Topics I presented in my practice’s clinical meeting today:
1. ADHD referral update
a. ADHD referrals are rejected by a clinician in the specialist team if thought to
be unsuitable for the service but sometimes this is a team decision, so they
prefer not to give a specific name on the rejection letter.
b. They don’t have the ability to “pause” referrals. Hence,
if key information is missing, a referral is rejected as they can’t put it on
hold.
c. When making a
referral, ensure that the key diagnostic criteria are all included. These
should be in the referral form but are also available online.
d. Private patients and overseas patients. Consultant
Connect can be used to get advice quickly and this can allow medication to be
continued if indicated for patients with a confirmed diagnosis. Consultant Connect for the ADHD service is currently
under-used by local GPs.
e. Referral numbers have increased substantially in recent
years, making waiting times for assessment very long (currently around 2
years). Consultant Connect can be used for advice (search for ‘mental health -
adult ADHD and autism’).
2. Supporting healthcare workers with work related stress
Many healthcare workers report problems such as stress,
anxiety and burnout. I recently published a clinical guide on this area in the
BMJ. https://www.bmj.com/content/379/bmj-2022-070779
3. Access to ‘fast-track’ cancer tests
General practices will be able to directly order fast-track
cancer diagnostic tests for their patients. This is a potentially useful
development but there are some caveats. Firstly, there needs to be sufficient
capacity to cope with an increase in referrals for investigations by GPs. This
means having enough equipment – such as scanners – and the staff to operate the
equipment and report on the scans. GPs would also need a dialogue with
radiologists before ordering scans to ensure the correct scan was ordered and
that the request was appropriate.
Finally, the cancer system is not coping well with the
current number of referrals with for example the number of patients starting
treatment within 62 days of referral is below target. Hence, there is a need to
look at the entire cancer care pathway (not just diagnostics). It’s essential to ensure there is capacity in
the system to see patients and start treatment within the target times.
Increasing the number of tests (and patients with suspicious lesions who need
further assessment) may lead to a further deterioration in NHS cancer
performance if this is not done.
4. Diphtheria and other infectious diseases in refugee centres
Cases of Diphtheria have been reported among people living
in refugee centres. Such locations are high-risk settings for the transmission
of infections. It’s important to check the vaccine status of any new migrants
joining the practice and offer both adults and children any necessary vaccines.
5. Appointment data
This has been published and is available online for the
public to view. It’s important to log all patient contacts and discussions about
patients with external healthcare professionals on the appointment screen to
ensure that practice activity is picked up in the data. It’s also essential ensure
the correct consultation mode is selected (e.g. face to face in surgery, home
visit, telephone).
6. Covid-19 Update
Not much change recently. Hospital admissions and deaths remain relatively low but may begin to increase from December onwards due to greater indoor mixing. Vaccination rates in London for the Autumn booster programme are well behind the average for England.
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