Proposal to close St Damian’s Surgery in Melksham

Increased demands on healthcare services and the national shortage of GPs are having an impact on primary care across the UK and in Wiltshire. The Bradford on Avon and Melksham Health Partnership (BoAMHP) have been unable to recruit enough clinicians following the retirement of three full-time GP partners and have sought approval to close St Damian’s Surgery in Melksham.

Dr Richard Sandford-Hill, NHS Wiltshire Clinical Commissioning Group Chair said:
“We understand the challenges facing primary care, particularly around recruitment of clinical staff. BoAMHP has sought approval to close its branch surgery in Melksham because, despite their best efforts, the partners feel unable to maintain a full range of patient services at all of their sites.”
Dr Janice Patrick, Senior Partner at Bradford on Avon and Melksham Health Partnership said:
“This has been a very difficult decision for us to take. Over the past year we have put a lot of measures in place to try and maintain the surgery at St Damian’s, but we find ourselves in a position where we cannot continue to provide a service in Melksham with the resources we have available to us.

“BoAMHP is keen to continue to provide services to as many of the St Damian’s registered patients as wish to stay with their current GP, should our proposal to close the surgery at St Damian’s be approved. We are writing to all St Damian’s patients to explain to them what the proposed closure would mean for them.”

St Damian’s patients who want to continue to see a GP in Melksham would need to register with Giffords Surgery or Spa Medical Centre after the decision is made about the practice closure, in the New Year.

Patients who have questions or would like further information about the proposed closure should contact St Damian’s Surgery.

Transforming Maternity Services Together

A proposal to transform maternity services across Bath and North East Somerset (BANES), Swindon and Wiltshire has been shared with the general public for their consideration today, Monday 12 November.

The proposal has been developed after listening to the views of women, families and staff over the last two years by all the NHS organisations that plan and buy health services as well as those that provide or manage maternity services across Bath and North East Somerset, Swindon and Wiltshire. Together these organisations make up the Local Maternity System.

Lucy Baker, Acting Director for Maternity Services at Wiltshire Clinical Commissioning Group
and Lead Director for the project said:
“Our proposal is the result of feedback gained from listening to over 2,000 women and families, staff, midwives, obstetricians and others with an interest in maternity services to look at ways we can improve the services we provide to mothers and families across the region. To do that, we need to make some changes to how we currently do things”.
Lucy added:
“Our proposal would allow us to provide more choice for more women across our area about where and how they are supported before, during and after the birth of their baby, and allows us to make more efficient use of our resources and workforce so we can further improve our antenatal and post-natal and birthing services. We also want to ensure we are delivering the services that can meet the changing needs of our local women and families both now and in the future.

“Despite the financial pressures facing the NHS locally and nationally, we are not planning to reduce how much we spend on maternity services, nor are we proposing to reduce the amount of staff we have or to close any buildings.”

The proposal addresses the issues posed by changes to the population. The average age of a woman giving birth in the UK is now 35. More and more women are experiencing high risk pregnancies (for example, because of high blood pressure, obesity or diabetes) which means they need to be supported in a hospital setting with an expert medical team available. The combination of these factors means there is vastly increased pressure on services at the Obstetric Units at the Royal United Hospital in Bath, Great Western Hospital in Swindon and Salisbury District Hospital.  

In addition, many women with a low risk pregnancy are choosing to have their babies in an Obstetric Unit because they are worried about having to move by ambulance to another site during or after their labour if they need the help of a doctor. Women need a safe, convenient alternative so staff at the three obstetric units at Bath, Salisbury and Swindon hospitals can focus on mothers who really need their care.

Sarah Merritt, Head of Nursing and Midwifery at Royal United Hospital, Bath, said:
“Some of the changes we are proposing are because, particularly at the RUH, certain services are underused and we are often staffing empty buildings and beds. 85% of women give birth in one of the three Obstetric Units with fewer than 6% giving birth across our four Freestanding Midwifery Units in Chippenham, Trowbridge, Paulton and Frome.

“We believe we have the right number and mix of staff but they’re not based in the right locations to ensure efficient use of our resources and provide women with the services they need.

“In our Freestanding Midwifery Units – particularly at night – staff are covering areas even when there are no or very few births. On average only one baby is delivered every two or three days in each of these units but they need to be staffed to support births 24 hours a day seven days a week.”

The plans have been developed to ensure services are efficient and sustainable to support future population growth, changes in housing policy, and the repatriation of military personnel to South Wiltshire from April 2019.

