Page 3
MORE TO BE DONE IN BID
TO CELEBRATE PLAUDITS
Page 5 - Heartbeat Q&A
IF THE CAT FITS WEAR IT,
SAYS HR SUPREMO KIM!
Heartbeat
KEEPING YOUR FINGER ON THE PULSE OF DEVON DOCTORS’ HEALTH SERVICES
DECEMBER 2014
Access Health
Care to run
new practice
Dr Terese Tubman is involved in our
bid for the Cornwall OOH contract
THANKS FOR
EVERYTHING!
CHIEF OPERATING OFFICER IAN PARSONAGE LOOKS BACK ON 2014
F
IRSTLY, I must take this
opportunity to wish everyone
connected with Devon Doctors a
very merry Christmas and thank all our
staff for their commitment and effort
throughout 2014.
This has been a challenging year, with
the introduction of NHS111 heralding a
shift in the way the urgent healthcare
system works and significant change
in the way patients act and use their
healthcare facilities.
However, the adaptability of Devon
Doctors has shone though and the
much closer working relationship
between us and SWASfT – to the
benefit of the healthcare system and,
more importantly still, the patient – is
testimony to this.
The biggest challenge of the last 12
months has been to plot a successful
course though a financial challenge not
dissimilar to the one being faced by the
entire NHS at the minute.
The good news is that our hard work
and perseverance throughout the
course of this year leaves us much better
placed to secure financial sustainability
into the future.
Despite all the challenges we face,
the commitment shown to patient
care by our clinicians, not to mention
all of their support colleagues, remains
outstanding and has led to heaps of
praise from commissioners, partner
organisations, practice members and,
most pleasingly of all, our patients.
Indeed, this was highlighted when
we were visited by the Care Quality
Commission who commented that
the caring part of the report they were
compiling would ‘write itself’.
Once again, the next 12 months
looks like being a particularly important
period for Devon Doctors with the outof-hours contract in Cornwall being
decided and continuing work into the
retendering of the urgent care system
in Devon, alongside the ongoing
management of a large financial deficit
for the wider healthcare system.
Nevertheless,
we will continue
to look for opportunities to support
the local healthcare system and our
partner organisations, whilst the Senior
Management Team work hard to affect
the retendering design in order to
ensure that Devon Doctors continues
to be at the heart of any future urgent
care system.
DEVON Doctors’ sister
company Access Health
Care has been awarded
the contract to operate a
new GP surgery.
Cranbrook Medical
Practice will serve the
3,000-plus residents of
the rapidly expanding
new town on the border
of Exeter and East Devon
when it opens in March
of next year.
“We are delighted to
have won this contract
and look forward to
working with the local
community to provide a
first-class service to the
residents of Cranbrook,”
said Access Health Care
manager Mark Knight.
The practice will
be located in premises at the East Devon
District Council-owned
Younghayes Community Centre, pending the
development of a health
& wellbeing hub at some
point in the future.
Wide variety
of vacancies
DEVON Doctors is recruiting for a variety of roles.
Details of a number
exciting new opportunities to work for us, or
sister company Access
Health Care, are now
available on SharePoint
and at www.devondoctors.co.uk
Alongside vacancies
for drivers / operational
assistants at our treatment centres in Honiton
and Tiverton, we are also
looking for receptionists
and administrators for
the new GP surgery at
Cranbrook and experienced nurses.
PAGE 2: NEW DEVON LATEST PAGE 4: PALLIATIVE CARE COLUMN
Heartbeat
NEWS in brief
Green Party candidate
at Devon Doctors HQ
THE Green Party’s
candidate for the
Exeter Constituency
in next year’s General
Election visited our
Manaton Court HQ
earlier this month.
Diana Moore
enjoyed a tour of
the buildings and
the opportunity to
learn more about our
work in a 60-minute
meeting with chief
operating officer Ian
Parsonage.
“I’m always very
happy to meet anyone, such as Diana,
who is as passionate
as I am about the
NHS and the role notfor-profit organisations, such as Devon
Doctors, can perform
within it,” said Ian
afterwards.
“It’s great that
Diana get’s what
Diana Moore
we’re all about and
I was delighted to
have the opportunity to answer her
questions and, at the
same time, explain
in a little more detail
exactly what it is we
do. “
Afterwards Diana
tweeted to say how
impressed she had
been and how she
had no idea Devon
Doctors was involved
in quite so many different services.
