2

REVIEWING THE FUTURE OF THE PATIENT GROUP

By Dr Alan Stranders and Roger Gedye

Dr Alan Stranders, Senior

Partner

SURGERY TRANSFORMATION

The transformation of Davenport

House is well underway. Our

doctors are hot-desking from

dawn until well after dusk in the

newly converted first floor of the

Surgery, while builders attack

the gutted ground floor with

sledge hammers and drills. The

restful décor and the spacious

consulting rooms are some

compensation for the difficult

conditions with which all the

staff must cope during the

months of transition. Heather

Hassall and her team are to be

congratulated on managing the

complexities of a major

programme of renovation in

such a way that their impact on

patients has been minimal.

YOUR PATIENT GROUP

The Patient Group is

approaching its 20th anniversary

and it is hoped that readers will

feel that like Davenport House it

has served its members well.

However, there have been

profound changes in General

Practice since 1993. The shift

from twenty-four hour patient

care by the GP to a daytime

service supplemented by an Out

of Hours team is perhaps the

most significant. Medically, the

emphasis has changed from the

(Continued from column 1)

diagnosis and treatment of

specific illnesses to the holistic

management of every patient‟s

health and wellbeing in relation

to the wider health of their

family and community.

NHS CHANGES

In the future there will be GP

control of expenditure on

healthcare and, in contrast to

extended stays in hospital, an

increasing emphasis on the

treatment and care of patients

in the community.

Roger Gedye, Chairman of

the Patient Group

PROPOSED REVIEW OF THE PATIENT GROUP

Given these changes, your Committee believes that this is a

good time to review the work of the Patient Group, to ask

whether the objectives set out below by its founders are still

relevant to 21st Century healthcare.

The Patient Group aims are to HELP:-

a. Influence the future policies and decisions of the

Practice.

b. Improve quality of services offered to patients of the

Practice.

c. Improve communication and understanding between

the doctors and members of the Practice staff on the

one hand and the patients of the Practice on the

other, by (but not limited to) such activities as:-

The preparation &/OR circulation of information

relevant to the Practice and the health care of its

patients,

Organising and providing lectures, forums and

discussions on subjects relevant to the Practice and

the health care of its patients.

We shall invite doctors and patients to offer constructive

criticism of what we have achieved and identify what can be

done to meet the needs of patients in the future. We look

forward to receiving your suggestions and feedback. The AGM on

Monday 6 February 2012 will be an opportunity to start the

discussion and your Committee and the doctors look forward to

welcoming you to Rothamsted for that event.

A VERY HAPPY CHRISTMAS AND SUCCESSFUL 2012.

3

ENJOYING A HEALTHY CHRISTMAS

By Dr Mark Sandler

During the festive season it is important to

endeavour to stay healthy as we all change our

routine with time off work, accommodating

visitors or travelling to enjoy parties,

celebrations, and family get-togethers. The

temptation to eat and drink too much and

exercise too little is probably greater at this time

of year than at any other. However, we must be

sensible about how and what we eat and drink,

within moderation of course!

However, it is important to stress that it is not all

bad news. An important study of alcohol and the

heart concluded that moderate alcohol intake was

good for the heart and was safer than being tee-

total. How you define moderate is of course a

matter of debate but current recommendations

remain up to 14 units weekly for females and 21

units weekly for males.

Exercise is also key as ti isat other times of year

and is of course less appealing in December than

in some other seasons, but a Christmas afternoon

stroll around the block rather than the more

usual sleep on the sofa (post-lunch I would

suggest) has various benefits. You can get some

crisp fresh air into the lungs, stretch the legs,

enjoy discussion of all the news shared across

Christmas lunch and, dare I say it, this gives an

opportunity for any stresses to evaporate! The

additional benefit can be in admiring all your

neighbours‟ house decorations and the excited

children bounding around inside.

Equally, a traditional Boxing Day family walk is to

be recommended as a way to try to balance all

the calories enjoyed in food and drink with a

good burn off of all that energy.

For those who do experience some

indigestion Gaviscon Advance can

be a useful over-the-counter

remedy to try.

