Clinical notices

We currently use Jaffe as the main method for measuring creatinine in all sample types, however we will replace it with an enzymatic method for all sample types i.e. serum, plasma, urine or any other fluids. This change will be effective Monday 5 June 2023.

This change is based on National recommendations to ensure that creatinine assays are traceable to isotope dilution mass spectrometry (IDMS) method and have minimal bias and acceptable imprecision. Enzymatic creatinine assays are less susceptible to interference than Jaffe-based assays and are recommended in both the CKD and AKI NICE guidelines: 

• https://www.nice.org.uk/guidance/cg182
• https://www.nice.org.uk/guidance/CG169

Moreover, Getting It Right First Time (GIRFT) a national programme designed to improve the treatment and care of patients has recommended that all laboratories measure creatinine, only using the enzymatic method, for the reasons stated above.

Measuring creatinine by enzymatic method has been in place for a number of years but is limited to serum/plasma sample types and for patients under 18y of age or is reflex added due to interference with high bilirubin. So it is not a completely new method that is being introduced.

Serum creatinine measurements are used to calculate acute kidney injury (AKI) score that requires comparison to a previous creatinine value in the last 12 months. AKI is a system generated alert to highlight acute decline in renal function, requiring urgent investigations. With this method change, while generating an electronic AKI alert, a historic creatinine measured using Jaffe method will have to be used for a period of time.

We have conducted extensive verification studies using both Jaffe and enzymatic creatinine methods and the CV and total error for both methods are well within the recommended limits. We do not expect that this should result in misclassification of AKI as the variation observed between the two creatinine methods is unlikely to be higher than the biological variation for creatinine.  Duty Biochemist or Consultant on call can be contacted in case you suspect a discrepancy, to assist with interpretation or repeat measurements.

Currently the UKAS accreditation for enzymatic creatinine only applies to blood samples. We have not been measuring any urine samples using enzymatic method in the past, therefore current UKAS accreditation will not apply to urine samples as well as any calculations that uses urine creatinine measurement e.g. urine Alb/creatinine ratio. However, the urine creatinine using enzymatic method has been internally verified and there is no clinical impact. Processes are in place to apply for UKAS accreditation for this test.

If there are any clinical trials that require us to continue providing Jaffe creatinine measurements, we can make arrangements to continue the Jaffe method specifically for those patients.

Any queries should be addressed to duty biochemist (duty.biochemist@hslpathology.com) during working hours -Monday to Friday and during out of hours through the consultant on call via switch board. 

Dear colleagues,

On Saturday 1 April, Enfield Community Services (ECS) transferred from Barnet, Enfield and Haringey Mental Health NHS Trust (BEH) to North Mid.

We are excited to welcome more than 600 ECS colleagues to the North Mid family and we will ensure they have all they need to thrive here.

ECS will be more resilient as part of a provider that already has a strong focus on physical health care, and North Mid has a strong track record in smooth and safe onboarding of community-based health services, following the 2020 transfer of Enfield’s 0-19 services. 

There will be no interruption of service for patients receiving care in the community, thanks to a detailed programme of transfer preparation by BEH, North Mid, and North Central London Integrated Care Board over recent months.

We have also made robust arrangements to ensure that existing contact details – phone numbers, email addresses and other information – transfer smoothly, so you do not need to change how you communicate with Enfield community service teams. If we need to change any details in future, we will contact you with new information in good time.

If your patients have any questions or concerns, please encourage them to discuss this with their community health professional. If you would like further information for you or your practice staff, please contact us at northmid.ecstransfer@nhs.net

Thank you for your continued support.

Best wishes

Dr Vicky Jones

Medical director

North Middlesex University Hospital NHS Trust

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GP liaison service

The GP liaison service at North Mid is the first point of contact for non-urgent queries, including escalating concerns, requests for education sessions or information on operational processes.

When contacting the service, if relevant, please include the following information:

• patient’s details (name, date of birth and NHS number)
• department the enquiry relates to
• examples if the query relates to more than two patients

You can contact the GP liaison service by email: northmid.gpliaison@nhs.net

The team will aim to respond within three working days. More complicated enquiries may take longer to resolve.

The GP liaison service is not intended to be used by patients.

GP hotline phone numbers

We are in the process of updating our GP hotline phone numbers. If you need to contact us please use the below:

GP hotline numbers

Area	Phone number	Opening times
Emergency Department	07718 981712	(Monday to Sunday, 24hours)

Patient initiated follow-up appointments

North Mid has introduced patient-initiated follow-up (PIFU) appointments for general surgery, ophthalmology, and orthopaedics.

Patients being cared for under these services can contact us directly for an appointment when they feel one is needed. This may be a face-to-face, phone or video appointment.

All the details patients need, including contact information, is available on North Mid’s website here.

Phlebotomy services

North Mid provides blood testing services for children in clinics in the hospital and for adults in the community. There is no walk-in service.

Details and guidance about blood tests can be found on North Mid’s website here.

Following up blood test results

If you need to follow up with us about any blood test results, please call 0208 887 2484 or email nmuh.sra@hslpathology.com

Dear colleagues,

Welcome to our first GP newsletter of 2023.

We know some of our patients are waiting longer than we would like for treatment. Please remember, if you have any concerns about any of your patients, to escalate these through our GP liaison service. They will make sure the relevant service is aware. You can find the contact details for the service in the first section of this newsletter. 

Moving forward, we will be sharing updates with you every six weeks and reviewing this frequency regularly. Please be assured that if there are any urgent updates we need to share with you before the next newsletter, these will be sent by email.

If you have any feedback or would like to see anything specific included, I would be grateful if you could let our GP liaison service know.

I would like to take this opportunity to say thank you for all your support. I look forward to continuing to work with you to ensure the communities that we serve receive the best care possible.

Best wishes

Dr Vicky Jones

Medical director

North Middlesex University Hospital NHS Trust

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GP liaison service

The GP liaison service at North Mid is the first point of contact for non-urgent queries, including escalating concerns, requests for education sessions or information on operational processes.

When contacting the service, if relevant, please include the following information:

• patient’s details (name, date of birth and NHS number)
• department the enquiry relates to
• examples if the query relates to more than two patients

You can contact the GP liaison service by email: northmid.gpliaison@nhs.net

The team will aim to respond within three working days. More complicated enquiries may take longer to resolve.

The GP liaison service is not intended to be used by patients.

Prostate cancer referrals

When you are referring patients on the 2ww prostate cancer pathway, please ensure that they have a recent PSA and eGFR blood test result. 

This must have been carried out within the last four weeks. If a test has not been done, it may delay diagnosis. 

If you have any queries, please contact our urology team: northmid.urology@nhs.net 

Phlebotomy services

North Mid provides blood testing services for children in clinics in the hospital and for adults in the community. There is no walk-in service.

Children

Under two years old

An appointment can be booked by calling 0208 887 3095/3863, Monday to Friday, 9am until 4pm.

Children aged between two and 16

Appointments can be booked online via swiftqueue and parents do not need to phone the department.  Children and young people under 16 attending for a blood test need to be accompanied by an adult.

If parents/guardians experience any issues booking an appointment online, please advise them to call us on 0208 887 3663 / 3664 (press option 6).

Adults - 16 and over

Appointments should be booked online in advance.

Please encourage patients to book an appointment at a community site: Evergreen Surgery, Laurels Healthy Living Centre or Forest Road.

