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GP Bulletin - April 2017

Introducing our new Fragility Fracture Service

Our new Fragility Fracture Liaison service is doing some really great work – and we’d like to share some of its achievements with you here. With only 42 per cent of hospitals countrywide hosting this service we are very proud to be able to provide this for our local population. The service is being coordinated by our newly appointed Fragility Fracture Liaison Sister, Janine Connor, who is supported by a wider multidisciplinary team.

Janine explains what the service is all about: “The purpose of the service is to identify patients at risk and prevent them from sustaining any further fractures. Our motto is ‘Capture the first fracture, prevent the second’. We use a specialised pathway ratified by the Foundation Trust and the CCGs,” she said. “Fragility fractures differ from ‘high energy’ fractures (such as you might sustain by falling down the stairs or a road traffic accident) in that they occur during relatively low impact. They can be caused by something as simple as going over on your ankle or even just knocking your wrist against something, perhaps a minor trip or fall.

Janine added that our Consultant Radiologist Dr Clare Groves has also set up a unique system of compiling lists from x-rays. As a result Janine receives fragility and vertebral facture lists on a weekly basis. “Once patients have been identified, they will be assessed using the FRAX system, a series of questions and checks (developed by Sheffield University) which will determine whether they are at further risk of fracture. Patients are given percentage-related green, amber and red scores,” explained Janine. “Those with an amber score will go on to have a DEXA scan (bone densitometry) and those with red scores will be put on a treatment pathway straightaway. We write out to their GP and the usual course of treatment is to prescribe bisphosphonates – drugs that slow down further bone damage. Patients are also given lifestyle and dietary advice and we work closely with the National Osteoporosis Society and their local support group.”

Since the launch of our Fragility Fracture Liaison service last December, more than 350 patients have been referred and those deemed at risk are now on treatment pathways. Janine added: “We are also ahead of the game with the National Fragility Fracture Database, entering data before it becomes a mandatory requirement. It is a vital tool for collating how many patients are being seen, the treatment they receive and for preventing further fractures. This helps us compare data across the country.”

Our new macula centre will have real vision

We are pleased to share with you news that plans are well underway with the creation of our new macula centre. This will be known as the Bradford Macula Centre and be based in what is currently the Trinity Centre, Trinity Road – near to St. Luke’s Hospital.

Consultant Ophthalmic Surgeon Helen Devonport explains: “The project has been a joint working agreement with Bayer Pharmaceuticals, who have contributed over £130,000 for a new Optical Coherence Tomography scanner for the unit. Optical Coherence Tomography, or OCT as it is more commonly known, is a scanning system that produces highly-detailed images of the retina,” she said. “It is often likened to an MRI or x-ray of the eye. OCT scanning is the most sophisticated tool available for assessing eye health and detecting eye conditions, including macular degeneration and glaucoma as well as detached retinas and other eye disorders. This scan allows us to see detailed images of the retina, enabling us to accurately detect, monitor and manage changes to the retina. This procedure is currently the only one that shows in-depth images of the eye’s internal structures. Other procedures only show the surface of these structures. So we are very grateful to Bayer for their support. The new centre will increase the number of referrals we have and ultimately we hope to be able to treat twice as many patients as we see at the moment. We will be able to increase the number of clinics from five per week, run over two and a half days at present, to 10 clinics over five days,” she added.

Our ophthalmology team is now busy liaising with local optometrists to let them know about this new and improved facility, which we hope to have up and running by the end of next month.

Invitation to the Learning and Innovation Day, 19 May 2017

Inspiring people to work together and shining a spotlight on good practice are two hallmarks of our work which we strive to endorse and promote. That’s why it’s a pleasure for us once again to be involved with a second Learning and Innovation Day, which brings together healthcare professionals and practitioners from across Bradford District and Craven.

The aim of the event, which is being held at Bingley’s Mercure Hotel on Friday, 19 May, from 9am to 4pm, is to share best practice and inspire health and care professionals to make a difference. It follows on from last year’s event and we are sure it will be just as successful, and we invite you to attend.

Once again, it promises to provide the perfect opportunity for us to learn from other people’s stories, to connect with our healthcare partners, share our successes, develop joint working, and stimulate possibilities for tomorrow’s health and care services.

The day will begin with an introduction from our very own Director of Research at Bradford Institute for Health Research (BIHR), Professor John Wright, and we are pleased to say that one the keynote speakers will be Clinical Leadership Fellow and Neurology Registrar, Stefan Williams, who will give a first-hand insight into the success of our Diagnostic Virtual Ward project.

By way of a reminder, the event is on Friday, 19 May 2017, 9am to 4pm, at Mercure Bradford Bankfield Hotel, Bradford Road, Bingley, BD16 1TU. More details on the event and how to book your place can be found here.

