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Ophthalmology Services Update

Our Focus on Quality

Skin Diseases in Pregnancy

Same Day Appointment Ultrasound Service

Dates for your Diary

Saying Goodbye to Dr Mike Baxter

GP News Feedback Form

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March 2012

Ophthalmology Services Update

Ashford and St. Peter’s NHS Foundation Trust have recently undertaken a full service review taking into account patient comments from national surveys and ideas for improved efficiency from members of staff in the ophthalmology department.

This has resulted in:
  • Revision of clinic templates
  • Consultant led casualty service
  • An electronic referral form to assist GP referrals
  • Increasing choose and book slot capacity
  • Redesign of the clinic cancellation protocol to reduce patient cancellations

Consultant Led Casualty Service

Emergency, or Casualty referrals from GPs and the walk in centre should be faxed to the following number:

01784 884350 (urgent eye casualties)

These faxes will be graded by a Consultant and the patient will be telephoned with an appointment depending on the severity of the condition. These appointments will be within 72 hours. If deemed necessary same day appointments will be made if it is a sight threatening condition.

Depending on the referral details some patients may be classed as routine and not urgent these patients will be sent a routine appointment.

This service enables a patient to be seen by a consultant on the same day if necessary.

Urgent faxes received from GPs are logged by the secretaries and immediately given to a consultant for grading. If it is agreed they are to be seen as a casualty, the referral is taken to the eye clinic, where the PA or receptionist telephones the patient to make the appropriate casualty appointment.

How to refer

Routine or urgent referrals should be made using the Choose and Book system where possible. Please see the service directory for further details (an updated version will be distributed shortly).

Alternatively, a letter can be sent directly to the Appointments Centre at Ashford Hospital or emailed to An electronic referral proforma is available on request from

If you have any comments or queries about the Ophthalmology service please contact Gail Bacon, Office Manager for Ophthalmology on 01784 884086 or by email at:

Our Focus on Quality

By focusing on patient safety, patient experience and clinical effectiveness in everything that we do, the Trust has an on-going programme of developments aimed at providing continuous improvement in patient care and service delivery.

Patient Safety

Leadership in Patient Safety

The Trust has pledged to continuously reduce the harm to patients from infections, falls, pressure ulcers and clinical complications such as from venous thrombotic embolism and sepsis. There will be a Patient Safety event in the spring where Ashford and St Peter’s will launch the implementation of a Trust- wide program of patient safety improvements.

Safety and Quality half days

Each division in the Trust on a monthly basis now have a half day dedicated to patient safety and quality issues with a focus on death and complications with a view to learn and continuously improve. This will lead to a workforce constantly reflecting on their practice, which would have a favourable impact on the outcomes for the patients they serve.

Patient Experience

Volunteer Website

The Trust launched its newly designed volunteers section on the website which provides a valuable resource for existing volunteers and members of the public who are considering becoming a volunteer.

This can be found at:

The website includes a ‘Frequently Asked Questions’ section, profiles of existing volunteers and role profiles, (similar to a job description) for new roles the Trust is recruiting into. We believe this would ensure that anyone wishing to volunteer for the Trust has accurate and helpful information around the expectations of a volunteer, the support available and the benefits they would gain from giving their time as a volunteer. This supports the Trust strategy to continue to build upon the existing volunteer workforce in a way which both benefits patients and the local community.

Improving the care of the Bariatric Patient

With the new bariatric gastric surgery service and general rise in bariatric patients being admitted to the Trust, authentic bariatric handling training is vital to deliver high standards of care and minimise risks to patients and handlers. The Trust is pleased therefore to have purchased a bariatric training suit as an innovative way to teach handling techniques to staff.

The bariatric training suit not only gives staff an excellent model to practice manual handling techniques, but also gives the person wearing the suit an insight into the difficulties faced by these patients every day.

This invaluable tool can be used for many other teaching purposes for example:
  • Wound care – care of skin folds and pressure necrosis of skin folds
  • Challenges of bariatric resuscitation.
  • Specific theatre handling/positioning.
  • Patient dignity
  • Day to day care needs
  • Maternity – delivery and monitoring
  • Fire evacuation

Clinical Effectiveness

Assurance around standards of clinical practice

The Clinical Effectiveness team support clinical services to review quality of patient care and implementation of best practice. The work includes designing patient feedback surveys, collating data for submission to national audits and support to review recommendations and guidance to improve patient care and clinical practice, e.g. from the National Institute for Health & Clinical Excellence (NICE).

The Best Care Programme

The team is an enabler to the Trust’s Best Care Programme, which is the program of monthly matron audits and local improvements to the issues raised. The team designed the audit tools and undertakes the monthly analysis of the data collected, results are then presented at every board Trust Board.

Your Feedback

Since July 2010, the “Your Feedback” survey offers every patient the opportunity to provide feedback on the service they have received. Results from the surveys, including written patient comments, and results from many other projects supported by the team provide the evidence for clinical staff to review the quality of their service and drive improvements to patient experience and the care and treatment they receive.

Enhancing Quality (EQ)

Ashford and St Peter’s is part of the Enhancing Quality Programme (EQ) which covers Kent, Surrey and Sussex. Since June 2010, EQ initially involved 11 South East Coast NHS Trusts and tracks progress and outcomes measured in four clinical pathways – Acute Myocardial Infarction (AMI), Heart Failure (HF), Hip and Knee (H&K), elective replacements and some surgical treatments for fractured neck of femur and Pneumonia (Pn) As a result of being part of this regional programme we are proud of improvements in two pathways

Skin Diseases in Pregnancy

Dr S.A. Vaughan Jones MD. FRCP
Consultant Dermatologist, Ashford and St Peter’s Foundation Trust

As a registrar in Dermatology at St John’s Hospital, London I spent two years seeing pregnant women with skin problems in a dedicated pregnancy dermatoses clinic. My research findings formed the basis of my MD Thesis and a few associated publications on this topic. For a number of years I have planned to set up a similar clinic locally at ASPH, and the Foundation Trust has now given me the green light to do this.

