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GP News: July 2012

GP News is your monthly source of information about Ashford and St. Peter's

In this month's edition:

Why Choose to Refer for Bariatric Surgery?

Launch of the Abdominal Aortic Aneurysm Screening Programme

New GP Link Email Newsletter

Are You Using Our GP Browser and GP Resource Centre?

Dates for Your Diary

Welcome to Mr Pasha Nisar


Download in PDF format

Download in PDF format
Why Choose to Refer for Bariatric Surgery?

Resources are short in the NHS and it is not easy choosing how best to use them to ensure you are acting fairly and in the best interests of every patient and all patients.

Bariatric Surgery is one of those areas where many people wonder whether it should be provided on the NHS. Surgery always carries risks and many people see it as a drastic option for dealing with obesity. However the outcomes can be compelling and that is why Ashford and St Peterís NHS Hospitals Foundation Trust has been accredited by specialist commissioners to deliver this service to patients in Middlesex, London, Surrey, Hampshire, Kent and Sussex. We have opened a dedicated Bariatric Unit (the WREN unit) recently to provide specialist care to this group of patients.


A male patient, aged, 44 years old with an excess body weight of 70.4 kg was referred in October 2010.

On referral co-morbidities included:
  • Type 2 diabetes
  • Hypertension
  • Dyslipidaemia
  • Asthma
  • Depression
  • Poor mobility due to a back injury.
  • Only able to walk 50 yards and climb half a flight of stairs

After assessment by the multi disciplinary team the decision was to proceed with two stage surgery, consisting of an intragastric balloon followed by Laparoscopic Roux-en-y Gastric bypass

The intragastric balloon was inserted in February 2011 with the patientís weight at 156kg and BMI 45.6. When the balloon removed in September 2011 his weight was 152kg and BMI 44.4, which constituted 5.4% of excess weight lost.

Following this a Laparoscopic Roux-en-y Gastric Bypass was performed in January 2012 with the patientís weight 134kg and BMI 39.2.

At a follow up appointment in April 2012 his weight was 112.5kg and BMI 32.9, a total of 61.8% of excess weight lost (43.5kg since the insertion of the balloon in February 2011).

At his 6 week post op follow-up the following medications were stopped: Ramipril 2.5 mg (OD) Lantus 80units (stopped day 1 post op) Metformin reduced, previous 1000mg BD now 500mg OD (reduced day 1 post op) Omacor, Simvastatin 40mg (OD), Fenofibrat 267mg


The patient is now able to climb 3 flights of stairs easily and walk his dogs, and it is possible that the patient will be able to be taken off further drugs as he progresses. The likelihood of future complications arising has also been significantly reduced.


The approximate cost of the surgery, including Outpatient appointments to date was £13,151. The current cost of the drugs which the patient no longer requires would have been at least £666 per annum.

The life-changing impact on the patientís mental and physical health and quality of life is immeasurable.


If you would like to know more about the service we are inviting GPs, Practice Managers, Practice Nurses, and anyone else involved in the care of patients with obesity-related illnesses to attend an evening Spotlight Seminar on 18th July at the Runnymede-on-Thames Hotel. Please contact Debbie Beesley (debbie.beesley@asph.nhs.uk) for details.


Launch of the Abdominal Aortic Aneurysm Screening Programme

The NHS Abdominal Aortic Aneurysm (AAA) Screening Programme is being introduced gradually across England and is led and coordinated nationally.

Phased implementation began in March 2009 and coverage across all of England will be achieved by 2013. Screening is delivered locally in line with national quality standards and protocols and there will be around 42 local screening programmes in total once national implementation is complete.


Surrey Vascular Group

The Surrey & North Hampshire AAA Screening Programme is about to launch. Men will be invited for screening during the year they turn 65 while men over 65 can self-refer or be referred directly. Please send any referrals directly to the address below with the following information:

Patient Full Name
Address
Date of Birth
GP name and Address
NHS number


The programme will coordinate screening for the population in Surrey and North Hampshire and organise invitation letters, screening and surveillance clinics, results letters and referrals to the appropriate consultant of the Surrey Vascular Group.

We have received details of eligible patients registered at each practice in the area from the NHS Connecting for Health system. The Programme will start by inviting the cohort of men who turn 65 between 1 April 2012 and 31 March 2013. There are a number screening locations in the community that have been identified. However if your surgery would like to express an interest in hosting the programme, please contact us (details below).

The NHS AAA Screening Programme aims to keep primary care workload to a minimum. However, it is important that GPs are aware of the programme prior to local implementation so they can respond to patientsí questions and discuss the screening process with them.


For further information please contact:

AAA Screening Programme - Surrey & North Hampshire
Ashford & St. Peters Hospital
London Road
Ashford, TW15 3AA
Tel: 01784 884975 or 01784 884859
Fax: 01784 884334
Email: aaascreening@asph.nhs.uk


Alternatively you can visit the national website http://aaa.screening.nhs.uk for more details.

