surface Antigen, Inactivated) Seqirus) only recommended where aQIV and QIVr are not available. 

QIVe products are Sanofi’s Quadrivalent Influenza Vaccine (split virion, inactivated) and Viatris (formerly Mylan)’s Influvac sub-unit Tetra vaccinations. The QIVe (egg-based Quadrivalent Influenza Vaccine) is not recommended by JCVI advice for the vaccination of the 65 years + cohort and is not covered in the pharmacy PGD or national protocol. Therefore, it should not be administered to patients aged 65 years or over.

If this occurs it should be reported, and the patient recalled for a discussion about further vaccination with the recommended vaccines. Please speak to your Public Health Commissioning team or Community Pharmacy Commissioning team for further advice. National programme guidance for health care workers also provides advice on Individuals who have inadvertently been given a flu vaccine that is not the one recommended for their age group. https://www.gov.uk/government/publications/flu-vaccination-programme-information-for-healthcare-practitioners

The vaccines for each cohort are set out in the annual flu letter 2023/24.

2. Shingles Programme Changes  - Update on immunocompromised cohort identification 

The Immunisation Team in PHCO has been receiving a few queries around the challenges in identifying severely immunocompromised patients aged 50+ who should be eligible for the shingles vaccination programme based on the Green Book definition. 

GPES business rules and Green Book definition of severely immunocompromised 50+ cohort 

The GPES business rules are built for payment purposes and the criteria should not be used as a basis for identifying the eligible severely immunocompromised cohort aged 50+. 

The development of the coding clusters to identify this cohort in the GPES business was developed to align as closely as possible to the Green Book definitions for severe immunosuppression for shingles however, it is not possible to build an automated payment extract that exactly mirrors the Green Book definitions. This is due to limitations in the way the relevant data can be extracted and clinically coded by practices. To ensure the payment extract sufficiently covers the definitions, it is in places over inclusive to reduce manual payment claim burden and allow clinical discretion, but in others it is limited for example, where a patients needs to be on a specific drug dosage. 

Therefore if practices are using the business rules as a basis to create the cohort search criteria, they need to exclude patients who do not fall under the Green Book definition of ‘severely immunosuppressed’ from their routine call and recall, and consider any patients who may be missed but would be eligible due to specific drug dosages. Practices should apply searches that match the Green Book eligibility criteria which would also be in line with the PGD inclusion criteria as well.

Shingles technical guidance is due for publication this week and will be available on the GP Contract webpage,  providing key advice for practices to ensure they identify eligible patients correctly. 

3. Vaccines in Pregnancy good practice examples from teams delivering COVID-19, flu and pertussis (whooping cough) 

A revised Vaccines in Pregnancy inequalities toolkit has been published and shared on FutureNHS and is available on the link below:

Reducing health inequalities by supporting COVID-19 flu and pertussis vaccination uptake during pregnancy - Vaccinations and Screening - FutureNHS Collaboration Platform.  

This toolkit shares good practice examples from regional teams delivering vaccines in pregnancy - COVID-19, flu and pertussis (whooping cough) which we hope provides insights for those seeking to help tackle health inequalities which affect women in pregnancy.

For any queries, please contact ENGLAND.londonimms@nhs.net

New catalogue of resources available for maternity staff 
A new hub of resources has been developed to support the professional development and wellbeing of maternity staff.

The crucial role maternity teams play in supporting women, birthing people, families, and newborn infants is vital; and improving their wellbeing will ultimately have a positive impact on delivery of care.

This catalogue serves as a one stop shop for maternity staff to access advice and support on a range of topics including:
  • Menopause awareness
  • Supporting physical and mental wellbeing in the workplace
  • Supporting other colleagues
  • Equality, diversity and neurodiversity
  • The programme also includes a host of existing elearning for further professional development, such as Saving Babies Lives, Perinatal Mental Health and Fetal Monitoring.

It has been developed in response to the NHS Long Term Workforce plan which recognises that to retain our workforce, we need to support their health and wellbeing by working with local leaders to ensure integrated occupation health and wellbeing services are in place for staff.

For more information and to access the catalogue, please visit the Maternity and Neonatal Resource Hub.