All of these activities

and tips will of course

prepare you for later in

the week when you

have to overcome the

challenge of New Year‟s Eve!

Have a Happy and Healthy

Christmas.

Please remember that you can access the appointments system every

day between 2am and 11pm using the telephone booking service. The

system allows you to book, cancel and check appointments. To access just dial the Surgery number

(01582 767821) and press 1. You will be asked to enter your date of birth and telephone number via

the key pad and then you will be talked through a series of prompts. The system is straightforward

and the feedback from users is excellent.

SURGERY SNIPPET

4

AVOIDING ACCIDENTS OVER CHRISTMAS

By Dr Alka Cashyap

HAZARD ZONES

If I asked you what

words come to your

mind when you

think of Christmas,

I have a feeling

that accidents

would not be on

your list. Yet

statistics show that

some 80,000

people attend

hospital each year

from Christmas

related injuries!

A normal house can easily become a hazard zone

in the run up to and during the Christmas period.

The Christmas tree is one of the big culprits as it

is responsible for nearly 1,000 injuries each year,

ranging from scratches to the eye or broken

bones, from people falling off ladders and tables.

Opening presents is another health hazard. People

often stab or cut themselves with knives and

scissors when they are opening presents too

quickly, and they trip over toys and electric cables

once they get up. While others are engrossed in

opening presents, young children end up putting

small toys in their mouths and choking, or

touching lighted candles and burning themselves.

Hot fat, boiling water, a large turkey and sharp

knives leading to burns, cuts and fractures, make

the kitchen

the next

most

dangerous

place.

Turkeys often

get dropped

on young

children, or

somebody

slips on a bit

of goose fat

on the floor.

People have chopped off fingers while carving the

turkey and even burnt themselves while using the

blow torch on the Christmas pudding.

Overeating causes tummy pain and bloating, but

this is nothing compared to the diarrhoea that

Auntie Maud gets just while you are clearing up!!

If you did not cook the turkey properly then you

might be the one responsible for the latest

salmonella outbreak.

AVOIDING ACCIDENTS (Websites page 7)

How then does one avoid the festive occasion

turning into a nightmare? Clearly, prevention is

always the best strategy. So safety starts right

from the time when you begin to think of buying

presents or decorating the tree. For young

children, be sure to buy those which conform to

strict toy safety requirements and beware of

small parts as young children can swallow these

and choke on them. Always use a step ladder to

put up the decorations and don't over-reach. Test

your lights and the wiring before you put them

up, and don‟t overload sockets. Check that your

smoke alarms are working and have your First

Aid kit ready.

Clear up the house so

that there is room to

put away the presents

once opened, and keep

stairs free of clutter.

Keep big bin liners

nearby when

unwrapping presents

so that all the

wrapping can be

removed immediately.

Remember, children

and pets are the most vulnerable, so keep glass

decorations, candles, tea lights, alcohol and

medicines out of their reach, and also make the

kitchen a „No Entry‟ zone for them.

Follow the instructions properly when cooking the

turkey, and watch that knife! Be careful about

your alcohol consumption and try to avoid

drinking till the meal is on the table. Alcohol

impairs judgement, affects your concentration

and reduces your awareness of risk. These

effects are worse if you are tired or dehydrated,

both of which are also likely to happen on

Christmas Day. You will not be surprised to learn

that alcohol is directly or indirectly responsible for

a large proportion of Christmas injuries.

My list of safety suggestions is by no means

complete. All I wish to convey is the need to be

careful and to reduce the chance of having an

accident over the festive season by careful

planning and organisation and less haste.

Let‟s be honest, we‟d all rather see Santa Klaus

around Christmas, rather than Doctor Klaus (or

even one of those doctors from Davenport

House!)

Merry Christmas to everyone!

5

One of the important

non-clinical

functions a GP needs

to become involved

with is to attend

some of the various

committees that are

concerned with the

delivery of services

and medical care for

patients in their local

community. One

such committee is

known as the Local

Medical Group [LMG]

which comprises GP

and Practice Manager representatives from all

local Practices in Harpenden, St Albans,

Wheathampstead and London Colney, along with

members from the Primary Care Trust [PCT] and

Patient Forum. There are LMGs that cover all

areas of the county and country which cover

anything up to fifty Practices in any one locality.

