Primary care bulletin - 1 November 2023
Bulletin:
More measles reported in NW London; making decisions on cardiopulmonary resuscitation; HIV GP champions and more


Welcome to this week's primary care bulletin


Key points this week include:
  • Important: More measles cases reported in NW London
  • Guidance: Making decisions about Cardiopulmonary Resuscitation (DNACPR)
  • HIV GP champions
  • Domestic abuse awareness podcast
  • Primary care 111 feedback for NHS pathways
  • Roll out of 50GB Outlook mailboxes
  • Diabetes level 2 FAQs
  • Staff stress and burnout group with Keeping Well
  • Opportunity to work with the medicines and pharmacy team 
  • Training, webinars and more

IMPORTANT: More measles cases reported in NW London
The NW London Health Protection Team (UKHSA) this week have reported a confirmed case of measles in Westminster and one probable in Hillingdon (awaiting laboratory confirmation). Both are unvaccinated children of primary school age.

If a child or adult presents with signs and symptoms of measles please consider this a differential diagnosis and contact the NW London Health Protection Team as soon as you suspect or become aware of a suspected case of measles (9am-5pm Mon-Fri 020 3326 1658 or out-of-hours on 01895 238282) 

Do not wait for laboratory confirmation. Measles is a notifiable infection.


Action required: 

· Rerun searches for any children who have not received either one or both doses of the MMR vaccination as per the Routine UK Schedule. 

· Invite children with an uncertain or incomplete immunisation status for vaccination as soon as possible. 

· Check immunisation histories for all new entrants from abroad and newly registered patients of all ages.  Particularly those living in temporary accommodation.  Practices will receive an item of service fee for any vaccinations given.

· Maximise the ability to offer opportunistic vaccination when children visit the G.P Practice for any other reason (even when accompanying a parent to their appointment). 

· Ensure that appropriate triage and isolation procedures are in place so that those presenting with a fever and rash can be isolated immediately, to avoid exposing others.

Suggested wording for text message recall: 

“Measles is very contagious and is currently circulating locally. Our records show that your child is not up to date with their routine MMR vaccination and therefore are at an increased risk of contracting measles. Please contact your practice as soon as possible to book your child in for vaccination’’.

Any communications from the Health Protection Agency to Primary Care staff will be added to the ‘General Practice Correspondence’ here. 

Guidance: Making decisions about Cardiopulmonary Resuscitation (DNACPR)
Clinical guidance has been created to ensure clinicians are aware of the key ethical and legal principles that should inform all DNARCPR decisions. The high-level ethical and legal principles are the same for all people in all settings. However, differences in clinical and personal circumstances make it essential that all CPR decisions are made on an individual basis and must never be dictated by ‘blanket’ policies.

The briefing notes includes valuable information on: 

-       Assessing Mental Capacity to have DNACPR

-       Making best interest decision on behalf of the person

-       When to involve Independent Mental Capacity Advocate (IMCA)

-       Where and how  to request IMCA support

If you have any questions, contact Musthafar Oladosu m.oladosu@nhs.net (Designated Professional for Safeguarding Adults) or Dr Amit Patel (Integrated Urgent Care Clinical Lead, West London Federation and Bi-borough Clinical Lead for Older Adults, Care Homes and End Of Life Care)
Download the guidance

HIV GP Champions
Are you passionate about effecting change within primary care and your community? We are looking for GPs working in London to become Fast Track Cities HIV GP Champions for their area.

Fast-Track Cities London is a partnership working to end new HIV infections, put a stop to HIV-related stigma and discrimination, stop preventable deaths and improve the health, quality of life and well-being of people living with HIV across the capital. Primary care plays a crucial part in the success of achieving these goals.

The new HIV GP Champion role offers an opportunity to improve care for people living with HIV by removing the historic barriers between services and offering an integrated approach to long-term health across primary care, secondary care, Local Authorities and voluntary sector organisations for people living with HIV.

The aim is to work collaboratively between all care settings for the patient as a whole person, reducing obstacles to access care and improving patient outcomes. This approach is consistent with and supportive of London’s overall HIV response, the Evolving HIV Care Report, the BHIVA Standards of Care, and the Fuller Stocktake on integrated primary care.
Find out more here

Domestic abuse awareness podcast
Dr Vasumathy Sivarajasingam, GP Partner at Hillview Surgery in West London recently featured on the podcase 'Always and Never About Money.' 

In this eye-opening episode, Chelsea Williams and Dr Vasu dive deep into domestic abuse, its far-reaching impact on lives and finances, and the path to healing. They discuss how we can all work together to make an impactful and lasting difference! 

Together, we can make a difference. Share this episode and spread the message of support and empathy.

#AlwaysandNeverAboutMoney #Podcast #DomesticViolenceAwareness 
Listen to the podcast here

Primary Care 111 feedback for NHS Pathways
The NHS Pathways team at NHS England is currently reviewing all NHS 111 Primary Care dispositions (the triage endpoint that specifies level of care and timeframe). The overall aim of the work is to better align with the realities of current service delivery. 

We are very keen to hear about your experience managing patients sent from NHS 111, how you manage direct appointment booking, and what you think needs to change. We will use your responses to ensure that our improvements deliver value for Primary Care services and patients.  

We would therefore greatly appreciate it if you could take 10 minutes to complete our survey. 

The survey will close on 6 November, so please submit your response prior to this date. 

More information: 

· We are keen to hear from anyone working in a Primary Care service or care setting who has a good understanding of how the service interacts with 111. You could be a clinician, Practice Manager or administrator.  

