Covid 19 vaccination in pregnancy

COVID-19 Vaccination in Pregnancy

A letter from Matthew Jolly, Professor Jacqueline Dunkley-Bent and Dr Jonathan Leach to Maternity and Primary care services, with urgent actions to improve rates of vaccination in pregnancy against COVID-19.

The letter includes actions for the NHS to take to make every contact count in providing evidence-based advice to women on the benefits of vaccination in pregnancy for them and their babies.

Read the letter in full on the NHS Website here: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2021/07/C1363-vaccination-in-pregnancy-letter_.pdf

‘Pregnant? Have your COVID-19 vaccines’ posters

There are four designs of the same ‘Pregnant? Have your COVID-19 vaccines’ poster which can be found on the Health Publications website.

4 x Posters can be downloaded using the following link (product code: COV2021PG):

https://www.healthpublications.gov.uk/ViewArticle.html?sp=Spregnanthaveyourcovid19vaccinesposters

‘Pregnant? Have your COVID-19 vaccines’ Social media cards (product code: COV2021PGS)

Download here directly from the Health Publications website:

https://www.healthpublications.gov.uk/ViewArticle.html?sp=Spregnanthaveyourcovid19vaccinessocialmediacards

COVID-19 vaccinations for 16-18 year-olds working in health and social care

We’ve received feedback that a number of 16-18 year-olds who work in health and social care have been unable to get their COVID-19 vaccine. This group of young people are eligible for the Pfizer vaccination under the current national protocol and Patient Group Direction (PGD), as per the Green Book definition:

“Young people aged 16-18 years, who are employed in, studying or in training for health and social care work should be offered vaccination alongside their colleagues.” (Chapter 14a, page 16).

We hope this is a useful reminder for PCNs and practices who are continuing to deliver vaccinations, and to any other practices who may get queries from patients about this.

COVID-19 Vaccination in Sussex

The latest vaccination update for East and West Sussex and Brighton & Hove can be found on the Sussex Health and Care Website.

Launch of our summer ‘Think Twice’ campaign

We have come together with our providers to launch our summer “Think Twice” campaign which aims to urge the public to ‘Think Twice’ about which services they use for urgent care this summer. The new ‘Think Twice’ campaign aims to inform residents and visitors in Sussex about where to go when it’s not an emergency to get the most effective care.

The campaign launches at a time when front line services in Sussex are under significant demand and aims to highlight the many alternatives available for conditions like pains, sprains, bites, stings and other illnesses.

You may just see some of our adverts dotted around town or hear our messages on Smooth Sussex or Heart Sussex as you’re out and about over the next few weeks, we have a full programme of summer messages and a toolkit containing campaign materials.

Please help us to share these messages using GP Practice Digital Channels, display screens and posters.

Access the toolkit on the Intranet: https://www.sussexccgs.nhs.uk/think-twice-summer-campaign-toolkit/

Call to action: Still time to have a say on proposals for mental health inpatient services in East Sussex

There’s still time for people working in primary care across Sussex to have their say about proposals by the local NHS to improve the quality and safety of mental health inpatient services in East Sussex.

The consultation started on Monday 14 June and will run until Monday 6 September. The proposals are to move inpatient services based at the Department of Psychiatry (DoP) in Eastbourne District General Hospital to new facilities to be built on a different site.

Currently people are referred to DoP from across the whole of Sussex so we want to hear from those as many people as possible who are working in primary care across the region.

The inpatient services could be relocated to a greenfield site next to Mount View Street, North East Bexhill, Bexhill-on-Sea, or a site around Amberstone Hospital, near Hailsham. The Bexhill site is the preferred option.

If approved, this would be the first phase towards a potential long-term vision to create a leading centre for a range of mental health services on a single ‘campus’, which could, over time, address all mental health inpatient needs in East Sussex.

Since the consultation began, we have received a good number of completed questionnaires, both online and in print, attended focus groups, visited pop-up stalls in shopping centres and other venues and had individual conversations.

Over the next two months, we will also be attending Locality meetings in East Sussex to provide an update on the consultation and will be holding stakeholder workshops which any interested parties would be welcome to attend.

