GP Admin Updates

Welcome to the new L&D ‘GP Admin Alerts’ section of the Trust’s GP pages. These admin alerts will be emailed to all Practice Managers, generic GP surgery email addresses and other GP administrators on a frequent basis. This new section will provide the archive of all the useful out-patient information which is designed to keep administrators in general practice up to date with the latest administrative changes at the hospital. Such changes include:

updated contact details for Consultants and secretaries
changes to referral guidance and processes
updates related to C&B/e-Referrals
ICE and other systems

Please see historic GP Admin Alerts
GP Admin Alerts No.1
GP Admin Alerts No. 2
GP Admin Alerts No. 3

If you have any queries with regard to the selections then please contact our Head of Client Liaison.

Blood Collection System
The L&D Pathology Service is standardising its blood collection system to bring it in line with other pathology departments around the network. The Vacuette Blood Collection System from Greiner Bio-One UK Ltd has been chosen.

This new system can collect blood samples simply and safely while the new tubes enable a more consistent ‘draw’ of blood to ensure the right volume is taken. The cap colours in the new system are standardised to meet recent guidelines and all fill volumes have a clear level indicator on the labels. The ICE system will be updated to reflect the collection bottles to use.

Points to Note:

The new system will come into effect on 1^st April 2019 for all existing users of L&D pathology services.
There will be an initial 2 weeks supply of the new blood bottles to be sent to each GP surgery from 18^th March 2019.
Current versions of collection needles in use are not compatible with the new system.
We have arranged for your current provider (listed below) to order and supply the collection needles that are compatible with the new system.

Service Management Team (Primary Care Support Services), Transformation and Corporate Operations Directorate, Skipton House, 2nd Floor, 80 London Road, London, SE1 6LH

Please contact them to order the new collection needles required, but for information the new products will be:

Orders for the new blood bottles can be gained by downloading a new Luton and Dunstable University Hospital Pathology Supplies Order Form here
Pathology cannot receive orders by Fax or Telephone. From the 1^st April 2019 orders must be send through by email to: ldh-tr.pathologysupplies@nhs.net
If current stock levels are high, excess stock can be returned via the Pathology courier service to the L&D Pathology Department, prior to conversion.
After April 1^st, left over stocks of the old blood bottles and collection needles can be returned to the L&D Pathology Department for use and/or disposal, or they can be collected by Greiner after the start date.
Each surgery will be contacted in due course by Greiner to arrange on-site training between 18^th and 29^th March. If there is a preferred date and time, please contact as per below and Greiner will try and accommodate it as best they can:
- Helen Storer, Sales Manager, Greiner, via email: helen.storer@gbo.com
If you would like a preview of the system please follow the links below:

GP Communications – e-RS and Paper Switch Off (PSO)
Please see presentation slide pack related to the forthcoming changes to e-RS. Please download the 3 page PSO guidance for GPs, please circulate widely within your surgeries.

Rapid Access Chest Pain Service – Our waiting time is now touching 8 weeks.
In the past 15 years since the RACPC has been established in 2001 we have avoided breaching the 2 week wait until this year. We have 5 clinics running permanently now each week and sometimes fit in an extra 2, clinicians and clinical rooms permitting. Until this year the most referred to RACPC was 33 per week. By way of comparison in the week ending the 8th Sept we had 48. A business plan for an extra nurse is going in at the end of the month as a matter of urgency.

Regarding referrals:
I vet each referral and reject those whom I can- but with the information provided there are precious few rejected. We don’t yet discriminate on basis of age but for those in their late 80s or 90s the emphasis is on optimising medical management and avoiding the increased risk of revescularisation. Aim to optimise before referral. Those already in the ‘system’-ie who have stable disease or had coronary angiogram or a normal functional or anatomical test within the past year are not suitable. Please refer to the secretaries.

There have been a spate of recent referrals of males and females in their 20s, many of whom may be worrying, e.g. because of a middle aged relative who has ischaemic heart disease. Vanishingly few have a compelling history of exertional angina. If worried I would suggest arranging open-assess echocardiogram / ETT but these may need cardiologist or specialist nurse review. We ourselves in RACPC will do little more than arrange these simple tests anyway in the first instance, so as to avoid the radiation burden of a CTCA.

I will not see patients with normal CT coronary angio or conventional angiogram but will see those originally found to have minor disease on these investigations, either as a followup or new referral. Those young low risk patients who have palpable chest wall tenderness/ epigastric tenderness and non-anginal chest pain (ie with no exertional component) are probably best dealt with by watching and waiting or pursuing a non-cardiac cause.

We have had several patients who are not really aware of why they have been referred-ie no chest pain but we do treat Shortness of breath as anginal equivalent in diabetics.

We are not in the business of screening people with a high risk of CHD on paper but without significant symptoms.

We have been fielding a lot of internal referrals for patients having been seen in ED. Until the last couple of years these would, almost without exception, go back to the GP for their consideration prior to referral to RACPC. Partly due to the lack of the lack of GP surgery appointment slots it is being increasingly requested that we see patients directly from a yellow board adding more strain on our capacity, also, I presume, with funding implications.