NHS North West London cancer bulletin
This edition of the cancer bulletin includes:

BOWEL CANCER

1. London Bowel Screening Campaign running from 16th October 2023 – 3rd December 2023.

2. Supporting patients completing FIT if symptomatic – webinars for primary care administrators and clinicians

BREAST CANCER

3. Breast Screening Communications Toolkit.

Pan London Cancer Alliances Research Fellowship

4. New round of 12-month cancer research fellowships  -  Deadline for submission is Monday 30th October 2023.

CANCER EDUCATION

5. Tell us how you would like to receive Cancer Education!

6. Lymphoedema – How to be aware of it and manage it in your role

7. RMP Cancer Education Programme.

Accompanying documents:

Lymph flyer

New free fit note resources
NEW Fit note resources to help awareness of the importance of supporting patients back to work

We are a professional network of the Chartered Society of Physiotherapy and would be thrilled if you could help us to disseminate our new resources to the individual GP practices within your ICB. Further details can be found below.

ACPOHE is pleased to showcase our new set of resources, available to download from our Work & Health Learning and Development Hub

(click Free Guest Access and go to Resource Library).

Resources include:

1. A 6-minute podcast to outline our new resources and why they are important

2. A video (to play on screen in GP reception waiting rooms) to help manage patient expectations of 'fit note' certification.  This is 1 minute in length.

3. A 2-minute video aimed at increasing awareness to GPs of the role of FCPs, particularly around work conversations and completion of the fit note. Please share this with the GPs you work alongside.

4. An 8-minute training video, which is a reminder of the importance of keeping people at work to help health outcomes (aimed at GPs, FCPs, other healthcare workers in primary care.

5. Infographics to patients on what is the fit note, and how to get the most out of your fit note (ideal for notice boards within GP practices).

6. Infographics to healthcare professionals on completing the fit note (a quick easy reminder to all involved in completing the fit note).

7. Completed fit notes, with audio presentation on a variety of case studies.
Access the hub

C the Signs North West London surveys
All North West London GP practices – regardless of whether or not your practice uses C the Signs - are encouraged to complete the C the Signs survey at the following link:

https://docs.google.com/forms/d/e/1FAIpQLScTCHek4fYLwlkpkbyRMgX3iT517eSM6z6hfcwabk4Qw341Mw/viewform

C the Signs is integrated with your primary care electronic health system and supports users by risk assessing patients with concerning symptoms using local and national cancer guidelines.

It generates locally configured cancer referrals and provides live dashboards, allowing monitoring and tracking suspected cancer referrals and investigations for enhanced safety netting.

By completing this form, this facilitates continual improvement to C the Signs so that it is meeting your needs.

Thank you in advance for taking the time to complete this survey, which should take around 2 minutes to complete.

Community eating disorders 
Community Eating Disorders Service for Children and Young People is widening its acceptance criteria from 1 November
 
The Community Eating Disorders Service (CEDS) for Children and Young People (CYP) is widening its acceptance criteria from Wednesday 1 November 2023.

From this date the service will consider referrals for young people who have ‘mild’ eating disorders, not only those young people who may have a ‘moderate’ or ‘severe’ eating disorder. 

We hope this will mean that young people who are in the early stages of an eating disorder will be able to be assessed much quicker, and if appropriate, provided with evidence-based treatment even quicker too.

Please see the Medical Emergencies in Eating Disorders (MEED) guidance from the Royal College of Psychiatrists that will help all referrers identify if a young person is presenting with (significant) enough risk indicators to warrant a referral to our service.

You can find out more about the service and how to refer on the service page. The service accepts referrals for the boroughs of Brent, Harrow, Hillingdon, Kensington and Chelsea and Westminster.

Do your bit to save the planet by working with us to understand the carbon footprint of your practice estate and what it will take to move towards net zero 
Legislation now requires the NHS in England to reach net zero by 2040, with an ambition to reach an 80% reduction by 2028 to 2032 for any emissions we control directly. Reach net zero by 2045, with an ambition to reach an 80% reduction by 2036 to 2039 for the emissions we can influence.

Turner & Townsend Consulting Ltd have been commissioned by the Greater London Authority (GLA) and the London Estates Development Unit (LEDU) to establish the baseline for carbon emissions within general practice estates across London, and to pull together a roadmap for what is needed to move those estates to a net zero position (where they are no longer adding to the total amount of greenhouse gases in the atmosphere).

