CONTENTS:
The Doctor as a patient... - A grateful GP
A year in the Life... - Gill Vincent-Clayden
"In the Pipeline" - Practice Nurse Group Committee
Clinical Articles:
Cholera - Practice Nurse Group committee
CHOLERA
...Is a bacterial bowel infection. Acute diarrhoea follows infection which can lead to severe dehydration. Cholera is caught by eating contaminated food and drinking contaminated water.
Cholera is an uncommon intestinal infection which presents as acute diarrhoea. Although the disease is endemic in many tropical regions, the risk to the traveller is very low. The diarrhoea is effectively managed with Oral Rehydration Therapy. If fluid losses are replaced the disease rapidly resolves.
Vaccine provides minimal protection against cholera. Prevention is by paying attention to food and water hygiene.
This information taken in part from Traveller-Worldwide Health Information
Presented to you by the Practice Nurse Group committee.
GP DEVELOPMENT CENTRE
I recently participated in a "Development Centre" Workshop with my GP colleagues from the Education Board. Six of us spent two days at Coulsdon Manor with three facilitators from the Salamon Centre in Tunbridge Wells, and took part in an intensive programme talking about ourselves! A big change from a routine day in the surgery. We took part in exercises to demonstrate core competencies in General Practice, including communication, leadership and reading vast amounts of paper very quickly. Psychometric exercises proved extremely interesting and the opportunity to talk alone to a skilled stranger about oneself was a chance to reflect on many aspects of life both personal and work related.
Feedback on the second day made clear many issues which were raised earlier and group discussions and support were essential between all of us who participated.
Some doctors in New Addington have since taken part in the "Development Centre" Workshop and ten places remain. Future dates for further workshops will be announced. If you would like to participate in a workshop, please let us know by return. Any colleagues who have previously attended a "Development Centre" would be pleased to talk to you about their experiences and I will put you in touch.
Dr Alex Trompetas GP Tutor On behalf of the Education Board
THE DOCTOR AS A PATIENT OR A VIEW FROM BEHIND?
I was once told as a medical student by a down to earth consultant that being a patient and experiencing some of the procedures we inflict on patients will make us better doctors. And I now have to admit he was correct in his advice. After a six weeks history of change of bowel habit following my summer holidays, I was seen by a colorectal surgeon whose preliminary findings were negative. An amusing sentence which appeared in his letter to my GP which read: "Although today’s examination has excluded most of the organic causes, I feel for added safety and reassurance a colonoscopy is recommended so that hopefully he can put this behind him and get on with his work". The preparation consisted of two doses of laxative and plenty of clear fluids. And boy did they work well. It is imperative you are within yards of a loo as the word "urgency" dominates your day. By the time I had the examination I had been starved for 48 hours. The only miscalculation I made was thinking that Heinz Tomato Soup was acceptable, which it was not. The day of judgement came and dressed in a regulation hospital gown and a dressing gown (which would not be out of place in an Edwardian melodrama), I anxiously waited my turn in the Day Care Unit. I was soon on the couch with a butterfly in my hand. "Did your preparation go well?" questioned the specialist. "Yes" was my guilty reply (I didn’t wait to tell him about the soup). Soon I was given Pethidine and Midazolam IV and I remember nothing for the next 90 minutes (just as well!) My first memory was waking up in the recovery area with my dear wife and a helpful nurse by my side. I was soon tucking into toast and tea. I thought my little secret about the soup was safe but alas my wife was told I talked quite a lot throughout the procedure and had informed the surgeon of my mistake with the soup. If his view was obscured during the procedure then "Heinz sight is cloudy cloudy vision!"
A grateful GP
To all Croydon General Practitioners, Practice Managers and Practice Nurses
The Mayday Infertility Team now has a 24 hour on-call pager. This service is available for infertility patients and for professional support and advice. Out of office hours we can be paged by dialling 01523 523 523, ask for pager Mayday 2 and leave your contact telephone number. Your call will be returned by the doctor or nurse on call. During office hours we can still be contacted on 0181-401 3586. We hope you will find this service useful.
Mr Michael Booker Consultant Obstetrician and Gynaecologist Julie Tucker, Alison Lamb-Crawley & Terri Morgan Infertility Nurse Specialists
A YEAR IN THE LIFE OF... Gill Vincent-Clayden HV for the Elderly
Gill Vincent-Clayden, Croydon’s first Health Visitor to work specifically with elderly people, started work in Shirley just over a year ago. Here she reports on her progress so far:
"It has been an extremely interesting, challenging and enjoyable year, I now work half-time for nine GP practices in Shirley serving a population of more than 5,000 people aged 65 and over.
I have already received 160 referrals and made nearly 600 home visits. Most of the referrals are from the GPs but there is an increasing number from other members of the primary health care team and now more referrals from elderly people themselves.
