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Clinical Update for Dr Curran and Partners 1 December 2022

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.

https://selondonccg.nhs.uk/wp-content/uploads/2022/09/SEL-ICS-Adult-ADHD-referral-criteria-v1-2022.pdf

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.

 See https://www.pulsetoday.co.uk/news/clinical-areas/cancer/gps-to-have-direct-access-to-fast-track-cancer-tests-from-this-month/

 

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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