The proposal offers the following:

  • To continue to support births in two, rather than four, of our Freestanding Midwifery Units across Bath and North East Somerset, Wiltshire and Swindon. Women will still be able to have their baby in Chippenham and Frome Freestanding Midwifery Units, and antenatal and postnatal clinics will continue to be provided in all four – at Chippenham, Frome, Paulton and Trowbridge as well as all other current locations e.g. GP practices. A detailed travel impact analysis was undertaken to inform our proposal to continue supporting births in two of the Freestanding Midwifery Units.
  • To create two new Alongside Midwifery Units, one at Salisbury District Hospital and one at the Royal United Hospital, which will provide more women with the opportunity to have a midwife-led birth. These two units will be in addition to the White Horse Birth Centre that already exists at the Great Western Hospital in Swindon.
  • To improve the range of antenatal and postnatal services, for example by providing more breastfeeding support to women in their own homes. We also want to support more women to give birth at home if this is their preferred choice.
  • To replace the nine community postnatal beds (four at Chippenham and five at Paulton Freestanding Midwifery Units) with support closer to or in women’s homes. Women who need to be admitted for medical treatment after giving birth would be treated in their local Obstetric Unit at one of our acute hospitals in Bath, Salisbury and Swindon.
  • 95% of the time post-natal beds in our Freestanding Midwifery Units are empty as women rarely need to stay in a community hospital after giving birth.
  • 89 antenatal or post-natal beds are available at our Obstetric Units for women who need them

Once the public consultation has closed, the responses will be carefully and independently analysed and the results used to help the Governing Bodies of Bath and North East Somerset, Swindon and Wiltshire Clinical Commissioning Groups make a final decision by Spring 2019.

Lucy Baker said:
“Our proposal is just that – a proposal. It addresses what women and staff have told us they think will work, but we want to hear people’s views and encourage them to have their say.

“The consultation will run from 12 November 2018 until 24 February 2019, to enable plenty of time for people to give their views.

“We will make the consultation results available to the public and explain how their feedback has helped shape our plans. We are aiming to make our final decision in Spring 2019.”

Find out more on our consultation webpage.

All the consultation information and documents, including ways to get involved and to provide feedback will be available online from Monday 12 November, at: www.transformingmaternity.org.uk

Helping each other to stay well this winter

Today is the start of Self Care Week and Wiltshire Council and NHS Wiltshire Clinical Commissioning Group are encouraging people to be well-prepared ahead of winter by taking simple steps to look after themselves and helping their families, friends and neighbours to do the same.
 

This year, the theme for Self Care Week is ‘Choose Self Care for Life’ and preparing now for the winter ahead will help people, particularly those who are elderly or vulnerable, to stay as well as possible.

This means trying to stay active even when the weather is colder, and eating a balanced diet. Wiltshire Council’s health trainers can help people every step of the way – the service is for people aged 18 + and is free. They can also help you find other services and activities to keep you healthy and well over winter.

For more information visit www.wiltshire.gov.uk/public-health-trainers or call 0300 003 4566.

There are also benefits and grants available to help with energy efficiency, such as cavity wall insulation to help keep homes warm. Call Warm & Safe Wiltshire on 0800 038 5722 or visit www.warmandsafewiltshire.org.uk for more information.

Jerry Wickham, Wiltshire Council cabinet member for public health, said:
“It’s also sensible to check on vulnerable neighbours and relatives and ensure they have everything they need to stay safe and warm. Sometimes, simply offering to do the shopping for someone can make a big difference.

“There is a lot of support available to help people to stay safe, healthy, warm and out of hospital this winter and beyond.”

NHS Wiltshire CCG has created an easy-to-use eight-step guide, to help people know what simple steps they can take to help keep themselves well over the winter months.

S – see your pharmacist at first sign of illness

E – eat plenty of fruit and vegetables

L – learn more about around the clock healthcare services in Wiltshire

F – find out if you’re eligible for a free flu vaccine

C – check in on your neighbours

A – arrange to pick up your prescription

R – restock your medicine cabinet 

E – ensure you stay warm

Dr Andrew Girdher, GP at Box Surgery, explains:
“We’re encouraging people to be proactive with their own self-care, to help them stay as healthy as possible and to know where to go if they do need health care advice.

“Healthcare services are put under enormous pressure over the winter months and by doing what you can to look after yourself where you can, helps to free up valuable practitioner time to see those people who really need to be seen.”

Flu season is approaching – get your flu jab now


The clocks have gone back which means winter is on its way. And with winter comes flu. On average, flu kills around 8,000 people a year in England. Getting a flu vaccination is the single best way to protect yourself and others against the flu.

You can have your flu jab at your GP surgery or local pharmacy and for those who are most at risk of suffering serious consequences if they catch the flu, the vaccination is free – it’s free because you need it.

Dr Andrew Girdher, a GP at Box Surgery who had the flu last year, is encouraging those who need the vaccination, to have it:
“For the first time last winter I felt what it was like to experience flu and having a flu jab is definitely on my list of ‘must dos’ at the moment.
“Flu certainly knocked me for six – I had to take five days off work, the first time in 25 years, and I missed the surgery Christmas party. I’m someone who is very fit and active but once I got sick, I was physically unable to get out of my house, even getting out of bed was a challenge.
“People owe it to themselves to get a flu jab before winter, to protect their own health but also to protect the health of their family, work colleagues and friends from the debilitating effects of the flu.
“I also urge all patient-facing workers in health and social care to ensure they get a flu vaccination to reduce the risk to themselves and their patients this winter.”

