LOCUM INFORMATION PACK

June 2010 

Version 1 

Hillingdon Independent GP Group

APPENDICES

APPENDIX A

  

APPENDIX B 

CONTACT DETAILS FOR SAFEGUARDING CHILDREN TEAM

Jenny Reid (Lead /Designated Nurse Safeguarding Children) – Kirk House Tel: 01895 452119 M: 07958 224288 Email: .Reid@hillingdon.nhs.uk Lisa Crawshaw (Named Nurse Child Protection) – Minet Tel: 0208 573 2634 M: 07956 273655 Email: .Crawshaw@hillingdon.nhs.uk Monica Sherry (Named Nurse Child Protection) – Minet Tel: 0208 573 2634 M: 07506 713274 Email: .sherry@hillingdon.nhs.uk Karen Evans (Secretary – Child Protection) - Minet Tel: 020 8573 2634 Email: .evans@hillingdon.nhs.uk Teresa Chisholm (Named Nurse Children Looked After) – Minet Tel: 0208 573 2634 M: 07956 273663 Email: .Chisholm@hillingdon.nhs.uk Sue Jones (Secretary – Looked After Children) – Minet Tel: 0208 573 2634 Email: .Jones@hillingdon.nhs.uk Dr Chelvi Kukendra (Designated Doctor) - CDC Tel: 01895 279845 Email: .Kukendra@hillingdon.nhs.uk Dr Yusuf (Named Doctor) – CDC Tel: 01895 279818 Email: .Yusuf@hillingdon.nhs.uk In addition to the PCT Team, there are Named professionals at each of the Hospitals

1. HILLINGDON HOSPITAL – 01895 238282 [switchboard] Named Doctor: Abbas Khakoo Named Nurse: Geraldine Evans

2. MOUNT VERNON – 01923 826111 [linked with Watford Hospital – West Herts]

Named Nurse: Jill Young (Hospital) & Geraldine Evans (with Jean Kember for Minor Injuries Unit linked to Hillingdon Hospital)

3. HAREFIELD HOSPITAL – 01895 828737 [switchboard - linked with Royal Brompton

Hospital] Named Doctor: Rosemary Radley-Smith – Consultant Paediatric Cardiologist 01895 828554/828689 Named Nurse: Annabel Bryant – Sister [children’s clinic] 01895 823737 ext. 5181/5573

SOCIAL SERVICES – All referrals for the maltreatment of any child should be directed to: Education & Children Services Social Services – Children & Families Department Tel: 01895 250 053 and ask for the Duty Social Worker (Monday to Friday 9-5pm) Out of hours referrals – Tel: 01895 250111 and ask for the Emergency Duty Team (EDT).

APPENDIX C

APPENDIX D

Low Priority Conditions according to NWL and their respective codes – These are conditions / interventions not normally funded by the NHS

NWL selected interventions not normally funded on NHS and evidenced-based criteria for exceptionality

OPCS Code 4.4 Codes

Abdominoplasty or Apronectomy S021; S022

Blepharoplasty C131, C132, C133, C134

Breast augmentation (breast enlargement) B312

Breast reduction B311

Breast prosthesis removal or replacement B303, B308, B309,

Face lift or brow lift S011, S012, S013, S014, S015, S016

Gynaecomastia - Male Breast reduction B311

Hair depilation (Replaced by Electrolysis of the hair) S606

Hair grafting – Male pattern baldness S331, S332,S333, S334, S338, S339

Hyperhidrosis treatment with Botulinum Toxin S532

Inverted nipple correction B356

Liposuction S621, S622

Mastopexy B313

Pinnaplasty D033

Removal of Tattoos S603

Removal benign skin lesions S041, S042, S043, S048, S049, S0.51, S052, S053, S054, S055, S058, S059, S061, S062, S063, S064, S065, S068, S069, S101, S102,S103, S104, S108, S109, S111, S112, S113, S114, S118,S119

