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GP Bulletin November 2015 - Focus on Gynaecology

Welcoming new appointments in gynaecology and obstetrics

We have recently welcomed four new Consultant Obstetricians and Gynaecologists to the existing team of 13 Consultants. These posts will allow for more Consultant presence on the Labour ward and out of hours cover thereby improving the support and facilitation of teaching for junior medical staff. Ward rounds on both the Maternity and Gynaecology wards now have Consultant presence seven days a week thus improving the care planning and decision making for patients.

The four new consultants are;
¢ John Anderson Gynaecologist with experience in hysteroscopy
¢ Omotayo Bajulaiye Gynaecologist with experience in benign gynaecology
¢ Nicola Cawley Gynaecologist, interested in laparoscopic and in early pregnancy assessment.
¢ Nada Sabir Gynaecologist with experience in maternal medicine.

Newly expanded Womens Health Unit (WHU)

We are excited by our newly expanded Women's Health Unit in the Women's and Newborn Unit at Bradford Royal Infirmary. This is as a result of Transitional care being re-located onto Ward M4. We also applied, and gratefully received, funding from the Friends of BRI to purchase number of new items which included four new chairs and footstools for our dedicated Percutaneous Tibial Nerve Stimulation (PTNS) suite. The PTNS suite was developed following comments we received from patients through the Friends and Family questionnaires.

There is now a dedicated room for the Lilac team which has improved privacy and dignity for women. To improve the patient experience, we now have a ward clerk working four days a week to help welcome patients to the unit as well as supporting the nursing staff with the day to day admin tasks.

Urodynamic investigations at our Women's Health Unit commencing 14 December 2015

We now have a team of three dedicated uro-gynaecologists in place - Carmel Ramage, Sue Calvert and Carolyn Robertson (who was appointed earlier in the year). They are supported by three nurse practitioners Anne Bowyer, Joanne Hodgson and Kataryna Butterworth.

From 14 December 2015, the Urogynaecology Consultants and specialist nurses will be undertaking Urodynamic investigations within the Women's Health Unit at Bradford Royal Infirmary. This will provide better continuity of care for the women under the Urogynaecology service and offer a one-stop service with tests and consultation taking place at the same visit. Referral into this service will follow an initial review in the Consultant clinic or by direct referral through the Primary Care Continence Pathway. There is also now a dedicated Urodynamics room on the WHU, alongside clinic and treatment rooms and our new PTNS suite.

Holding Urogynaecology clinics in this recently expanded unit has received excellent feedback from patients.

Hysteroscopic Morcellation now offered at BTHFT

Bradford Teaching Hospitals NHS Foundation Trust has often been at the forefront of outpatient hysteroscopy and hysteroscopic surgery both locally and nationally. This position has now been enhanced from October 2015 as we now offer Hysteroscopic Morcellation at Westwood Park (with a service at BRI due to commence in December at BRI). The service is led by Professor Sian Jones, supported by Professor Peter O'Donovan, Consultant Hema Dadi and GP Anne Connolly. We also have two nurse Hysteroscopists in Helen Ludkin and Mary Jackson.

Morcellation will allow half of all women who require tissue removal (such as polyps and fibroids) to be seen and treated on the same day without the need for an inpatient episode. This greatly improves the patient journey and patient experience. A local tariff has been agreed for this "See and Treat work. If a woman is diagnosed at her hysteroscopy appointment with either a polyp or a small fibroid the morcellator can remove the lesion at the same appointment. The process is particularly useful for patients who wish to retain their fertility as it works mechanically with no thermal energy causing less scarring or adhesions.

Referrals for this service are via the hysteroscopy e-Referral Service. Search under ˜Not otherwise specified or Hysteroscopy' as a clinical term; for more information please contact Sian Jones on sian.jones@bthft.nhs.uk.

Lilac Service

We are pleased to announce that Nicola Cawley is our new Clinical lead for this service. She will be supported by Amal Mighell, and Speciality doctor Parsa Mushtaq. They currently work alongside the nursing team which is led by Maureen Jones (Sister), and includes Sue Inman, Charlotte Kelly, Angela Brownjohn and Denise Kirton.

The Lilac Clinic offers services for termination of pregnancy up to 12 weeks and 6 days. Our core medical and nursing staff offer a confidential and comprehensive service which meets targets for referral to appointment times (99.8% < 5 days) and decision to treatment times (99.2% <5 days). Our nursing staff hold recognised counselling qualifications and we use professional face to face interpreting services when required. We also have good links with adult and child safeguarding services.

We have clinics 3 times a week and women are often seen outside these times for their treatment to allow them more flexibility. We thank GPs for their continued support by enclosing completed HSA1 forms allowing women to be treated at first appointment if they wish. We follow up women with pregnancy of unknown location until they have a definite diagnosis/management plan. We also follow up women with retained products of conception.

In 2014/15 79.7% of terminations were done as outpatients (medical management, under 9 weeks) and the remainder done as day case surgical procedures. Those having surgical procedures are also offered long acting contraceptives such as IUCDs, IUSs and Nexplanon. All are offered oral/depo contraceptives. All women are offered screening for STIs including Chlamydia and HIV.

