Issue 1
Welcome to the first of the new style Yellow Card Roundup. This update will be sent every 34 months to highlight the key themes, trends and issues we are hearing through the Yellow
Card system.
For those who may not know Yellow Card is, please click here.
For more information on how to access the Yellow Card form, please click here.
Between January and May 2016, we have received 180 Yellow Cards. The number Yellow
Cards received about provider has been broken down below:
Devon Referral Support Service
The Care Company
Devon County Council
Devon Doctors
Royal Devon and Exeter NHS Foundation Trust
Mount Stuart
Pharmacy 2 U
South West Ambulance Service NHS Foundation Trust
Devon Partnership Trust
NHS England
Plymouth Hospital NHS Foundation Trust
Torbay and South Devon NHS Foundation Trust
1
1
1
1
2
2
2
3
5
5
5
152
0
50
100
150
200
The following themes have been identified:
- Poor discharge from TSDFT:
Through the YC system, it was apparent that health care professionals were experiencing
issues around incomplete or lack of discharge summaries. As a result of this feedback, the
Quality Team raised this issue around information on discharge summaries with the Trust.
The executive summary here summarises the report taken to Quality Committee and the
actions taken.
-
Neurology at TSDFT:
TSDFTs neurology service is currently experiencing considerable pressures, with the
workforce having reduced from four consultants to two since January. As a result, 350
patients are waiting for their first general neurology outpatient appointment, and 200 patients
are awaiting follow-ups. All referrals are triaged by the team, and urgent requests are
prioritised.
The longest wait for a first appointment is three months, but people referred who need a
routine neurology appointment can expect to wait a minimum of seven months for a first
outpatient appointment. The CCG is working with the Trust to stabilise this situation.
Measures being put in place include seeking agency and NHS locums, continuing to
advertise for substantive consultants, scoping nurse led service models, and working with
neighbouring Trusts to look at the potential for a networked solution and joint appointments.
Unfortunately, as they are also experiencing significant pressures in neurology, this is not a
swift solution.
-
Emergency Department (ED) at TSDFT
Several YCs have raised concerns around a range of issues in ED. A number of work
streams connected to an overall action plan have commenced and this is being monitored by
the CCG. Actions include updating the symphony records system, improving patient flow via
the newly instigated AMU and ensuring patient safety and experience is prioritised.
Performance to the 4 hour standard has been variable however there has been a noted
improvement in time to triage and initial assessment. The CCG is continuing to quality
assure all aspects of safety and quality via regular monitoring meetings.
-
What do you do with a patient presenting with haematuria?
From Dr Nick D’Arcy
This is not an unusual occurrence in our surgery consultations. At a recent Two Week Wait
(2ww) Pathway Meeting TSDFT raised a couple of cases where patients who had presented
with Haematuria had a confused journey to get investigated. Feedback from other practices
also suggested that some GPs were unsure of the referral criteria for a valid 2WW referral.
The 2WW Urology Pathway has some very helpful guidelines of what type of haematuria
needs referral and when. If, like me, you were not 100% clear then please click on the link
here for a quick update.
-
Lower Leg Therapy Service (LLTS)
It has been identified through a number of YCs that a number of HCPs have experienced
difficulties in relation to the LLTS. This has been raised on a regular basis at the CCG’s
Quality Committee to gain assurance on the service.
Since December 2015 the service has made positive steps forward whilst recognising that
one particular issue (Tier 2 funding gap) remains unresolved. The service has had a number
of successes such as average healing times being better than anticipated, positive patient
feedback, nomination for WOW awards, establishment of comprehensive monthly reporting
to the CCG and a reduction to the waiting list.
The identified commissioning gap regarding payments to primary care for on-going Tier 2
treatment remains on the CCG’s risk register. This issue continues to impact on the waiting
list and although the waiting list has reduced by 50% since mid-November 2015, the rate of
reduction has now become almost static over the last few months. A detailed plan for Tier 2
treatment went to the Operational Support Group (OSG) last month and work is now
underway to agree a primary care service specification for management of tier 2 leg ulcer
patients.