In the meantime, to get involved, we would encourage you to go to the consultation website:

https://www.sussexhealthandcare.uk/get-involved/mh-eastsussex/

There, you will find the consultation document, questionnaire and other information. A summary of the consultation document and the questionnaire are also available in Easy Read, 10 community languages and British Sign Language (BSL).

Further information is available by contacting the consultation team.

• Email: esxccg.eastsussex.mh@nhs.net

• Dedicated telephone line: 0300 304 0330 (local rates apply)

• Write to: FREEPOST SS1018, PO Box 530, Swansea SA1 1ZL

Please support our consultation by sharing with friends and family members too. Thank you.

Medicines Management Update: Monthly Prescribing Newsletters

July 2021 edition can now be viewed at: https://www.sussexccgs.nhs.uk/clinical/clinical-guidance/prescribing/prescribing-news-bulletin/, along with all archived editions for all areas.

The newsletter contains both Sussex wide and local content which will be displayed on the website according to your locality. However, there is also the option of viewing content from all areas by clicking on the “ALL” button under Locations on the newsletter page.

Newsletters will also be sent out in PDF format using the established local distribution lists for prescribing newsletters. If you have any questions or feedback please contact your local medicines management team on:

•                   Brighton and Hove and High Weald Lewes Havens: bhccg.mmt@nhs.net

•                   East Sussex: esxccg.mmt@nhs.net

•                   West Sussex: wsxccg.mmt@nhs.net

On this intranet page there is a link to subscribe / unsubscribe from receiving the newsletter in PDF format by e-mail.

Management of tetanus prone wounds – information from PHE

To: A&E Depts, Minor Injury Units, GP practices and Walk in Centres in Surrey and Sussex

Dear colleagues

In the last three weeks the Surrey and Sussex Health Protection team have been notified of two probable cases of Tetanus, both seeming to have had exposures placing them at risk from Tetanus prone wounds. (There was only one case notified in 2020 and one in 2019)

On neither occasion was Tetanus vaccine offered to these patients on their first attendance in A&E and both returned with clinical symptoms of Tetanus within days.

Therefore, this seems an ideal opportunity to remind colleagues about the management of Tetanus prone wounds.

Although any wound can give rise to tetanus, clean wounds are considered to have a low likelihood of harbouring tetanus spores and of developing the anaerobic and acidic conditions that promote spore germination. Therefore, in the case of wounds such as clean cuts, immediate post exposure treatment is not indicated.

However, for those who are incompletely immunised, further doses should be offered to complete the recommended schedule to protect against future exposures.

Tetanus-prone wounds include:

• puncture-type injuries acquired in a contaminated environment and likely therefore to contain tetanus spores e.g. gardening injuries
• wounds containing foreign bodies
• compound fractures
• wounds or burns with systemic sepsis
• certain animal bites and scratches – although smaller bites from domestic pets are generally puncture injuries animal saliva should not contain tetanus spores unless the animal has been routing in soil or lives in an agricultural setting.

The full guidance for health professionals on the management of suspected tetanus cases and on the assessment and management of tetanus-prone wounds can be found via the following link:https://www.gov.uk/government/publications/tetanus-advice-for-health-professionals

Information about the use of the vaccine and IVIG can be found in Chapter 8 of The Green Book (Immunisation against infectious disease).

Guidance on the use of IVIG can be found via this link: https://www.gov.uk/government/publications/immunoglobulin-when-to-use

Kind regards

Surrey and Sussex HPT

Digital First Self-Monitoring Health Kiosk Pilot

The Sussex CCGs’ Digital First team is currently piloting health kiosks within practices across Sussex.

The Health Kiosk allows patients to complete blood pressure, weight, height and oximetry readings from the waiting room. It also allows patients to complete questionnaires to help support with monitoring of their health, e.g. long-term condition monitoring and pathways, oral contraception checks, mood self-assessment (PHQ-9), GPPAQ, new patient information and more.

The kiosk integrates with the clinical systems to enable data to be coded directly into the patient’s record. Further information on the Health Kiosks can be found here: Self-Screening Kiosk for GP Practices | EK Interactive

We are looking for a small number of additional practices across Sussex to join the pilot. This would entail installation of the health kiosk at the practice, training for relevant practice staff, and having regular updates with the Project Manager to provide feedback for the pilot.

