HeartbeatTHE Access Health Care-operated surgery in Devon’s first new stand-alone settlement since the middle ages now boasts its very own table-tennis table.

Cranbrook Medical Centre is the latest loca-tion to join the free street ping pong phenomenon which has seen table tennis tables popping up in remarkable and surprising places across the Exeter area.

Cranbrook almost missed out as finding a suitable location for the table amidst all the ongoing building works was proving problem-atic. However Access Health Care manager Mark Knight came to the rescue and suggested the surgery as a location for the table.

“We were very happy to help,” said Mark. “Any-thing that encourages our patients to be active, fit and healthy has got to be a good thing.”

WITHIN just a few weeks of Cornwall Health as-suming responsibility for urgent out-of-hours provision in the county, a number of exceptional plaudits have been re-ceived.

“A great improvement,” wrote one patient. “I had two bad experiences with the previous operator and would not have called them out again.

“I now have faith again in the OOH service be-cause you use local GPs.”

Surgery signs up to craze for ping pong

Cornwall OOH earns plaudits

CEO CHRIS WRIGHT REFLECTS ON ALL THE LATEST DEVELOPMENTS

TENDER TALK IS PUT ON ICEA S you will be aware, since the

last newsletter Devon Doctors has withdrawn from the NEW

Devon CCG community urgent care procurement.

Sensibly, the CCG is taking a pause to consider forthcoming national guidance on the procurement of out-of-hours and NHS 111 services – which is expected by the end of October – and assess its options going forward.

The CCG will not commence a new procurement until after this guidance is received, which will not leave sufficient time to re-procure before the completion of our current contract at the end of March 2016.

One assumes, therefore, that there will need to be a further extension of Devon Doctors’ contract. Of course,

I will let you know as and when that happens as I appreciate the uncertainty created by all this isn’t great for either Devon Doctors or staff, clinicians, practices and the CCG.

In the meantime, the only thing I would ask of all concerned is not to assume that Devon Doctors will not continue to be a major player across Devon in the delivery of urgent care services for many years to come.

Our reputation, the support we receive from all of you and the fact that we have an exceptional team, which delivers on everything it commits itself to achieving, should ensure that Devon Doctors has a bright future. l We have appointed two new medical directors to replace Dr Mike Richards and Dr Chris Bastin, who retired

earlier this week. The role of medical director is key to our performance and Mike and Chris will be a difficult act to follow. However, I am delighted with the appointments of Dr Justin Geddes [Honiton] and Dr Mark Eggleton [Tavistock]. We are all looking forward to working with them both.

I also wanted to take this opportunity to pay tribute to the other excellent applicants who were interviewed for the position – the standard was exceptionally high.l The summer rota has been a challenge. The rota team and I wanted to thank the staff and clinicians out there who have helped us meet that challenge.

The CCG has paused community urgent care procurement while it awaits national guidance

The CCG has paused community urgent care procurement while it awaits national guidance

l CONTINUED ON PAGE 2

NEW GOVERNANCE HEAD GOES UNDER SPOTLIGHT

Page 5 - Heartbeat Q&A Page 6 - End of an eraMEDICAL DIRECTORSBID A FOND FAREWELL

KEEPING YOUR FINGER ON THE PULSE OF DEVON DOCTORS’ HEALTH SERVICES

PAGE 3: CHILD DEATH REVIEW PAGE 4: PALLIATIVE POINTERS

September 2015

Heartbeat

CORNWALL Health is now into its fourth month of operation and the

memory of midnight on June 1 is beginning to fade.

We inherited a great team who are enthusiastic to make the new service work well. We never forget that Serco delivered excellent care to patients, even if the model was not financially sustainable and they encountered difficulties in recruiting sufficient clinical staff.

As of September 1, the new rota – the conception of which was a mammoth task for all concerned – became operational in the county.

There are now six main bases and five minor bases. Each weekday and weekend, we will have clinicians based in the following main bases: Penzance, Helston, Truro, St Austell, Bodmin and Liskeard, while Stratton clinic will be operational on a Friday evening and Saturday afternoon. All 11 bases will remain operational, ready to see patients if needed and if a patient can’t travel to a main base, a mobile clinician can open up a minor base.