People who are eligible for a free flu vaccination include:

  • Adults aged 65 and over
  • Adults aged 18-64 with long-term conditions such as COPD, bronchitis, emphysema, diabetes, heart, kidney or liver disease
    or those who have had a stroke
  • Pregnant women
  • Children aged 2-3 years
  • Children in school years: reception, 1, 2, 3, 4 and 5
  • Carers
  • Health and social care workers.

Get your flu vaccination from your GP practice, or pharmacy before the end of November 2018 to help protect you and those around you this winter.

Flu is a highly infectious illness characterised by a fever, chills, headache, aching muscles and joint paint and fatigue. For most healthy people, flu symptoms can make you feel exhausted and unwell so that you have to stay in bed and rest until you get better.

If you think you may have the flu, stay at home and rest until you feel better. Call NHS 111 if you have an underlying health condition or feel really unwell.

Weekend and evening GP appointments available from 1 October

Wiltshire’s GP Practices are working together to offer people better access to GP appointments in Wiltshire. This means people who are registered with a Wiltshire practice will be able to see a GP, Practice nurse or other health professional at a time which is most convenient for them.

From 1st October 2018, people will be able to pre-book routine appointments to see a GP, practice nurse or other health professional based at Wiltshire GP practices in the evenings from 6.30pm to 8pm, and at weekends and Bank Holidays. In total, an additional 235 hours per week of additional clinical time will be available to 100% of the Wiltshire population.

Dr Richard Sandford-Hill, Chairman of Wiltshire Clinical Commissioning Group, said:
“This is a Wiltshire-wide initiative, and means that patients who would like an evening appointment, or who need to be seen by a GP at the weekend, can book appointments at a practice in their local area. The appointment offered may not be at your usual practice, but you will not have to travel very far for your appointment. It’s only through groups of GP practices collaborating together that we’ve been able to ensure all Wiltshire patients have this option”.

Appointment types will vary – some being face-to-face, some on the phone – and there will be a mixture of bookable and same-day appointments available across the week. Patients will be triaged to ensure they see the most appropriate healthcare professional who can best deal with their needs, so appointments may also be with a nurse practitioner or a practice nurse. Some appointments will be conducted over the phone, where appropriate.

Dr Lindsay Kinlin, who has led the Wiltshire initiative, said:
“Whatever your local area of Wiltshire, appointments will be offered as usual during the week, but you can be seen at any participating surgery during the evening or weekend. People can book a weekend or evening appointment by contacting their usual surgery during normal opening times. Your practice will explain the process, and ensure the booking is appropriate for your need. We will also request your consent to allow us to share your medical records with the practice where your appointment is due to be. More information is available on your usual GP surgery’s website”.
Dr Richard Sandford-Hill added:
“We will be providing access to primary care services during peak times of demand, including bank holidays and across the Christmas, New Year and Easter periods, but the key is to book through your normal GP surgery. This is not a walk-in service, and patients will only be seen if they have pre-booked their appointment or if they have been advised to see a GP by the 111 service and have been booked in”.

Know where to go for bank holiday health care

Wiltshire Clinical Commissioning Group is encouraging people in Wiltshire to know where to go in case they need to access healthcare advice and treatment over the bank holiday weekend.

To help with this, Wiltshire CCG has an easy to use ‘Around the clock healthcare’ leaflet that explains what services are available and when, and is downloadable from their website.

Dr Richard Sandford-Hill, Chair of Wiltshire Clinical Commissioning Group said,
“Bank holidays are extremely busy times for the NHS and we are asking people in Wiltshire to know where to go if they need to access our local health services.

“A&E departments are often thought of as the first port of call, but in many cases another service may be more appropriate such as NHS 111, minor injuries units or local pharmacy.

“Knowing where to go and when helps you and your family to access the right health care service at the right time and helps to keep the emergency services free for those patients who really need them.”

Healthcare services in Wiltshire
There are a number of healthcare services available around the clock in Wiltshire:

NHS 111 – available 24 hours a day, 365 days a year and calls are free from landlines and mobiles. It is staffed by a team of fully trained advisers, supported by experienced clinicians. Healthcare advice can be given over the telephone, or you may be directed to a local service if appropriate.

