How the Money is making a difference
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- Smoking Cessation
- Coronary Heart Disease
- Cancer Services
- Diabetes
- Diet and Obesity
- Mental Health Services
- Older People's Services
- Teenage Pregnancy
- Dentristry
What we are doing
Gloucestershire Smoking Advice Service (GSAS) trains over 300 advisers in Gloucestershire. These include Support to Stop advisers in GP surgeries, school nurses, dentists, pharmacists and neighbourhood project workers.
Gloucestershire Smoking Advice Service is also able to provide the services of 6 specialist advisers in the county, who support the 300 advisers and work with heavilydependent smokers. One of the specialists works with pregnant women who wish to stop smoking and another is working in hospitals to help patients who are not able to smoke or who want to quit.
In addition GSAS has a Tobacco Control Officer who is responsible for raising awareness of the harmful effects of smoking and of second-hand smoke. This is done by, for example, educating school children through school assemblies and during actual lessons. She coordinates the county’s approach to No Smoking Day, which is a national event that aims to encourage smokers to quit, starting on that day. The service also has a Workplace Smoking Policy Adviser, who works with employers to help them to introduce smoking policies into their workplaces.
To support all these activities, GSAS develops many resources, including training manuals, leaflets, brochures, posters and displays. It also supplies carbon monoxide monitors (to measure the amount of this dangerous substance in a quitter’s breath), to healthcare professionals and other advisers across Gloucestershire.
The key target (2004-2005) for the PCT was to get 1,174 people to quit smoking for four weeks or more. The PCT met this target and exceeded it by over 200 people. The total number of four week quitters was 1,382 - this figure represents 1,382 people across the PCT area who decided to improve their life chances by making the decision to stop smoking - congratulations to all and we wish them well in their efforts to remain non-smokers!
What the Service Users say
Caroline Rees, Littledean
“I had been a smoker for 8 years and was smoking too many cigarettes. I realised that this was no good for me and it could potentially damage my baby’s health. My biggest challenge was breaking the routine but I wanted to give my baby a good head start.”
“I was given contact details for GSAS and their advisor gave me guidance and practical advice every step of the way”.
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What we are doing
2003-2004 saw the expansion of services for local patients with heart failure after the PCT secured funding from the British Heart Foundation for three specialist nurses.
The nurses will receive intensive training to enable them to deliver high quality care and advice to patients.
The funding will enable Gloucestershire to offer a comprehensive service to heart patients, highlighting early recognition of the condition and responding with appropriate treatment. It will also support the NHS in its efforts to offer care to those more severely affected with the illness in their own homes.
In January 2004, three new ultrasound machines each costing £33,000 became the latest weapons to help the county identify the early stages of heart failure and save lives.
The mobile machines are part of continuing moves to develop a greater understanding of the health of individual patients by carrying out a greater number of investigations, which examine the heart, rather than relying solely on signs and symptoms.
Previously patients seen by GPs and showing symptoms of heart failure had to be referred to a consultant cardiologist for treatment, but since October 2003, they can now be fast tracked to the new Primary Care ‘Open Access’ Echo Service which is available at three locations in West Gloucestershire (Dilke Memorial Hospital, Lydney and District Hospital and Gloucestershire Royal Hospital).
The new high-tech echocardiography machines help the NHS locally to provide more scans for more patients. They screen breathless patients to find out if they have heart failure. As a result, the NHS is becoming even better placed to work with the patient to put a detailed care plan in place ensuring they have access to a wide range of services at the right time.
Following their scan, patients are now able to see GPs who are specially trained in heart failure and heart failure nurses who are then responsible for drawing up a care management plan to meet the individual needs of service users. The NHS in Gloucestershire can also report significant progress in other areas to improve and speed up access to services for patients with coronary heart disease.
Since 2003 angioplasty (a procedure where a tube is inserted into the body to expand arteries and keep them open) operations have been carried out at Cheltenham General Hospital ensuring that patients across Gloucestershire are treated closer to home and usually removing the need for them to travel to Oxford or Bristol for these procedures.