If you would like more information on AAA programmes outside of the West Surrey or North Hampshire area please contact the National office on 01452 318844


New GP Link Email Newsletter

We are going to start sending our regular newsletter to GPs by email. It will be emailed out to Practice managers and we would be very grateful if they would forward it to all relevant colleagues.


We believe this has the following advantages:

  • It will be easier for readers to quickly glance through our topics and only read the articles of most interest to them.
  • We can include links and attachments which can be quickly and easily accessed to provide further details where relevant.
  • We can more easily extend or reduce the size each month to match the information we need to share with you rather than being limited by a four page printed document.
  • More recent news can be included as we wonít have to allocate time in the production process for printing.
  • We can more easily get your feedback via email response.
  • Electronic distribution is more cost-effective than printing and postage.

In July we will send out both the physical GP News and the electronic GP Link newsletter. After this we plan to continue only with GP Link. It will include a print PDF option for you to use if this is your preference.


Are You Using Our GP Browser and GP Resource Centre?

Included in the tools and information on our online GP Resource Centre Ė www.asph.nhs.uk/gp - is the GP Browser. This tool has been available from ASPH for some years but usage has been dropping so we thought it would be helpful to give you a reminder of what it can do for you. Itís available for all our local GPs and Practice Managers to use.


Carol Jenkins, practice manager at the Carlton Surgery in Feltham explains how she uses it.

ďI have been using GP Browser for quite a few years now and find it extremely useful and easy to use.

Logging in with my unique name and password allows me access to patients registered at the practice who are also on the ASPH database. I can see how many patients are current inpatients, patients who have been discharged in the previous week, recent outpatients and A&E attenders.

The browser also allows access to individual patients. Information available includes hospital admissions, outpatient appointments (including DNAs), and results of x-ray, CT scans and MRIs undertaken in outpatients or during an admission.

The ASPH online GP Resource Centre contains a wealth of information with contact details, useful leaflets and instructions for procedures such as Bowel Prep and useful web-links and information resources. Referral forms are available for downloading and compatible with SystemOne.

All in all the GP Browser is a valuable tool and I would strongly recommend practices to sign-up to it if they haven't already done so.Ē

To access the GP Browser you need to fill in and return our three page Honorary Contract and include a copy of your current Information Governance training certificate.

A copy of the Honorary Contract and our data confidentiality agreement can be downloaded from the Forms page of our online GP Resource Centre www.asph.nhs.uk/gp.

If you have any queries, feedback or suggestions about the GP Browser or the online GP Resource Centre then please contact ellen.pirie@asph.nhs.uk


Dates for your Diary

Date Venue Topic Speaker
10/07/2012 PGEC, SPH Dementia Study Day See attached flyer
10/7/2012 GP Luncheon Club, PGEC, SPH Dementia at the front of GP Surgeries Dr Raad Nari
Consultant Elderly Care Physician
Speciality Lead for Elderly Care and Dementia
12/07/2012 PGEC SPH Survival Skills For Appraisal (sessional GPs) See attached flyer
17/07/2012 GP Luncheon Club, PGEC, SPH Asthma and COPD Dr Michael Wood
Consultant Respiratory Physician
18/07/2012 Runnymede-on-Thames Hotel , Egham Bariatric Surgery Spotlight Seminar See attached flyer
26/09/2012 Education Centre, ASHFORD Ashford GP Evening TBC
12/11/2012 PGEC, SPH Resuscitation training Resuscitation Team
12/11/12 Ė 14/11/12 PGEC, SPH GP Update Course See attached flyer



Welcome to Mr Pasha Nisar

    

Ashford and St. Peterís NHS Foundation Trust are delighted to welcome Mr Pasha Nisar to the Colorectal Surgery team at the Trust. He qualified in medicine in 1998 from Trinity College, Cambridge and Addenbrooke's Hospital.

After that he spent 4 years as an SHO and then research fellow at Nottingham University Hospitals where he gained the MRCS and Doctor of Medicine degree in colorectal surgery.

Higher surgical training was undertaken in the London/KSS Deanery and rotated through Ashford & St. Peterís Hospitals, Frimley and Royal Surrey Hospitals.

After gaining the FRCS in general and colorectal surgery he spent one year at the Cleveland Clinic Foundation, USA where he further developed his interests in rectal cancer, inflammatory bowel disease and improving the quality of surgical outcomes. Mr Nisar has presented research work internationally, been published in high impact journals and has been awarded substantive research grants in colorectal surgery.

Mr Nisar is experienced in laparoscopic surgery and is developing single port laparoscopy for colorectal cancer patients at Ashford & St. Peterís Hospitals as well as novel minimally invasive approaches for inflammatory bowel disease. He has an interest in health IT and is developing electronic PROMs to help to assess the quality of life for patients after colorectal operations.