Removal of lipomata S601, S602,

Repair of lobe of external ear D062

Resurfacing procedures: dermabrasion, chemical peels and laser S091, S092, S093, S098,S099, S103, S113

Revision mammoplasty B314, B302

Rhinoplasty E023, E024, E025, E026

Thigh lift, buttock lift and arm lift, excision of redundant skin or fat S031, S032, S033, S038, S039,

Grommet insertion D151

APPENDIX E

Tonsillectomy F341, F342, F343, F344, F345, F346, F347, F348, F349

Circumcision N303

Ganglia T591, T592, T593, T594, T598, T599, T601, T602, T603, T604, T608, T609

Gender reassignment surgery X151, X152

Varicose veins L841, L842, L843, L844, L845, L846, L847, L848, L849.-, L851, L852, L853, L858, L859-, L862, L863, L869.-, L871, L872, L873, L874, L875, L876, L877, L878, L879, L881, L882, L883, L889

Caesarean section for non-clinical reasons R172, R178, R179

Dilatation and curettage Q103, Q108, Q109

Reversal of female sterilisation Q291, Q292, Q298, Q299.-, Q361, Q368, Q369.-

Laser surgery for short sight C461

Apicectomy F121

Dental implants F115

Orthodontic treatments of essentially cosmetic nature F141, F142, F143, F144, F145, F148, F149, F151, F152, F154, F155.

Therapeutic use of ultrasound N132

Drug treatment for erectile dysfunction N324

Reversal of male sterilisation N181 There may be certain patients where there are expeceptional circumstances and these conditions may be funded. Usually this involves the case being assessed by the PCT Exceptions Committee who will then decide if the treatment is justified on the NHS. The detailed documentation for the above can be found on the HIGP website in a separate link.

APPENDIX F

APPENDIX G

APPENDIX H

CDC ELIGIBILITY CRITERIA

Hilligdon Consulting Rooms Telephone List

APPENDIX J

APPENDIX K

Criteria for referral to Diabetes Specilist Nurses The aim of the Diabetic Specialist Nursing (DSN) is to support healthcare staff as well as patients, carers, and relatives to improve diabetes management and prevent further complications.

• Referrals are made by Health Care Professionals completing the referral form and faxing it to 01895 486034

• Patients must be registered with a Hillingdon GP or live within its borders. • Patients who are being managed by their GP and have been discharged from

secondary Diabeticare. We also see patients who are under Diabeticare • Patients who’s GP practice does not run the LES for Diabetes (please state on

referral if this is so) • Patents who require Insulin conversion or Byetta initiation and the GP practice does

not do this. • Patients having recurrent hypoglycaemia or who have unstable diabetes. • Newly diagnosed type two diabetes patients who will benefit from a structured

education programme – DESMOND program (must be within the first year of diagnosis).

• People with complex issues affecting self management of there diabetes resulting from physical illness or psycho/social issues..

• The patient must be aware of the referral and have consented to seeing the DSN. • Please note that receipt of a referral may not constitute acceptance of a referral. If a

referral is considered inappropriate by the team, a DSN will inform the referrer. • The DSN will not see patients or give advice to patients who have not been referred.

Hillingdon Community Diabetes Specialist Nurses Hesa Centre, Tel: 01895 486 040 Fax: 01895 486 034

Referring a Patient to DESMOND

Confirm Diagnosis of Diabetes (2 fasting blood glucose >7 or OGTT fasting >7, 2 hour >11) Discuss with patient the benefits of attending DESMOND If patient agrees then Fill out the DESMOND referral form ensuring that all the boxes are filled out (this information is used in the course) Please note this referral must be made within 1 year of diagnosis. Fax to Diabetes Clinic on 01985 486 034

APPENDIX L

DIABETES NURSES REFERRAL FORM

PLEASE ENCLOSE ANY FURTHER INFORMATION IF APPROPRIATE

Primary Care

Secondary Care

Shared Care

Name Mr /Mrs/ Ms

Ethnicity Date of Birth M / F

Address

GP/Consultant Clinic Address Telephone No:

Telephone No.

