dppg newsletter - summer 2009
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PARTNERSHIP FOR HEALTH Davenport House Surgery & Patient Participation Group
The Joint Quarterly Newsletter www.davenporthouseppg.org.uk
Issue No 43 June 2009 www.davenportsurgery.demon.co.uk
Thank you very much for your tremendous support in responding to the increase in annual
subscription, which secures the financial future of the of the PPG. As a result we are reviewing
the contribution the Group can make to the Practice and the well-being of its patients. Here are some of the developments on which we would welcome suggestions from members.
Increasing the attractiveness and accessibility of the quarterly Newsletter.
Attracting more patients to our quarterly programme of talks and events at
Rothamsted, giving the programme greater variety and audience appeal. For example:
Redesigning the PPG website to make it more attractive and an up-to–date source of
information and communication.
Involvement in the development of the Davenport House premises when its lease is
renewed in 2010. The PPG will be consulted and will be working with the Practice to make the Surgery as welcoming and efficient as possible.
Increasing ways in which groups of patients with particular concerns
can be helped by the PPG beyond the present Small Group Meetings. For example are we doing enough to support carers and those suffering from chronic illness?
Do let us have your views and recommendations using the email addresses below. Roger Gedye, PPG Chairman
WHAT NEXT FOR THE PPG?
On Monday 13 July the
Practice Partners will form the
panel for ‗Any Health Questions‘ from our members: do submit your own questions using the form enclosed with
the Newsletter.
PPG COMMITTEE MEMBER CONTACT DETAILS
Chair Roger Gedye 832374 [email protected]
Secretary Rosemary Horne 762620 [email protected]
Treasurer Ian Drew 460597 [email protected]
Membership Helen Hartley 767462 [email protected]
Newsletter John Harris 713246 [email protected] Education Sheila Uppington 764230 [email protected]
Education Tom Love 766242 [email protected]
PCT Liaison Malcolm Rainbow 762590 [email protected]
Recruitment Pam Morris 620306 [email protected]
SPECIAL FEATURE
Pages 2, 3 & 4 in this edition are devoted to children‘s health. Please encourage mums with young children to read this e d i t i o n o f t h e N e w s l e t t e r a n d
become members of the PPG.
On Monday 19 October the focus will be on
the health of the ‗Under Fives‘. We are plan-
ning a less formal evening with parental and grandparental participation and a range of invited representatives to consider how to keep babies and young children safe with the
actions to be taken in emergency.
2
CHILDREN‘S HEALTH—SNIPPETS FOR PARENTS BY DR KIRSTEN LAMB
COMING SOON
Your PPG is running an event on 19 October 2009 at Rothamsted
looking at how to spot and manage emergencies in children. There will
be a series of short talks and then a panel discussion. There will also
be stalls from various organizations providing further information. The
topics covered will include: spotting when your child is really sick,
accidents and what to do, when your child has a cough and when it is
serious, advice from St Johns ambulance about first aid and
resuscitation plus information about local courses and guidance about
allergy and its occasional frightening consequence, anaphylaxis.
CHILDREN‘S FEVERS
NICE, the National Institute for Health and Clinical Excellence, issued the following guidance
to both parents and health professionals on managing and diagnosing the cause of fever in
children under 5, back in 2007.
YOUR CHILD HAS A FEVER
(HIGH TEMPERATURE) Most children who are ill
with a fever (temperature) will have a brief viral infection which will get
better on its own. The
doctor will only prescribe treatment such as an antibiotic when there is an
obvious cause for the temperature for which an antibiotic would be helpful
– such as tonsillitis.
Looking after your ill child:
If your child is uncomfortable with the
fever then you can give them medicine to lower their temperature and take away pain. You can try either paracetamol or ibuprofen. If one does
not work try the other. If your child is not uncomfortable with the fever there is no need to give medicine just to
lower the temperature.
Give your child regular drinks. If you
are breast feeding your baby then continue.
Do not over or under-dress your child.
Leave them in clothes in which they seem to be comfortable.