If your practice is interested in being part of this pilot, please contact Wayne Harding: wayne.harding5@nhs.net

Engage, eConsult & SystmOne – Video Consultation (VC) and SMS Training Workshops 

The CCG has previously communicated that VC and SMS will need to be procured for Sussex by April 2022. We have arranged some virtual training workshops with our existing contracted providers in Sussex (Engage, eConsult and SystmOne), to allow them to demonstrate their VC and SMS functionality within their existing products.  We are inviting all Practices to attend, and the sessions will be between 45-60 minutes, with time for a Q&A.  

Please note they will also be recorded and a link will be shared with practices for staff to view in their own time if they are unable to attend the live demos. 

Engage Demonstration to show one-way SMS, video conferencing and developments with a batch messaging feature.  

Two sessions available via Microsoft Teams

Tuesday 24^th August 6-7pm, please book your place via Eventbrite  

Wednesday 25 August 1-2pm, please book your place via Eventbrite  

eConsult Demonstration to show two-way SMS, video conferencing and ‘click to call’.   

Dates to follow but please register your interest via Eventbrite 

TPP (SystmOne) Demonstration to show a variety of in-built functionality for video consultations, SMS messaging and batch SMS messaging.   

Three sessions available:   

Wednesday 18^th August 1pm – 2pm, Please book your place via Eventbrite 

Thursday 19th August 1pm – 2pm, Please book your place via Eventbrite  

Thursday 9th September 1-2pm, Please book your place via Eventbrite 

The joining links for the events will be sent out to those who have registered, a couple of days before the event.

Child death Review Partnership newsletter

The third edition of the Child Death Review Partnership newsletter is now available to read on the intranet.

This issue focuses on learning disabilities and wider CDOP learning.

Read the newsletter here or on the Child Death Review intranet page:

Home » Clinical » Guidance » Specialties » Safeguarding » Child death review

Social Prescribing survey

NHSE/I have launched a survey for social prescribing link workers to find out more about your experiences of working in and with PCNs, and the training, supervision and support you receive.

This information will help the NHSE/I team to plan our work to support link workers over the next year. All data collected in the survey is anonymous and cannot be traced back to you or your FutureNHS profile. The survey should take less than 10 minutes to complete and closes on 3 September 2021 at 5:00pm.

You must be a member of the FutureNHS social prescribing collaboration platform to complete the survey. Use this link to take the survey online: https://future.nhs.uk/socialprescribing/view?objectId=28228144

Email england.socialprescribing@nhs.net with any questions about the survey or to report technical difficulties. You can also request the survey in an alternative format; for example, if the FutureNHS platform survey is not fully functional using screen reader software.

Please share with your colleagues to ensure the survey is circulated as widely as possible and direct them to sign up to the FutureNHS collaboration platform by emailing england.socialprescribing@nhs.net if they are not a member.

Badgernet goes live at ESHT

The maternity department at East Sussex Healthcare NHS Trust has started to introduce Badgernet. This is a digital system that provides full electronic notes for pregnancy, birth and the post-natal period. This will mean that pregnant women will no longer be given a paper copy of their notes to take to appointments, instead they will be able to access selected information through an app. Pregnant women will be added to Badgernet at booking, so women who already have paper notes will continue with these for the duration of their pregnancy.

Following feedback locally, GPs will not have direct access to the Badgernet system. If, during an appointment, a GP does want to look at a patient’s maternity notes, they can ask to look at the BadgerNotes app on the patient’s smart device.

More information about Badgernet is available in the FAQs on the East Sussex Pregnancy intranet page.

If you have any queries, please contact Janice Dunkley, Project Lead Midwife – janice.dunkley@nhs.net

New Lung pathway UHSussex (West) – Important information for GPs

Dear GPs,

University Hospitals Sussex (West) is introducing a new pathway for chest x-rays which will streamline the lung cancer diagnostic pathway. The new pathway will be supported by patient navigators who are contactable on Worthing: 01903 205111 Ext. 84116 St Richards: 01243 788122 Ext. 32936.