Pharmacists – are experts on medicines and how they work. They can also offer advice on common complaints such as coughs, insect bites, ear ache, aches and pains and other health issues and help to decide whether it’s necessary to see a doctor. Find your nearest pharmacy: https://beta.nhs.uk/find-a-pharmacy/

Minor Injuries Units – for patients with minor injuries such as sprains and strains, cuts, infected wounds and scalds. No appointments are required and they are led by qualified nurse practitioners. For opening times of Chippenham and Trowbridge MIUs visit http://www.wiltshireccg.nhs.uk/local-services/minor-injury-units

Salisbury walk-in centre – open from 6.30-10pm week days and 8am-8pm at weekends, including bank holidays. Run by a team of experienced doctors and nurses and operates on a first come first served basis, unless someone is acutely unwell and needs immediate attention. Visit www.salisburywalkincentre.co.uk for more information.

NHS Choices – the UK’s biggest health website offering thousands of articles, videos and tools, which are available 24/7.

For immediate life-threatening situations, serious injuries, loss of consciousness, chest pain or suspected stroke you should always call 999.

Change to the prescribing of over the counter medicines

Wiltshire Clinical Commissioning Group (CCG) is following new guidance set out by NHS England in March 2018, meaning that for 35 minor, short-term conditions, medicines that are available over the counter will no longer routinely be prescribed.

The guidance has been published following a period of national public consultation and recommends that over the counter medicines associated with minor, short-term conditions which get better by themselves, or can be self-treated by the patient, should no longer be available on NHS prescription.

Medicines under the guidance include treatments for coughs, colds, dandruff, mild cystitis, nappy rash, warts and verrucae, ear wax, head lice and mild dry skin.

In the year prior to June 2017 the NHS spent approximately £569million on prescription medicines, which could have been bought over the counter from a pharmacy or other retail outlet.

Dr Richard Sandford-Hill, Clinical Chair of Wiltshire CCG and GP at Market Lavington Surgery explains:
“It’s no secret that the NHS nationally is feeling the pressure of delivering healthcare services in the face of increasing patient demand and finite financial resources. In Wiltshire it’s no different, which is why as commissioners it’s important that we spend the money we have available in the most effective way that will benefit the most number of people.

“The cost of medicines to the NHS is significantly higher than those available to buy over the counter and because all licensed medicines are regulated by the Medicines and Health Regulatory Authority, they really are as good as your GP can prescribe.

“For this reason we are encouraging people to seek advice from a pharmacist and buy their medicines over the counter where they can.”

There are certain scenarios where certain patients should continue to have their treatments prescribed, including:

  • Patients prescribed an over the counter medicine for a long-term, or more complex condition or;
  • Where a clinician (doctor, nurse, pharmacist) considers that patient’s wellbeing could be affected due to health, mental health or significant social vulnerability.

Patients who contact their GP Practice to make an appointment regarding any of the 35 minor, short-term conditions may be advised by the receptionist to seek advice from a pharmacist instead.

Dr Sandford-Hill continues:
“By not routinely prescribing treatments for the 35 minor, short-term conditions and encouraging people to seek advice from a pharmacist and buy medicines over the counter where they can, means we will also free up valuable GP Practice appointments for those people who really need them.”
Alison Kidner, Community and Practice Pharmacist in Salisbury comments:
“It’s a wonderful opportunity to encourage patients to engage with their community pharmacy teams. Pharmacists are experts in medication and can provide health advice for our customers to help improve their health and wellbeing. The great thing about visiting your pharmacy is that you don’t need to make an appointment and many have a room where you can talk to the pharmacist in private. By visiting the pharmacy it means your GP’s time is freed up for those who really do need an appointment.

“We are all very aware of funding challenges to the NHS and by treating minor, short-term conditions ourselves where we can and by visiting a pharmacy for advice, we can help to save the NHS money. In many cases, the cost of buying a medicine from a pharmacy is cheaper than a prescription charge.”

For more information visit www.wiltshireccg.nhs.uk/over-the-counter

‘Stub it out’ – six months to go!

NHS sites and services across Bath and North East Somerset, Wiltshire and Swindon are preparing to become smoke free from 1 January 2019. 

In six months’ time staff, patients and visitors (including contractors and suppliers) will no longer be able to smoke anywhere on NHS sites, including the grounds and gardens or in vehicles and car parks.

All NHS providers across BaNES, Swindon and Wiltshire are committed to no tobacco use on site and many have already started to provide support to staff and patients to either stop smoking or manage their nicotine dependency while at work or during their stay in hospital.

Associate Director for Nursing and Quality at the Avon and Wiltshire Mental Health Partnership (AWP) NHS Trust, Alan Metherall, said: “Our trust became completely smoke free in November last year with all staff, service users, visitors and contractors no longer able to smoke or use tobacco products on any of our sites.

“We have focused on how best to support and assist our staff and service users to abstain from smoking and using tobacco products while at work or receiving treatment.

“Since the policy was introduced we have seen a number of positive outcomes. Many of our service users have been able to reduce the amount they smoke as well as their reliance on cigarettes during challenging periods. 

“We want to ensure that our staff and service users are as healthy as they possibly can be and we are training our staff to become Stop Smoking Practitioners so that they can support service users who wish to give up.