Sponging your child down when they
have a temperature is not helpful and may actually increase the temperature
inside their body. Check your child during the night if they
were ill when they went to bed.
Keep your child away from school or
nursery until their temperature is normal. But let school or nursery know they are unwell.
What to look out for so you know when to call for help again:
Your child gets a non blanching rash –
you can check for this using the tumbler/glass test
Your child has a fit
Your child‘s health gets worse
The fever lasts for 5 days or more
You are worried. Your instinct about
your child is very important.
You are finding it hard to look after your
ill child.
Tumbler test
Press a glass over the rash
If the rash disappears when you press
then there is no concern
If the rash does not disappear call the
doctor
3
CHILDREN‘S HEALTH (CONTINUED)
DIARRHOEA & VOMITING In April 2009, NICE issued guidance for us all about how to deal with gastroenteritis in young children. You can find this at the NICE
websi te http://www.nice.org.uk/
guidance/CG84 . Diarrhoea and vomiting in children under 5 is
commonly caused by a virus – rotavirus. Occasionally a child may have diarrhoea and vomiting as part
of another illness – such as other infections like ear and chest infections.
It is called gastroenteritis when it is just a gut infection and not a feature of one of these other
infections. Most children can safely be managed at home. Vomiting usually only lasts for a day or two but diarrhoea may last a full week. The most
important part of looking after children with diarrhoea and vomiting is to make sure they are well hydrated, in other words are getting in enough fluid.
Spotting when and if your child is becoming dehydrated is important. If you are
concerned that your child is much droopier than usual and is deteriorating, is failing to keep down any fluids, is passing less urine than usual, has very sunken eyes and
generally appears unwell, then your child should definitely be checked.
When your child has diarrhoea and vomiting it is important to make sure they are drinking
enough fluid. Continue breast feeding and you can still offer other milk drinks. Give your child other fluids such as water to drink. You can also buy rehydration sachets from the
chemist, which give your child exactly the right combination of chemicals in the drink. Do not use pure fruit juice or fizzy drinks. If you are struggling to get enough fluid into
your child and you are concerned, get your child seen at Surgery. If you are
managing, do not worry about food at this stage but as soon as your child is drinking well
restart food. It does not matter
if they still have diarrhoea. You are the best person to
assess whether your child is managing. If you are concerned
your child is dehydrated, your child is not getting better, your child develops other
problems that worry you or you cannot get your child to take enough fluid, then they must be seen by us at Surgery.
Remember that this is an infectious illness.
You must practise excellent personal hygiene
– hand washing, not sharing towels etc. Your
child should not attend school, nursery or
other child care till 2 days after the last
episode of diarrhoea or vomiting. They should
also not go to the swimming pool till 2 weeks
after they are better.
IMMUNISATION
The UK immunisation schedule for all children can be see at http://
www.immunisation.nhs.uk/Immunisation_Schedule . This website is regularly updated
and gives you details of all the immunisations your child will receive. The UK immunisation
schedule has been fantastically successful at reducing the numbers of
children catching these diseases. Impressively, since the introduction
of the meningitis C vaccine (now given to all babies from their first
jabs), the incidence of meningitis from this bug has virtually vanished.
We do not have a jab for meningitis B so it is still important to be
aware of this illness. At Davenport House the uptake of immunisations
is exceedingly high. It is very important that we maintain that rate.
We need immunisation rates well over 90% to prevent these diseases
from appearing in our community.
4
CHILDREN‘S HEALTH (CONTINUED)
CHILD SAFETY Summer is here and our children will be out and about and playing outside more than in the winter. Accidents happen! The Royal Society for the Prevention of Accidents (www.rospa.com) gives statistics – in
2002 there were 2,000,000 accidents involving children aged 0-14. Almost 1,000,000 of these were play related. Child safety week is 22-
28 June 2009. This website gives you advice about keeping your child safe. http://www.childsafetyweek.org.uk - follow the link to
parents‘ section. What is more, there are leaflets available that concern safety at each age and stage of development of your child. Obviously it is a different matter protecting an 8 year old from an 8 month old! It also gives practical advice about these
topics: burns and scalds, electrical safety, falls, fire safety, poisons and road safety. Favourite hazards include the trampoline and the skate board!