In our area there are sixteen Surgeries.

In the past the LMG‟s interest was to be involved

mainly with services provided by Practices, the

health authority and local hospitals. However,

increasingly it is also becoming the medium for

maintaining clinical standards of care, both

within doctors‟ Surgeries and those provided by

hospitals. Medical performance in general and

the actual commissioning of most medical

services for patients were originally undertaken

by parts of the PCT. However, under the new

Health Bill currently passing through Parliament,

these are now gradually being replaced by local

commissioning groups with several local LMGs

feeding into each of them.

The local commissioning group that will affect

patients in Harpenden will cover the whole of

West Hertfordshire and is known as the Herts

Valleys Clinical Commissioning Group [HVCCG].

Two representatives from each LMG in West

Hertfordshire are elected to sit on the HVCCG.

They are currently Dr. Phillip Griffin and Dr.

Richard Pile, GPs from The Lodge and Parkbury

House Surgeries within St Albans, who represent

our local Harpenden and St Albans LMG.

At a time when NHS money is being suddenly

and savagely cut, commissioning groups and

their related sub-groups of LMGs are charged

with trying to find ways of streamlining

investigations and care for patients in many

areas that reduce reliance on hospital referrals,

which are often less responsive and certainly

more expensive. They are involved in monitoring

and commissioning currently operating local

services providing specialist investigations and

care, closer to doctors‟ Surgeries known as

Clinical Assessment Team [CAT] services. Many

patients at this Surgery will have had ultrasound

scans and referrals for problems relating to ear

nose and throat, eyes, skin, urology,

gynaecology, musculoskeletal problems in this

way, outside hospital outpatients and radiology

facilities, over the last few years. Their delivery,

services and standards all need periodic review

and adjustment to maintain quality and value for

patients within the NHS.

The LMG is also currently looking at areas such

as attendance at local casualty units. Many of

these are not appropriate for minor illnesses yet

they are costly and invariably inefficient for both

hospital and patient. There are often better

alternatives and the LMG is trying to look at

ways of educating patients and promoting these

as safe alternative ways for seeking medical

attention. It also reviews other areas relating to

cost efficient prescribing, health promotion

services such as helping patients to stop

smoking and preventing sexually transmitted

disease in young people, Out of Hours and

mental health service provision and many more.

Patients can be forgiven for thinking GPs are

only involved with direct patient care. More and

more during my own career I have seen this

become increasingly but necessarily encroached

on by wider responsibilities for medical services

in our community and hopefully for the good of

patients in general. However, with the likely

passage of the new Health Bill next year and

with it the predicted explosion of new

responsibilities and potential further distractions

from patient care I, like most GPs, have some

very mixed feelings. Happy Christmas!

LOCAL MEDICAL GROUPS

By Dr Andrew Chafer

As mentioned above the Herts Valley consortium, (HVCCG) which the St Albans and Harpenden PBC

(our local doctors‟ consortium) has joined, has now formed a Board and will be operating as a

shadow purchasing organisation for the next 18 months. In practice the PCT will be working very

closely with them to make any necessary changes. Malcolm Rainbow has been nominated as the

Hertfordshire LINKs Observer to their Board.

OUTSIDE THE PRACTICE by Malcolm Rainbow

6

MEDICAL RESEARCH PROJECTS

By Dr Chas Thenuwara

BACKGROUND

Several years ago I was

sitting in the coffee room

and I picked up a leaflet

asking for doctors‟ help in

trialling a new piece of

technology called a “mole

mate.” This was a new

tool being used to

evaluate precancerous

skin lesions. I had an

interest in dermatology

so I decided to give them

a ring. Unfortunately I

happened to be outside the catchment area for

this research project but my name was then

forwarded to the NHS National Institute for

Health Research (NIHR). Soon I was contacted

by the local arm of NIHR, the Primary Care

Research Network, to take part in the Erectile

Dysfunction and Statins Trial. Since then I have

taken a keen interest in research.

