GP News is your monthly source of information about Ashford and St. Peter's

In this month's edition:

Trust to Provide Lucentis Treatment for Wet ARMD

Trust Welcomes Two New Respiratory Medicine Consultants

Tackling Early Problems with New Surrey Pathology Service

Dates for Your Diary

New GP Relationship Manager

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Ashford and St. Peter’s Hospitals NHS Foundation Trust Ophthalmology Department have introduced a new service for the treatment of wet ARMD, based at Ashford Hospital. The service aims to treat patients within the current guidelines (patients to be seen within 9 days of referral) and is run by Mr Roger Wong, Consultant Ophthalmologist, with the assistance of two experienced staff grade doctors and a dedicated team of ophthalmic trained nursing staff. Within NHS Surrey and NHS Hounslow, referrals can be made directly from certified optometrists and GP Practices, although this may not be the case amongst other PCTs or CCGs. Referrals can be made either by fax to 01784 884350 or by using Choose and Book. Search under the service of ”Ophthalmology” and clinic type ”Other Medical Retina”.

Wet ARMD (also called neovascular or exudative ARMD) occurs in about 1 in 10 cases of ARMD and approximately 6 in 10 cases of intermediate/advanced ARMD are due to wet ARMD. It is likely to cause severe visual loss over quite a short time - sometimes just months. Very occasionally, if there is a bleed (haemorrhage) from a new blood vessel, this visual loss can occur suddenly, within hours or days. In wet ARMD, in addition to the retinal pigment cells degenerating, new tiny blood vessels grow from the blood vessels in the choroid and break through Bruch's membrane into the central part of the retina. These vessels are fragile and tend to leak blood and fluid. This can cause scarring in the macula, causing further vision loss.

In recent years, a group of drugs called anti-VEGF drugs have been developed. Vascular endothelial growth factor is a chemical that is involved in the formation of new blood vessels in the macula in people with wet ARMD. By blocking the action of this chemical, these drugs help to prevent the formation of the abnormal blood vessels that occur in wet ARMD. Anti-VEGF drugs are also called anti-angiogenic drugs - which means that they act against substances that promote new blood vessel growth.

Anti-VEGF drugs are an exciting new development in the treatment of wet ARMD.

Anti-VEGF drugs include ranibizumab (Lucentis®), pegaptanib (Macugen®), and bevacizumab (Avastin®). Others are being developed but due to the new technologies involved, these drugs are very expensive (estimated at between £2,000 and £9,000 per year per patient). The National Institute for Health and Clinical Excellence (NICE) appraised these therapies in August 2008 and gave approval to ranibizumab to be used in the treatment of wet ARMD.

Treatment is by fine needle injection directly into the vitreous humour of the eye every four weeks. Ranibizumab will improve vision in about 1 in 3 people treated. However, treatment in most people will maintain vision and prevent the condition from getting worse. About 1 person in every 10 treated, will not respond at all. Clinical (drug) trials to evaluate other anti-VEGF drugs are ongoing but currently they are not approved by NICE.

Dr Farzaneh Harraf (L) and Dr Melanie Irvin-Sellars (R)

Ashford and St Peter’s Hospitals NHS Foundation Trust has recently welcomed two new Specialist Consultants to join their respiratory service, adding additional resource and valuable experience to an already highly respected team. Both new consultants – Farzaneh Harraf and Melanie Irvin-Sellers who, coincidentally, completed their medical training at Leeds University, bring considerable talents and skills to complement the existing respiratory team working alongside Dr Paul Murray and Dr Michael Wood.

Part of their role will be to work with the emergency medical team to review respiratory patients who are admitted to hospital via the Medical Assessment Unit at St Peter’s Hospital, ensuring they receive specialist respiratory input. This will help to speed up assessment and treatment and ensure patients are discharged or moved to a specialist ward more quickly.