Progress is being made in meeting the targets for providing clot busting drugs (thrombolysis). National targets state that if a patient has a heart attack they must receive clot busters within a specified time after arriving at hospital.
Throughout Gloucestershire Hospitals NHS Trust, 86% of patients requiring clot busting drugs are treated within 30 minutes of arrival at hospital and 70% receive treatment within 20 minutes.
In a development of the thrombolysis service, for the first time in 2003-2004, fully trained paramedics now treat patients who have suffered a heart attack with the clot busting drugs in ambulances if an examination indicates they are required.
Over the next year, the PCT’s priorities are to work with Hospital Trust colleagues to purchase a 37 new laboratory in Cheltenham to support the local diagnosis and treatment of heart conditions, provide more funding for more heart operations (coronary artery bypass surgery and angioplasties) and expand the service further for patients with heart failure.
What the Service Users say
Mrs Averil Ost, Sling, Coleford
Averil has suffered from Atrial Fibrillation and high blood pressure and has received advice and treatment from her GP, Practice Staff and the Heart Failure Nurse.
“The services that I have received have been excellent. My GP listened and obtained an appointment for me at Dilke Memorial Hospital to have my heart scanned and examined by a Doctor and Nurse. I feel I was able to discuss my problems and explain my concerns and it was helpful to have results of blood tests and medication monitored. The Cardiac Nurse saw me regularly and my breathlessness, discomfort and lack of confidence decreased quickly.”
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What we are doing
Starting with prevention, the PCT has been involved in a range of initiatives aimed at supporting people to improve their general health and fitness and reducing rates of diseases such as cancer. Perhaps the most significant of these is our work to support people who wish to give up smoking, a major contributor in a number of diseases including cancers of the lung and mouth. Details of this work are provided elsewhere in the report.
Last year breast cancer screening was rolled out to the 64-70 age group (previously only routinely available to those aged 50-64) - ahead of many other areas of the country. The screening intervals for cervical screening have also been reviewed to better target those at higher risk of developing cancer of the cervix. Liquid based cytology, a better way of testing for cancer of the cervix, is due to be introduced in Gloucestershire in 2006.
Patients referred urgently with suspected cancer are seen quickly within Gloucestershire (within a maximum of two weeks) and work is now underway to make further progress towards the Government’s targets to ensure that patients wait no longer than one month from diagnosis to treatment for all cancers by December 2005 and to achieve a maximum waiting time of two months from urgent referral to treatment for all cancers by December 2005.
An annual investment of £200,000 was made available to support growth in the county’s hospital cancer treatment programmes and Gloucestershire Hospitals NHS Trust was successful in being awarded approval to be the single upper gastrointestinal cancer site for people living in Gloucestershire, Hereford and Worcestershire. A further £30,000 was invested countywide to support multidisciplinary (healthcare workers who specialise in different areas of service) team working – the work of these teams is critical in ensuring speedy and co-ordinated diagnosis and treatment.
Looking to the future the PCT will need to consider how new cancer treatments are evaluated and prioritised for additional funding. Positron Emission Tomography (PET) Scanning and Brachytherapy (a treatment for prostate cancer) 38 are two treatments which are currently not normally funded but in which there is considerable clinical interest at the current time.
Palliative and supportive care form an important part of local services, and national funding has enabled us to establish a third palliative care consultant post in the county. As part of an emerging countywide strategy, the funding has also supported further investments in training, Marie Curie nursing, physiotherapy and occupational therapy services, and community equipment.
Building on last year's success, 30 of the PCT's 32 GP practices are working to the Palliative Care Gold Standards Framework. The aim is improve the quality of care for patients reaching the end of their lives. This is done through improved communications, awareness, knowledge, team work and co-ordinated planning.
What the Service Users say
Margaret Beagles, Gloucester
Margaret was diagnosed with breast cancer in 2001 and has accessed surgical inpatient and outpatient services and chemotherapy and oncology outpatient services.
“I was diagnosed in 2001 and, as a doctor, was fully aware of the implications. Like most other people who have had cancer it took probably about a year after my treatment finished before I was able to come to terms with it and move on. I now enjoy life again and have very much adopted the attitude of ‘what will be will be’, so that I enjoy today and worry about tomorrow when it comes!”