Radiology, respiratory and the cancer team are confident that the new pathway is clinically efficient and will benefit your patients.

Full details on the pathway can be found on the Lung Cancer intranet page (west) but the key messages are:

1. The new pathway will be launched on Monday 6th September 2021

2. From 6th September, all chest x-rays that are requested in primary care via ICE will be assessed for suspected lung cancer. If the chest x-ray is deemed abnormal and warrants further investigation, a CT (with or without contrast) will be requested by radiology. The patient will be contacted by Zoe Clarke or Lindsey Crimmen, our Lung Patient Navigators (who are not clinically trained) who will arrange for the patient to attend for a CT and bloods where necessary.
3. It is imperative that GPs advise the patient that a CT may be organised if the radiologist needs to have a “closer look at the lungs” as a result of the chest x-ray.
4. Please remind the patient to have their x-ray (and CT if required) promptly. In line with local policies, chest x-ray requests will be returned to the practice if the patient does not attend for an x-ray within 7 days and GP notified accordingly.
5. Chest x-rays and CTs will be reported with specific codes. The codes determine whether primary or secondary care is required to take further action and therefore have the responsibility for communication with the patient (see appendix 1). If the patient has concerning features suggestive of lung cancer, onward investigation will be organised directly by radiology and GPs will not be asked to complete a 2WW referral. Code Red reports for chest x-rays will no longer exist because patients are automatically on a suspected cancer pathway.
6. If the patient requires a CT, a Lung Patient Navigator will seek consent from the patient to access their Summary Care Record so that the respiratory physicians are able to make an informed diagnostic plan.
7. Where patients have had a negative chest x-ray but clinical symptoms are suggestive of lung cancer, we recommend that you consider a 2WW referral to the respiratory department with further clinical information.
8. Where patients have had a CT which show no signs of cancer or a non-cancer abnormality, GPs may wish to refer the patient to respiratory with relevant clinical information for respiratory opinion.

Link to new pathway overview: https://www.sussexccgs.nhs.uk/clinical_documents/lung-pathway-overview-uh-sussex-west/

Yours sincerely,

The Lung Pathway Team

Jo Thomson and Mandeep Ahluwalia (Macmillan GPs), Respiratory, Radiology and Cancer Teams, University Hosptials Sussex (West)

Clinical Harm Review Education sessions

In 2018-19, concerns were raised around an ultrasound scanning service, BestCare Diagnostics Ltd, that affected many patients and GP practices in the West Sussex area. The services were suspended in September 2018 and the CCG undertook a detailed Clinical Harm Review. This review involved many GP practices who had highlighted issues and an independent review of the records for patients who had been identified as being scanned by either of the two sonographers of concern.

As the clinical harm review has now concluded we would like to share the findings with you and importantly, the lessons learnt which are very relevant to general practice across all of Sussex. This is both to minimise to risk of similar issues arising again and to ensure that best practice is followed by all.

The learning can be separated into two areas:

• Procedural issues that highlight the need for robust processes are in place that meet the regulations stipulated in the CQC “Safe” domain.
• Clinical issues that identified inconsistent following of clinical pathways in primary care

To reflect these areas of learning and raise awareness of the issues identified, we are running two educational sessions across the Sussex CCGs.

• Thursday 16^th September at 1pm-2pm to discuss the procedural matters. This is particularly relevant to practice managers, CQC registered managers as well as clinicians who request investigations or referrals.
• Thursday 30^th September at 1pm-2pm to discuss the clinical areas of focus. This will be relevant to all clinicians.

We would like to encourage as many people as possible to attend sessions which will be held on MS Teams. Invites for both events will be issued shortly, if you don’t receive an invite and would like to attend the sessions please email sxccg.primarycare@nhs.net

Regards

Amy Dissanayake – Deputy Medical Director, Sussex CCGs and GP at Northbourne Medical Centre

Home First, Act Now elearning programme

Please see below for details of a new elearning programme to support the safe and timely discharge from hospital.

Health Education England’s elearning for healthcare (HEE elfh) has worked with NHS England and NHS Improvement, The Queen’s Nursing Institute, Allied Health Professionals and the Department of Health and Social Care, to develop the new Home First, Act Now elearning programme.