Many skin diseases can present in pregnancy and provide a diagnostic challenge.

Accurate diagnosis depends on the history and typical clinical findings. Apart from immunofluorescence (to diagnose Pemphigoid gestationis – PG) investigations are rarely helpful. Physiological changes in the skin are also common during pregnancy (Table 1) , and must be distinguished from true skin disease 1,2,3.

Changes in the immune system during pregnancy, designed to prevent foetal rejection, can modify a woman’s susceptibility to skin disease 2,3.

Reduction in cell-mediated immunity and increased antibody production during pregnancy can switch on atopic eczema while psoriasis often improves. Hormonal factors also play a part: increased oestrogen levels can cause or exacerbate acne rosacea while increased circulating androgens can lead to a flare of acne vulgaris.

The 2 commonest pregnancy dermatoses are Atopic Eruption of pregnancy (AEP) and Polymorphic eruption of pregnancy (PEP). Together these conditions account for about 70-75% of women seen in a Pregnancy Dermatoses Clinic4 – see pie chart below). The other specific dermatoses of pregnancy include Pemphigoid gestationis (rare) which presents with a blistering rash, Prurigo and Pruritic Folliculitis. Miscellaneous skin diseases occurring in pregnancy include contact dermatitis, urticaria, pityriasis rosea and other similar common skin conditions affecting women of child-bearing age.

Many women are anxious to be given information regarding their diagnosis and any potential risks to their unborn baby. Prompt diagnosis and reassurance are essential to the optimum management of these women. For this reason we are pleased to introduce the Pregnancy Skin Clinic at APSH. This will be the first of its kind in the UK and women can be referred directly from their GPs into this clinic, or referred via Obstetric colleagues or midwives at ASPH. I am hoping this will enable us to collect more information on the prevalence of skin disease in pregnancy, and to help us research further into the pregnancy dermatoses.

If you wish to find out more information regarding this service please contact the dermatology department on 01932 723720.

Further Reading:
  1. Vaughan Jones SA. 2007. Dermato-logical Disease in pregnancy. Maternal Medicine – Medical Problems in preg-nancy. Elsevier, Oxford 1st edition Chapter 15 p264-277.
  2. Vaughan Jones SA Colour Atlas of Obstetric and Gynaecologic Dermatol-ogy edited by MM Black. Mosby Wolfe, London 2008 3rd edition.
  3. Vaughan Jones SA and Black MM 2002. Skin Diseases in pregnancy. Chapter 20. De Swiet Medical Disor-ders in Obstetric Practice 4th edition. Blackwells, London p566-577.
  4. Ambros-Rudolph CM, Mullegger RR, Vaughan Jones SA et al. The Specific Dermatoses of pregnancy revisited and reclassified: Results of a retrospective two-centre study on 505 pregnant patients. J Am Acad Derma-tol 2006:54: 395-404

Same Day Appointment Ultrasound Service

We would like to remind you that our extremely popular, rare and successful “Same Day” Ultrasound Service is for non urgent scans. This service runs along side our appointment system and current waiting times for an appointment in that system are approximately 3-4 weeks (the industry standard being 3-6 weeks).

Medically urgent referrals should be requested either via a Consultant Radiologist or the Ultrasound Manager and appointments can usually be made within 24 to 48 hours.

Dates for your Diary

GP Lunchtime Meetings — Spring term 2012:


WEDNESDAY 14th MARCH DIZZINESS - ENT or not? Miss Harriet Patmore
Consultant Surgeon ENT ASPH
TIA and STROKE – diagnosis and secondary prevention Dr Bhaskar Mandal
Consultant in Stroke Medicine and Care of the Elderly ASPH


– non motor symptoms
Case presentations
Meet the PD nurse team
Dr Zahid Dhakim
Consultant Physician Care of the Elderly ASPH

There will be no lunchtime events in April but these will resume in May on Wednesday 9th at Ashford Hospital and on each Tuesday at St. Peter’s Hospital. Programmes are still being finalised and will be published as soon as possible.

Saying Goodbye to Dr Mike Baxter

Around a hundred members of staff - past and present - met to wish Dr Mike Baxter well as he retired from the NHS and from over 20 years with us at Ashford and St Peter's.

Mike first joined the Trust in 1992 as a consultant diabetologist and endocrinologist, before becoming Clinical Director for seven years and then Medical Director in 2002. Mike will continue his clinical work as an independent medical advisor, doing work both in the NHS and the commercial health sector.

At his leaving party on Wednesday 25th January, Mike said: "Leaving Ashford and St Peter's brings a huge mix of emotions; I feel excited, terrified and sad. ASPH has been a huge part of my life for so long, but after over 20 years it feels right to move on and face a different challenge. This move will call on all the skills and experiences that have been developed at ASPH and will also bring me back to my clinical specialty, of diabetes.

But, I refuse to say goodbye - Andrew has invited me to continue to do some work for the Trust and I hope I can continue to contribute in this capacity. Thank you to everyone here for being my friends and colleagues and I will miss you all hugely."

Andrew Liles, Chief Executive, added: "Mike has put such an enormous amount of passion and commitment into Ashford and St Peter's during his 20 years here. He really cares about all the people here - staff and patients - and that is what we will miss the most. We wish him every success for the future."


You have any feedback or require any further information about the Ashford and St Peter’s NHS Hospitals Foundation Trust or require this document electronically please contact:

Sue Robertson,
Marketing Manager
01932 722420

Debbie Beesley,
CAB Manager
01932 723511