“Inpatient services at Lydney hospital were excellent. The staff were very compassionate and professional, but were working under great pressure.”
What we are doing
A countywide review of diabetic services across Gloucestershire was undertaken and during October 2002 a random sample of almost 3,000 people living with diabetes were surveyed about the services they receive from the NHS. The results presented in November of last year showed that whilst patients are largely positive about the services provided, the patient experience or perception of diabetes services in West Gloucestershire is not as positive in some aspects of care, as elsewhere in the county.
'In response to this the PCT has invested extra money in diabetic services. We have appointed three Diabetes Specialist Nurses (DSN's) in the Forest of Dean, Gloucester City and one in partnership with the Neighbourhood Management scheme (Community Counts) to work with the Black and Minority Ethnic groups in the Barton, Tredworth and White City areas of Gloucester.
Diabetes can have a major impact on the physical and psychological well being of individuals and their families and can lead to other complications. However there is evidence to show that these conditions can often be prevented or delayed by high-quality care. The PCT has therefore established a range of networks and partnerships that are actively promoting initiatives such as Healthy Eating, Smoking Cessation, Weight Management and Physical Activity.
Growing numbers of people with diabetes are being managed in the local community and the PCT intends to invest in the development of diabetes services in GP surgeries, with particular emphasis on prevention and selfmanagement of the condition.
Funding has already been identified for the appointment of a Diabetes Specialist Nurse whose key responsibilities will include the setting up of an education programme and providing ‘expert’ advice and support to all GP practices in West Gloucestershire.
2005 has also seen the introduction of Patient Held Records which provides patients with a compendium of information relevant to them and their treatment. Another development in the pipeline is the expansion of the retinal (eye) screening programme.
What the Service Users say
Mr Robin Clark, Gloucester
Robin was diagnosed with Diabetes in July 2003.
“Staff at my local surgery and the local hospital have both been a great source of aid and inspiration. I have made necessary changes to my eating and drinking habits as I was informed that being overweight could cause many adverse medical problems. Losing weight has been a key factor and eating more healthily has made a real difference to my quality of life.”
What we are doing
Gloucestershire Weight Management Project was established in December 2002 to improve weight management services across the County.
The Project Team consists of 2 part-time Dietitians, a part-time Administrator and a part-time Physical Activity Adviser.
The Project aims to help people who need and want to lose weight to achieve control over their own eating and activity to enable gradual, sustained weight loss and then weight maintenance. It also helps those who are not overweight to maintain a healthy weight throughout life.
The Project raises public awareness of the risks associated with excess weight and the benefits of weight loss.
What has been achieved in the West Gloucestershire area?
- 85 health care workers have been trained to provide
an effective weight management service in their locality:
- 90% of GP surgeries have at least one trained member of staff
- The Neighbourhood Project at Matson Learning Centre now offers a weight management service
- 90% of GP surgeries have at least one trained member of staff
- A range of written resources have been developed for use by health care workers
- A dietitian-led weight management group is currently running at GL1 as a pilot to determine whether this is an effective option to be offered more widely around the county
- Links have been developed with the Bangladeshi community in Gloucester: two meetings have occurred to determine the needs and priorities within the Community regarding weight management, and training has been arranged
- Exercise referral schemes are operating in Gloucester (5 GP surgeries refer to GL1, the Leisure Centre), Newent (2 surgeries refer to Newent Leisure Centre) and Lydney (local surgeries refer to Whitecross Leisure Centre)
- Links have been made with Whitecross School in Lydney to develop physical activity with girls that do not normally engage in traditional sports. A pilot health and well-being course is being developed in partnership with teaching staff
- Staff at the Adult Mental Health Team at Weston Road have been trained in weight management and now offer a health and wellbeing programme for their clients
- Training has been provided to:
- Early Years Centre Staff
- Teachers and caterers.