The programme supports health and care professionals involved in the discharge process, to act in a way that values patient time and helps facilitate safe and timely discharge from hospital. The elearning programme also aims to increase awareness around Home First Principles in the Discharge Policy.

By completing the sessions, learners will understand the principles of Home First, benefit from first hand case study examples and be able to share best practice.

Home First, Act Now is suitable for a range of health and care professionals including nurses, AHPs, care staff and students across NHS providers, commissioners and social care.

Sessions available as part of the programme include:

·                     Section 1: The principles of Home First

·                     Section 2: Working together

·                     Section 3: Valuing people’s time

·                     Self assessment questionnaire.

For more information about the elearning, including how to access it, please visit the HEE elfh Home First, Act Now programme page.

Green Inhalers- reducing the carbon footprint in primary care

There is growing concern from health care professionals (HCPs) and patients alike about the impact of respiratory inhalers on our environment. In the UK alone we prescribe about 50million inhalers a year¹ with the majority (approx. 70%)² being Metered Dose Inhalers (MDIs). MDIs contain propellants called hydrofluorocarbons (HFCs) which are potent greenhouse gases, thousands of times more powerful than carbon dioxide.³ Dry Powder Inhalers(DPIs) do not contain propellants and have a small fraction of the carbon footprint of MDIs. The most commonly prescribed inhaler in the UK, Ventolin Evohaler MDI has the same carbon footprint as the greenhouse gas emissions of driving 175miles in a small car!⁴

There is a strong argument for starting new patients on DPIs and where clinically appropriate, provided it is a shared decision between patient and clinician, moving patients from an MDI to a DPI. To help facilitate a conversation during reviews between Health Care Professionals (HCPs) and patients around the environmental effect of inhalers we have developed some resources to be used within Sussex. www.sussexccgs.nhs.uk/clinical_documents/inhalers-the-environmental-effect/

To launch these resources and discuss the topic of the environmental effect of inhalers in more detail, and to hear from a GP practice in Sussex that has been using these resources we will be doing a webinar on Thursday August 12 1-2pm. If you would like to attend please register using the link below

Register online: https://www.eventbrite.co.uk/e/green-inhalers-reducing-the-carbon-footprint-in-primary-care-tickets-161728707919

1.     https://www.thedatalab.org/blog/77/new-measure-inhalers-and-the-environment

2.     https://www.greenerpractice.co.uk/inhaler-switch

3.        Janson C, Henderson R, Löfdahl M, et al

Carbon footprint impact of the choice of inhalers for asthma and COPD

Thorax 2020;75:82-84.

4.        GreenInhaler.org The problem with Inhalers

SMI Health Checks Webinar: Mind the Gap – the scandal of the 20 years of lost life.

People with SMI (Schizophrenia, bipolar and psychosis) face stark health inequalities and are less likely to have their physical health needs met as a result of their diagnosis. National evidence highlights this particular patient cohort as having an average of 15 – 20 years mortality gap with 3 times the risk of hypertension and metabolic syndrome and 5 times the risk of dyslipidaemia. They have double the risk of obesity and diabetes and are 3 times more likely to smoke.

The key to tackling this issue is not just a physical health check but the interventions that need to follow the findings of the health check. There is good evidence that people with SMI are able to benefit from lifestyle interventions if supported to access them. Physical health checks can also be an opportunity to re-enforce the benefits of vaccinations and national screening programmes such as cervical smears.

General practices across Sussex had started to carry out the nationally mandated physical health checks through locally commissioned services before Covid struck. The uptake was not high, running at about 16- 18% and sadly this figure has not improved with Covid. We need to address this. As of April, this year, all the baseline checks fall within QOF. There is a newly designed locally commissioned service coming on stream and new access facilitators will be recruited to support people with SMI to access the appointments and lifestyle interventions that they need.

Join the webinar on September 9th at 13;00 to find out more. If you haven’t received the invite please email sxccg.primarycare@nhs.net and it will be forwarded to you.

Contact Information

If you need to contact the Primary Care Team, please email: sxccg.primarycare@nhs.net