Appointments can be booked online via swiftquPatieneue.

If patients experience any issues booking an adult blood test appointment online, please advise them to call us on 0208 887 3663 / 3664 (press option 6).

If your patient needs an urgent blood test, the GP practice must call the number above to book an appointment. We are unable to book urgent tests at a patients’ request.

Details and guidance about blood tests can be found on North Mid’s website here.

Following up blood test results

If you need to follow up with us about any blood test results, please call 0208 887 2484 or email nmuh.sra@hslpathology.com

Patient initiated follow-up appointments

North Mid will be rolling out patient-initiated follow-up (PIFU) appointments in the coming weeks.

Patients being cared for under specific specialties will be able to contact us directly for an appointment when they feel one is needed. This may be a face-to-face, phone or video appointment.

You can find out more on north central London Integrated Care Board’s website. We will share more details about PIFU at North Mid in due course.

Diagnostic tests for children with asthma

We have received a number of referrals for children and young people for measurement of exhaled nitric oxide.  This test is not used for the diagnosis of asthma in children and so is not offered.  If there is diagnostic uncertainty, please refer to the paediatric clinic for assessment.

North Mid staff awards: nominate your unsung hero

We will be hosting a special event to recognise and celebrate the achievements of our incredible staff.

One of the awards categories is, Unsung Hero, and you can nominate a North Mid staff member or team.

Nominations are open until Friday 3 March.

Click here to nominate.

When you are referring patients on the 2ww prostate cancer pathway, please ensure that they have a recent PSA and eGFR blood test result. 

This must have been carried out within the last four weeks.

If you have any queries, please contact our urology team on northmid.urology@nhs.net  

Reducing our radiology backlog at North Mid has been a priority for us, particularly given that GPs do not have access to scans. As such, we have prioritised reducing the number of outstanding Direct Access scans, and has involved:

• temporarily increasing the number of reporting radiographers we have to enable support of the reporting function as opposed to scanning,
• Involving our consultants in reducing in-week reporting and additional reporting lists at the weekend for Direct Access specifically,
• Increasing tele-radiology capacity to support and maintain a backlog reduction.

As a result, we have seen a significant reduction in the backlog resulting in our average turnaround times, from 12 weeks in September to less than four weeks now (the national best practice for Direct Access x-rays turnaround times is four weeks). We currently have 25 patients waiting over four weeks which we working hard to eliminate.

If you have any particular concerns about a patient, get in touch with our GP liaison.

Dear colleagues,

We have spent the last couple of months revising our structure for engaging with GPs across Enfield and Haringey, which we talked through in our Planned Care Board last month. I would like to use my newsletter this month to provide an overview of what that is:  

• Our reinvigorated GP liaison function, led by our patient access services team, will be the first point of contact for non-urgent queries, including escalating concerns, requests for education sessions or information on operational processes. You can contact the team on northmid.gpliaison@nhs.net and they will aim to respond to you within three working days.
• Our monthly Planned Care Board combines our clinical interface meetings with the original Planned Care Board and takes place monthly. Here GPs can bring any issues they are having accessing services and our teams will also be providing updates from around North Mid.
• This newsletter will be sent shortly after Planned Care Board with a follow up on outstanding issues raised.

I hope you find this new structure suitable for you as we work together for the benefit of our local communities.

If you have any questions, please do let me know.

Dr Vicky Jones

Medical director

North Middlesex University Hospital NHS Trust

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What else is happening at North Mid

Covid-19 update

Like the rest of the country, we are beginning to experience the effects of another wave of Covid-19 at North Mid, with a small rise in the number of patients we cared for with Covid-19 (approximately 25). Crucially, many of these patients are not in hospital because of Covid-19, but because a different condition or injury. Thankfully, less than handful of these patients were admitted to intensive care.

We continue to follow our robust infection prevention and control measures to keep our patients, staff and visitors safe.

Blood stock levels

The NHS Blood and Transplant service has declared an Amber alert due to a shortage of red blood cells. We are following NHS BT’s guidance.

Patient safety remains our focus, and at this At this stage, the actions are focused on conserving current stocks by exploring alternatives to transfusion rather than restricting the availability of blood. 

A small number of adult patients listed for elective, non-cancer operations over the next 4 weeks may be cancelled, if their operation is likely to require a blood transfusion. These cases are currently being reviewed by the Transfusion Team and the relevant operating surgeons. 

NHS BT advise using a transfusion threshold of 70g/L unless patient is bleeding, has acute coronary syndrome, or is on a chronic transfusion programme.  This aligns with the longstanding policy at North Mid.

Operational performance

Urgent and emergency care: Challenges around urgent and emergency care remain, and we are working with primary care and system partners to help make sure that patients are not only seen in the most appropriate setting in the first instance, but also help increase discharges so that flow through our hospital is smoother.

In order to improve the experience of patients in our adult A&E waiting areas, and to be as transparent as possible with how long people will be expected to wait to be treated by a doctor or specialist nurse, we have introduced an A&E waiting time digital display. This is automatically updated every five minutes and people can access it in two ways: through a QR code in our waiting area, and on our website.

Elective recovery: After a rise at the start of September in the number of people waiting for surgery, we are now seeing a steady reduction. At the time of writing, 18,985 people are waiting for surgery at North Mid, with 5,051 waiting over 18 weeks and 193 waiting over a year.

If you are concerned that a patient has experienced delays to a follow up appointment and require urgent review, please contact the relevant service the patient is being seen under. Contact details can be found on our website.

Making sure that local people are able to get surgery when they need it is incredibly important, so we are thrilled that work begins this month to build a new Day Surgery Unit (DSU) at North Mid to help tackle and reduce our backlog of patients waiting for surgery and provide sustainable surgery through challenged winter months.

The Trust was one of 50 to receive £6million funding from NHS England for this new hub which will help treat an additional 4,000 patients here every year once construction is completed.

Construction of the unit starts in October, is due to be completed in Spring 2023 and will treat a mix of outpatient and admitted (including overnight or day cases) patients.

Cancer performance: There continue to be challenges over our cancer performance but we are beginning to see progress after a long period of foundation setting and the introduction of a turnaround paln. We are maintaining our good performance around 31-day treatments, the number of patients waiting over 62 days for treatment has halved since May and our 28 Day Faster Diagnosis has risen significantly over the last month, reaching 56.7%. While this doesn’t meet the national standard, it is the highest we have achieved in some time and signals our commitment to continuing to progress towards the standard.

Work continues on improving our 62 Day performance standard, which has held stable around 70%.

New boric acid containers for urine microscopy and culture

The specimen containers used for urine microscopy culture test are changing.

The new containers include boric acid preservative. National Guidelines recommend that if a urine specimen if likely to take more than 4 hours to reach the laboratory then boric acid containers should be used. The presence of boric acid helps to maintain the microbiological quality of the specimen and prevents overgrowth of organisms during transport to the lab – a simple way to improve the reliability of urine MC&S results. Boric acid containers are used commonly in most laboratories.

Boric acid containers will be supplied for routine microbiology urine culture and can be obtained using your normal requisition process. There is no additional cost for boric acid containers.

If boric acid preservative is used, ensure that the container is filled up to the line and the contents mixed well. Suitable samples for tests are: Mid-stream urine, urine collected from catheter port (not bag samples), cystoscopy urine, nephrostomy urines, suprapubic aspirate.