- Early Years Centre Staff
What the Service Users say
Mrs Beryl Monk, Gloucester
“I became involved with the Weight Management Project through my GP who felt I would benefit from the course as my weight had been increasing over a period of time. The Weight Project has helped me to have a great respect for food and mentally I have become a better person, more positive about food and my life. Over the last 2 years I had put on over 3 stone. In the past 6 months I have turned this around and my weight is going down.”
What we are doing
West Gloucestershire PCT has been working with its partners to further improve the range and quality of services available to patients with mental health needs.
During 2003-2004, the Assertive Outreach service was developed to provide support to people who have severe mental health problems with complex needs to support them within their home/ community setting, helping to prevent repeated admissions to hospital. A further 98 people used this service in 2004-05
Mental Health services in GP surgeries - new staff were recruited in 2003/04 and have completed a training programme. A new service begins in 2004 providing support for patients with common mental health problems such as depression and anxiety. These new teams will work closely with GPs and will work within the doctor’s surgery. This has been positively received by patients and their GPs and has now been rolled out to a further six GP surgeries.
A new substance misuse service has been developed consisting of GPs with special interest, specialist nurses and drug support workers to improve access to services for patients. This will significantly increase capacity in this high demand area. Clinics will be held in Gloucester City and the Forest of Dean.
Further work is taking place within the PCT in partnership with Gloucestershire Partnership NHS Trust to provide a range of new services in 2004/05 including:-
- Carer support workers
- Support teams for those with a mental illness who have a crisis at home, and for those with a new diagnosis of severe mental illness.
What the Service Users say
Graham Crawshaw, Lydney
Graham was a service user for 30 years and now works for Gloucestershire Partnership NHS Trust:
“Service users have direct experience of mental health care and treatment and have personal knowledge of the effects and disadvantages of medication. It is good to see people with mental health needs becoming increasingly involved in service developments in primary care and acute care, but more needs to be done. By involving service users in the planning, monitoring and audit of service provision, everyone stands to benefit.”
What we are doing
The PCT has supported the development of an In-Reach team - a nurse, Occupational Therapist and Care Manager, who work with colleagues in the Accident and Emergency Department of Gloucestershire Royal Hospital, to ensure that older people who are seen at the hospital, are supported to return home as quickly as possible. This helps to avoid unnecessary admission into hospital.
This team is part of an expanding Intermediate care service, which has seen more people this year, and helped transfer more older people from hospital to their own homes. The number of people who have been delayed in transferring out of hospital has reduced over the year and this has been due to considerable partnership working with staff in the PCT, Social Services Department and the Hospital.
The PCT is also investing in Great Western Court, with the Social Services Department, in order to make the very best use of the facilities there. This residential service is providing an increased number of beds, where older people can be supported in their rehabilitation and usually return home.
The PCT has also worked in partnership with the City Council to develop a flat that can be used for older people who no longer need to be in hospital, but may be waiting for housing adaptations to be completed or more suitable accommodation found.
Podiatrists have trained Home care staff to provide basic foot care services in response to requests from older people who find this difficult. Uptake during this year has not been as sizeable as had been anticipated, and further work will be done on publicising this service in the coming year.
An ‘Active Ageing Strategy’ is being designed for West Gloucestershire PCT. Work began in October 2003 with the appointment of a Co-ordinator for Health and Active Life in Older Age.
The strategy aims to promote a healthy, active life in older age in order to prevent or delay the onset of ill-health and social isolation. This will be done through engaging older people in activities which promote both physical and mental well-being.
A good local example, of the type of activity group older people can get involved in, is the Longlevens After Retirement Health and Exercise Group. This group is run via Longlevens surgery and provides a fun and social environment for people 50+. Each session consists of a mixture of physical activity, an informal talk on a wide variety of health related topics and a social session to mix and chat with friends.
The aim is to set up similar types of groups in other areas of the PCT and build up a range of activities, in a range of locations that older people can access.
What the Service Users say
Ken and Della Davies, Longlevens
Ken and Della regularly attend the Longlevens After Retirement Health and Exercise Group.
“The group helps us to keep active and the talks are very interesting. It is socially a happy place and brings together people who enjoy each others company. The exercise and dancing are great fun and the talks we have are most interesting and keep us all informed of what is going on with various services in the county.”