HEALTHY CHILDREN
However, to balance the risk about
accidents, it is also important that our children are healthy and therefore are
allowed to have fun and get exercise. This of course
i n c l u d e s t h e trampoline and the skate board! There is an excellent website http://www.nhs.uk/Change4Life/Pages/default.aspx which is
full of tips and help on how to do the best for our kids. It describes 8 ways to Change4life: me size meals, 5 a day, sugar swaps, snack
check, cut back fat, up and about, 60 active minutes and meal time. Looking at each of these gives you advice about healthy meals and snacks, the amounts your child should
be eating, good tips about fun exercise including local facilities. It is well worth having a look at. We may all think we are experts but there is always good advice to be
had.
ROLE OF THE HEALTH VISITOR -
BY JUNE DUNN
The role of the Health Visitor (HV) is essentially one of support for families with children. With nursing and midwifery
training, plus the postgraduate training required to qualify as a HV, we aim to offer friendly support and advice (take what you want from it!) and will endeavour to help
deal with any concerns that family life can produce.
The role also includes child development screening.
One of the big concerns recently has been weaning i.e. when to start or not. It is important to take each baby‘s needs individually: some need to begin solids
before 6 months and rest assured that the paediatric dieticians are happy about that.
Unfortunately, due to a decision made by the Primary Care Trust, HVs are no longer based in GP Surgeries. However, liaison
between Davenport GPs and myself has always been excellent thanks to everyone‘s efforts, which I‘m sure will continue.
NEWS FROM THE EDITOR
I‘m attempting to modernise
the Newsletter to attract a
wider PPG membership.
I would welcome ideas and help from anyone with experience of Microsoft Office Publisher and/or design.
Earlier this year I was successful in becoming
a Governor of Luton & Dunstable Hospital.
Thank you to all those voted for me. As I am your representative, please let me know if you have any matters which you wish
to raise by contacting me:Tel:01582 713246 Email: [email protected]
5
YOUR APPOINTMENT WITH THE DOCTOR
TOP TIPS FROM THE NHS
BEFORE YOUR
APPOINTMENT
Write down your two or three most important questions.
List or bring all your medicines and pills - including
vitamins and supplements.
Write down details of your symptoms, including when they
started and what makes them better or worse.
Ask your hospital or Surgery for an interpreter or
communication support if needed.
Ask a friend or family member to come with you, if you
like.
DURING YOUR
APPOINTMENT
Don‘t be afraid to ask if you don‘t understand. For example
‗Can you say that again? I still don‘t understand.‘
If you don‘t understand any words, ask for them to be
written down and explained. Write things down or ask a family member or friend to take
notes.
BEFORE YOU
LEAVE YOUR APPOINTMENT
Check that: - you‘ve covered everything on your list. - you understand, for example ‘Can I just check I
understand what you said?‘
- you know what should happen next—and when. Write it down.
Ask: - who to contact if you have any more problems or
questions. - about support groups and where to go for reliable information.
- for copies of letters written about you—you are entitled to see these.
AFTER YOUR
APPOINTMENT, DON‘T FORGET
THE FOLLOWING
Write down what you discussed and what happens next.
Keep your notes.
Book any tests that you can and put the dates in your diary
Ask:
- ‗What‘s happening if I‘m not sent my appointment details?‘
- ‗Can I have the results of any tests?‘ (If you don‘t get the results when you expect—ask for them.) Ask what the results mean.