Date is set for Devon Doctors AGM
DEVON Doctors’ AGM
will coincide with the
away day, scheduled to
take place at the Hartnoll Hotel in Tiverton on
February 11.
As the organisation’s owners, every GP
practice in the county
is entitled to nominate
a representative to attend and mandate them
to vote on their behalf.
The AGM will receive a
report from chief operating officer Ian Parsonage, who will outline his
plans for the year ahead.
If your practice would
like to be represented at
the meeting then please
advise us as soon as possible as space at the venue is relatively limited.
Non-executive directors Dr Bruce Hughes
[North Devon] and Dr
Simon Murray were due
to step down at the
AGM but will now stay
on having offered themselves up for re-election
and no other candidates
coming forward.
If you would like any
further
information,
please contact stuart.
[email protected] who
will be happy to respond to any queries.
NEW Devon to revisit
its initial proposals for
bridging financial gap
Bid to recruit GPs for
mentoring scheme
THE Tamar Faculty
of the RCGP and GP
School at Health
Education South
West has set up a
mentoring scheme
to support GPs
in their first five
years following
completion of
training.
“Supporting
new GPs as a
mentor can help
them to develop
professionally and
personally, help
them to grow in
confidence, and
sustain them as they
develop their skills
in the workplace,”
said Devon Doctors
Head of Operations
[Treatment Centres]
Jane Moxon, who is
keen to encourage
GPs working for
the organisation
to participate.
Training, for
which places are
limited, will be held
on March 5, 2015,
at The Arundell
Arms, Lifton.
For further
information, please
contact Dr Susanna
Hill, Associate
Dean, GP School,
HEE South West
via drsrhill0@
btinternet.com or,
alternatively, email
[email protected]
Few places remaining
on next GP study day
THERE are just a few
places remaining on
the GP study day to
take place at Buckfast
Abbey Conference
Centre on Thursday,
January 29.
Speakers will
include consultant
psychiatrist Colm
Owens, who will talk
about the mental
health capacity act,
and doctors Jemma
Cooper and Fay
Murray-Brown who
will discuss pain relief
in the terminally ill.
More details are
available from Linda
Ward on lward8@
nhs.net.
NEW Devon is revisiting its
plans to reduce its deficit
N
ORTHERN,
Eastern
and
Western
Devon
Clinical Commissioning
Group [NEW Devon CCG] has
announced a review of the
‘urgent and necessary measures’
it had been proposing to address
its financial issues.
The proposals would have
seen the introduction of a
series of measures alongside
a temporary reduction in
services, with a focus on planned
operations and treatments. For
instance, there would have been
an immediate requirement for
those with a BMI over 35 to have
lost weight and for those who
smoke to quit prior to routine
surgery.
However, following feedback
from healthcare professionals,
experts and patients over the
course of November, the CCG is
now looking again at how the
range of measures might best be
implemented.
“Prioritising the requirements
of the NHS Constitution and
encouraging those who smoke, or
are overweight, to quit smoking
and lose weight remain a priority,”
said a spokesperson for NEW
Devon. “However, while patients
will be encouraged to lose weight
and quit smoking they will not be
required to do so.”
Local clinicians will be leading
the process of deciding which
proposals should progress to
the development of formal
commissioning
policy
for
implementation in 2015-16.
These proposals will be
subject to an assessment and,
where appropriate, formalised
into policy through the Clinical
Policy Committee [CPC]. At
the same time, there will be
opportunities for the public
to feed back their views about
this work and ask questions
throughout the course of the
process.
The CPC is made up of local
clinicians, lay representatives
and patient safety and quality,
public
health,
contracting,
finance, clinical effectiveness,
medicines optimisation and
secondary care representation.
It is charged with assessing
each
proposal,
including
evidence, the reasons for any
proposed change, the number
of patients affected, safety,
stakeholder
engagement
[including the public] and costeffectiveness. While the CPC
process is ongoing, no changes
to the services or treatments
under review will take place.
l Devon Doctors is one of a
number of organisations in the
county, such as NEW Devon
CCG, committed to working
together under the Financially
Challenged Healthcare Economy
[FCHE] banner to address the
issues faced by the county’s
healthcare providers.