Mobile No. NHS Number

Brief Medical History

Medications

Date Diagnosed

Type 1 /Type 2

Known Allergies

Feet /Eyes

Height Weight B P HbA1c Chol

HDL LDL eGFR Smokes Day

Units Alcohol

Complications Reason for Referral Home Visit Needed Yes / No Please state why ________________________________________ Referred By

Print Name Date

Designation

Contact Tel No.

Diabetes Specialist Nurses – Hesa Primary Care Centre 52 Station Road Hayes Middlesex UB3 4DD Tel: 01895 486040 Fax No. 01895 486034

DESMOND REFERRAL FORM We would like to refer the following patient to a DESMOND Course: Practice Name Patient Name Address and Phone number NHS Number Date of Birth Ethnicity Date of Diagnosis Latest test results Signed……………………………………………. Date…………………………

Please fax to Clinic Administrator Fax No. 01895 486034

These must be filled out before referral. Patient meets criteria (See below) Glucose or OGTT ( if done) Fasting 2 hr HbA1c Total Cholesterol HDL LDL Triglycerides BP BMI or Waist Circumference

 

APPENDIX M 

APPENDIX N

A Care Pathway for Women for an alternative Vaginal Ring Pessary service May 2010

Woman complaining of symptoms of uterine prolapse and/or urinary incontinence

Clinical assessment by GP e.g. pelvic examination, stress test, urinalysis,

ultrasound scan if indicated

Refer to Gynaecology Service at Hillingdon Hospital Urogynaecology assessment and urodynamics tests as appropriate

Assessment and management of condition according to Local Guidelines.

For surgical repair - on waiting list Recommended for pessary use in interim –

vaginal pessary fitted Referred back to GP for interim care

Follow up by Gynae as indicated

Unsuitable for or declines surgery. Lifestyle measures and pelvic floor exercises recommended

Suitable for ring pessary – Pessary fitted

Referred back to GP

Unsuitable for ring pessary

Referred back to GP

GP not able to fit ring pessary or Patient requests a Female Practitioner

GP refers to Community Contraceptive Service (CCS)

GP refers to Continence Service

Patient sent an appointment at a CCS clinic within 3 months of request. Has first assessment with ring

pessary by a Medical Practitioner

Ring pessary checked and re-fitted. Follow up advised at 3 or 6 months as

appropriate or if any problems.

Follow up visit at CCS No problems.

Ring pessary checked and changed.

Follow up arranged

Follow up visit at CCS Has a problem.

Referred back to GP for treatment or for referral back to

Gynaecology as appropriate

APPENDIX P

Drug Dose and route Maximum daily dose Dose titration & duration of trial

Side-effects/comments

Tricyclic antidepressants Amitriptyline (unlicensed)

Initially 10-25mg daily at night orally

Up to 75mg daily (higher doses under specialist supervision of 150mg dependent on age & co-morbidity)

Increase dose by 10 to 25mg weekly. Duration of adequate trial 3 months at maximum tolerated dosage

Side-effects: Dry mouth, sedation, cardiotoxicity, postural hypotension, bladder problems, constipation. Give dose at night to minimise sedation. Unlicensed indication.

Nortriptyline (unlicensed) £24.02 x 100 25mg

Initially 10-25mg daily at night orally

Up to 75mg daily (higher doses under specialist supervision, see above)

Increase dose by 10 to 25mg weekly. Duration of adequate trial 3 months at maximum tolerated dosage

Use in place of amitriptyline if sedation with amitriptyline is problematic. Unlicensed indication.

Anti-epileptics Gabapentin £16.08 x 100 300mg caps

300mg orally OD on day 1, then 300mg BD on day 2, 300mg TDS thereafter, increased as needed. Initial titration can be slower if concerned about side effects

Maximum dose 1.8g daily in 3 divided doses.

Increase dose gradually each week to a max of 1.8g total daily dose. Duration of adequate trial 3 months in total including titration period.