Boric Acid Universal Containers (red cap)

Must ONLY be used for:

• Microbiology urine microscopy and culture

All other tests using this universal will be rejected

Fill to line & mix contents

Please do not remove the boric acid (white powder) and use as a plain container – the residual boric acid may affect the tests results

White cap

Plain Universal Containers (white cap) Used for: Dip stick tests in clinics and GP* Paediatric urines (where small samples are expected and the preservative concentration may affect the result) Urine Chlamydia/GC NAAT testing Urine for pregnancy testing Urine for legionella/ pneumococcal antigen Urine for mycobacterial culture/ parasitology (i.e. Schistosoma) Sterile fluids (i.e. CSF/Pus/ tissue) Other pathology tests If boric acid containers are unavailable, then the white topped universal container may be sent for urine microscopy & culture but please ensure samples are sent to the laboratory within 4 hours of collection

*For diagnosis of UTI and use of dipstick: Diagnosis of urinary tract infections - quick reference tool for primary care (publishing.service.gov.uk) – Note: DO NOT dipstick for suspected UTI in catheterised adults or those >65 years

Phlebotomy – Booking blood tests online

Around 65% patients currently book their phlebotomy appointments online which helps to direct them to the community options available. It would be a great help if you can help to direct patients who have online access to book online via: https://www.northmid.nhs.uk/blood-tests. This will prevent them waiting in a queue for the call center.

Dear all,

I wanted to let you know that I will be joining the Integrated Care Board for North Central London  on secondment as the clinical director of transformation to work with the Tavistock and Portman NHS Foundation Trust on clinical improvement, for a period of 12 months from Monday 8 August 2022.

My time at North Mid working with you to improve the lives of people in Enfield and Haringey has been remarkable. The progress we have made in such a short space of time, and in the face of a global pandemic, has been nothing short of incredible and for that I want to thank you.

Dr Victoria Jones, consultant paediatrician, current deputy medical director will step into the medical director role for the duration of my secondment. Some of you will have already worked with her in her role as chair of the clinical integration group and I’m sure many of you will work with her more closely as she takes over as medical director.

I have really enjoyed working with you and want to thank you all for everything you have done to support me, and North Mid, over the last three and a half years.

 

Dr Emma Whicher
Medical director

North Middlesex University Hospital NHS Trust

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What else is happening at North Mid

Temporary disruption to pathology laboratory results on Tuesday 9 August 2022

TDL Keystone (pathology links for North Middlesex pathology lab results) will be offline for maintenance on Tuesday 9 August 2022 between 9am to 3pm.  During this time, results for pathology will be held and sent once the service resumes.

Results will continue to be available on EMIS Review.

If urgent results are required during this period, please contact the laboratory.

Covid-19 update

Like the rest of the country, we experienced another wave of Covid-19 at North Mid, with a significant rise in the number of patients we cared for with Covid-19 (approximately 70 in patients at peak). Crucially, many of these patients were not in hospital because of Covid-19, but because a different condition or injury. Thankfully, only a handful of these patients were admitted to intensive care.

We continue to follow our robust infection prevention and control measures to keep our patients, staff and visitors safe.

Operational performance

Urgent and emergency care: While our urgent and emergency care pathways continue to be challenging, we have made a concerted effort to reduce the number of patients spending over 12 hours from arrival to discharge or admission and this has resulted in a notable fall.

However, we continue to have high ambulance handover delays and know that this is due to delays in discharging patients into more suitable locations when they become medically fit to leave our hospital site. By working with partners, we’ll refocus our attention on timely discharge of patients to help relieve the need to use escalation beds and the delays within our emergency department.

Elective recovery: We are pleased to report that there are no longer any patients waiting longer than two years for surgery. We want to say a huge thank you to our teams who have worked hard to make this happen.

Work is now focussed on reducing the number of people waiting over a year and we are making steady progress. 

Cancer performance: There have been concerted efforts by many teams and individuals over recent months to recover our cancer performance. Whilst we continue to maintain our good performance around 31-day treatments and have resolved some long-standing pathway challenges, our current approach has not yet delivered the sustainable improvements we have wanted and needed to demonstrate in cancer 62 Day PTL backlog clearance or improvements across our 28 Day Faster Diagnosis (FDS) and 62 Day performance standards.

The Trust has experienced an increase in referrals in urology and colorectal as Covid-19 enters its endemic phase and this has impacted the timeliness of care for some patients. We have also seen some delays in care for breast cancer which are beginning to reduce thanks to working in partnership with other Trusts.

We have recruited additional clinical, management and administrative resource to fully support patients being fast-tracked through their pathways and facilitate treatment more quickly where appropriate. The Trust is being supported in this programme by the North Central London Cancer Alliance and Cancer Improvement Support Team.

Reminder of BCG pathway

We have received a few queries recently about the BCG pathway. Below is a reminder of the process for this which includes self-referral for Enfield residents, the pathway from maternity and the pathway from primary and community care.

For Enfield residents – the referral email is: northmid.bcg@nhs.net

• Key document: BCG Pathway.docx [docx] 460KB

For Haringey residents – the referral email is: Whh-tr.bcgimmunisationreferral@nhs.net

• Key document – London neonatal BCG protocol  [pdf] 1MB

Phlebotomy – change in barcode forms

From Friday 5 August, the printed proforma associated with the new HSL Pathology (NCL) tQuest system is changing for Practices sending pathology requests to North Middlesex University NHS Trust. It does not impact any other tQuest system.

The new proforma provides clearer information to patients. It offers a QR code for quick access to phlebotomy services and a link to find out more about the tests ordered.

Patient information is held outside the printed proforma allowing it to be amended by the lab at any time without impacting the application.

The new proforma contains pre-printed specimen labels that, when used with the correct stationery, can be peeled off and added to the specimens, avoiding handwriting on specimen containers. The use of these labels is optional.

To request the appropriate stationery, contact the HSL support at Helpdesk@tdlpathology.com or call 020 7307 7365.

For more information about the new proformas and/or the rollout of our consolidated tQuest across NCL, contact Nilesh Khimani (Nilesh.khimani@tdlpathology or call 07570 243 473.

• Key document: Proforma - Blood Tests.pdf [pdf] 117KB

Phlebotomy – Booking blood tests online

Around 65% patients currently book their phlebotomy appointments online which helps to direct them to the community options available. It would be a great help if you can help to direct patients who have online access to book online via: https://www.northmid.nhs.uk/blood-tests.

This will prevent them waiting in a queue for the call center.

From 22 March 2022, the paediatric non-complex dermatology service will not be provided anymore at North Mid.

Any referrals already made to North Mid will be sent to UCLH or Royal Free.

GPs will need to refer any paediatric non-complex dermatology to UCLH or Royal free.

For information or questions about this, please contact Hassan Ahmed (hassan.ahmed3@nhs.net) – deputy service manager for paediatrics. 

Dear all,

As you will be aware, the Omicron variant of Covid-19 is having an impact on services across the country, including the NHS. At North Mid, the number of patients we are caring for with Covid-19 has risen to between 130-160 a day, although this has stabilised to around 130 in the last week.
 
As a result, we have had to reintroduce some visiting restrictions at the hospital. I want to assure you that this is not a decision we have taken lightly and we review these arrangements regularly at our ethics panel. These measures are on top of the robust infection prevention and control measures that we already have in place at the hospital and in our community sites.
 