“In the coming months ahead we will be looking to work more closely with our community mental health teams to support all service users and to continue to support our inpatient services with their smoke free journey.”

Claire Radley, Director of People at the Royal United Hospitals Bath (RUH) NHS Foundation Trust said: “As a hospital, we have a responsibility to look after people’s health. Studies show 80% of second hand smoke is odourless and invisible, and those who breathe it are exposed to the same risks as smokers, including heart disease and cancers.

Going smokefree is the right thing to do to ensure those on our site are protected from second hand smoke.  We’re six months away from being completely smokefree, but our Healthy Choices Advisors are already in place and are busy supporting patients and staff, whether that’s providing help to quit smoking or ways to manage cravings whilst on site.”  

Charlie Revell, Health Improvement Practitioner at Salisbury District Hospital said: “The smoking cessation service for inpatients has received six times more patients than last year. As a result many more patients are consenting to follow up in the community by a factor of ten!”

Justin Wride, Health Improvement Service Manager, Virgin Care said: “A recent Smoke Free survey conducted by Virgin Care for the benefit of their colleagues, visitors, patients and suppliers reveals that 81% of people did not consider it acceptable to smoke on NHS sites “because of patients’ health” and “second hand smoke to patients” with most thinking it was a “good idea” and a “very positive step”. 

“We are now offering all our colleagues and patients stop smoking specialist support if they wish to quit and are regularly promoting the benefits of stopping smoking through social media, via team meetings, on-site promotional work and other internal communications. We believe this is a really important step to ensure that our sites are healthy environments for people to work in and to visit.

“For the six-month countdown we have really stepped up our social media and internal communications to ensure that everyone is aware of the Smoke free ‘Go-live’ date on the 1January 2019. It is really important to us that everyone feels supported and ready for this positive change.”    

The decision to become completely smoke free is in line with The Health Act (2006) and The National Institute for Health and Care Excellence (NICE 2013) guidelines which state that all hospital sites, including mental health hospitals, and sites where NHS services are provided, should be 100% smoke free.

Kevin McNamara, Director of Strategy and Community Services, Great Western Hospitals NHS Foundation Trust said: “The Smoke Free campaign is an excellent tool to highlight the benefits of stopping smoking and the importance of reducing the impact it has on health and the NHS.

“While the number of smokers has been declining, it still remains one of the leading causes of premature death in the UK. Stopping smoking not only saves lives, but also saves the NHS money too.”

For staff, patients and visitors who want to stop smoking before Tuesday 1 January 2019:

  • A range of information and support on how to stop smoking is available at nhs.uk/smokefree
  • Face to face advice on Nicotine Replacement Therapy (NRT) and or E-cigarettes is available from your local pharmacy, your GP surgery and local stop smoking services.

Northlands Surgery nominated for Surgery of the Year award!

Northlands Surgery in Calne is one of 81 practices nationwide that has been nominated for The People’s Choice Award: Surgery of the Year, as part of the national General Practice Awards for 2018.

‘Surgery of the Year’ has been added as a new award for 2018 and offers the general public the chance to give their thanks and show appreciation for their local healthcare team.

Alison Ingham, Practice Manager at Northlands Surgery comments, “It is an absolute thrill that Northlands has been nominated for this prestigious award. Everyone in the Practice Team works tirelessly to provide outstanding care for our patients and I think it is wonderful for our staff to have been recognised in this way.”

Voting is now open and people have until 10 August 2018 to show their support for Northlands Surgery in one of two ways:

The final three shortlisted surgeries will be announced on 3 September and will be invited to attend this year’s Awards Event, which takes place on 30 November in London.

The General Practice Awards are an annual celebration of the hard work, innovation, and dedication taking place in primary care across the UK, showcasing the very best projects, teams, and leaders and sharing in achievements.

A full list of the awards and nominees can be found at www.generalpracticeawards.com

New dads in Wiltshire, B&NES and Swindon get support in the early weeks of fatherhood with the launch of mobile app

A new app, aimed at new dads in the Wiltshire, BANES and Swindon area, is to be launched this week. The “DadPad” app is a new easy-to-use resource to support dads in the early days and weeks following the birth of their child. DadPad contains practical information on topics including advice on how to change nappies, what to know about breastfeeding, support with bottle feeding and how babies like to be held. The aim of the app is to support dads across B&NES, Swindon and Wiltshire to enjoy their new babies and feel more confident about fatherhood.

Lucy Baker, Programme Director for Maternity the B&NES, Swindon and Wiltshire Maternity Transformation Partnership said:
“We’ve had loads of conversations with dads, who have told us that they want information on how to care for their new babies, so that they can be more involved right from the start. The DadPad has practical advice which dads can access quickly and easily to help support them in caring for their newborn.”

The DadPad app is also designed to help prepare dads-to-be before the birth of their baby, and can be used as a quick reference tool after their baby is born.