Between now and 31 October 2023, they will be asking all of general practice in London to submit data to them regarding their electricity, gas, water and waste usage.  

 Turner & Townsend will also request data directly from NHS Property Services (NHS PS) and Community Health Partnerships (CHP) so please note that, if your property is located in a building that is managed by these organisations, there is no need to make a submission.

The format of submissions

Turner & Townsend are flexible and will take whatever data you can provide to help them build up an accurate picture of your estates.

You could, for example, consider sending the following:
  • copies of bills – they will take anything from 1 month’s to 3 years’ worth
  • meter readings 
  • energy spend data from your accountancy software package
  • a download from your smart meter
  • any outputs from using the online general practice non-clinical carbon calculator
What will happen to the data?

The data provided by NW London and the other ICSs, will be reviewed and a carbon baseline will be calculated for all the practices who have submitted in London. A net-zero roadmap for what needs to be achieved to attain the desired ‘net zero’ position, will then be pulled together and shared. 

Greener initiatives have the potential, to bring about many benefits. These include: 
  • supporting climate change
  • improving air quality for patients
  • it is anticipated that there will be grants available to support practices to achieve these targets but that, to qualify, practices will need to know their baseline data and what they need to do. Participation with this work will enable practices to be in the position to apply. 
Please could you send your bills and meter readings to info.bcc@turntown.com by 31 October.

Education and training

NWL Homeless Health Programme

The NWL Homeless Health Programme is pleased to invite you to two upcoming webinars we are holding:

·       Thursday 19th October, 12:30-13:30 –North West London Homeless Health Clinical Community of Practice (MS Teams)

This is a network bringing together clinicians working in primary care who have an interest in homeless/inclusion health, and aims to offer opportunities to clinicians to extend their skills, development and support in this area of care. 


The agenda will include: 

· A talk on brain injury and alcohol from a guest speaker - Dr Mike Dilley, Consultant Neuropsychiatrist in Brain Injury, King’s College Hospital NHS Foundation Trust

· Hear the results of a survey of NWL practices and their experiences caring for patients experiencing homelessness

· Identify future development that would support GPs working in this area

· Shape the future direction of care for this population

Contact North West London Clinical Lead for Homeless Health Dr Natalie Miller natalie.miller9@nhs.net to join us at our inaugural meeting. All clinicians working in primary care are welcome.


·  Thursday 2nd November, 12:00-13:00 – Homeless Health Lunch& Learn – for Social Prescribing Link Workers, Health and Wellbeing Coaches and Care Coordinators (MS Teams)

Social Prescribing Link Workers, Health and Wellbeing Coaches, and Care Coordinators (or those in similar roles) across NWL are invited to join us at a session focussed on supporting patients experiencing homelessness. This webinar will cover: 

Information on homelessness and its impact on health and wellbeing
Ways to improve care for people experiencing homelessness in primary care
Advice and tips on how best to support these patients as a Social Prescribing Link Worker, Health and Wellbeing Coach, or Care Coordinator
Myth-busters / practical advice- including how to look after yourself as a practitioner working with this cohort  
 
Guest Speakers- Dr Natalie Miller, GP Clinical Lead for Homeless Health across North West London and Kat Florez, Social Prescriber – West-End and Marylebone PCN (working in a homeless specialist practice) 

Contact claire.wilson49@nhs.net to join. 

 

Do you use SystmOne? Are you looking for ways to work smarter on administrative tasks? 

Join our SystmOne GP Automate demo.  

The demo will show you how GP Automate can process your patients’ normal lab reports accurately and efficiently, saving you time and reducing your manual workload. By joining the demo, you’ll be eligible to use the tool for free at your practice, for a limited time. 

Sound interesting? Please contact Sam Awotayo via the Digital First mailbox: nhsnwl.digitalfirst@nhs.net for further details. 
Contact the Digital First team

Type 2 Diabetes in the Young (T2DAY) Webinar 

To launch the roll out of the T2DAY/Early Onset Type 2 Diabetes (EOT2D) Service in NW London, Dr. Shivani Misra, who played a pivotal role in developing the national T2DAY program will be conducting a training session to support practices on 19th October 2023 5pm. 

The training will encompass the five key components of the T2DAY intervention, emphasising best practices in each area while focusing on addressing any grey areas that may require further discussion or input. 