Side-effects: Dry mouth, dizziness and cognitive impairment. Licensed for treatment of neuropathic pain (age >18 years), unlicensed use in trigeminal neuralgia.

Pregabalin £64.40 x 56 75mg

Initially 75 mg BD orally, increased if necessary after 7 days

Maximum dose 600mg daily in 2 divided doses

Increase after 3-7 days to 150mg BD, increased further if necessary after 7 days to maximum dose of 300mg BD. 3 month trial to assess efficacy.

Licensed for treatment peripheral and central neuropathic pain (age > 18years) Consider if side effects develop with gabapentin, which aren’t tolerated but has had a response to therapy (these could also be a problem with pregabalin).

Carbamazepine (Trigeminal neuralgia only) £4.50 x 84 200mg

Initially 100mg OD-BD orally & then titrate upwards to usual dose around 200mg TDS-QDS. (MR tablets may reduce side effects experienced)

Maximum 1.6g daily in some patients given in divided doses.

Small doses should be used initially to minimise side-effects. Build up dose slowly with increments of 200mg every week. 3 month trial to assess efficacy.

Licensed for treatment of paroxysmal pain of trigeminal neuralgia. Counsel patient to recognise signs of blood, hepatic or skin disorders – seek medical advice if fever, sore throat, rash or mouth ulcers, bruising/bleeding develop. Side effects; dizziness, nausea & vomiting, visual disturbances.

Lamotrigine (unlicensed) £4.92 x 56 25mg

Initially 25mg daily orally for 2 weeks, increased to 50mg daily for 2 weeks

Titrated upwards every 7 days by 50-100mg until reach maximum of 100mg BD

Titrate slowly to minimise side effects. 3 month trial to assess efficacy including titration period.

Counsel patients to contact doctor if signs of rash, most occur within first 8 weeks of therapy. Be alert also for signs of bone marrow suppression e.g. anaemia, bruising or infection.

Serotonin & noradrenaline re-uptake inhibitor anti-depressants Duloxetine (Cymbalta®) £27.72 x 28 60mg

Initially 30mg for one week (to minimise side effects including nausea)

Maximum 60mg daily Titrate to 60mg OD after first week. Trial period to assess efficacy 2 months.

Licensed for diabetic neuropathy in >18 years of age. Side effects; drowsiness, constipation, dry mouth, insomnia, nausea.

£1.62 x28 25mg

Additional therapy Lidocaine (Versatis®) (postherpetic neuralgia only) £72.40 x 30 5%

5% w/w medicated plaster for topical application. One plaster to be applied to affected area at any one time for up to 12 hour duration. Plaster-free period of at least 12 hours a day.

A maximum of 3 plasters to be applied once daily for up to 12 hours, at any one time to cover the affected area.

Some pain relief may occur on 1st day of using the plaster. It may take up to 2-4 weeks until the full pain-relief effect is seen. Trial period to assess efficacy 1 month.

Lidocaine 5% medicated plaster is licensed for treatment of pain caused by post-herpetic neuralgia. Useful in the elderly population as topical application minimises side effect profile. Side-effects: skin irritation at or around site of application.

Capsaicin cream (Axsain®) £12.15 x 45g

Capsaicin 0.075% topical cream. Apply a small amount up to 3-4 times a day

Do not apply more than four times a day.

Trial period to assess efficacy 2 months.

Avoid contact with eyes, inflamed & broken skin. Only to be used for postherpetic neuralgia once open skin lesions have healed. Hands should be washed immediately after use. Side effects include transient burning sensation during initial treatment.

Baclofen (unlicensed) £3.17 x 84 10mg

Initially 10mg OD, orally with or after food. Increased after 7 days if necessary to 10mg BD for 7 days then 10mg TDS

Maximum dose 30mg TDS

Titrate slowly each week to minimise side effects. 3 month trial period to assess efficacy.

Side effects include sedation, nausea, urinary disturbances, ataxia, insomnia, hallucinations.

