NEWSLETTER FOR THE GENERAL PRACTICE LINK OFFICE
JANUARY 1998 ISSUE 45
CONTENTS
JOIN IN THE CELEBRATIONS AND TAKE PART IN CROYDON CARNIVAL
As you are no doubt aware, 1998 sees the celebration of the 50th Anniversary of the NHS. However, you may not be aware that this year's Croydon Carnival on 4 July 1998 will follow this theme, and all NHS organisations in Croydon will be taking part. We hope to get as many and as wide a variety of floats as possible. So come on! Let your hair down and join in the fun! Ideas for floats and volunteers to man the floats and the stands at Lloyd Park after the procession would be welcomed. It is hoped that Croydon Health Authority, Bethlem and Maudsley, Croydon Community Health and Mayday will provide at least two floats, with Croydon Community Health Council providing one. Also, we hope that primary care practitioners will also get together and man at least one float. Anyone interested in taking part, should contact their representative on the NHS 50th Anniversary steering group.
These representatives are as follows:
Andrew Davies, Croydon Health Authority Tel No:0181-401 3976
Angela Walker, Croydon Community Health Trust Tel No: 0181-680 2008 Ext. 207
Emma Rayment, Croydon Mental Health Services Tel No: 01883-622101
Peter Walsh, Croydon Community Health Council Tel No: 0181-680 1503
Natalie Hyde, Mayday Healthcare NHS Trust Tel No: 0181-401 3627
JOIN IN THE FUN!
UPDATE ON MAYDAY CARDIOLOGY SERVICE
GP OPEN ACCESS ECG SERVICE
We shall, in future, be sending you the ECG with the report as other centres do. We ask that you keep it in accordance with the EEC legal requirements on the maintenance of medical records and include it with any referral to the Cardiologists.
COMMUNITY ECHO SERVICE
We have, unfortunately, run into some considerable difficulties with this scheme. Bristol Myers had been providing major support with some running costs and loan of the equipment, enabling us to offer the service free of charge. They are now no longer able to continue this, so for the present, neither are we. We are committed to providing you with an echo service but, as yet, are not sure what form this will take. Please bear with us while we work on it - we'll be in touch as soon as we can.
Mayday Cardiology
Last year saw a continuation of the education programme. Approximately 60% of practice nurses have now attended the basic course and update study days and these are set to continue into 1998. Last year's audit showed an improvement in healing rates of leg ulcers but highlighted that reoccurrence was the same as the National figures (67%). In order to address this, the Practice Nurses, District Nurses, Nursing Home Nurses and Course Facilitators have worked together to design a leaflet for patients which should be available during this year. The education programme continues to go from strength to strength. A wound formularly has been put together for use in the community and should be available in the early part of this year. It is hoped that this will consolidate the education nurses have received and enhance their practice. Lastly thank you to all the Leg Ulcer Link Nurses and their practices for their help in 1997. Many of these nurses are attending other practices to provide technical support, which we know has been greatly appreciated.
Locality Development Nurses
TRAVEL HEALTH UPDATE OF DISEASES
CHOLERA
There has been a resurgence of Cholera world- wide. It has swept through Latin America after an absence of one hundred years. Cholera in international travellers has also seen a resurgence, with outbreaks on flights and increases in returned travellers world wide.
FISH POISONING ALERT IN HAWAII
Travellers are advised to avoid eating sturgeon fish known as kole locally, as people have become ill with poisoning.
DISEASE OUTBREAKS
Central America - Dengue fever
Costa Rica - Dengue fever
Cuba - Dengue fever
Venezuela - Dengue fever and cholera
Chad - Meningitis
Rwanda - Cholera
This information has been taken in part from Traveller-World Wide Health Information and brought to you by the Practice Nurse Group Committee.
Out of the hundred child deaths occurring each year in Britain from Child Abuse, one third will have a history of living in a violent household. Violence is an underestimated problem in our community and is the cause of much ill health both in adults and children.
Croydon now has a ONE STOP advice centre for vulnerable people in Ambassador House (opposite Thornton Heath BR station). It is a multi agency venture and is staffed not only by police but by professionals from other agencies able to give housing and legal advice and other support. Clients will include people experiencing Domestic Violence, Elder Abuse, Racial harassment and Anti-Gay Attacks.
Opening hours: Tuesday and Thursday 10am to 6pm
Telephone No: 0181-649 1707
Facilities for children are available and there is disabled access
Briony Ladbury Child Protection Adviser - Croydon Health Authority
CROYDON PRESCRIBING LIAISON GROUP
Croydon Prescribing Liaison Group (CPLG) was set up as an advisory group to Croydon Health Authority and others in late 1994 as a result of the Department of Health's guidance EL(94)72 - Purchasing and Prescribing.
This guidance asked "purchasers" to develop and agree strategies for improving the cost effectiveness of prescribing across the primary/secondary care interface. Particularly ensuring the appropriateness of hospital-led prescribing and developing a policy for the managed entry of new drugs into the NHS. The terms of reference of CPLG address these issues, but the group also aims to promote good prescribing practice.
Membership of CPLG includes
the Director of Public Health (Chairman).
Pharmaceutical Adviser
Director of Acute Commissioning
three GPs (two LMC nominees, one fundholder representative)
three hospital consultants (two from Mayday, one from Croydon Mental Health Unit)
two Chief Pharmacists (one from Mayday, one from Croydon Mental Health Unit)
a community pharmacist
and a clinical pharmacologist.
The group advises on Croydon Health's Interface Prescribing Policy, which is included in our contract with Mayday, has issued guidance to GPs for Accepting Shared Care and has developed a policy for the Managed Entry of New Drugs into Croydon.