I can bridge the gap for the isolated frail elderly person who perhaps doesn’t require social services or district nurses but needs someone to link up the health services to help maintain their independence and dignity at home. Often with minimal intervention, I can make a real difference to their quality of life by giving information, health education and promotion, and making referrals to other services.
In a short time a growing need for the service I offer has been highlighted. I am able to make a clinical assessment and have received such good support from the GPs, district nurses, social services and other members of the community team.
I have met some wonderful characters – including one gentleman with 27 clocks which all chime at the same time and a lady whose budgerigar always comes to my hand. One lady I visit told me her reason for getting up every morning was to check that Charlie her tortoise was OK ("…that is my life at 83") while another said my visits had made her house like a home again and given her the confidence to carry on rather than go into residential care.
The elderly people have taught me a lot and I am delighted and inspired by the job. My work has not increased GP workloads, rather it may have deflected some time away from the surgery on to my caseload. In many cases old people are loathed to ask for help and may be unaware of the services available. This need can be met professionally and efficiently using the HV skills of communication, liaison health education and promotion to support the elderly in the community".
CRISIS RESPONSE NURSING TEAM
The Crisis Response Nursing Team (CRNT) was formed to enhance the current Crisis Telephone Help Line Service; more importantly, it is an integral part of the existing Crisis Response ;Service within Croydon.
The aim of the team is to provide a seamless service to those experiencing a crisis affecting their mental health. The team will work closely with other crisis services in Croydon. Hence it is important that this service is viewed as a segment of the whole crisis service within Croydon and not an independent entity.
To date, an operational policy has been formulated and agreed upon subject to minor changes. All five members of the team are in post. They undertook an initial two week training course together with representatives from the CMHTs. Follow-up sessions consist of two study days per month until March 1998.
The telephone Help Line will be staffed by personnel who are trained and experienced in telephone counselling. A shortlist for potential candidates is out and interviews are scheduled for October. Successful candidates will undertake a training course prior to commencement of duties, which is likely to be in December. In the meantime the Help Line will continue to operate as it is.
The team is actively promoting its service through presentations, distribution of leaflets and an advert in Croydon Health Promotion which will be displayed in public places in Croydon e.g. Health Centres and delivered to 14,000 households in the Croydon area.
The team will be operational from 5 October 1997.
For further information and arrangements for presentations about the service please contact:-
Marcella Hand (Team Leader) Westways 49 St James Road Croydon
Telephone:- 0181-700 8500/8542.
GUIDELINES FOR DISTRICT NURSE GIVING INFLUENZA VACCINATION AT HOME
New guidelines launched this winter aims to ensure the safe administration of the influenza vaccine to clients at home. The authorisation form included in the pack or an equivalent must be completed and signed by the General Practitioner. It is understood that Influenza Vaccination is undertaken by the District Nurses for clients on their existing caseload. On discussion with the G.P., other clients can be visited for Flu-Vac at the discretion of the D.N.
This system guarantees that written permission is given by the G.P. before the vaccination procedure is carried out by the District Nursing Team. Thank you for your continued co-operation.
D.N. Quality Group Croydon Community Health Trust
LINK NEWS CLASSIFIED
The GPLO does not necessarily endorse or support any of the positions, products or people advertised herein
Practice Nurse required to undertake General Nurse duties, 15 hours per week. Experience required in Cytology and Immunisation as well. For further information apply in writing with CV to Practice Manager, 21b South Norwood Hill, London SE25 6AA. Telephone number 0181-653 0635.
Working Together The LMC and the Health Authority have agreed to a programme of enhanced communication with practices and would like to hear from GPs who would be willing to invite Croydon Health Authority personnel into their Practice for an informal exchange of ideas, and an opportunity to see Primary Care from the "sharp end". The same opportunities are available for Practice Staff to spend time in the Health Authority.
If you would be interested in participating in this new venture, please contact Lorna ( 018-401 3990 who will help arrange times and dates.
"IN THE PIPELINE"
This is a regular feature which we hope to run in Link News to "shower" you with information about pending projects in and around Croydon.
Quality Assurance – Near Patient Testing (Blood Glucose Monitoring) Medico – legally we are responsible for any equipment we use and the results that are issued from the equipment. We must also be trained to a competent level to use the equipment and understand the correct action to take with the results. The General Practice Link Office, (GPLO) in conjunction with Dr Paul Collinson, Consultant Chemical Pathologist will be initiating a scheme for quality assurance testing of blood glucose monitors used currently in General Practice. A test kit will be sent out to all General Practices every quarter. The test kit consists of a serum which we will use on our blood glucose monitors. The results we obtain will be sent back to the GPLO and then by us on to Chemical Pathology. Chemical Pathology will then let us know if the results are accurate. The GPLO will follow up any inaccurate results/non returned tests and offer help/advice where appropriate.
This information is brought to you via the Practice Nurse Group Committee