6
HOW‘S THE PRACTICE PERFORMING? ―Lies, damn lies and statistics‖ - By Dr Sneha Wadhwani
WEST HERTFORDSHIRE PCT SHORT EXTRACT FOR
GP PRACTICE BALANCED SCORECARD DAVENPORT HOUSE
Standard Total PCT Ave Data Source/Description
Access/Availability of Primary Care
Satisfaction with telephone access 75% 87% GP Patient Survey 2007/08
Patients able to get GP appt. within 48 hours 90% 88% GP Patient Survey 2007/08
Patients able to book 2+ days in advance 63% 79% GP Patient Survey 2007/08
Quality Clinical Outcomes
Cervical Screening Programme 85% 80% NHS data
Smoking 4 week quitters vs Herts target 31% 13% Herts PCT data
Childhood Immunisations 96% 92% NHS data
Pre-school booster 92% 89% NHS data
Influenza immunisations for over 65’s 79% 76% Dept of Health for 2007/08
Wouldn‘t it be helpful to know how the Practice is performing? Patient surveys are undertaken annually. In addition, statistics are collected centrally by the
NHS. All this information is now being brought together by the Primary Care Trust (PCT) in a Balanced Scorecard, ―management speak‖ for a GP Practice report, a bit like a school report. (See an extract below based on 2007/08 data.)
This report is being updated and published on the PCT website (www.wherts-
pct.nhs.uk) quarterly, although some data is only available on an annual basis.
How is the Practice being scored?
The Practice performance within each measure is being compared with the
PCT average performance. The relative score is graded RED, AMBER or
GREEN, with green
indicating that the Practice exceeds the PCT average and with amber and red
denoting respectively lower performance.
What information is being provided?
The accessibility and availability of services
How the Practice is helping patients with
long term conditions
How it is meeting its clinical targets
Environment (i.e. premises, buildings) and
infection control Patient views
All sounds great! – What are the snags?
Statistics can be made to prove anything, so
some of the results could be misleading. For example, if a Practice scored ―red‖ for ―cost effectiveness of prescribing‖, what does this
mean and what are the implications for patients? This could be interpreted in two ways. Firstly, the Practice is spending too
much NHS money on drugs resulting in less money for other areas. Or secondly, the Practice is spending more money on drugs for their patients who are healthier as a result of
the increased prescribing. More fundamentally, there is little reflection
within the measures for patient satisfaction with their GP with whom a relationship is built
over many years. Patient feedback each year shows that this rating is very high.
So how will the Practice and PPG use these reports?
The aim of the reports is to provide simple but effective answers to the questions ―What is the Practice doing well?‖ and ―How can it
further succeed?‖ For its part the PPG will monitor the information and work with the
Practice to identify areas for attention, based on the performance of other Practices in
similar locations and of a similar size. Any patients interested in studying these reports and the guidance notes on how they
are produced can find them on the West Herts PCT website www.wherts-pct.nhs.uk. Enter the keywords ―balanced scorecards‖ in the top
left hand box, then click on GP balanced
scorecards. If you have any matters that you wish to raise, please email one of the PPG committee members.
"Lies, damned lies, and statistics" is part of a phrase attributed to Benjamin Disraeli and popularised in the United States by Mark Twain: "There are three kinds of lies: lies,
damned lies, and statistics." The statement refers to the persuasive power of numbers, the use of statistics to bolster weak arguments, and the tendency of people to disparage statistics that do not support their positions.
7
BRIEF PPG MEETING REPORTS By Sheila Uppingham
HAND & FOOT SURGERY ADVANCES
After the AGM David Williams, a retired Orthopaedic surgeon from the QE2 Hospital, gave a very full account of recent advances
in hand and foot surgery.
He explained how the surgeon was part of an important team that included
occupational therapists, physiotherapists, podiatrists, osteopaths and GPs who all listened to the patient to help in diagnosis
and treatment.
His talk emphasised the place of non-invasive imaging
leading to accurate diagnosis as well as minimal invasive
surgery and quicker recovery. This imaging included such
techniques as ultra sounds (cheap and painless), CT and
MRI scans (expensive and uncomfortable),
and radiographs. Numerous examples were given during a very amusing and illuminating presentation
with a large number of graphic slides.
COPING WITH BACK PAIN In April Matthew Tant, a well-established Harpenden osteopath, gave an
excellent presentation to a Small Group Meeting on
back problems.
Using a model skeleton he explained how the normal anatomy of the spine could
be worn, inflamed or misaligned to cause back problems. He drew diagrams to show how disc problems could occur and how some of the treatments worked to improve
various conditions.