The change in the rota has meant almost all clinicians,

operational assistants [receptionists] and drivers have had rota changes. I would like to thank everyone for their patience in this process – it is never easy.

At the same time, clinicians have been adjusting to Cornwall Health’s new model of care. Supported by the triage / telephone consultation workshops run by the Devon Doctors team, all calls to Cornwall Health out-of-hours are now being triaged.

The new way of working is now bedding in well, and many clinicians now say they prefer this method, particularly triaging the patients that they then see in clinic or on visits. Also, healthcare professionals in the county can now directly contact the OOH service on our healthcare professional line. This is being increasingly well used and has been warmly welcomed by district nurses, paramedics and MIU staff.

Almost all the IT in the clinics is now working, thanks to a huge amount of work from the IT team. I am particularly pleased that prescription printing is now working throughout the county as this is safer for all parties.

Looking forward there are already plans to improve the service further. We will be working to enhance information exchange for patients needing palliative care. This will include a web-based service visible to all relevant healthcare professionals.

We are looking at the Truro clinic too. It’s too small and we are not happy with the set-up. It houses a clinician working in isolation from other clinicians. Talks are on-going with other healthcare trusts to look at alternatives to make sure we offer a comfortable, safe service to patients in Truro.

Cornwall Health is taking its place among the many health and social care organisations in the county. It is closely supported by Kernow Health – the GP organisation, which is lively and ambitious. There is much change about to happen in the county, not least the ‘Case for Cornwall’ promising a lot of local control over health and social care resources, aiding integration.

What this might bring to Cornwall Health is not yet clear, but we are well positioned to benefit from any changes.

Cornwall Health’s chief operating officer Kate LockCornwall Health’s chief operating officer Kate Lock

Fourth month of new service heralds the launch of revised rota

Three months in, Cornwall Health’s chief operating officer Kate Lock reflects on the progress made by the new service

CORNWALL HEALTH HAS ITS OWN SECTION ON SHAREPOINT

New faces join teams in Devon and Cornwall

Nominations sought for non-executive vacancy

NEWS in brief

DEVON Doctors Group would like to take this opportunity to welcome all those who have joined the organisation since the last edition of Heartbeat in August. They are as follows: Faye Sutton – head of governance; Keith Coles – driver / operational assistant; Kirstie Yelland – treatment centre nurse; Jenna Gale –driver / OA; John Langley – driver / OA; Jayne Roberts – dental nurse; Andy Spencer – rota team administrator; Sinead McDonagh – call operator; Zena Lowe – call operator; Justin Geddes – medical di-rector; Mark Eggleton – medical director; Jean King – call op-erator; Josie Pringle – patient engagement

administrator; Arron Nematollahy – driver / OA; Aimee Seward – practice nurse.

In addition, aside from departing medical directors Dr Chris Bastin and Dr Mike Richards, the organisation has also bid a fond farewell to Natasha Pollard, Geoff Bellamy, Barry Langley, Elaine Rolfe, Alice Lamb, Matthew McDonald, Hannah Partridge and Andre MacKenzie in Devon, while Brownwen Drai, Michelle Hodges, Dr Alan Middleton, Dr William Moore, Sarah Mclachlan, Lyn Hicks, Sarah Wild, Dr Alison Nankervis, Liz Weston, Michael Garner and Shiobhan Whitmarsh have moved onto pastures new across the bor-der in Cornwall.

There are a large number of GPs and staff who have been just brilliant in terms of your flexibility and your willingness to work. However, all of you – even those who for very good reason could not help – deserve our gratitude for your patience, good grace and understanding.l And finally... there will be a non-executive vacancy on our board for a clinician to represent Torbay, when Dr Simon Murray stands down at the end of March. Simon has been an excellent board member in pretty much every way – except, that is, for his strange and continuing attachment to Liverpool Football Club!

As a result, I would like to hear from any clinicians who

would like to put themselves forward for this role. Anyone who nominates themselves will go forward to election next month.

A nomination can come from a GP or nurse – candidates should live and / or work in South Devon and either work in a local practice or out of hours in the area. Email chris.wright1@nhs.net for more information.