There is a complex network of research centres

in the UK all carrying out fantastic work. You

maybe familiar with some of them, for example

the National Cancer Research network. The

Department of Health has emphasised the

importance of research as a cornerstone to

providing excellent evidence based care in the

NHS. It is one of the few areas where funding

remains strong. As General Practitioners we are

in the front line of seeing patients at an early

stage of their illnesses and therefore are in a

great position to record and analyse data, look at

possible causes and hopefully prevention of

diseases or even cures!

There are different types of trials: Cohort,

Randomised Control Trials and Clinical Trials of

Investigational Medicinal Products.

Confidentiality is fundamental to research. All

data that contains clinical information is made

anonymous before leaving the Practice. In-house

information is kept in a secured cabinet.

Information from trials goes to various centres.

For instance data from the trial I am involved in

at the moment goes to Oxford University.

To be involved in research various standards

have to be reached. The Practice has to be

approved as Research Active. This involves

meeting certain standards such as having a

“secure unit for confidential information” and

correct IT competence. Staff involved in research

also have to go on courses to gain the Good

Clinical Practice (GCP) certification. Practice

nurses Jenny Hughes and Heather Warwick as

well as myself are GCP trained. This course

emphasises the 13 Core Principles of good

research, for example “The Rights of Patients are

more important than the research project itself”.

For more information and details of the 13 Core

Principles see www.gcp-education.com.

MY CURRENT RESEARCH PROJECT

I am involved in the Cough Complication

Cohort Study. This is an observational study

where patients who come in with a possible

chest infection are asked a series of questions

with symptoms and signs recorded.

28 days later their records are observed by one

of the Practice team to see whether there are

any complications. Most people with chest

infections get better without antibiotics but it

can sometimes be difficult to predict who might

get worse without treatment. By analysing this

data we will hopefully get a better idea. A new

study called the Target Study will be looking at

children in similar circumstances and I will

hopefully become involved here also.

At present patients are being identified and

either sent letters if they are eligible or

identified during routine visits to the Surgery. In

due course I hope to have an area on our

website to provide more information, although

there is currently information available on our

notice-board. On a personal note I have been

encouraged by the attitude of our patients to

research. Most have been very happy to

participate and are appreciative of its aims. My

aim is to make patients more aware and

hopefully in the future co-operate further with

other Practices in the area to become a hub for

research providing valuable information for our

future health.

7

PATIENT GROUP MEETING REPORTS By Sheila Uppington

MENTAL HEALTH IN THE ELDERLY

Dr Michael Walker, a local expert

geriatrician, spoke authoritively and at

times amusingly to members and guests

about the ageing process at Rothamsted on

Monday 10 October. This was an open

meeting chaired by Dr Alan Stranders,

Senior Partner.

Dr Walker explained that dementia is a

progressive problem interfering with daily

function and abilities in areas of memory,

language, calculation and performing complex

tasks. Having just one of these problems is not

dementia if daily function is unimpaired, and is

often due to normal ageing.

Mild cognitive impairment

has an unpredictable rate

of progression to dementia

and only 10-25% will end

up with Alzheimer's. New

drugs do not stop this

progression, nor do they

affect the long-term

outcome or patient

behaviour.

Of patients with diagnosed

dementia 60% will have

Alzheimer's, with other

causes due to strokes,

alcohol, or other areas of

brain disease. Dr Walker

used slides showing how

the memory area of the

brain shrinks in early

Alzheimer's, although he

finds talking to the patient

a better diagnostic tool.

Prevention measures include eating a similar

healthy diet as for your heart and not having a

family history of the disease. Sadly crosswords

and Sudoku have not been proven to help.

Maintaining a broad active life, without smoking,

but with exercise, will all help to keep blood

pressure and weight down, a general

preventative against vascular disease affecting

the brain.

Management of dementia at the early stage

should include writing an enduring power of

attorney, updating wills and writing a future care

plan. Locally we have a range of social care

support, a cognitive stimulation therapy clinic,

voluntary agencies, Evergreen Day Centre, and

intensive outreach teams.