Another award for “innovative and forward-thinking” success story

The Bradford Electronic Frailty Index (eFI) pioneered right here at Bradford Royal Infirmary, and now breaking new ground in older people’s care nationally, has picked up another major award. This fantastic innovation has won a prestigious Royal College of Physicians’ Patient Care Award, presented at a ceremony in Manchester.

The eFI team won the Innovation category, which recognises outstanding clinical activity that contributes to excellent patient care in an innovative and forward-thinking way. Last year, the eFI won the Health IT Product Innovation category at the EHI Live 2016 Awards and was cited as a major factor in the Yorkshire and Humber region retaining international recognition for its active and healthy ageing initiatives. The eFI was also a finalist in the recent Medipex NHS Innovation Awards.

The eFI helps calculate an elderly person’s risk of disability, impairment, falls and complications of chronic diseases, as well as their diminishing independence and capability. It has now become official NICE (The National Institute for Health and Care Excellence) guidance and impressively, is now leading the way nationally in older people’s primary care as it is available to an amazing 90% of all GPs across the country. The index helps GPs identify older people with frailty who face an increased risk of care home admission, hospitalisation and mortality by using information within a patient’s electronic health record.

It was described as “one of the most effective pieces of innovation I have ever come across” by NHS England’s National Clinical Director for Older People and Integrated Care, Dr Martin Vernon when he spoke at the Yorkshire and Humber Academic Health Science Network’s (AHSN) Innovation and Impact Conference in January this year. Andy Clegg, Consultant Geriatrician on Ward 3, along with colleagues, Dr Tizzy Teale, Consultant Geriatrician on Ward 31 and Professor John Young, who was previously the Government’s Frailty Tsar, developed and refined the eFI which started three years ago.

Andy explained: “Our team is delighted with the award, which is a great success for BTHFT. The award recognises the contribution that the eFI is making to improving clinical care for older people with frailty in Bradford, across Yorkshire and throughout the UK. This is really important because enabling improvements in clinical care for older people with frailty has been the main aim of our eFI project.

The eFI project has been a real team effort, involving a major collaboration between clinicians and academics at BTHFT, the University of Leeds, TPP/SystmOne, the University of Birmingham, the University of Bradford, and the Academic Health Science Network Improvement Academy, based at the Bradford Institute for Health Research. When we set about developing it, our thinking was that there was already a wealth of information captured in GP medical records, such as vision problems, hearing, dementia, falls, problems with mobility etc. It was just a case of developing a tool that could collate and interpret this data and bring it all into one massive database. Nationally there has been a big push to identify frailty and give older people better services by keeping them at home for longer, improving the quality of their life and preventing admissions to care homes and hospitals. The problem was that historically there were a number of tests looking at this but they all took time and resource so our approach was to use the GPs’ primary care records and identify frailty through these, and as you might expect this was not a straightforward task.”

But with the help of TPP, the company behind the SystmOne GP IT programme, the doctors established a massive research database covering six million patients. From this data, they extracted information covering an over-65s cohort which was narrowed down from 2,000 GP “read” codes related to a patient’s diagnosis, which are entered by GPs on the individual’s electronic patient record, to 36 “deficits”, which assess a person’s clinical signs of frailty, including their symptoms, disease and disabilities, as well as their requirement for care.

Andy continued: “The eFI helps identify older people who are fit as well as those with mild, moderate and severe frailty who are at increased risk of future nursing home admission, hospitalisation, longer length of hospital stay, and mortality. It represents a major advance in frailty care because, for the first time, it enables identification of frailty using routinely available data, without the need for a resource intensive clinical assessment. By implementing eFI in routine primary care we are catching people early, before they reach crisis point, which, in turn, is enabling us to better target, evidence-based interventions, which not only improve planning within our health services but help us to create and develop more appropriate, proactive, goal orientated care pathways for older people with frailty.”

This is a great example of innovation, collaboration and service improvement for the benefit of our patients, at its very best – and we’re sure you’ll agree that our colleagues thoroughly deserve the recognition for this fantastic innovation.

Launch of short-stay ward proves a success

Since opening its doors on March 1, we are seeing an ever-increasing number of our patients being transferred to the ward each day, with the result that bed occupancy rates are also climbing.  As promised in the previous bulletin, here is the latest update from colleagues on the ward that we would like to share with you all here:

  • Approximately 5 to 6 patients are being transferred into the short-stay ward each day
  • Length of stay (excluding current inpatients) is between 1 and 1.5 days
  • Bed occupancy is between 62 per cent and 77 per cent - compared to 57 per cent towards the end of March
  • We have continued to witness a significant reduction in the number of medical patients in surgical beds
  • Capacity in our Acute Medicine Unit has been available earlier in the day
  • We have also seen an encouraging impact on overall bed availability earlier in the day.
This is a great platform on which to build further and has had a hugely encouraging start.

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