In addition, the non-executive roles for East Devon and Plymouth are also up for re-election. Both Dr Mike Slot [East Devon] and Dr Andrew Potter [Plymouth] are happy to continue but, at the same time, would welcome others coming forward. Should this occur, these positions will go up for re-election alongside the Torbay non-executive role.

l FROM PAGE 1

Heartbeat

Review of child deaths provides some helpful learning for clinicians

Record-sharing initiative landmarkNEW Devon CCG has reached a landmark with a total of 73 GP practices now signed up to share records digi-tally.

It means that GPs can now electronically share information with fellow clinicians outside

their GP surgery, which will avoid costly, time consuming phone calls and paper chases.

Individual GP practic-es decide which hospi-tals and care providers they wish to share re-cords with. Devon Doc-tors, Northern Devon

Healthcare NHS Trust and Devon Partnership NHS Trust are among the organisations that have already signed up to share records.

Then, at each and every encounter out-side the GP practice, the patient can decide

whether they will per-mit their record to be viewed by the clinician who is treating them.l For more informa-tion visit www.newd-evonccg.nhs.uk/your-ccg/ccg-wide-projects--/local-shared- care-re-cord-/101513

DEVON Doctors is now represented on the SW Peninsula Child Death

and Overview Panel, writes Dr Andy Potter, Devon Doctors’ named GP for child safeguarding.

The remit is to anonymously review all child deaths to see whether there are any discern-ible trends and, where appro-priate, to point these out to the relevant bodies.

There is a strong Public Health presence on the panel. As you might expect, more than half of deaths are neonatal in relation to prematurity, but about a third of deaths are unexpected and in older children.

I am attending meetings that

deal with these deaths – as this is of relevance to clinicians work-ing out-of hours – and was struck by the similarities in the numer-ous ‘cot death’ cases.

We are, perhaps, familiar with advising that babies should sleep on their backs and not to over wrap. However, parental smoking, alcohol drinking, drug taking and a poor standard of accommodation were almost uniform themes.

Earlier this year, Peter Flem-ing had an editorial published in the BMJ reminding us of the key factors which have casualty. In the same way that smoking only causes an myocardial infarction [MI] or a stroke in a small propor-

tion of patients, parental smok-ing only ‘causes’ a small percent-age of cot deaths.

At an individual level you can’t attribute a cause. When dealing with ‘hot infants’, I sometimes lose sight of broader issues to do with their health. I for one need to remind myself to advise par-ents of infants to avoid smoking, alcohol, recreational drugs and co-sleeping on the sofa.

If we did this for all infant consultations, we could make a difference. If there is popular de-mand for a small and simple, Let’s reduce the risk of cot death leaflet – like the feverish child safety-netting leaflet – then I’ll happily produce one.

Co-sleeping with your baby can increase the risk of sudden infant death syndromeCo-sleeping with your baby can increase the risk of sudden infant death syndrome

l Do syringe driv-ers shorten people’s lives? No. Syringe drivers are a reliable way of getting essen-tial medication into patients when the oral route is impos-sible, dangerous, or burdensome. Near the end of their lives people often cannot swallow or are not absorbing medica-tion well, so, they are often erroneously as-sociated with people dying. I’ve seen patients who ap-peared desperately ill improve unexpect-edly after starting a syringe driver and sit up the next morn-ing demolishing a bacon sandwich! It may be that they were actually in undiagnosed status

PRN breakthrough analgesia they need is the usual 1/6 of the 24-hour dose – 20mg sc diamorphine. This is much more than a JIC bag for opiate naïve patient or one on starting doses of opiates. Once or twice a year, I see pa-tients near the end of life whose distress, either pain or more usually delirium, is so severe that our stan-dard treatments are useless: something more is needed. I get a 30ml syringe and put in much more medication than I will possibly need and dilute it to fill the syringe. Then I inject it IV slowly over 10 minutes, stopping as soon as the situation is back

epilepticus due to brain metastases or biochemical chaos, and midazolam has controlled this.l When should a Just In Case bag be utilised? Just In Case bags are very helpful in the treatment of sudden deteriora-tion, saving unneces-sary distress and admission. However, there are two issues worth highlighting: [1] The contents of the JIC bag may become out of date if it has been in the house for some time; [2] Confusion with PRN injections for someone on a syringe driver. If someone was on, say, 120mg diamor-phine over 24 hours in syringe driver the