As part of the discussion, questions were
answered on age-related spinal conditions, dietary supplements, the place and types of conventional pain relief, exercises to help back problems and which activities tended to
aggravate them. Current advice is not to rest for days but to start some gentle movement as soon as
possible.
MEETING NOTICE
There are a few places left for the two Small Group Meetings to be held at the Surgery on
Tuesday 10 November (on respiratory problems) and Wednesday 2 December (on weight loss). If you are interested in attending (which is by invitation) please contact Sheila Uppington via the PPG Surgery letter box giving your name, address and phone number.
BEYOND THE SURGERY
By Malcolm Rainbow
I am delighted that our editor John Harris was elected to the L & D Council. I hope I
might receive your support this year as my three-year term is up and I shall be standing for re-election in July. I have learnt a lot in the past three years and feel
this will help me make an increasing contribution to the L & D‘s future, on which we in Harpenden will increasingly be
dependent.
The continued success of the L & D in combating infection has been recognised by a
grant of £150,000 as the best hospital in the East of England. It will be spent on increased infection control measures.
The part of the PCT which provides all the
local services, e.g. health visiting, district nurses and the community hospitals has
been set up at an arms length organisation called Hertfordshire Community Health Services (HCHS). This is part of the process of separating the commissioning activities
from the providers like the hospitals. The providers will increasingly have to compete for business to improve efficiency and drive
down costs but not at the expense of quality.
Finally the new Hertfordshire LINks Board, including 5 St Albans residents, was elected
at the AGM on 14 May. As there were insufficient candidates for all the posts I remain a Board member. Now into its first full year the priorities will be to ensure that
patient views are properly represented.
8
SURGERY SNIPPETS By Anthea Doran, Practice Manager
ACCESS TO THE DOCTORS By telephone – Please do this after 10.00am via the enquiry line 01582 767821 option 3 Then we will:
Check that it is not a request for a visit
Check that it is not urgent. If it is urgent the duty doctor will be alerted so he can
respond appropriately.
Ask for a brief outline of your request, since some matters can best be dealt with by
the medical secretaries such as a referral to a specialist or via reception such as the results of a test or scan.
Put the information on the GPs computer screen to be accessed by them at the
beginning or end of their next Surgery, where delays in returning your call can sometimes occur due to other urgent priorities.
Ask for your mobile telephone number in addition to your land line as the time of a
return call from your doctor cannot be confirmed. If you have any comments or suggestions regarding telephone access to your doctor, please forward these to the Practice Manger and/or a member of the PPG committee.
By email
Doctors Cashyap, Chafer and Wadhwani are currently available by email via the Surgery
website (www.davenportsurgery.demon.co.uk) with other doctors to be added in due course.
Please read the information on the Surgery website regarding privacy and turnaround times.
WELCOME NEW STAFF
Kathryn Dewdney is an experienced practice nurse with specialist knowledge of respiratory disorders. She will provide
treatment room cover on Tues. pm & Thurs.
Kevin Gandon is a primary mental healthcare worker attached to the Surgery who offers psychological therapies on a
Wednesday. He complements the counselling team who work on a Monday (Mary Anne Keen) and a Tuesday (Maggy Swift). These
services can only be accessed via referral from your GP.
SWINE FLU Advice from the Health Protection Agency
Anyone who has recently travelled to the affected areas and is experiencing flu like illness should stay at home to limit contact with others and
contact their GP by telephone for advice. Patients with swine flu will feel ill for a few
days. Cover your nose and mouth when coughing and sneezing, use a tissue where possible. Dispose of dirty tissues promptly
and carefully. Maintain good basic hygiene,
for example wash hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other
people. Clean hard surfaces (e.g. door handles) frequently using a normal cleaning product. Make sure your children follow this advice.
WANTED NEWSLETTER DELIVERERS
If you could spare an hour once every three months to deliverer newsletters in your area we would be extremely grateful. Please contact Helen Hartley – Tel: 01582 767462
Email: [email protected]