Copies of these policies are available from Helen Marlow, Pharmaceutical Adviser at Croydon Health.
NEW DRUGS
The CPLG considers new drugs that are new in their class or are likely to have a significant impact on primary or secondary care. An independent review of the evidence for a new drug is considered, and advice taken from local specialists, CPLG may then give advice to Croydon Health, GPs or Trusts on how the new drug should be used. Copies of the independent reviews on new drugs considered by CPLG are available from Helen Marlow, Pharmaceutical Adviser at Croydon Health.
A summary of advice issued by CPLG on new drugs is included below:-
| DRUG NAME | ADVICE | DATE |
| Beta-interferon l a (Betaferon) | GPs advised not to prescribe, Dr Schon to undertake prescribing | Dec 95 |
| Insulin lispro (Humalog) | Insufficient evidence to support use over existing therapy at present | June 96 |
| Mycophenolate mofetil (Cellcept) | Discuss with transplant centres | June 96 |
| Riluzole (Rilutek) | GPs advised not to initiate prescribing. Dr Schon to undertake prescribing | Sept 96 |
| Meloxicam (Mobic) | Prescribers are advised to continue prescribing NSAIDs based on the following principles: Ibuprofen should be used first line, it is still the safest NSAID | Sept 96 |
| Budesonide (Entocort CR) | Not recommended for general use, use in carefully selected patients | Sept 96 |
| Somatropin (Genotropin Humatrope) in adults | Insufficient evidence to support use outside existing clinical trials | Sept 96 |
| Olanzapine (Zyprexa) | Should be initiated by a psychiatrist, GPs can prescribe under shared care arrangements. Criteria for use being agreed with psychiatrists | Dec 96 |
| Sertindole (Serdolect) | Should be initiated by a psychiatrist, GPs can prescribe under shared care arrangements. Criteria for use being agreed with psychiatrists | Dec 96 |
| Toremifene (Fareston) | Insufficient evidence to support use over existing therapy at present | Feb 97 |
| Omeprazole (Losec) for prevention of NSAID-induced peptic ulceration | Insufficient evidence to support use over existing therapy at present. Misoprostol should still be used as a first line gastroduodenal protectant | May 97 |
| Didronel PMO for treatment of osteoporosis and prevention of bone loss in post-menopausal women and corticosteroid induced osteoporosis | GPs advised that can be prescribed for treatment of non-vertebral osteoporosis and corticosteroid induced osteoporosis, but insufficient evidence to support its widespread use in prevention of osteoporosis, HRT should be used fist line | July 97 |
| Dermagraft (artificial skin replacement for diabetic foot ulcers) | Insufficient evidence to support use over existing therapy at present. Review evidence in 12 months time | Nov 97 |
| Quetiapine (Seroquel) | Should be initiated by a psychiatrist, GPs can prescribe under shared care arrangements. Criteria for use being agreed with psychiatrists. | Nov 97 |
Helen Marlow, Pharmaceutical Adviser, Croydon Health Authority
May I take this opportunity to introduce myself to you all? I am your new prescribing adviser, Vikki Williams, replacing Susan Grieve. My previous post was drug information pharmacist for Bromley Hospitals NHS Trust where I worked for six years. I am based at Knollys House, working on Mondays, Tuesdays and Wednesdays, and can be contacted on 0181-401 3900 ext. 5985. I will be working with Helen Marlow on areas such as PACT analysis, practice formularies and the prescribing incentive scheme.
I look forward to meeting you all individually (eventually!!) and in the meantime wish you a very Happy New Year.
A51 SPECIALIST PRACTITIONER - GENERAL PRACTICE NURSING
Congratulations to the following practice nurses who were amongst the first to achieve the ENB A51 by portfolio assessment at Croydon College.
| Zoe Beaumont | Janette Swift |
| Carrie Hyde | Lisa Eve |
| Karen Bloxam | Amanda Waite |
| Glynis Lovelock | Carole Hartley |
| Sally Brzezicki | Sally Walters |
| Jenny McDonough | Jane Hull |
| Rosalind Ching-a- Sue |
Well done to everybody involved in achieving higher targets during 1997. All but four practices are now meeting the 90% target for primary immunisation. May we take this opportunity to remind practices to continue sending the pink forms to the Community Trust as this is important for provision of national data .
Locality Development Nurses
The GPLO does not necessarily endorse or support any of
the positions, products or people advertised herein
PRACTICE MANAGER required asap for 3-doctor practice Kent/SE London border. AMSPAR
desirable. Computer literate. Accounts and general practice experience essential. Hours
negotiable (P/T). Apply in writing with CV to Practice Manager, 33 Croydon Road, Penge,
London SE20 7TJ. Tel. 0181-778 5135.
VACANCY FOR A PART TIME CLERK/RECEPTIONIST - 4 HOURS PER DAY Monday - Friday. Morning and Evenings - negotiable. This busy practice needs a competent computer literate, reliable person to assure responsibility for all duties. Ability to work as part of a team essential. Salary will be negotiated. Please write with CV to the Practice Manager at Mersham Medical Centre, 30 Norbury Road, Thornton Heath, Croydon CR7 8JN.
PRACTICE NURSE required for Coulsdon Surgery. 11 hours per week.
RECEPTIONIST required. Contact Practice Manager Sue Douglas on 0181- 660 0193 for details.
PRACTICE NURSE required for Thornton Heath practice, Three evenings plus one morning. Rate of pay "F" grade plus London Weighting. For details please ring 0181- 684 1174.