Heartbeat
Devon Doctors set to
do more to celebrate
any plaudits received
Devon Doctors will do more
to celebrate any plaudits
D
EVON Doctors chief
operating
officer
Ian Parsonage, inset,
has launched a new
initiative to celebrate
any plaudits received
by the organisation
or any of its subsidiary
companies.
“So exceptional is the
job our staff do day in
day out, it’s all too easy
to take their excellence
for granted,” said Ian.
“While it’s fantastic
they routinely go the
extra mile, I think it’s
important that we do
more to recognise this and,
with this in mind, as of now
we will be putting aside a
space in every edition of
Heartbeat to share some of
the exceptional feedback we
receive.
“Of course, lots of this
comes from patients
but, at the same time,
we should not overlook
the results of, for
instance, the IPSOS
Mori GP survey which
also provide a glowing
endorsement for Devon
Doctors efforts.
“What is more, I often
hear
exceptionally
positive things from
those who commission
our services and, moving
forward, I will be making
it my mission to share
any feedback of that
nature with staff.”
A cross-section of some
of the organisations most
recent plaudits can be found
elsewhere on this page. As
you will see, adjectives such as
excellent, fantastic, helpful and
wonderful are not uncommon
when describing the services we
provide.
Indeed, one patient opines:
“It is very reassuring to know
that it [Devon Doctors] is run
by local doctors for the people
of Devon and the range of
services provided is remarkable,
including the Clock Tower
Surgery for homeless people,
the end-of-life register etc.
“I think it would be a disgrace
for such a brilliant service to
be farmed out to the private
sector.”
PLAUDITS
It’s very reassuring that it’s run by local doctors
lI “I USED the Devon
Doctors Service for the
first time this morning
at Totnes Hospital. I
found this a positive
experience for the following reasons:
I was rung by the doctor approximately one
hour after contacting
NHS111 which was
well within the set
two-hour time slot.
The receptionist and
the nurse on duty were
friendly and helpful,
as was the doctor who
gave clear information
& advice.
I waited one hour to be
seen and received an
apology for this from
the doctor but I did not
think the waiting time
was unreasonable for a
walk in appointment.
lI “I WOULD like to
say that any dealings I
have had with Devon
Doctors have been very
positive.
It is very reassuring
to know that it is run
by local doctors for the
people of Devon, and
the range of services
provided is remarkable,
including the Clock
Tower Surgery for
homeless people, the
end-of-life register etc.
I think it would be
a disgrace for such
a brilliant service to
be farmed out to the
private sector.
My elderly neighbour has recently been
quite poorly over a
weekend and was very
pleased with the treatment she received.
PLAUDITS
Eternally grateful for
relieving me of pain
lI I JUST wanted to
express my thanks to
everyone who helped
me. I had a very painful night and in the
morning called NHS.
Although I had to
wait some time to be
connected with the
service thereafter everything was excellent
– the nurse was very
comforting, efficient
and everything ran
smoothly.
I was called back
by the Devon Doctors
team, my thanks to
the driver, the doctor
at the hospital and
especially the doctor
who visited my home.
She administered to
me in a very friendly,
professional manner
and more importantly
relieved my pain for
which I am eternally
grateful.
From start to finish
everything was done
within one hour.
Excellent!
I consider myself
very fortunate that
there are people who
work within the NHS
that are exceptional.
lION behalf of my
family, I would like to
express my thanks for
the care you and your
colleagues provided
for our mother, over
several years and especially during the last
weeks of her life. With
your support, she was
able to stay at home
and be nursed there,
which was her express
wish and hope.
Your consistently
courteous support
was much appreciated, as was your
prompt attendance
to every query or problem. We felt we were
part of a team that
provided excellent and
compassionate endof-life care.
Please pass our
thanks to all members
of your dedicated
team who were
involved by telephone
or by visiting, day or
night.
lITHE doctor on call
till 10pm was excellent. Very reassuring,
calm and explained all
very clearly and with
great compassion.
He referred to a
similar personal experience which made
my feel understood. I
was going through a
miscarriage.
He called back
twice to check on me
through the evening. I
really appreciated his
care, medical explanations and advice.
He also got me an
emergency appointment which reassured
me too.