The Omicron variant has also impacted on our delivery of elective activity and we are working with hospitals within north central London to provide ‘mutual aid’ so that patients can get the right care, including surgery, when they need it.
 
Our cancer performance remains challenging. We are monitoring cancer waiting times very closely and are working with hospitals across north central London and the independent sector to diagnose and treat patients as quickly and equitably as possible.
 
We have made some progress with our breast cancer pathway, which was of particular concern, after adding extra resource to the team and regularly speaking  with our patients to help them understand what’s happening and answer any questions they may have. 
 
If you are aware of a patient who is waiting for elective treatment and you feel their condition has deteriorated please contact the relevant team so we can prioritise their treatment. In recent weeks we have been working with Proactive Integrated Care Teams in Enfield and Haringey to proactively manage and support patients waiting for elective care at North Mid.
 
Vaccines continue to be the best line of defense against the virus, and I am grateful to primary care colleagues across Enfield and Haringey for not only encouraging our local communities to get their first, second and booster doses, but also making it as easy as possible for them to get it.
 
We would love to hear what you think about how we inform you about what’s happening at North Mid. If you have any feedback or suggestions please let us know at: northmid.comms@nhs.net
 
Dr Emma Whicher
Medical director
North Middlesex University Hospital NHS Trust

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Primary care redirection pilot reaches phase two

As we wrote last month, we are running a primary care redirection pilot in our A&E department for patients who can be better managed in primary care. This partnership work with Haringey and Enfield GP Federations went live at the beginning of December and we have been successfully and safely redirecting up to 20 people a day to the extended access hubs. Patients are supported by a navigator who is employed by the GP Federations and have choice about whether to accept this offer. To complement this, we have also introduced an on-site primary care hub where patients can be redirected to see a GP face to face.

Reviewing non-coronial deaths in the community

Medical examiners (MEs) are senior doctors working in acute trusts reviewing all non-coronial deaths. The role of these offices will be extended into the community in the coming months.

Across NCL, pilot sites in the community have been selected and work is ongoing to ensure there is a smooth and efficient system in place for GPs and MEs. In most cases, MEs will only require access to relevant parts of the medical records to carry out reviews. Details on referral processes are still being finalised, and further communication will be shared in due course.

North Mid works with partners to open virtual ward

We have worked with Barnet, Enfield and Haringey NHS Trust (BEH) and Whittington Health to set up a virtual ward. This is for patients who would otherwise need to have care in hospital, can instead have same care delivered at their own home. Care in the community will be provided by BEH for Enfield patients and Whittington health for Haringey patients. The patient care will be documented on Careflow and the patient’s medical and consultant care will remain under the care of North Mid.

This is a pilot to March 2022 with a team of nurses, carers, and therapists available to support patients in their own home on the virtual ward under the care of the North Mid Same Day Emergency Care Consultant.  
 
Read more about the report on our website.

Hormone injections for prostate cancer patients to be given in primary care across NCL

From 1 January 2022, men currently attending a hospital outpatient clinic for prostate hormone injections every 3 or 6 months will be advised that (unless not clinically appropriate) their next injection will be administered at a local GP practice, usually by the practice nurse. This change, led by the NCL CCG and the NCL Cancer Alliance, will be gradual and phased in over the next 6-9 months. Two thirds of GP practices in NCL already administer these injections but are unpaid. They will now be properly remunerated under a new Locally Commissioned Service specification.
 
Detailed information has been prepared for GP practices about implementation and training sessions are being arranged. Please see the NCL GP website for further information.

Dear all,

I want to start by saying thank you. The work you are doing to support the accelerated vaccination campaign in light of the Omicron variant as well as see patients in Enfield and Haringey is truly appreciated.

We are experiencing the effects of the rise in Omicron with increasing numbers of admissions to North Mid, with around 40-50 people in our care with Covid-19 each day. This is understandably putting pressure on the hospital and community sites but we are using every opportunity to provide flu and Covid-19 vaccinations for our inpatients who are eligible. 
 
We are continuing with our elective work at present and will do all we can to carry on with this despite the competing demands on our teams. If you are aware of a patient who is waiting for elective treatment and you feel their condition has deteriorated please contact the relevant team so we can prioritise their treatment.

As 2021 draws to a close, I would like to thank you for all your support over the last year and wish you all a healthier, happier and brighter 2022.
 
Dr Emma Whicher
Medical director
North Middlesex University Hospital NHS Trust

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Working in partnership to support primary care redirection

We are collaborating with the Haringey and Enfield GP Federations to run a primary care redirection pilot in our Emergency Department for patients who can be better managed in primary care. This went live as planned at the beginning of December and we have been successfully and safely redirecting up to 20 people a day to the extended access hubs in Haringey and Enfield. Patients are supported by a navigator who is employed by the GP Federations and have choice about whether to accept this offer and those that have used the service have received it well.

We are now working in partnership on phase two which is to provide an on-site primary care hub where patients can be redirected to see a GP face to face. This is planned to go live next week.

ABC parents accepting referrals 

ABC Parents is a project funded by the NCL Inequalities System fund and is focused on the most deprived wards around North Mid in East Haringey locality and East of Enfield.
 
The aim of the project is to co-produce a community outreach project with local parents to:

• Educate and improve parents’ confidence to deal with childhood illnesses and injuries.
• Decrease anxiety related and avoidable A&E visits by signposting to reliable self care information and alternative NHS services.
• Increase social support structures, reduce isolation and give resources that empower parents.

You can now refer families into the ABC parents project via our online form.
 
For any queries, contact the ABC Parents team on northmid.abcparents@nhs.net

Referral criteria:

Please note the ABC program targets families living within the A10 corridor in east Enfield and the east Haringey locality only.

1. We welcome expectant parents and families with babies 0-6 months.
2. Families with babies under 12 months old with below additional needs, will be prioritised.

Additional needs include:

• Targeted communities/families from areas of deprivation (incl. those with language barriers)
• New parents struggling to navigate healthcare systems (incl. transfer ins)
• Families in need of awareness of appropriate local and national services and support
• Isolated and anxious new parents especially those with limited social networks
• Anxiety and/or Mental health problems
• Child admitted to NICU or has a chronic illness
• Financial or housing difficulties
• Family has a support worker or social worker
• Domestic abuse or violence

North Mid maternity - innovative services, comprehensive training, improved team work, and collaborative partnerships

Families using the maternity service at North Middlesex University Hospital NHS Trust can be confident their care will be provided by staff who have the right mix of qualifications, training and experience, who work well together, and are committed to continually improving services, according to a new report published in November 2021.
 
The report from the Care Quality Commission (CQC) which regulates all providers of health and care services, summarises findings of a team of CQC inspectors who visited our hospital-based maternity service in September 2021, to undertake a focused inspection on progress against an action plan we developed to support ongoing improvement.
 
Read more about the report.

At a recent Clinical Interface meeting our Primary Care colleagues said that it would be helpful to understand our current waiting times for diagnostic tests. Please see below information about this.

Diagnostic waiting times

Diagnostic	Waiting time	Opening times
Routine MRI	2 to 3 weeks	8am – 7.30pm
Routine CT	2 to 3 weeks	8am – 4.30pm
X-ray	Walk in service	9am – 4.30pm
GP non-obstetric ultrasounds	4-5 weeks	9am – 5pm

Please see out new radiographic request form.