We have a number of developments planned for the service to improve patient experience:

¢ in the near future we hope to improve and extend our services by including termination of pregnancy by manual vacuum aspiration.
¢ we also hope to establish a self-referral system to enable women or GPs to telephone the unit in working hours and book an appointment.
¢ from early December 2015 we will offer the ability for patients to refer themselves for a termination of pregnancy. Flyers and information leaflets for patients are currently being developed and will be distributed in the near future.
¢ the nursing staff also cover our dedicated pre-assessment service (PAC) which is held on WHU. We are will be reviewing practice and hope to develop a streamlined PAC service which can run alongside our existing Gynae clinics.

Colposcopy service “ additional appointments now available

Nick Myerson is our Clinical lead for Colposcopy and works alongside Sue Calvert, Peter O'Donovan and Hema Dadi (Hospital based programme Co-ordinator (HBPC) for the Trust) and Anne Connolly. Our Nurse Colposcopists are Cath Whelan and Suzanne Taylor.

Colposcopy clinics are held 3 days a week on the WHU, with additional smear sessions on alternate weeks. We see patients who have been referred directly as a result of abnormal smears and patients with a history of post-coital bleeding, inter-menstrual bleeding and persistent vaginal discharge. These patients must have had a negative STI screen prior to referral unless malignancy is suspected.

We have recently opened up additional e-Referral appointments for ease of your referral. Where possible we offer see and treat appointments which is in accordance with national guidance and helps to reduce anxiety for our patients.

DNA rates within our Colposcopy service are noted to be high and we would welcome your help to encourage women to attend. This is of particular concern with follow up appointments which are currently averaging a 20% DNA rate. We routinely offer all patients two appointments, but should they fail to attend we will refer them back to your care. If they have had a referral with severe dyskaryosis or query invasion we would endeavour to contact patients directly if they have DNA'd an appointment.

In April 2016 we are proud to be hosting the BSCCP national conference here in Bradford and will be welcoming colleagues from around the world.

Fast track referrals

We continue to receive both electronic and paper referrals for fast track cases. We would actively encourage you to utilise the e-Referrals service wherever possible as this speeds up the process of the referral by at least two days. Consultants all have access to the e-Referrals service and access it daily to triage the referrals into the appropriate sub-speciality; this ensures a more appropriate, prompt appointment for the patient.

Our weekly MDT meeting ensures thorough review of our patients. The meetings are chaired by our Cancer Lead Professor Peter O'Donovan who works alongside Mr Richard Hutson Gynaecological Oncologist from Leeds, Dr Sue Cheeseman Medical Oncologist, as well as colleagues from Radiology, Pathology, Hysteroscopy and our Macmillan Cancer Specialist Nurse, Beverly Hurst.

Reproductive medicine and assisted conception

Our two Reproductive Medicine specialists, Virginia Beckett and Shiva Kukreja, currently run two outpatient clinics per week and are working to introduce a third clinic per week, given current demand for this popular service.

We provide a whole of life approach to the management of Polycystic Ovarian Syndrome, a condition which is especially common in our local population. We also see a significant number of paediatric gynaecology cases. The recently published NICE guidance on the use of HRT will increase demand for treatment of menopausal women and we are poised to support primary care where required.

We have a high incidence of conception delay in our population. Our consultants have expertise in assisted conception, ensuring appropriate and swift treatment if necessary. Their interest in pre-conception care and high-risk obstetrics also ensures a holistic approach.

BTHFT has previously announced its intention to cease the provision of assisted conception services. We are working closely with the CCGs to ensure a smooth transition to a new provider and in the meantime the three nurse specialists; Peta Harrison, Elizabeth Thornton and Susan Riddiough along with our administrator Lidia Galluci continue to ensure the smooth running of the service for the patients that we are still treating. Other Fertility services will continue to be delivered as normal.

General news -

A free to access training package for GPs and advanced nurse practitioners is available now

A bespoke training session covering prevention and management of common breastfeeding problems is available to all Bradford GPs and advanced nurse practitioners at no cost. The training covers common misconceptions and issues around infant feeding, diagnosing mastitis/thrush and prescribing medication appropriately. There are a number of options of delivery which provide the flexibility to fit the training around your schedule. The training can be delivered in-house by the Specialist Midwife via a face to face session lasting approximately 60-90 minutes. Or if preferred, an e-package is available to access which provides a certificate upon completion “ this is also free to access.

To date, over 180 GPs have accessed this training with overwhelmingly positive feedback received from the participants. This training is part of the Every Baby Matters infant mortality recommendations to increase the numbers and percentages of women who initiate and continue to breastfeed for at least six to eight weeks.

To book an in-house session or gain access to the free online module please contact Samantha Britton on 01274 364583 or by email on Samantha.Britton@bthft.nhs.uk.

An invitation to the Grand Round

The Foundation Trust invites all local GPs to attend the Grand Round. These meetings provide an excellent opportunity to meet with fellow professionals whilst remaining up to date with key issues and developments.

The next Trust Grand will take place on 24th November. The subjects presented will cover -

¢ ˜Big Ideas in Bradford' by Dr Alastair Lansbury, Consultant Neurologist

The Grand Round is held in the Sovereign Lecture Theatre at Bradford Royal Infirmary on the last Tuesday of each month. Meetings start at 12.45pm and last for an hour. Lunch is available from 12.15pm.

This monthly bulletin aims to keep local GPs up to date with the trust's new services and developments. If you'd like any further information about any of the items in this month's briefing contact Naveed Saddique on 01274 272635, email gp.comments@bthft.nhs.uk.