In St Albans we also have the Early Memory

Diagnosis & Support Service (EMDASS). Its

work was explained to us by Mr Richard Pogson

and has been developed as a result of the

National Dementia Strategy (2009). With a staff

of four memory nurses, psychologist, speech &

language therapist, doctor and an Alzheimer's

support worker it offers diagnosis, care planning

and after-care. Referral is usually through the

GP. The route towards recovery and well-being,

taking some 38 weeks in total, is shown below.

The charities Carers in Herts and the Admiral

Nurses attended the meeting to give practical

information and the Alzheimer's website was

recommended. Age UK & MIND are other helpful

agencies in this field. It is of note that Watford

Hospital has a ward for dementia patients with

other problems.

Dr Stranders finished the evening by saying that

Dr Walker is one of two people he'd like around

as he ages, a urologist being the other!

For food safety: www.food.gov.uk The Royal Society for

the Prevention of Accidents: www.rospa.com

NHS Choices: www.nhs.uk/livewell/healthychristmas/pages/christmasinjurie.aspx

Keeping your children safer this Christmas:www.direct.gov.uk/childsafety

AVOIDING ACCIDENTS WEBSITES

8

SURGERY SNIPPETS By Anthea Doran, Practice Manager

STAFF CHANGES

Dr Bagga has joined the Practice until August

2012 for his next stage of GP training after

completing his first part at Luton & Dunstable

Hospital.

Frances, Elizabeth and Victoria, three of our

receptionists, are leaving us and will be missed by

the whole Surgery team.

John, who has worked with us in a temporary

capacity for the last 4 years whilst completing his

first degree and master‟s, is leaving for a

permanent job.

These changes mean that we are currently

training new staff and we would ask for your

patience whilst they learn the ropes.

DAVENPORT HOUSE WEB SITE

There is a wealth of information on our web site:

www.davenportsurgery.co.uk The “How Do

I” section contains information on appointments,

accessing the most appropriate NHS service,

finding a support group, accessing your medical

records and many other topics.

In addition the online services allow you to order

a repeat prescription, leave a non urgent message

for a doctor, ask the nurse about your asthma

concerns and check if you require travel

vaccinations. We also post news items to our

home page and are using this forum to update

patients with ongoing building work. Please

have a look at the site and let the Practice managers know if there are items or information

you would like included.

Sometimes patients suffering from anxiety,

depression, phobias and other emotional and

mental disorders can be referred for 'talking

therapies' as part of a treatment regime. We are

lucky at Davenport House to have in-house Mary

Anne Keen as a counsellor, and Lyndsay Stanton

as a cognitive behavioural therapist (CBT), to

whom we can be referred by our GP.

These two ladies, along with their backup teams,

led an extremely informative patient group

evening telling us of their work. Both are able to

offer six 50 minute focussed sessions, totally

confidentially, as a minimum. There are options

for further referral if required.

Counselling encourages clients to put their

feelings into words, facilitates understanding of an

issue and gives tools to cope. Through offering a

listening ear in a slightly structured way clients

gain insights into problems. CBT starts with the

'here and now' of the problem situation and

through looking at thoughts, emotions,

behaviours and physical sensations gives

strategies of how to manage the situation. This

latter therapy requires active commitments as

homework and diary keeping is needed. The type

of talking therapy prescribed will depend on the

patient and the condition and may run alongside

drug treatment. CBT can also be delivered

through computers and over the telephone,

depending on the severity of the problem.

Two websites may give further help:

www.getselfhelp.co.uk and

www.livinglifetothefull.com

INFORMAL SMALL MEETING REPORT ON TALKING THERAPIES

By Sheila Uppington

Open Meetings at Fowden Hall, Rothamsted on Monday evenings commencing at 8.00pm

Monday 6 February Members Annual General Meeting, plus GPs‟ presentations

Monday 14 May Weight Management

Monday 2 July Sports and Exercise Injuries

Monday 8 October Health Screening

Informal Group Meetings at the Surgery commencing at 7.30pm by member application.

Tuesday 6 March Prostate conditions

Tuesday 12 June Holiday Diseases

Tuesday 6 November Issues of Fatherhood

Tuesday 4 December Home First Aid

FURTHER DETAILS IN SUBSEQUENT NEWSLETTERS AND BY SEPARATE FLYER

2012 PATIENT GROUP DATES FOR YOUR DIARY