Change to ECG bookings

Due to ongoing Covid-19 infection control restrictions we are still unable to provide a walk in ECG service. To book an appointment please send a referral form to northmid.cardiologyinvestigations@nhs.net. Patients will be booked in by the Cardiology admin team and sent a letter with their appointment date and time. No walk-ins will be accepted due to IPC protocols and safety measures deployed during and post covid.

We will continue to review capacity and safety measures currently in place and increase it accordingly.   Any further changes will be communicated to the GPs accordingly.

If you need to speak to the service regarding an ECG please use the following contact number - 020 8887 3612

Contact details for children’s blood testing service

Our paediatric day assessment unit is receiving numerous calls from parents or carers with children over two years old to arrange blood tests.

Blood tests for children between two and 16 take place in our children’s outpatient department and parents need to book appointment online via our website. This page also contains the correct contact details for our children’s outpatient department if parents have any issues with booking a blood test online.

Find out about blood tests at North Mid | North Middlesex University Hospital

 

 

We are writing to let you know that, as per the latest advice from the Joint Committee on Vaccination and Immunisation (JCVI), certain categories of patients who are at risk of immunosuppression are eligible for the extra dose (third dose) of Covid-19 vaccine.

These include patients who are currently on active chemotherapy and/or immunotherapy for cancer and those who had this treatment in the last 6 months. This is being advised as a precautionary measure to increase the immunity level and provide a better vaccine response, based on studies and experience with other vaccines. It is part of the primary course of vaccination and is separate to a booster vaccination, which they will likely become eligible for later, pending further advice.

We have been contacting patients in clinics advising them of their eligibility for the third dose and have asked them to contact their respective GPs regarding this.  We would be extremely grateful if you could kindly support this by providing vaccine appointments for the third dose. The optimal timing of the third dose vaccine is generally just prior to the next cycle of chemotherapy and this information can be provided by the patients. The third dose must be at least 8 weeks after their second dose of Covid-19 vaccine.  The recommendation is to avoid vaccination on the day of the chemotherapy.

Any queries with regards to the vaccine should refer to the ‘Green book’ as with all other vaccination queries. Please also find attached recommendation from UK chemotherapy board for reference.

 

Yours faithfully,

Dr Venkatesh Gajapathy

Clinical Director

Oncology and Palliative Care

North Middlesex University Hospital Trust

Due to ongoing Covid-19 infection control restrictions we are still unable to provide a walk in ECG service. To book an appointment please send a referral form to northmid.cardiologyinvestigations@nhs.net.

Download the form: GP ECG request form.docx [docx] 156KB

Patients will be booked in by the Cardiology admin team and sent a letter with their appointment date and time. No walk-ins will be accepted due to IPC protocols and safety measures deployed during and post covid.

We will continue to review capacity and safety measures currently in place and increase it accordingly.   Any further changes will be communicated to the GPs accordingly.

If you need to speak to the service regarding an ECG please use the following contact number - 020 8887 3612.

Covid-19 updates and service recovery

There has been a national focus on recovering elective activity in 2021/22. We are on track to meet these requirements and have had a continued focus on clinical review and prioritisation of patients who have waited longer on the elective pathways. We are working hard to reduce the number of patients waiting over 52 weeks but recognise that some patients may be anxious or their condition may have changed.
 
If you are concerned that a patient has experienced delays to a follow up appointment and require urgent review, please contact the relevant service the patient is being seen under. 
 
Contact details for our services can be found on our website.

Urgent and emergency care

We have been seeing a substantial increase in attendances at the emergency department (ED) for Type 3 (minors) attendances over the past few weeks, and June 2021 has been the busiest month we have ever had at our ED. There has been a particular rise in the number of children and patients attending who do not require admission. On top of this, 111 activity is also very high.

In order to cope with this exceptional demand particularly during the evenings, we have been booking additional medical and nursing staff particularly for our urgent care centre (UCC).
 
Ways in which you can help: 

• If any local GP would like to work shifts here please contact Salmaan Khan, our GP lead, on salmaankhan@nhs.net.
• Maximising referrals to the medicine or care of the elderly hot phones to help bypass the emergency department:
  • Acute medicine hot phone number: 07436 036 515
  • Care of the elderly frailty hot phone number: 07890 039 025
• Supporting us with work on high intensity users and development of Coordinate My Care (CMC) plans. We will be approaching practices where individuals are registered over the next couple of months to work with you on how we better support these people.

Any support to encourage patients to access care in primary or community care settings would really help us to provide good care for those patients who need urgent and emergency care.

Canterbury ward opening

A 22 bedded unit opened on Canterbury Ward at Chase Farm Hospital on Thursday 20 May as a facility for North Middlesex Hospital to step down medically optimised patients to support patient flow on the acute site.
 
Medically optimised patients that are experiencing discharge delays will be transferred from North Middlesex Hospital to Canterbury ward. This unit will provide a calmer, more suitable environment, with nursing, AHP and GP care provided until they are ready to be moved to their ongoing discharge destination. 
 
North Middlesex Hospital GPs will be providing cover on the unit and may be in contact with patients’ GPs to support their discharge and ongoing provision of care at home or in the community.
 
The GP can contact the ward manager or the matron on the unit on the number below:
 
Ward contact number: 0207 794 0500 Ext. 30103 - 30104
Mobile: 07890 039 026

Book ECGs for patients through ERS

The ECG service is now only available via pre-booking through eRS. No walk-in will be accepted due to infection control protocols and safety measures deployed during and post covid.

If there are no appointments available please add the patient to the Appointment Slot Issues (ASI) list. The service will ensure that the ASI list is monitored regularly and book patients as soon as possible.

We will continue to review capacity and safety measures currently in place and increase it accordingly.  Any further changes will be communicated to the GPs accordingly.

Please note, currently there is no telephone service to book patients, thus patients should not contact the service directly about the ECG appointment. 

If you need to speak to the service regarding an ECG please use the following contact number - 020 8887 2664.

Covid-19 updates and service recovery

The National Operating Plan published last month states that Trusts must achieve 70% of 2019/20 elective activity, increasing to 85% by July. The Trust is on track to meet these requirements. In May the Trust reached 113% activity for inpatients, 84% for day cases and 92% for outpatients.

North Central London has received additional funding to accelerate recovery and this is being used at North Mid to support extra operating lists and through increased weekend and evening working.

To ensure patients whose elective procedures have been delayed do not come to harm, there has been continued focus on clinical review and prioritisation of long waiters on the elective pathways. We are working hard to reduce the number of patients waiting over 52 weeks. As at 13 May 2021 the number of patients waiting 52+ weeks from referral to first definitive treatment is 88; a reduction compared to April, during which 149 patients were waiting 52+ weeks.

Cancer recovery

Once a patient has been diagnosed, the Trust has continued to provide the same number of treatments as pre pandemic, with surgery happening at independent sector sites.

Radiotherapy has continued to operate throughout the pandemic in line with the new infection control guidelines and have extended the working day to ensure that patients can be treated in a timely manner.   

Chemotherapy during the first wave was delivered in two mobile chemotherapy units and continued to deliver treatments throughout this period. 

Following an extensive refurbishment of the original Chemotherapy Day Unit treatment has returned to the main hospital.  The 31-day decision to treat to treatment standard has consistently been in the 90% and in December 96.55% of patients were treated within 31 days.