Jerry Wickham, Wiltshire Council Cabinet Member for Adult Social Care, Public Health and Public Protection, said:”As a dad and granddad myself, I know from personal experience that this app will really help new dads. It’s user-friendly and full of hints and tips to help new dads truly enjoy the experience of fatherhood and to offer them reassurance and support – particularly in those early weeks and months.”

The DadPad was previously launched in Wiltshire as an online and printed leaflet. It is now available in an updated version as a free to download app. Visit the DadPad website to download the app: www.thedadpad.co.uk/app

CQC states that people receiving health and social care services in Wiltshire are safe

A recent and detailed review of Wiltshire’s health and social care system has found that people receiving services in the county are safe.

The Care Quality Commission is carrying out targeted reviews of health and social care in local authority areas and Wiltshire was visited on 20/21 February and 12-16 March 2018.

The review, which was coordinated by Wiltshire Council and NHS Wiltshire Clinical Commissioning Group (CCG), also included extensive data and evidence gathering from key partners in the local adult health and social care sectors. All partners involved provided information and evidence of what it’s like to receive care in Wiltshire.

The CQC focused on five main questions in relation to service provision and the impact on users:

  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people’s needs?
  • Are they well led?

The final review published today (14 June) recognises the hard work and effort already being done by all partners to improve the care and support for Wiltshire residents, and provides useful insight into the areas where we acknowledge we must do more to improve for people in Wiltshire. Positive aspects outlined by the CQC include:

  • Those who needed care and support were judged to be safe.
  • The review found that there was a positive and proactive programme for the transformation of adult social care particularly around prevention, reablement and safeguarding.
  • Integrated discharge teams in the hospitals worked effectively to define the pathway of care out of hospital and to begin that process.
  • There was effective inter-agency working between the Voluntary, Community and Social Enterprise (VCSE) sector and hospital services in emergency departments to help people to avoid admission and return home safely.
  • People were supported to stay safely at home for as long as possible through the work of GPs and care coordinators.
  • There were systems in place to identify people who were frail or who were at risk of deterioration in their health or social situation.
  • GPs were key in supporting people to stay safe.
  • People were able to access a number of services in the community to prevent social isolation and when they came into contact with services through their GPs there was good support from them to access other services and sign-posting. They were helped to stay well at home for as long as possible.
  • Avoidable admissions to hospital from care homes in Wiltshire were low compared to similar areas and the England average, and significantly lower with regard to admissions resulting from pneumonia.
  • Frontline staff who provide care were recognised by reviewers for their commitment to achieving the best outcomes for people and being genuinely caring in their approach.
  • Staff who supported people living in Wiltshire were caring in their approach. There was a clear will to put the person at the heart of services.
  • There were systems and processes in place to ensure that people in crisis were supported through the health service.
  • People using hospital services and their loved ones were treated with dignity and respect.
  • People who were in crisis could access support from a variety of settings, and this was provided in a timely way. Wiltshire performed better than the England average in preventing admissions to hospital for common clinical conditions.
  • There were systems and processes in place to ensure that the transition between health and social care prevented any avoidable harm.
  • Acute hospitals were focused on promoting early discharges.
  • There was effective partnership working to ensure that people were discharged from hospitals safely.
  • People’s needs and choices were considered at all stages when planning their return home.
  • All services were focused on improving flow through hospitals and care, with systems being designed and redesigned according to activity and performance.
  • All services had the right skills to support the effective transition of people between health and social care.

With regard to the areas for improvement or where things need to be done differently, we have already produced a detailed action plan, and a single overarching strategy will be produced to address the following areas:

  • Continuing the programme of work to transform adult social care services
  • Adopting national best practice and reviewing the Better Care Plan and will be adding some new initiatives that have been successful across the country
  • A commitment to introduce additional Local Area Coordinators in Wiltshire by early Autumn, to support communities
  • We continue to see the number of people who are medically fit to leave hospital, and the numbers of those people who are experiencing delays in getting home, is reducing
  • Changes are being made which mean that the professionals who are the first point of contact to services are working together better to look at how people return home
  • Creating a provider led Integrated Programme Board to review and improve the post hospital discharge pathways to include Homefirst and Reablement
  • Simplifying our current complex governance structures
Jerry Wickham, Wiltshire Council cabinet member for adult social care, public health and public protection, said:
“We welcome the findings of the review and we are extremely pleased that the services we provide in Wiltshire were found to be safe.

“Given the challenge for the care and health sector this is something that is good to hear and their overall feedback and fresh perspective has been welcome and has already helped to guide improvement in our partnership working and the services we provide for residents.

“The CQC’s findings are very much in line with our own assessment of the local system and how it works, and, most importantly where further improvement can be made.

“Much of this work is already underway as we continue to work towards our long-held vision and priority to integrate health and social care. Our shared focus is to continue to develop services so that people in Wiltshire receive the best care available.”