under control. This controls a dreadful situation for the patient and carers, and allows us an idea as to what needs to be used in a syringe driver to prevent such distress again. l Can you mix several drugs? Yes. We use up to five if necessary. Usually an analgesic such as diamorphine, an anti-emetic like Le-vomepromazine and an anticonvulsant / sedative like mid-azolam. In the hos-pice we have tables of safe combinations. Ring 01392 4025686 for advice, 24 hours a day, seven days a week. Cyclizine, while useful is the drug most likely to mix poorly.

Syringe drivers don’t shorten people’s lives

PALLIATIVE CARE

with Dr Tim Harlow of Hospiscare

A syringe driver being utilisedA syringe driver being utilised

HeartbeatIG crossword

ACROSS1. Which Act protects the information of individuals [4, 10]3. In order to protect our systems from un-authorised access you must use a strong [8]6. How many Data Pro-tection Act principles are there? [5]7. Patient information must be kept? [12]10. Who is responsible for keeping information safe and confidential? (9)

12. The [15 down] ___ [6] Act protects private and family life13. The Access to Health Records Act explains how we must keep secure informa-tion relating to patients who have [4]14. When you leave your computer for any time you must [4, 2]18. __ [8] records are just as sensitive as medical records.DOWN1. When disposing

of files, they must be securely [7]2. Files should be safely stored in a confidential [7]4. Independent body safeguarding the rights of individuals and their information [3]5. Person responsible for risk management at the highest level of our organisation [4]8. An assessment to identify potential areas of concern to be ad-dressed [4]

9. You must securely destroy confidential paperwork using a [5,3,8]11. The best way to share patient informa-tion is with [7]15. The ___ (5) [12 across] Act protects private and family life16. If we cannot keep information secure, this could damage public (5) in our organisation17. We were recently subject to an inspec-tion from the [3]

Recognition for new wellbeing hubTHE team behind a new health & wellbeing hub aimed at some of Ex-eter’s most disadvan-taged communities has been invited to address a keynote conference on public health and housing.

Exeter Council for Voluntary Service is de-veloping former Exeter City Council offices at Wat Tyler House in King William Street into a

multi-agency wellbeing hub aimed at support-ing people with multi-ple and complex needs in their recovery, and to play a fuller part in their communities.

On opening the hub will be the new home for the services currently provided by Devon Doctors subsid-iary Access Health Care at The Clock Tower sur-gery. It will also house a

mental health outreach team, substance mis-use recovery workers, a housing advice team, community learning tutors, volunteering ad-vice staff and the city’s Street Homeless Out-reach Team.

The King’s Fund – a charity and think-tank that works to improve health and health care through innovation and policy development

– has announced that the team behind this ambitious new project will address its October conference themed on health in housing.

The project was se-lected for its innovative approach in bringing together a range of ser-vices from across public, private and voluntary sectors to meet the needs of people with very complex lives.

Practical palliative pointers for clinicians

Visit should be norm in mental health cases

NEWS in brief

IN the out-of-hours setting we are seeing increasing numbers of palliative patients, quite rightly, being cared for in their own homes. For these patients, when in need we almost be-come the emergency service of choice [albeit minus the si-rens and unrestricted response times... but that is another issue].

It is with this in mind that I feel our dedicated palliative care line needs more publicity, writes Dr Ben Usher.

The spark was ignited when I visited two palliative pa-tients who were very much in their final few days, as a result of which concerned relatives were in need of urgent assis-tance. Unfortunately,

in both instances the relative had been unaware of our dedicated line and going via NHS 111 only served to make an already tricky situ-ation even trickier.

Subsequently, I have attended a number of similar patients who were unaware of our dedi-cated patient line.

I fee this is unac-ceptable and hope that this article will highlight the need to not only endeavour to provide the best possible pal-liative care for these patients, but also encourage you to is-sue them with details of how to access our service quickly at their time of need.l Call 0845 5049113 to access the palliative care line.

OUTGOING medical director Dr Chris Bastin recently had a meeting with the bereaved family of a patient who had committed suicide.