Duration of trial: If partial response occurs to 1st drug, consider adding in another drug from a different class. If no response is seen within the trial period or side effects are intolerable discontinue therapy and choose another agent from the treatment algorithm.

Chronic Pain Contact at UHL & referral system: Chronic Pain Service at UHL can be contacted on telephone 0116 258 5653 Any referrals into the hospital should be completed through the “choose & book” system available at your surgery.

APPENDIX Q

APPENDIX R – Red List Drugs

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NWL redlist and shared care document final March 2009

5.2 Antifungal drugs Voriconazole, posaconazole 5.3.1 HIV infection All antiretroviral drugs for treatment/prophylaxis of HIV infection 5.3.2.2 Cytomegalovirus Cidovir, ganciclovir, foscarnet, valganciclovir 5.3.3 Viral hepatitis Entecavir, interferon alpha, peginterferon alfa, ribavirin, adefovir,

lamivudine, telbivudine, tenofovir 5.3.5 Respiratory syncytical virus Palivizumab, ribavirin 5.4.8 Drugs for pneumocystis pneumonia Pentamidine 6.5.1

Hypothalamic and anterior pituitary hormones and anti-oestrogens Chorionic gonadotropin, choriogonadotropin alfa Infertility treatments

Follitropin alfa and beta, Human menopausal gonadotrophins, Lutropin alfa, Urofollitrophin

Growth hormone for adults Somatropin Growth hormone receptor antagonists Pegvisomant

6.6.1 Calcitonin and parathyroid hormone Teriparatide 6.6.2 Bisphosphonates and other drugs affecting bone metabolism Disodium pamidronate, sodium clodronate (injection), zoledronic acid,

ibandronic acid (injection) 6.7.2 Drugs affecting gonadotrophins Cetrorelix, ganirelix 6.7.4 Somatomedins Mecasermin 7.4.5 Drugs for Erectile Dysfunction Alprostadil, apomorphine, sildenafil, vardenafil, tadalafil (unless for

indications in Schedule 2). 8.1 Cytotoxic Drugs Oncology use of all I.V and oral cytotoxics; all use if injectables 8.2.2 Corticosteroids and other immunosuppressants Basiliximab, daclizumab, 8.2.3 Rituximab and alemtuzumab Rituximab, alemtuzumab 8.2.4 Other immunomodulating drugs Interferon alfa, peginterferon alfa, interferon beta, aldesleukin,

glatiramer, thalidomide, lenalidomide, natalizumab8.3.4 Hormone Antagonists Fulvestrant 9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias Desferrioxamine (adults only), deferasirox, deferiprone, erythropoietin,

darbepoetin alfa, pegzerepoetin alpha 9.1.4 Drugs used in platelet disorders Anagrelide 9.1.6 Drugs used in neutropenia Filgrastim, lenograstim, pegfilgrastim, molgramostim 9.5.1.2 Hypercalcaemia and hypercalciuria Cinacalcet

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NWL redlist and shared care document final March 2009

9.8.1 Drugs Used in metabolic disorders Imiglucerase, agalsidase alfa and beta, laronidase, mercaptamine, idursulfase, galsulfase, nitisinone, carglumic acid, miglustat

10.1.3 Drugs that suppress the rheumatic disease process Etanercept, infliximab, adalimumab, anakinra, abatacept, methotrexate injections

11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment

Ranibizumab, Pegatanib, Verteporfin, bevacizumab(unlicensed indication)

13.5.2 Preparations for psoriasis Acitretin 13.6.2 Oral preparations for acne Isotretinoin 14.5 Immunoglobulins Intravenous immunoglobulin N/A Anabolic steroid Oxandrolone (not in BNF)

PART B: Shared care for drugs that would otherwise be considered red listed The following medicines reflect the priorities for developing shared care guidance across NWL for drugs on the red list. They should be managed according to local policies and prescribing responsibility should remain with the hospital doctors until shared care is agreed locally. Reference is given if shared care has already been agreed and these documents are available for local adaptation. Sharing organisations Date agreed Review date