· We are looking for participants from a wide range of Primary Care services, including GP surgeries, pharmacies, dental surgeries and optometry services.  
Click here to complete the survey

Roll out of 50GB Outlook mailboxes
The roll out of expanded 50GB mailboxes is currently happening for your emails. If your mailbox has not been expanded so far, this will be completed in the coming days.

Please continue to archive your emails regardless of this new size, as this helps you to manage your mailbox effectively and avoids delays in sending, receiving and potential loss of emails.
Click here to find out more

Diabetes Level 2 FAQs 
In anticipation of the launch of the NW London Diabetes Level 2 Service, please see the Diabetes Level 2 Service FAQs based on the queries from practices, PCNs and Borough Leads.  

The FAQs cover all three components of Diabetes Level 2 Service as below:  

Early Onset Type2 Diabetes (T2DY) 
Diabetes Multi-Disciplinary Teams (MDTs) 
Initiation and Optimisation of Insulin or GLP-1 therapy 

The FAQs also incorporate queries raised during the Diabetes T2DAY NWL primary care Webinars (4th and 19th October 2023). Please find the slides and recordings here in T2DAY Training Webinar Slides and Recordings.  

The FAQs will be updated periodically to cover any further queries.  

Please email any further queries to nhsnwl.diabetes@nhs.net.  

Staff stress and burnout group with Keeping Well 
Starting on Monday 13th November 2023 at 3.30pm to 5pm Keeping Well NWL will be running a six-week online Burnout Group specifically for staff experiencing stress at work. 

Incorporating an Acceptance and Commitment Therapy model, the sessions will promote positive wellbeing via psychological techniques, mindfulness practice, reflective exercises and group discussions. 

A few spaces remain, if you are interested in attending please complete the self-referral form selecting the ‘’burnout group’’ option or find out more information on the Keeping Well NWL website. 

Opportunity to work with the medicines and pharmacy team
The North West London medicines and pharmacy team are looking for doctors, nurses and pharmacists working in NW London to collaborate with them on optimising medicines use. 

If you are interested, please contact the Medicines & Pharmacy Team - nhsnwl.medicinesmanagement@nhs.net 
Find out more here

Education and training

NWL Improving Heart Failure Care Webinar

Wednesday 22 November, 1-2pm 

CLICK HERE to complete registration form - please sign into Microsoft Teams to receive your invitation

On behalf of Dr Neville Purssell (GP, NWL CVD Clinical Lead), Dr Carla Plymen (Consultant Cardiologist, NWL Heart Failure Clinical Lead) and Carys Barton (Heart Failure Nurse Consultant), we warmly invite you to join us for a primary care Heart Failure care and medication prescribing webinar on Wednesday 22nd November,1:00-2:00pm.

The webinar will cover:

· The difference in diagnosis and management of heart failure with reduced EF and preserved EF

· Management of heart failure and medications – rationale & ‘how-to’ with specific emphasis on SGLT2i 

· Awareness of the Heart Failure pathway and how to embed best practice care including patient recall

· Case examples to support PCNs and Practices 

· Q&A session 

Why is this important?

We know that there is a need to improve diagnosis and ensure optimal management of patients with HF; in NWL there is a significant detection gap - there should be 32% more people diagnosed with HF. Further, over 1000 patients are known to primary care with HF but have not had a formal echo, with more than 700 not being on adequate therapy. Most importantly, the Imperial College Health Partners dashboard shows that 43 lives could be saved with adequate detection and therapy with a cost saving to the ICS of £1.8 million.

The webinar will explore how reviewing and managing HF and medications can help:

· Patients to better manage long term conditions

· Meet target to ensure 90% of HF patients have had an annual review including review of medications for QoF targets 

· Reduce health inequalities (one of NWL ICB’s priorities)

· Provide cost saving opportunities

 
Please share the invitation with relevant colleagues in your sector and for any further queries, please contact nhsnwl.localcare@nhs.net

 

Next steps for PCNs webinar
Wednesday 8 November, 9.30-11.00am 

Join the upcoming webinar where primary care specialists Alison Oliver and Ruth Griffiths lead a discussion on the future of PCNs.

The session will cover:
  • Recent developments of PCNs
  • The future role of PCNs beyond the network contract DES
  • PCN incorporation - what is it, why do it and what is involved?
  • Mergers of PCN practices - an examination of the practices
Register here

Palliative care bites - Frailty and End of Life Care

Tuesday 21 November, 1pm-2pm

Guest Speaker: Kerry Lyons, Consultant Admiral Nurse for Frailty, Dementia UK 

We are witnessing an increasing overlap between dementia, frailty and end of life care. We are, therefore, delighted to have Kerry Lyons as our guest lecturer. She is the first Admiral Nurse focusing on frailty and dementia supported by Dementia UK. This session is relevant to all of us working in primary care and palliative care, especially those in Care Homes, District Nurses and General Practice. We have much to learn!
Register here

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.

Take a look at this short video to find out more.
Details available on the Learning Hub

Webinar: Your New Healthier You NHS Diabetes Prevention Programme Provider 
Join Thrive Tribe & Dr Richard Pile in November to learn:
  • How to make a referral. Get all your questions answered as Thrive Tribe explain the minimal impact to existing referral processes 
  • Why the Healthier You programme is different and how it will support your patients
  • How making a referral will benefit you, the practice and the patient - Dr Richard Pile
Register for this webinar 

Dates available:

Thursday 2 November, 12:30 – 1:15pm

Wednesday 8 November, 12:30 – 1:15pm

Thursday 9 November, 1-1:45pm

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

Wednesday 22 November, 12-12:45pm

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