Urgent and emergency care

We have been seeing a substantial increase in attendances at the Emergency Department (ED) for Type 3 (minors) attendances over the past few weeks. Any support to encourage patients to access care in primary or community care settings would really help us to provide good care for those patients who need urgent and emergency care.

Canterbury ward opening

A 22 bedded unit opened on Canterbury Ward at Chase Farm Hospital on Thursday 20 May as a facility for North Middlesex Hospital to step down medically optimised patients to support patient flow on the acute site.

Medically optimised patients that are experiencing discharge delays will be transferred from North Middlesex Hospital to Canterbury ward. This unit will provide a calmer, more suitable environment, with nursing, AHP and GP care provided until they are ready to be moved to their ongoing discharge destination. 

North Middlesex Hospital GPs will be providing cover on the unit and may be in contact with patients’ GPs to support their discharge and ongoing provision of care at home or in the community.

The GP can contact the ward manager or the matron on the unit on the number below:

Ward contact number: 0207 794 0500 Ext. 30103 - 30104

Mobile: 07890 039 026

Update to care of the elderly hotphone number

The hotphone provides a service for GPs and other providers calling about patients over 65 with geriatric medicine needs regarding care, advice and treatment plans.

The hotphone can also be used to refer to our Hot Clinics – Care of the Elderly hot clinics provide rapid access from GP referrals to a comprehensive geriatric assessment (CGA), MDT, and diagnostics for patients with frailty, with a focus on admission avoidance.

The Care of the Elderly hot-phone, held by a Consultant Geriatrician 9am-5pm Monday to Friday, and 8am - 4pm weekends and Bank Holidays.

The new care of the Elderly hotphone number is as follows:

Previous number: 07436 561 077

New number: 07890 039 025

Vaccine hub in Northumberland Park

North Mid has brought Covid-19 vaccinations closer to the people of Tottenham this week thanks to the opening of a pop-up vaccination clinic at the Eric Allin Community Centre in Northumberland Park. 

Working in partnership with Haringey Council, the clinic has been open to people over 40 years old wanting to have their first Covid-19 vaccination. There is no need for an appointment; people will be able to walk-in.

The vaccination clinic, run by our community services team at North Mid, is open for Haringey residents who have been unable to book an appointment or are not able to attend appointments during normal working hours. Opening days and hours are available on the Haringey Council website.

The North Mid in the Community team also run a mass vaccination centre at the Dugdale Centre in Enfield Town.

Same Day Emergency Care (SDEC) unit

The new Same Day Emergency Care (SDEC) Unit opened its doors to patients in April 2021 as part of our Hot Floor reconfiguration estates programme. The newly refurbished area, previously known as Ambulatory Emergency Care (AEC) has increased capacity with seven recliner chairs, four consultation rooms and patient waiting space. It provides consultant-led same day medical input for acute patients that can be rapidly assessed, diagnosed and treated in a day case setting.

Patient treatment pathways for SDEC include deep vein thrombosis (DVT), pyelonephritis, lower limb cellulitis, pulmonary embolus (PE), community acquired pneumonia (CAP), atrial fibrillation (AF), acute kidney injury (AKI), headache and hransfusion.

The SDEC vision is to provide outstanding same day care to our patients by:

• Rapidly diagnosing and treating patients who would otherwise beadmitted to hospital
• Enabling direct access via GP referral to reduce attendances to A&E
• Enabling early discharge with rapid follow-up that cannot bemanaged by GP
• Streamlining patient care with agreed pathways

For SDEC referrals or for acute medical advice, please ring the Acute Medicine hot phone: 07436 036 515

Faster access to patient records thanks to Health Information Exchange (HIE) 

We are delighted to announce that North Mid data is now available in the Health Information Exchange (HIE).

You will be able to view certain information in real time for patients being treated in north central London referred to North Mid, including:

1. Appointments (future)
2. Encounters (past visits)
3. Lab Results (including blood sciences, microbiology, virology and histopathology)
4. Radiology Reports

Data available on HIE is in line with your local information governance policies. 

If you have any concerns regarding technical issues with the data display, please contact your internal IT department in the first instance or the NCL support desk via email at nclccg.digitalhelpdesk@nhs.net for second line support.

This is the first phase of data sharing with North Mid and we will be working with them to include additional data sets in the future, such as clinical correspondence, vital signs and visit diagnoses.

Phlebotomy (blood tests) 

The on-site North Mid Blood Test Clinic no longer offers GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.
 
We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients. Location and opening times for our community hubs are as follows: 

• Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW,
  Monday to Saturday,
  8am to 5pm
   
• The Laurels Healthy Living Centre 256 St Ann’s Rd, Tottenham, London, N15 5AZ,
  Monday to Saturday,
  8am to 5pm
   
• Forest Primary Care Centre, 308A Hertford Road, Edmonton, London, N9 7HD
  Monday to Friday
  8am-12pm
   
• Grovelands Medical Centre, 1 Grovelands Rd, London N13 4RJ
  Monday to Wednesday
  10am to 2pm

All GP blood tests are bookable online by going to https://www.northmid.nhs.uk/blood-tests. Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.
 
Please do not advise your patients to come to North Mid as they will be asked to attend a clinic in the community.
 
To book an appointment for blood tests, please go to https://www.northmid.nhs.uk/blood-tests  or call us on 0208 887 3663 / 3664.
 
GPs are able to send the patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

New North Mid chief executive named as Dr Nnenna Osuji

Dr Nnenna Osuji has been successfully appointed to the role of Chief Executive at North Middlesex University Hospital NHS Trust. She is anticipated to take up her new role in summer 2021.

Dr Osuji will join us from her current role as Deputy Chief Executive and Medical Director at Croydon Health Services NHS Trust in south London. An experienced haematologist, she will continue as a clinician when she takes up her new role.

Dr Andy Heeps will continue as interim Chief Executive until Dr Osuji begins her role at North Mid. 

Covid-19 updates and service recovery

The NHS’s National Operating Plan, released last month, states that Trusts must achieve 70% of 2019/20 planned surgery activity, increasing to 85% by July. The Trust is on track to meet these requirements.

Our outpatient appointments are already at approximately 95% of 2019/20 levels and around 30% of outpatient appointments are being delivered virtually.

We have been seeing a substantial increase in attendances at the A&E Department over the past few weeks. We want to encourage people to seek help from healthcare services when they need it and not delay due to concerns of Covid-19. However, we would urge that people who do not need A&E use alternatives for example NHS 111, walk-in centres or their local pharmacy.

Covid-19 vaccinations and testing

Our mass vaccination centre run by our community services team in Enfield Town continues to be a success. To date we have vaccinated nearly 17,000 people with the first dose of the Oxford-AstraZeneca vaccine.

Phlebotomy (blood tests) 

The on-site North Mid Blood Test Clinic no longer offers GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.
 
We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients. Location and opening times for our community hubs are as follows: 

• Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW,
  Monday to Saturday,
  8am to 5pm
   
• The Laurels Healthy Living Centre 256 St Ann’s Rd, Tottenham, London, N15 5AZ,
  Monday to Saturday,
  8am to 5pm
   
• Forest Primary Care Centre, 308A Hertford Road, Edmonton, London, N9 7HD
  Monday to Friday
  8am-12pm
   
• Grovelands Medical Centre, 1 Grovelands Rd, London N13 4RJ
  Monday to Wednesday
  10am to 2pm

All GP blood tests are bookable online by going to https://www.northmid.nhs.uk/blood-tests. Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.
 