2.8.1 Parenteral Anticoagulants Certoparin, dalteparin, enoxaparin,

reviparin, tinzaparin

3.7 Mucolytics Dornase alfa RBHT, K&C Nov 05 Under review 4.9.3 Drugs in essential tremor, chorea, tics,

and related disorders Riluzole SMH, Westminster Aug 04 Under review

4.11 Drugs for Dementia Donepezil, galantamine, rivastigmine, memantine

CNWL, C&W, Westminster, K&C, Brent, Harrow, Hillingdon

March 04 Dec 09

5.1.4 Aminoglycosides Inhaled tobramycin 5.1.7 Other antibacterial Drugs Nebulised colistin 5.3.1 HIV infection Lamivudine (for chronic hep B) NWLHT, Brent, Harrow Mar 04 Jul 10 5.3.3 Viral Hepatitis Adefovir NWLHT, Brent, Harrow Apr 06 Jul 10 6.5.1 Growth hormone for children Somatropin C&W, K&C, Westminster,

H&F, Wandsworth Feb 04 Mar 09

8.1 Cytotoxic Drugs Oral cytotoxic drugs for non-cancer C&W, K&C (Methotrexate) Mar 05 Under review

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NWL redlist and shared care document final March 2009

indications 8.2.1 Antiproliferative immunosuppressants Mycophenolate mofetil 8.2.2 Corticosteriods and other

immunosuppressants Ciclosporin, sirolimus, tacrolimus (systemic)

8.3.4. Hormone Antagonists Goserelin C&W, K&C Jan 06 Under review Octreotide C&W, K&C, Westminster Jan 09 Jan 11 Lanreotide

9.1.3 Drugs used in Hypoplastic, Haemolytic, and Renal Anaemias

Desferrioxamine (paediatrics)

PART C: Other shared care documents for specialist treatments The following Shared Care documents are also available and the sharing organisations given. These documents are available for local adaptation. Drug Sharing organisations Date Agreed Review Date

Atypical antipschotics Central & North West London MHT Kensington & Chelsea

Oct 05 Under review

Stimulant use for ADHD in Children

Central & North West London MHT, , Brent, Harrow, Hillingdon, Kensington & Chelsea, Westminster, Feb 05 Feb 07 Chelsea & Westminster, Kensington & Chelsea, Hammersmith & Fulham, Westminster PCT Apr 06 Apr 09

West London MHTHounslow

Lithium for bipolar disorder Central & North West London MHT Brent, Harrow, Hillingdon, Kensington & Chelsea, Westminster

Jul 04 Under review

Anticoagulants (Warfarin) Chelsea & Westminster, Kensington and ChelseaMay 07 May 09

APPENDIX S

HAGAM, Old Bank House, 64 High Street, Uxbridge, UB8 1JP Tel: 01895 20 7 788 Fax: 01895 20 7744 Email: help@hagam.org.uk

Date of last substance misuse assessment* (if applicable): ........./............/...................

Changes in client’s circumstances since assessment: ...................................................................................

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*Please attach assessment and any risk documentation to this referral

Additional Information/Comments/Current Risk: (Risk factors e.g. Physical and mental health, suicide/self harm,

neglect, risk to self/others)

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Time/Day NOT available for appointments: (Please note, limited availability may result in longer waiting times for accessing

services):...................................................................................................................................................................

HAGAM’s Referral Criteria for Drugs and Alcohol Interventions:

They are resident, work or have a GP within the London Borough of Hillingdon.

They are over 18 years of age.

They are affected by Drug and/or Alcohol misuse and that this is their presenting issue.

They have misused alcohol or drugs during the past nine months

They are motivated and willing to engage with the service.

HAGAM makes all reasonable adjustments to ensure accessibility of its services. However, we require clients to

be physically and psychologically able to receive the interventions.

Those who are accessing one to one counselling services elsewhere are not suitable for Counselling Referrals