“The family is keen for the agencies involved in the care to learn from the situation, in order to minimise the risk of their experience being suffered by others in the future,” explained Chris.

“A short time ago I wrote an article in relation to triaging calls from patients / relatives suffering from dementia. I stressed the importance of gathering information from all sources.

“I believe that the same evaluation of evidence should be undertaken when triaging calls where there is an indication that suicide is being contemplated. Indeed, I would go

further and suggest that this should be the norm in all mental health cases.”

It is accepted good practice that a clinician should place himself / herself in a position whereby a considered judgement can be made. In many cases, the clinician might feel that a visit to the patient is not required, but after listening to relatives or friends a different presenting picture might be obtained.

Dr Bastin suggests that a visit should be seriously considered for, although it might be felt that the clinical management would not be altered, the support provided to the relatives and management advice given could be invaluable – carer support to hold a difficult situation should not be underestimated.

Q&A: HEAD OF GOVERNANCE FAYE SUTTON

Otterhound helps dog lover Faye escape from the grind of governance

What is your position within Cornwall Health and what does this involve? I am the Head of Governance and oversee the rest of the Governance Team. Together we are responsible for issues of quality, reputation and risk and what that means in practise is that we collate and investigate complaints and incidents and assess whether or not the issues that arise from these place the organisation, and the staff working with and for it, at any risk from both a reputational and legal perspective.

How long have you worked for the organisation and what roles, if any, have you performed previously? I started as the Head of Governance at the end of July, so I’m very much a ‘newby’ to Devon Doctors Group; before coming here I worked for the Royal Devon & Exeter Trust. Professionally I trained first as a nurse and then later as a midwife.

What do you enjoy most about working for Devon Doctors Group? Well, I haven’t been here very long but already I feel at home and everyone has made me feel very welcome. It reminds me of when I went from the hospital to work as a community midwife in Exeter – there is something about being based out in the community that is very different to the feel of being based within an acute hospital – it’s not that there is less to do but somehow the whole vibe is more relaxed and I really appreciate the sense of being out in the real world rather than in the ‘bubble’ of an acute hospital.

How do you relax? Walking the dogs has been the most regular way to relax but Izzy is getting on a bit at 13 years old, and she’s a bit wobbly on her legs now. We used to have three Otterhounds [a very old British breed but now quite

Rome it’s a city I don’t get tired of but really anywhere with family and / or friends makes it a good place to be.

What was the last film you saw? JurassicWorld in 3D – somegood escapist adventure.

If you had to choose a single ‘Desert Island Disc’ what would it be? The Benedictus from The Armed Man by Karl Jenkins – it’s a modern

rare; in fact there are more Giant Pandas in the world] but sadly have had to say ‘goodbye’ to two of them over the last couple of years.

Where is your favourite holiday destination? I like having things to do and places to see, here or abroad. We went to Malta last year and that was pretty amazing and Steve and I revisited Prague with friends earlier this year – like

Faye and her husband Steve on a visit to PragueFaye and her husband Steve on a visit to Prague

EMAIL DAMIENMILLS@NHS.NET IF YOU’D LIKE TO APPEAR IN THE HEARTBEAT Q&A

classical piece [a still living British composer] – go on, take a few minutes, sit down, close your eyes and listen…

What is your favourite book? Pride and Prejudice.

What TV programme do you always switch off? Things like Big Brother and, controversially, Bake Off. I like programmes with actors, acting.

What is your greatest extravagance? A Mulberry handbag but I love it and I use it a lot – it’s not just for special occasions and I am worth it!

What makes you most depressed? I don’t really get depressed – I’m a ‘glass half full’ kind of person – but it makes me sad to know that so many young people in this country are barely literate when we provide years of dedicated time and space to education.

If you could invite four celebrities / historical figures to a dinner party who would they be? Maya Angelou [author, poet, survivor, inspiration], Bette Davis [actress, icon] – they both had amazing lives and would be great company but I think we should balance things up and have some entertainment too, so I’d

also have Frank Sinatra and Robbie Williams. They’ve all ‘lived a little’ and it would make a fantastic dinner party.

What is the most important lesson life has taught you? Be flexible – life can be amazing if you stay open to the opportunities

that come your way.