Please do not advise your patients to come to North Mid as they will be asked to attend a clinic in the community.
 
To book an appointment for blood tests, please go to https://www.northmid.nhs.uk/blood-tests or call us on 0208 887 3663 / 3664.
 
GPs are able to send the patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

Prostate cancer pathway update 

We have undertaking mapping of the pathway and patient shadowing and interviews and as a result have implemented some changes. This includes changes which have significantly shortened the length of time on the diagnostic pathway and a new patient information leaflet.
 
We would really appreciate your support with these pathway changes and would ask you to consider the following when referring a patient to us on the two week wait pathway for suspected prostate cancer.
 
Referrals:

• Provide comprehensive past medical history and clinical details in referrals
• Avoid multiple referrals for the same patient
• Ensure that patients are available to attend appointments for the next 2 months after referral

Undertake:

• A recent PSA level ( 2 PSA levels if possible).
• An MSU. Please do not do a PSA if the patient has a UTI
• An eGFR

Patient experience:

• Inform patients why they are being referred. We find they are often not aware of why they have been referred so are worried and anxious
• Alert us if patients require assistance with translators if English is not first language
• Provide an up to date contact details (especially a phone/mobile number)

Dr Andy Heeps becomes interim Chief Executive

From Thursday 1 April 2021, Dr Andy Heeps took over as interim Chief Executive at North Mid following Maria Kane’s recent departure to North Bristol NHS Trust. He is a consultant obstetrician and has been chief operating officer at North Mid since 2018, and more recently, deputy chief executive.

Covid-19 updates

At the NHS England public board meeting earlier this week NHS Chief Executive Sir Simon Stevens announced that the national incident level for the NHS Covid-19 response will now be reduced from level 4 to level 3, effective immediately.

While we will continue to maintain a national incident infrastructure, this will shift the management of the incident from nationally co-ordinated to a regional level. This mirrors how we operated during the summer of 2020 and reflects the reduced number of Covid-19 patients in our inpatient wards and intensive care.
 
What this means for our services
The decline in Covid-19 hospitalisations means that we have been able to restart some elective surgery and we are currently reviewing all services so that we can plan to increase the number of these operations happening over the coming weeks.
 
Outpatient attendances have increased in March 2021 to pre-Covid-19 levels. In March 2021 approximately 10% of outpatient appointments were delivered via telephone or virtually.
 
Attendances at North Mid's Emergency Department (ED) have increased in March 2021 to pre-Covid-19 levels with an average of 530 ED attendances per day.
 
GP referrals are beginning to increase to pre-Covid-19 levels but are currently around 6% lower than March 2020.

Covid-19 vaccinations and testing
Our mass vaccination centre run by our community services team in Enfield Town continues to be a success. To date we have vaccinated nearly over 13,000 people with the first dose of the Oxford-AstraZeneca vaccine.

Phlebotomy (blood tests) 

The on-site North Mid Blood Test Clinic no longer offers GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.
 
We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients. Location and opening times for our community hubs are as follows:

• Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW,
  Monday to Saturday,
  8am to 5pm
   
• The Laurels Healthy Living Centre 256 St Ann’s Rd Tottenham London N15 5AZ,
  Monday to Saturday,
  8am to 5pm

All GP blood tests are bookable online by going to https://www.northmid.nhs.uk/blood-tests. Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.
 
Please do not advise your patients to come to North Mid as they will be asked to attend a clinic in the community.
 
To book an appointment for blood tests, please go to https://www.northmid.nhs.uk/blood-tests
 
GPs are able to send the patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

Rapid Diagnostic Centre (RDC) reminder  

North Mid launched the Rapid Diagnostic Centre (RDC) on  18 January. The RDC is a diagnostic pathway for patients with non-specific symptoms that could indicate cancer. This patient cohort doesn’t necessarily fit the criteria for a referral onto a site specific 2ww pathway.

All enquiries should be made to Northmid.rdc@nhs.net

Find out more information on the North Central London CCGs website.

Covid-19 updates

• Over the last month we have seen a rapid decrease in the numbers of patients with Covid-19 in our medical wards and a more gradual decline in ITU.

• Our ‘Captain Sir Tom Moore’s Centenary Ward’ opened last week and will be located next to the hospital’s Pymmes building and will be used to for our surgical elective pathway. 

Covid-19 vaccinations and testing

Our mass vaccination centre run by our community services team in Enfield Town continues to be a success. To date we have vaccinated nearly 3,000 people with the first dose of the Oxford-AstraZeneca vaccine.

Phlebotomy (blood tests)

The on-site North Mid Blood Test Clinic no longer offers GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.

We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients. Location and opening times for our community hubs are as follows:

• Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW,
  Monday to Saturday,
  8am to 5pm

• The Laurels Healthy Living Centre 256 St Ann’s Rd Tottenham London N15 5AZ,
  Monday to Saturday,
  8am to 5pm

All GP blood tests are bookable online by going to https://www.northmid.nhs.uk/blood-tests. Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.

Please do not advise your patients to come to North Mid as they will be asked to attend a clinic in the community.

To book an appointment for blood tests, please go to https://www.northmid.nhs.uk/blood-tests

GPs are able to send the patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

Covid-19 updates

There was a rapid increase in Covid-19+ patients in our acute and ITU beds last month.

We have seen the numbers of patients decreasing in our medical wards but the pressure on ITU remains. We have been able to close escalation areas such as Endoscopy Suite and Theatre Recovery. 

Following the decision to stop all non-emergency activity on a temporary basis, we have started our elective activity recovery planning that will take us out of the second wave and allow us to gradually increase our elective activity safely.

Vaccinations and testing

We have opened a mass vaccination centre at the Dugdale Centre in Enfield Town that will help us vaccinate hundreds of people a day. This will be open for priority groups set by the Joint Committee on Vaccination and Immunisation, including people over 70 years of age, frontline healthcare staff and clinically extremely vulnerable people.

As the national vaccination programme evolves and expands, so will the Dugdale Centre, offering vaccinations to residents in the local community in Enfield and Haringey according to Government prioritisation.

Rapid Diagnostic Centre (RDC) launched

North Mid launched the Rapid Diagnostic Centre (RDC) on the 18th January. The RDC is a diagnostic pathway for patients with non-specific symptoms that could indicate cancer. This patient cohort doesn’t necessarily fit the criteria for a referral onto a site specific 2ww pathway.

This service will offer a more holistic diagnostic experience to patients with non-specific symptoms and will provide a one-stop service where possible. Other benefits to patients include:

• Enhanced consultant-led triage process to enhance speed and efficiency of pathway
• To provide the patient with a clear diagnosis or onward management plan in addition to tests that exclude/identify cancer
• To provide enhanced support to patients from clinicians, CNS and navigators

The RDC diagnostic pathway offers the following key benefits to GPs:

• Enables effective communication between primary and secondary care
• RDC referral avoids the need for GPs to do multiple cancer referrals when cancer of unknown origin is suspected

How to refer to the RDC

In order to make a referral:

1. An RDC referral form must be completed via EMIS

Local EMIS global document library systems in the 2WW Pan London Referral Forms folder > Rapid Diagnostic Centre (RDC) for Non-Specific Symptoms Suspected Cancer Referral Form

1. Order ‘filter function’ test

When referring to an RDC, GPs should request a prescribed set of investigations (Filter Function tests) e.g. blood tests. Please include as many of the ‘Filter Function’ results as possible when making the referral.  Given the constraints created by Covid it may not be possible to arrange all investigations, and RDCs will be flexible until the situation changes.