Dr Richard Sandford-Hill, Chairman at Wiltshire CCG said:
“This is a comprehensive and realistic report and we are grateful to our staff and colleagues for their input to it. We are of course pleased that our services are considered to be safe, but we also acknowledge we still have much to do to improve our joint services on behalf of Wiltshire people. The report shines a light on those things that we need to do better or differently and has prompted us to re-energise our efforts. We are fully committed to working closely with all of our health and care partners across Wiltshire, with renewed vigour, to provide safe, high quality and seamless services for our residents.”

As this was a review, and not an inspection, the system isn’t subject to any overall grading or mark, but a detailed assessment on how it works has been provided.

The full report will be published  at www.cqc.org.uk.

Have your say on a new approach to gluten-free prescribing

Wiltshire Clinical Commissioning Group (CCG) is reviewing its policy on prescribing gluten-free foods in line with national guidance and is encouraging Wiltshire patients, the public and clinicians to have their say on two proposed options.

The review follows a national public consultation in 2017 by the Department of Health and Social Care (DHSC) on the ‘Availability of gluten-free foods on NHS Prescription’ and the resulting guidance announced in February 2018 to restrict gluten-free foods to bread and mixes only – although this does not affect a CCG’s statutory authority to determine its approach at a local level.

Gluten-free prescribing began in the 1960s when no gluten-free foods or products were readily available. Today gluten-free foods are found in most supermarkets, shops and many cafes – including in Wiltshire – and competition has driven pricing down meaning they are affordable dietary alternatives.

Wiltshire CCG has a duty to ensure that the funds it has available for prescribing are spent in a way that benefits most patients. Between 1 April 2017 and 31 March 2018 it spent £241,487 on products such as gluten-free bread, pasta and pizza bases, items which are now readily available and competitively priced. Wiltshire is also the highest prescribing CCG in England of Juvela gluten-free bread and bread mix.

Dr Richard Sandford-Hill, Chair of Wiltshire CCG explains,
“The two options proposed are to stop prescribing all gluten-free foods in primary care, or to restrict prescribing to bread and mixes only for those patients with a diagnosis of coeliac disease and/or dermatitis herpetiformis up to the age of 18 years.

“While these proposals will reduce the amount of staple gluten-free foods available on prescription in Wiltshire, it will not affect the vital help and support available to patients diagnosed with coeliac disease and/or dermatitis herpetiformis via their GP or dietician.

“There is also no strong clinical evidence that patients who receive gluten-free food on prescription are more likely to comply with a gluten-free diet, or have better health outcomes than those who do not.”

Patients, the public and clinicians in Wiltshire are encouraged to have their say on the proposed options via a short survey available at www.wiltshireccg.nhs.uk. The survey is open until 22 July 2018.

Findings from the survey will inform the future prescribing of gluten-free foods in Wiltshire.

Wiltshire Dying Well Community Charter

Wiltshire Clinical Commissioning Group has launched its ‘Wiltshire Dying Well Community Charter’ to coincide with Dying Matters Awareness week (14-20 May) and is appealing to local companies and organisations to sign up to the charter and make a commitment to support their staff towards the end of their life. 

The Charter encourages a community-wide approach to support people who are affected by dying, and identifies simple steps employers can take to demonstrate their commitment to supporting their staff and their loved ones.

Dr Helen Osborn, GP at Courtyard Surgery in Lavington and Wiltshire End of Life Programme Board member explains, “The Charter has been developed to help bring greater understanding of the problems faced by working people who have been diagnosed with a life-limiting illness, or who care for people who are approaching the end of their lives.”

Signing up to the Charter is easy and doesn’t cost anything. Businesses are simply asked to commit to demonstrating their support for the Charter by signposting employees, volunteers or students to additional support resources and embedding supportive practices within their organisations for people who are affected.

Helen added, “The Charter will help local businesses ensure they have the best possible resources for their workforce and show that they are committed to supporting their employees who may be trying to balance their work commitments with the difficulties they face at home.”

The Charter is led by the National Council for Palliative Care and its ideas and commitments were recognised by many local organisations who came together to look at how we could create a Wiltshire Charter. Organisations involved in the original development of the Charter and who have already signed up to supporting their staff are: Dorothy House Hospice Care, Great Western Hospitals NHS Foundation Trust, Healthwatch Wiltshire, Prospect Hospice, Public Health Wiltshire, Royal United Hospitals Bath NHS Foundation Trust, Salisbury Hospice Charity, Salisbury NHS Foundation Trust, Wiltshire Clinical Commissioning Group and Wiltshire Health and Care.

The Wiltshire Dying Well Community Charter was developed in 2017 after consulting with local people about the Wiltshire End of Life Care Strategy.

Wiltshire Dying Well Community Charter, visit www.wiltshireccg.nhs.uk or email wiltshire.dyingwell@nhs.net.