How would you like to be remembered? As someone who made a difference – even if only in a small way.

Heartbeat

Departure of MDs marks end of an eraI T’S the end of an era for

Devon Doctors with the departure of long-serving

medical directors Dr Mike Richards and Dr Chris Bastin.

Both Chris and Mike have been involved with the organisation for many years. Indeed, Mike’s involvement goes back as far as 1996 and he has been on the board ever since.

“One way or another I have worked for the out-of-hours service for many years,” reflected Chris. “Indeed, I was a member of the Wakely DOC committee right at the beginning.

“I have really enjoyed my roles as medical director and, latterly, director of clinical services. Obviously I enjoyed the job itself, but more than that I enjoyed working with everyone at Manaton Court.

“It has been a pleasure to take part in the control centre banter and this, along with the gossip, is something I am going to miss!

“I’m looking forward to

spending more time on my Lovejoy-come-Del-boy role in the antiques trade! However, I am not saying a complete goodbye and don’t be surprised if I pop up again at Manaton Court at some point in the future.”

“All the best to everyone who has helped to make my time with Devon Doctors so enjoyable. And, last but not least, ‘Come on You Bath!’ and ‘Up the Gunners!’

Mike said: “It has been both a privilege and a pleasure to work with the team at Devon Doctors and I am sure the organisation will be around for many years to come, in what guise is as yet unclear but patients will always need out-of-hours care and who better to provide it?”

“There are a handful of people without whom Devon Doctors would not exist and Mike is one of them,” said chief executive Chris Wright. “We owe him and Chris a debt of gratitude.”

END OF THE DAY

If you’ve got something you’d like to see included in the next edition then contact damienmills@nhs.net

Heartbeat

with Damien Mills

on Sunday, October 11, would welcome sponsorship for this most-deserving of causes from friends and colleagues.

If you would like to contribute then email tina.osbourne@nhs.net or call 07976 562429.

Hazel’s Big C ChallengeWhile Tina is raising cash for the Devon Air Ambulance, Urgent Health UK’s business manager and company secretary Hazel Harrison, who is also based at Devon Doctors’ Manaton Court HQ, is going the extra mile for another worthy cause.

Tina’s charity darts marathonControl Centre staff member Tina Osbourneis taking part in a 24-hour darts marathon to raise money for the Devon Air Ambulance Trust’s Sparkle for Samuel Appeal.

Ten-year-old Samuel Crocker, from Crediton, died in an accident on February 28, prompting his family to set up a fundraising appeal for the air ambulance.

Tina, who will be on the oche at the Rose & Crown, in Sandford, between 11am on Saturday, October 10, and 11am

Hazel has taken up the Big C Challenge, which has seen her give up chocolate [as well as anything with a hint of cocoa in it], and her beloved diet coke for the month of September. In return, Hazel is seeking sponsorship to help raise the cash required to train a robotic surgeon to help

operate on those suffering with cancer at the

Royal Marsden Hospital in London.

Hazel had been aiming to raise £100

but having reached the £185 mark with

half the month to go is now targeting £200.

Anyone who would like to help her realise her goal should visit https://

www.justgiving.com/Hazel-Harrison1

Mike, left, and Chris with the cake baked for them by Aileen McCloud

Mike, left, and Chris with the cake baked for them by Aileen McCloud

After more than a decade, medical directors Mike Richards and Chris Bastin are retiring

Heartbeat

Images credited to NKZS, www.sxc.hu, Microsoft clip art & Devon Doctors’ own collection. Items advertised or promoted on this page are not endorsed by Devon Doctors or its subsidiaries. Contact the editor: ddocs.governance@nhs.net Unit 5, Manaton Court, Matford Business Park, Exeter, EX2 8PF www.devondoctors.co.uk

Anyone for table-tennis?The arrival of a ping-pong table at Cranbrook Medical Centre – see story on Page 1 – prompted myself and practice manager Mark Knight to consider the possibility of putting on a Devon Doctors Group table-tennis championship.

Rumour has it control centre team manager Sophie Andrews is a champion ponger and will take all the beating!

If you fancy yourself as handy with a bat and might be interested in taking part then, please, ping me an email and if there’s sufficient interest we’ll see what we can come up with!