I wish I could thank
him in person for the
great medical care
I received over the
phone. Thanks Devon
Doctors!
lI I WOULD like to
give you some feedback about my contact with out of hours
over the weekend.
Contact was made
with the patient
who has on-going
issues which are
complicated. I would
like to feedback very
positively as to the
way this was handled
by the doctor.
I think this exemplary considering
that she would not be
in possession of the
patient’s full medical
history. This sort of
out-of-hours management which is above
and beyond tidying
someone over for the
weekend is greatly
appreciated by us in
practice and primary
care.
lI I WOULD just like
to say how grateful I
am to the doctor who
visited my mother. She
was very thorough,
honest and open, listened to our opinions
and gave my parents
a lot of confidence in
the GP service. I could
have easily lost my
mother that day but
I am pleased to say,
that although very
poorly, she is still with
us. Thank you.
Heartbeat
PALLIATIVE CARE
Nausea and vomiting
in a palliative setting
SOMETIMES it is
not clear what to
do, especially when
first-line treatment
doesn’t work, in the
treatment of nausea
and vomiting.
On occasions
there is no one
clear cause and it
seems to be just
the disease burden
causing the problem.
Other times there are
potentially treatable
causes such as drug
side effects, UTI,
hypercalcaemia, constipation, reflux, dyspepsia, cough and
anxiety though even
then the nausea
and vomiting needs
controlling while
specific treatments,
such as antibiotics,
have time to work.
One way to look
at anti-emetics is
to group them by
cause:
l Gastric stasis:
Tumour infiltration of stomach or
oesophagus, ascites
or hepatomegaly
and strong opioids
such as morphine
can all contribute to
this. A prokinetic, for
instance Metoclopramide, 30-100mg
/ 24hrs, oral or sc,
perhaps via a syringe
driver, can help. This
works both peripherally – increasing
gastric and intestinal
movement – and
crossing the Blood
Brain Barrier [BBB]
to work centrally.
But obstruction is an
absolute contraindication to prokinetics;
pain will increase
and they may cause
perforation. Dystonic
side effects are occasionally a problem
and then Domperidone 30mg / 24hrsoral only can help. It
does not cross BBB
much so it causes
less side effects
but has less central
antiemetic effect.
l Unknown or
multiple causes:
Metoclopramide
30-100mg / 24hrs,
oral or sc is helpful
here too. Second
choice [either added
to, or in place of,
Metoclopramide] is
Levomepromazine
[Nozinan] 6.2512.5mg sc or oral
[can cause drowsiness]. At higher
doses it is very sedative but can have a
place in managing
delirium although
there is rarely much
more anti-emetic effect at higher dose.
l Renal failure /
Chemical – Haloperidol 1.5-5mg/24hrs
oral or sc. Second
choice Levomepromazine but
drowsiness may be
limiting.
l Raised Intracranial Pressure:
Cyclizine 100-150mg
/ 24hrs, oral or
sc – this is a useful
drug but is irritant
in sc injection and
incompatible with
some other syringe
driver medications.
The prokinetic action
of Metoclopramide
is antagonised by
cyclizine so illogical
to use them both
together, but
not dangerous.
Second choice –
Levomepromazine.
Dexamethasone
8-16mg can be very
helpful combined
with anti-emetic.
l Radiotherapy or
chemotherapy: Ondansetron 8-24mg
/ 24hrs oral or sc
is good for nausea
and vomiting associated with tissue
damage. Adding in
Metoclopramide or
Haloperidol second
line can also prove
beneficial.
l Bowel obstruction: This may need
more specialist
advice and we would
be pleased to discuss
such cases, or any
other intractable
symptom, 24 hours a
day, 365 days a year,
on 01392 688 044.
with Dr Tim Harlow of Hospiscare
Valuable training on offer for carers
OUR friends at Living
Options Devon are offering some free training sessions for personal
assistants / carers.
First Aid Training from
the British Red Cross is
taking place at Cranmere Court, Exeter, on
Monday, January 26,
Monday, February 6,
and Monday, February
9, from 9am to 5pm.
Topics to be covered
will include managing
first aid in an emergency
and administering first
aid to a casualty who is
unconscious / choking
/ bleeding / suffering
from a burn or shock or
injuries to bones.
A course devoted to
Principles of Moving
and Handling will take
place at the same venue between 9am and
2.15pm on Tuesday, January 20. Topics covered
will include assessing
the risk and understanding your back, anatomy
and physiology.