What we are doing
The PCT supports the Emergency Hormonal Contraception (EHC) scheme, which has increased the availability of EHC to young women.
The Trust has now trained 28 pharmacists operating in 18 pharmacies across the PCT. Seven Practice Nurses and 10 Minor Injury Unit (MIU) staff have also been trained
Taking EHC within 72 hours of unprotected sex can help prevent unplanned pregnancies and providing staff training and places where people can get EHC such as pharmacies and hospitals is part of the Teenage Pregnancy Strategy.
The PCT also supports the newly established Countywide Boys and Young Men Network working to promote sexual health and contraception advice as part of an overall approach to the health and well-being of this group. Mental health, risk-taking behaviour including drug and alcohol use are also tackled.
The PCT is backing the development of young people’s health services in schools. This is led by School nurses who can offer information on sexual health and pregnancy issues. After local consultation several schools within the PCT now have a nurse who can issue EHC, free condoms and if appropriate carry out a pregnancy test. Other schools are currently discussing this possibility with parents and their Boards.
Young Mums groups and work with young fathers have been supported to help break the cycle of social exclusion experienced by young parents. The Brockworth Young Mums Group, running at the Community Project, has been particularly successful in engaging with local young mums with 2 of them spearheading recruitment and setting up fundraising and a programme of events.
Gloucestershire County Council has received £98,000 of Government funding to help tackle the high levels of teenage pregnancy in Gloucester City area. The money was awarded for a three year period (2003/06) and is being used to increase levels of service provision and information to young people.
The most recent county figures on levels of teenage pregnancy show that between 2001 and 2002 there was a reduction in both the under- 18 and under-16 conception rates in Gloucestershire and the county is in a strong position to meet 43 challenging government targets by 2010.
The PCT will also continue to develop sexual health services which young people are confident and happy to use. This will be achieved through staff training and improving information for young people, and those who work with them, about what services are available. Confidentiality, still a major worry for young people, is particularly important. As A&E nurses are trained up to participate in the free Emergency Hormonal Contraception scheme clearer guidance will be possible about its availability through Gloucestershire Royal Hospital and the Minor Injuries Units.
Appropriate support for pregnant teenagers and young parents will continue to develop. Over the coming years we will work to consolidate the progress so far, seeking funding for successful pilot projects.
Liz Mozol, Community Pharmacist, Gloucester
Liz has been involved in the Emergency Hormonal Contraception (EHC) Scheme since January 2001.
“The training was very challenging and it was at the time when EHC was about to be launched across the country. We had to pass four ‘real life’ assessments as part of this.”
“We have a consultation area, so after I had trained the staff it was fairly straight forward to implement the scheme within the pharmacy. The scheme has increased the availability of EHC to young people and it’s totally confidential.”
Improving Access to NHS Dentistry
The Primary Care Trust is committed to increasing the number of patients treated
under the NHS and improving the oral health of the population.
The PCT has made substantial progress over the last year with thousands more local people being given the opportunity to register for NHS treatment.
In Cinderford, patients are now benefiting from a new four surgery dental centre at 26 Market Street. Four dentists are employed there providing capacity for 10,000 NHS Registrations.
In Gloucester, a new dental practice, Eastgate Street Dental Centre opened in early June 2005 providing capacity for 10,000 new NHS registrations.
The premises were secured by the PCT's business partner for the project, Integrated Dental Holdings (IDH) and the brand new facility houses 4 surgeries, staffed by four full time dentists.
Patients are also benefiting from agreements reached by dentists in Gloucester and the Forest of Dean to provide NHS services. Earlier this year in Lydney, Central Surgery Practice in Hill Street opened its list to NHS patients providing capacity for 1,500 NHS registrations (see also 'Picture Story' below).
These projects form an integral part of the PCT's commitment to providing an additional 28,000 NHS dental registrations for residents of West Gloucestershire.
In June, an existing Gloucester City dental practice located in Annandale House, 105 Eastgate Street opened its list to NHS patients. The move was made possible by a new dentist joining the practice, together with additional sessions provided by the current dentist. This development provides capacity for 2,250 NHS registrations.