This session is a repeat of the 4th October session with the opportunity to ask questions. Everyone is welcome to attend, with the expectation is that at least one GP and one nurse from each PCN should attend a session. 

Click here to join the training session on Thursday, October 19th, 2023 at 5:00pm.

Diabetes NDPP Webinars
Thrive Tribe will be delivering NDPP starting 1st December 2023 and will be running webinars to explain how this change will affect you and how preventing type 2 diabetes is in everyone’s best interest.

Learn how to gain back time, earn £11.50 of national funding per patient referred into the NDPP programme encourage patients to start once referred and improve the long-term health of your patients in one 45-minute webinar!

Sign up to one of the following sessions:

Thursday 2nd November, 12:30 – 1:15pm

Wednesday 8th November, 12:30 – 1:15pm

Thursday 9th November, 1-1:45pm

Thursday 16th November, 12:30-1:15pm

Wednesday 22nd November, 12-12:45pm

Thursday 23rd November, 12:30-1:15pm

You’ll learn:

Who …is responsible? Thrive Tribe can support patients to prevent type 2 diabetes through their nine month Healthier You NHS DPP programme. Learn who they are and what the programme offers.

Why …should you care? We know that making a Healthier You NHS DPP referral is another item on a very long to-do list. Dr Richard Pile will explain just why making a referral will benefit you, the practice and the patient.

How …do you make a referral? All your questions will be answered. 

Sign up to the webinar

Free Training: Gender Identity Clinic information session for GPs - November 2023
The London-based Gender Identity Clinic (GIC) is inviting GPs, nurses and healthcare professionals to a free Gender Identity Information Session. The GIC is the largest and oldest gender clinic in the UK, dating back to 1966. It accepts referrals from all over the UK for adults (from the age of 17 years) with issues relating to gender. In the 50 years since UK NHS gender services began, it’s estimated that more than 130, 000 people have changed social gender role.

Occurring on Thursday 2 November at 18:00 via Zoom, our team of experts will deliver a high calibre evening of learning for GPs, nurses and healthcare professionals working at all levels. Hear about the latest updates in the field of gender work and find out more about prescribing guidelines. Meet gender specialists who have decades of experience working across primary and acute care, and network with your colleagues and peers.

At the session you will hear information on gender services, prescribing, as well as helpful advice about how best to look after this growing population of patients. There will be an opportunity to have your questions answered, and to share your concerns, ideas and experiences.

What you’ll take away
How to refer patients with gender dysphoria directly to a multidisciplinary gender identity clinic
An understanding that people in a new gender role usually need a lifelong prescription of maintenance hormone therapy and the implications for you
That a patient’s prior change of gender role is rarely clinically relevant and does not need to be mentioned
The need to consider birth gender when offering routine screening for cervical and breast cancer and aortic aneurysm
Clarity around how a patient with a new role would like to be addressed and how to amend records accordingly to avoid subsequent upset and possible complaints
Speakers on the night include:
Dr James Barrett, consultant psychiatrist and lead clinician at the Gender Identity Clinic. He is also an honorary clinical senior lecturer at the Imperial College of Science and Medicine. He is the Editor and main psychiatric author of the standard United Kingdom textbook in this area and is also the elected President of the British Association of Gender Identity Specialists.

Dr Leighton Seal is consultant endocrinologist at the Gender Identity Clinic at Charing Cross Hospital London where he is responsible for the diagnosis of endocrine disorders of these patients and supervision of the cross-gender hormone replacement of both pre-operative and post-operative patients.

You will receive a certificate of attendance for attending this session.
Sign up here

Diabetes primary care updates and training  

This diabetes updates contains information for primary care staff on the following:

  1. Information on the new NDPP provider Thrive Tribe 
  2. Early Onset Type 2 Diabetes (EOT2D)(T2DAY) Service (coming soon)
  3. Diabetes Level 2 Service: Diabetes MDTs (Multi-Disciplinary Teams) & Initiation and Optimization of Insulin or GLP-1 Therapy (coming soon)
  4. REWIND Monitoring
  5. Code your patients who have completed digital structured education + those patient who have created a KDS account
Read the full Diabetes Programme Update

NHS leadership academy
The NHS Leadership Academy has a number of training opportunities to support your development journey, including a webinar on understanding anxiety in the workplace (18 October), developing inclusive workplaces, and collaboration within in system leadership. 
Find out more
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