Anyone
interested
in attending is asked
to contact Living Options by phoning 01392
459222 or emailing
[email protected]
Initiatives to support
primary care through
community pharmacy
It is felt community pharmacies
are an under-utilised resource
D
EVON Doctors is working closely with Northern, Eastern and Western
[NEW] Devon and South Devon
and Torbay Clinical Commissioning Groups to promote a number
of community pharmacy initiatives to relieve winter pressures.
The recent NHS England Review of Emergency Care recognised that: “Community pharmacies are an under-used resource...
we [the NHS] can capitalise on the
untapped potential, and convenience, that greater utilisation of
the skills and experience of the
workforce can offer.”
And Head of Operations [Treatment Centres] Jane Moxon is asking all clinicians to familiarise
themselves with the initiatives
and, where appropriate, promote
them to patients.
Devon Local Pharmaceutical Committee [LPC] has been
awarded Prime Minister’s Challenge Fund cash to deliver three
services to support urgent care:
l
Winter ailments scheme:
NHS-funded supply of a limited
range of over-the-counter medicines for people exempt from
prescription charges to support
self-care [across all localities in
NEW Devon CCG and South Devon and Torbay CCG].
l Minor ailments scheme using Patient Group Directions:
Supply of a limited range of Prescription Only Medicines [POMs]
to treat urinary tract infections,
impetigo, nappy rash and bacterial conjunctivitis [across all localities in NEW Devon CCG and South
Devon and Torbay CCG].
l Emergency supply service:
Provision of emergency supplies of repeat prescriptions and
medicines at the expense of the
NHS [across all localities in NEW
Devon CCG and South Devon and
Torbay CCG].
All of these services are now
in place and community pharmacists are consulting patients and
supplying medicines where appropriate.
More details of each of these
services are now available at the
following location: SharePoint
>>> Treatment Centres >>> Pharmacy Services >>> Emergency
services - Pharmacy First Services
[December 2014 FINAL].
If you would like further information about the services please
contact the Devon LPC on 01392
834022 or email suet@devonlpc.
org.
Heartbeat
Q&A: HR TEAM LEADER KIM PEGMAN
What is your position
within Devon Doctors and
what does this involve? I
am HR Team Leader which
involves looking after
the HR team as well as
reception. And in April this
year I was given the GP
Lead Employer contract to
implement so I also look
after 240 trainee GPs.
Jimmy Choo shoes, cat
Esmé and husband Andy
put sparkle in Kim’s life
How long have you worked
for the organisation and
what roles, if any, have you
performed previously? I
have worked for Devon
Doctors for around four
and a half years now and
for most of that time
worked alongside Sara
Graham looking after
the company’s payroll.
What do you enjoy most
about working for Devon
Doctors? I enjoy the
diversity of my role and all
the challenges that come
with it. I actually do learn
something new every day.
Where do you live and
with who? I live with my
husband Andy and cat Esmé
in Axminster in East Devon.
How do you relax? I love
spending time with friends
and family. My sister had a
daughter, Abigail, last year
and she certainly manages
to fill lots of my spare time.
Where is your favourite
holiday destination? My
sister-in-law lives in Mexico
City with her family so
I have been over there
quite a few times. My
favourite place is Isla
Holbox off the Gulf of
Mexico because I got
to swim with whale
sharks and there
are no cars on the
island – the only
mode of transport
is golf buggies.
What was the last
film you saw at
the cinema? I’m
not a fan of the
cinema. Why
do they provide
such noisy food?
If you had to
choose a single
HR team leader Kim with her
husband Andy and cat Esmé
‘Desert Island Disc’ what
would it be? The song I
can listen to again and
again is Frontier Psychiatrist
by The Avalanches, it
never gets boring and
puts a smile on my face.
What is your favourite
book? Jayne Eyre by
Charlotte Brontë
What is your greatest
extravagance? My
Jimmy Choo
wedding shoes,
but they are
fabulous!
What
television
programme
do you
always
switch off?
The X Factor,
having
loved it once I think it’s
definitely had its day.
Which living person do
you most despise and
why? Gordon Brown
– nothing good came
from that political era.