Funding available for delivering a ‘step change’ in positive mental health and wellbeing within Wiltshire

NHS Wiltshire Clinical Commissioning Group is inviting bids from all stakeholders, including the voluntary and third sector, of up to £50,000 for delivering a ‘step change’ in positive mental health and wellbeing within Wiltshire.

Ted Wilson, Director of Community Services and Joint Commissioning for NHS Wiltshire Clinical Commissioning Group said,
“We are pleased to be able to offer these non-recurrent funds to support initiatives that aim to enable people to be more positive and confident about their mental health. We hope that the success of these initiatives will be a catalyst for future collaboration and support.”

Wiltshire CCG is aspiring to fund a number of different community based initiatives that support national and local priorities of increased focus on prevention and keeping well. Proposals for the funding could be smaller bids in a defined area of the county to larger multi-agency bids that cover the whole of Wiltshire, if agencies want to work together to apply collaboratively. 

Bids are welcome from those with an interest in delivering services where they are able to:

  • Develop and model a responsive preventative approach to mental health
  • Build on community resilience where individuals see themselves as part of a mutually beneficial collective, which aims to improve personal wellbeing through social interaction and inclusion
  • Encourage joint working and collaboration across agencies delivering services
  • Demonstrate an innovative and scalable approach to community based care that promotes independence
  • Be able to demonstrate benefits in 1 year

Applications will need to demonstrate how funds will be used to deliver the project and the bid also need to fully describe the expected outcomes.

Proposals for the funding should be made using the application form which can be downloaded from www.wiltshireccg.nhs.uk. The closing date for submission is 5pm on Friday 15 June 2018.

All proposals will be reviewed by an expert panel, including commissioning and GP leads and people with experience of mental health issues.  Successful applicants will be informed by 30 June 2018.

Stay safe in the sun

Summer’s almost here and with temperatures starting to soar, Wiltshire Clinical Commissioning Group and Wiltshire Council are supporting Sun Awareness Week (14-20 May) by offering advice to people in Wiltshire on how to stay safe in the sun.

Many of us enjoy spending time in the sun, but you can burn when you least expect it. Sitting in the garden, walking the dog or going for a run are just a few activities where you can be caught off guard.

Dr Richard Sandford-Hill, GP at Market Lavington Surgery and Chair of Wiltshire Clinical Commissioning Group, said:
“Although a moderate amount of sun exposure is recommended because it provides essential vitamin D, too much sun can be damaging. Don’t forget; you can still burn if it’s cloudy or overcast and while sunburn is usually short-lived and mild, it’s important to take precautions to avoid it because it can increase the chances of developing skin cancer later in life.”

How to protect yourself from sunburn

You can help safeguard your skin from the harmful effects of the sun by following these simple steps.

  • Cover up when you are out in the sun – wear loose clothing and a wide-brimmed hat to protect as much skin as possible and protect your eyes with sunglasses that block at least 99% of UV light.
  • Use a sunscreen with an SPF of 30 or higher and at least 4-star UVA protection and reapply every 2 hours and after swimming.
  • Seek shade and limit your direct exposure to the sun, especially between 11am and 3pm when UV rays are at their strongest.
  • Avoid tanning beds and sunlamps – both cause serious long-term damage and contribute to skin cancer.
Dr Sandford-Hill added:
“It’s important to enjoy the sun safely by keeping hydrated and when you are out remember to carry a hat, sunscreen and sunglasses with you for protecting yourselves from the sun’s harmful rays.”
Jerry Wickham, Wiltshire Council cabinet member for public health said:
“Wiltshire in the sunshine is glorious and we want people to enjoy it, but it can be easy to underestimate the strength of the sun when you’re outside, and you may not realise you are getting burnt.  If you feel you have sunburn, you should get out of the sun as soon as possible by heading indoors or into a shady area.”

What to do if you have sunburn

If you do have minor sunburn, you can treat this at home by cooling the skin down by having a cold bath or shower and then applying soothing after sun or calamine lotion to moisturise your skin.  You could also visit your local pharmacy for advice on treatment to help ease your symptoms and reduce inflammation.

Drinking plenty of fluids, will help cool you down and prevent you from getting dehydrated, and painkillers such as ibuprofen or paracetamol will help relieve any pain.

If you start to feel unwell or have any concerns about your sunburn, particularly if you are burnt over a large area, have blistering or swelling of the skin, chills, dizziness, sickness or a high temperature of 38c or above, call NHS 111 – they are available 24 hours a day, seven days a week.

If you notice any changes to your skin after being out in the sun, including a new mole, growth or lump or you have any moles or freckles that have changed in size, shape or colour, you should go and get them seen by your GP.  Skin cancer is much easier to treat if it’s found early.

For further information on how to keep safe in the sun, visit: www.wiltshireccg.nhs.uk