L&D Hospital Outpatients Team Contact List
It is now even easier to contact the L&D’s outpatient teams as you can now download the contacts list for the whole department.

List of L&D Hospital Services Available on E-RS
View the July 2017 list of all L&D services available for booking on the E-RS . This list will be regularly updated so please visit this page to keep up to date with all our services on the E-RS. Please note from October 2018 100% of hospital referrals must be made via ERS as part of new NHS rules. For any queries please email our Outpatients Booking Dept Manager.

Speech & language therapy led endoscopy clinic referral guidance
Luton and Dunstable Hospital ENT department are pleased to confirm that the new clinic described previously is providing appropriately referred patients with more timely access to stroboscopy and Speech and Language Therapy, as their primary treatment. This new referral pathway avoids separate waits for ENT/SLT as the clinic involves stroboscopic assessment of the patient’s larynx alongside a Speech and Language Therapy evaluation, to provide the most accurate diagnosis and management plan. This clinic is appropriate for anyone with voice change over the age of 16, who has no history of cancer, dysphagia, weight loss or lumps palpated (See e-referral system for more detailed criteria). Patients can be referred to this clinic via the e-referral system or by letter.

To refer patients via the e-referral system use keywords ‘voice change” or dysphonia’. We have had a few referrals which do not meet the criteria, which has led to them being moved back into the general ENT clinic. Two examples are a patient a suspected cyst on a tonsil and another with the sensation of a lump in the throat.

For further information please contact Zoe Knight, Highly Specialist Speech and Language Therapist, Head and Neck/ENT, SEPT Community Health Services Bedfordshire, Speech and Language Therapy Department, Luton and Dunstable Hospital, Tel: 01582 497049.

Arranging access to LDH ICE services
The Luton and Dunstable University Hospital’s IT Department have introduced a new process for practices and their staff requesting access to ICE. This should speed up the time to process your requests – though we ask that where possible, a week’s notice is given for the request to be processed.

You can access the request form which should be completed and submitted to the LDH IT Service Desk.

There must be one form completed per user to be added, multiple users on one form will not be accepted, although multiple forms can be attached to the same email request. TIP: Complete the top section of the form with your practice details and save that. This will mean that part does not need to be completed each time you make a request.

Please complete the appropriate section based on the user’s job role, making sure that all relevant information is supplied. Any missing information could lead to a delay in the account being created. When a GP or staff member leaves the practice, please notify the LDH IT Service Desk so they can remove them from the system. This is required for auditing and information governance purposes.

The new process will be implemented from 1st August – Please contact the IT Service Desk with any questions.

Promoting early self-referral using Hospital’s website
We have introduced a new self-referral form which can be accessed by clicking here. pregnant women wishing to book for maternity care can refer themselves by completing the form online at www.ldh.nhs.uk

The Community Midwife (attached to the woman’s GP surgery) will receive the referral within a couple of days. She will contact the mother within ten days to arrange her booking, scans and screening tests.

We hope this new service will reduce the number of General practitioner (GP) appointments that are taken up by women who did not realise that they do not need to see a GP to be referred to a midwife.

“Early Self-Referral” will ensure that women are given the opportunity to access Antenatal Screening tests at the optimum time for testing. Any questions contact the Antenatal and Newborn Screening Manager on 01582 497962 or 07714064377

Rheumatology launch new fast track pathway for Giant Cell Arteritis
Giant cell arteritis (GCA) is a condition seen in older people that leads to inflammation of the medium and large arteries around the head and neck. Devastating consequences such as irreversible sight loss or stroke can occur if treatment with high dose steroids is delayed. It occurs in about 20 per 100,000 people. Almost all are over 60 and almost all are Caucasian.

The key to improving outcomes in GCA is rapid diagnosis and treatment. The problem is that diagnosis can be difficult. The symptoms are similar to many other more common conditions seen by GPs and hospital doctors, who may only come across a few true cases of GCA in their career. Then, to prevent sight loss, doctors are advised to give immediate high dose steroids in all suspected cases, which usually rapidly resolves any sign of the condition on blood tests, imaging tests or biopsy.

Dr Vanessa Quick, Consultant Rheumatologist said, “Our pathway aims to provide rapid access to a specialist rheumatology assessment, temporal artery ultrasound and biopsy for all patients with possible GCA. We know this approach can dramatically reduce the rate of sight loss in GCA. It can also minimise the impact of high dose steroids in those who don’t have the condition, because tests such as ultrasound and biopsy can only reliably rule in, or rule out GCA, if done within a few days of starting steroids”. If GPs are concerned about a potential case of GCA, they can urgently refer their patient via the rheumatology nhs.net email, available from the Luton Rheumatology secretaries.

Common symptoms in GCA

A new type of headache
Pain and tenderness in the temple area
Distended, tender temporal arteries
Tiredness, fever, flu-like symptoms
Aching and stiffness across the shoulders and hips
Jaw ache after chewing or talking
Sudden partial sight loss

Traditionally, GCA is diagnosed on temporal artery biopsy. However, ultrasound is emerging as an exciting new way of making the diagnosis in many patients. Currently, the ultrasound is done in the rheumatology department by Dr Quick, but there are plans to develop the service further, so a rapid access service is available all year round.