Melanie, who has recently relocated from Yorkshire to take up this new post, explains: ”This is about giving patients the very best service and care whilst they are in our hospital. Access to a specialist consultant opinion is clearly going to be extremely beneficial to each individual patient’s recovery. Recruiting two new consultants gives the team the opportunity to develop a really first-class service, both Farzaneh and I already have lots of ideas we want to contribute.”

Farzaneh and Melanie will work closely with the existing two consultants in providing high quality care for their patients and further developing the respiratory service. They hope to achieve this by supporting patients to stay out of hospital with new respiratory rapid access clinics aimed for patients who arrive in A&E with respiratory problems who don’t really need to be admitted to hospital.

Farzaneh, who joined the Trust in January from Kingston Hospital explains more: ”There are many patients presenting to A&E with respiratory problems who may need urgent attention but not admission .

We would aim to review these patients to facilitate discharge and early outpatient review. We are very excited to be part of a dynamic and expanding respiratory team at Ashford and St Peter’s NHS Foundation Trust. I am thrilled to be here and am looking forward to working closely with our GP colleagues, therapists and other healthcare providers to ensure delivery of high standards of care to our local population.”

Farzaneh, who lives in Esher with her family, also brings considerable research experience from both Kings’ College London and the UCLA (University of California and Los Angeles) and will continue to take an active role in research within the department. She will also lead TB (tuberculosis) services at the Trust.

Melanie, who has now settled in Woodham with her family, previously helped to set up a home oxygen service in Harrogate where she worked as a locum consultant, and is hoping to support a similar service locally. She also has a background in Medical Education in supporting doctors in training.

A new Surrey wide Pathology service has been set up as a joint venture between Frimley Park Hospital NHS Foundation Trust, Royal Surrey County Hospital NHS Foundation Trust & Ashford and St Peter’s Hospitals NHS Foundation Trust. This is being done as part of a national programme for the reconfiguration and consolidation of Pathology services in the UK.

Once fully implemented this new service will deliver a range of benefits for patients including greater availability of point-of-care testing and health screening, more rapid availability of results, more frequent collections of samples and better access to results and specialist clinical advice. By consolidating the three services it is also possible to share the costs of investing in new equipment which allow us to work in a much more automated way and which can therefore help us to meet the increasing demand for tests without a subsequent increase in costs.

There are risks inherent to any major project and as one of the first areas to implement this reconfiguration we have faced a significant number of challenges which we are working to resolve as quickly as possible. We regret that service quality has been temporarily affected and there have been a number of issues reported to us by GPs. We provide details below on some of the urgent actions that are being taken to address these.

We would like to apologise to GP staff and their patients for the inconvenience that has been caused and to thank you for your support and patience. Once the change is complete we believe you will see significant improvements with regard to efficiency and turnaround. In the meantime, we appreciate your feedback about any issues you may experience so that we can address them promptly. Please direct your comments to Lesley Landucci, Support Services General Manager, Surrey Pathology Services (Lesley.landucci@fph-tr.nhs.uk).

		Ellen Pirie started at the Trust on the 1st May and will be responsible for developing our relationship with local GPs and primary care staff. Previously she did a similar role at the Royal Berks Hospital in Reading for over 2 years and prior to that she worked in the IT industry for more than 20 years where she had a focus on the public sector working with a variety of organisations including the NHS and local government. ”I’m delighted to join Ashford and St Peter’s and I’m really looking forward to getting to know our local GPs and Practice Managers and get your feedback on how we can be shaping our services to help address the challenges we’re all facing.” One of the key areas that Ellen will be working on initially is what she describes as ”Niggles”. ”These are the annoying things that we are doing that make life more complicated for GPs and Practice Managers than it should be. I want you to tell us what these are so that we can try and sort them out. Some departments here already handle your queries very well but if there are things that keep winding you up then please tell us. Please email me the details and if appropriate please provide specific examples of issues so that we can investigate them.” Ellen’s email address is ellen.pirie@asph.nhs.uk
Debbie Beesley will be working for Ellen and will continue to produce GP News, organise GP Events, handle GP enquiries and manage our Choose and Book service.