If you could invite four
celebrities / historical
figures to a dinner party
who would they be? Let
me think... Michael Caines
to cook, Jake Gyllenhaal to
look at, Steve Jobs to teach
me something and Ricky
Gervais for the comic value.
Which words or phrases do
you most overuse? None
spring readily to mind but
I’m sure there are one or
two; you will have to ask
Charlotte and Sophie who
work with me in HR.
What is the most important
Chef Michael Caines would be a
guest at Kim’s dream dinner part
y
lesson life has
taught you? There
will always be
someone who
knows more that
you, don’t be afraid
to ask questions.
How would you like
to be remembered?
As thoughtful,
honest and always
trying my best.
Jimmy Choo shoes
EMAIL [email protected] IF YOU’D LIKE TO APPEAR IN THE HEARTBEAT Q&A
Heartbeat
Staff get into
festive mood
to raise cash
for charities
D
EVON
Doctors
employees have been
going the extra mile
for charity over the course
of the last month, with a
series of Christmas-themed
fundraising initiatives.
Staff at our Manaton
Court HQ were only too
happy to don their favourite
item of festive knitwear, on
December 13, to raise cash
for Macmillan’s Christmas
Jumper Day.
Unfortunately,
IT
technician Liam Wakefield
wasn’t able to lay his hands
on the colourful Christmas
suit which caused such
merriment last year but
instead sported a fetching
blue and red Santa shirt.
More cash was raised
through the Christmas
hamper draw organised this
year by rota team member
and OTM Jane Wills. As
ever the money raised from
this initiative, as well as the
cash donated by some staff
members in lieu of giving
Hamper winner Charlotte
Christmas cards to their
colleagues, will be matched
by Devon Doctors, meaning
a cheque for almost £500 will
be winging its way to Little
Bridge House Childrens’
Hospice in North Devon.
Payroll
administrator
Sara Graham and HR
administrator
Charlotte
Wilson were the lucky
winners of the two hampers.
It was fitting that
Charlotte should win one
of the hampers, as she
had been responsible for
coordinating an appeal to
staff for coats to redistribute
to clients of the Devon
Doctors-run Clock Tower
Surgery for the vulnerably
housed in Exeter city centre.
END OF
THE DAY
with Damien Mills
I want to ride my bicycle
Inspired by the article in the last
edition of Heartbeat, Government
bike scheme offers a great way
to get fit, not to mention my
partner continually telling me
my face was getting fat, I am
now the proud owner of a cool
silver mountain bike and all the
paraphernalia that goes with it.
What is more, if you’ve been
contemplating taking advantage of
the scheme – which not only offers
big savings on the cost of a bike but
spreads it over the course of a year
– I’d heartily recommend doing so.
Simply go the www.
benefitsbrochure.com, type GP
Devon Doctors in the Find Your
Employer box, and you’re well on
your way to getting a new bike!
A word too for the Bike Shed
in Exeter – the guys there were
a fantastic help when it came
to choosing the right bike
and I couldn’t recommend
them highly enough.
Separated at birth?
A colleague of mine at
Manaton Court was the lucky
recipient of a Little Miss
Princess mug in her
department’s Secret
Santa shenanigans.
She voiced the
opinion the gift
had probably been
chosen as she was
widely regarded as
Manaton Court staff resplendent
in their finest Christmas knitwear
a princess, while I dared to suggest
it might have been because of the
uncanny resemblance she bore to
the Roger Hargreaves character!
So, the $64,000,000 question
is, on the basis of the image
below, can you guess who was
the lucky recipient of the mug?!
Satnav leaves us confused
Earlier this month, myself and a
photographer friend travelled
down to Cornwall to get some
photos to accompany our
bid for the OOH tender.
Having set the satnav
to take us to Bodmin
Hospital, we were
a little perturbed
when driving
down the A30 it
kept insisting we
should do a U-turn.
No matter, we
thought, it will probably put itself
right in due course. Needless to say,
it didn’t, though we did eventually
manage to find the hospital.
It was only when I went to
key in the postcode of our next
destination that I realised what
the problem had been – I’d
omitted to hit enter when I put
in the previous postcode and
so, throughout the course of our
journey, the satnav had been
doing its damndest to direct us
not to Bodmin Hospital but to
the address of my photographer
pal, no more than five or six miles
from Devon Doctors Exeter HQ!
Heartbeat
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