A ‘Filter Function’ bundle will be made available soon on tQuest.  

For any pending test results that you have organised at the time of this referral please provide information including type of investigation requested and the Trust performing the tests.

1. Select specific RDC clinics within e-RS
2. Submit RDC referral form over e-RS

All enquiries should be made to Northmid.rdc@nhs.net

Website with more information: https://gps.northcentrallondonccg.nhs.uk/service/rapid-diagnostic-centres

As part of this service change the Upper GI 2 Week Wait pathway will become a triage service and appointments will no longer be able to be booked directly. The triage process enables the Trust to determine the most appropriate pathway for the patient - this could be a test or endoscopy before an outpatient appointment.  After a referral has been received it will be vetted by a consultant and the patient will either be booked an appointment or have diagnostic tests organised.

Phlebotomy (blood tests)

The on-site North Mid Blood Test Clinic no longer offers GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.

We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients. Location and opening times for our community hubs are as follows:

• Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW,
  Monday to Saturday,
  8am to 5pm
   
• The Laurels Healthy Living Centre 256 St Ann’s Rd Tottenham London N15 5AZ,
  Monday to Saturday,
  8am to 5pm

All GP blood tests are bookable online by going to https://www.northmid.nhs.uk/blood-tests. Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.

Please do not advise your patients to come to North Mid as they will be asked to attend a clinic in the community.

To book an appointment for blood tests, please go to https://www.northmid.nhs.uk/blood-tests

GPs are able to send the patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

Inpatient paediatric care returns to North Mid

Last month, we informed you that we temporarily moved our paediatric inpatient services to Great Ormond Street Hospital, as part of our system-wide response to the Covid-19 pandemic. We have now moved these back to North Mid, and we continue to run paediatric emergency services at the hospital.

Post Covid-19 Assessment Service

A Post Covid-19 Assessment Service is being offered to support respiratory complications from Covid-19. This was established in order to follow up inpatients but is now open to GP referrals. The result of a referral may be advice back to the GP, direct access to a diagnostic test or a telephone or face to face appointment.

For queries about this service please contact northmid.postcovid@nhs.net & 0208 887 3511/0208 887 2780.

North Mid launched the Rapid Diagnostic Centre (RDC) on the 18th January. The RDC is a diagnostic pathway for patients with non-specific symptoms that could indicate cancer. This patient cohort doesn’t necessarily fit the criteria for a referral onto a site specific 2ww pathway.

This service will offer a more holistic diagnostic experience to patients with non-specific symptoms and will provide a one-stop service where possible. Other benefits to patients include:

• Enhanced consultant-led triage process to enhance speed and efficiency of pathway
• To provide the patient with a clear diagnosis or onward management plan in addition to tests that exclude/identify cancer
• To provide enhanced support to patients from clinicians, CNS and navigators

The RDC diagnostic pathway offers the following key benefits to GPs:

• Enables effective communication between primary and secondary care
• RDC referral avoids the need for GPs to do multiple cancer referrals when cancer of unknown origin is suspected

How to refer to the RDC

In order to make a referral:

1. An RDC referral form must be completed via EMIS

Local EMIS global document library systems in the 2WW Pan London Referral Forms folder > Rapid Diagnostic Centre (RDC) for Non-Specific Symptoms Suspected Cancer Referral Form

1. Order ‘filter function’ test

When referring to an RDC, GPs should request a prescribed set of investigations (Filter Function tests) e.g. blood tests. Please include as many of the ‘Filter Function’ results as possible when making the referral.  Given the constraints created by Covid it may not be possible to arrange all investigations, and RDCs will be flexible until the situation changes.

A ‘Filter Function’ bundle will be made available soon on tQuest.  

For any pending test results that you have organised at the time of this referral please provide information including type of investigation requested and the Trust performing the tests.

1. Select specific RDC clinics within e-RS
2. Submit RDC referral form over e-RS

All enquiries should be made to Northmid.rdc@nhs.net

Website with more information: https://gps.northcentrallondonccg.nhs.uk/service/rapid-diagnostic-centres

As part of this service change the Upper GI 2 Week Wait pathway will become a triage service and appointments will no longer be able to be booked directly. The triage process enables the Trust to determine the most appropriate pathway for the patient - this could be a test or endoscopy before an outpatient appointment.  After a referral has been received it will be vetted by a consultant and the patient will either be booked an appointment or have diagnostic tests organised.

Covid-19 update

There has been a rapid increase in Covid-19 positive patients in our acute and ITU beds and we are now treating patients across the hospital including in escalation areas such as our Endoscopy Suite and Theatre Recovery.
 
The Covid-19 pressure has been increased by the rapid growth of the new variant as well as a continuation or normal winter pressure numbers in our A&E department.
 
We have taken the very difficult decision to stop all non-emergency activity on a temporary basis. This will allow us to continue to safely look after patients, who need urgent, emergency and covid-19 care. We are reviewing this each week.
 
We continue to work with system partners to create additional stepdown capacity and decompress ITU on a daily basis.  
 
Vaccinations and testing

We have started to administer the Covid-19 vaccine to our staff, care home staff and to system partners including Barnet, Enfield and Haringey NHS Trust and local social services. So far, we have delivered 2800 vaccinations.
 
We are currently testing 45% of patient facing staff with PCR testing. Alongside this, we have rolled out Lateral Flow Testing to 2339 of our staff.

Phlebotomy (blood tests) 

From 4 January 2021, The on-site North Middlesex Blood Test Clinic will no longer offer GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.
 
We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients. Location and opening times for our community hubs are as follows:
 
Evergreen Surgery 

1 Smythe Close, Edmonton N9 0TW,
Monday to Saturday,
8am to 5pm
 
The Laurels Healthy Living Centre

256 St Ann’s Rd Tottenham London N15 5AZ,
Monday to Saturday,
8am to 5pm
 
All GP blood tests are bookable online by going to https://www.northmid.nhs.uk/blood-tests.

Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.
 
Please do not advise your patients to come to North Middlesex as they will be turned away.
 
To book an appointment for blood tests, please go to https://www.northmid.nhs.uk/blood-tests
 
GPs are able to send the patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

Radiology update

We have postponed all Routine MRI, CT and Ultrasound appointments. We have closed MRI, CT and Ultrasound to GP Direct Access with the exception of cancer pathways.

Please see the below summary of services available:
 

Radiology update

Patients aged over 18:
Imaging Modality	Clinical requirement	North Mid
Ultrasound	Urgent - Cancer suspected (Abdominal)	Yes
Urgent - Cancer suspected (Gynae)	Yes
Urgent - non cancer	Yes
Routine - All	No
MRI	Urgent - Cancer suspected	Yes
Urgent - non cancer	No
Routine	No
X-Ray	Urgent - Cancer suspected	Yes
Urgent - non cancer	Yes
Routine	No
CT	Urgent - Cancer suspected	Yes
Urgent - non cancer	No
Routine	No
Dexa	Urgent - Cancer suspected	No
Urgent - non cancer	No
Routine	No

Women’s health update 

We have cancelled all routine gynaecology clinics except Fertility clinics (2 per month as per The Human Fertilisation & Embryology Authority guidance). Routine hysteroscopy clinics are cancelled.

We are doing urgent gynae clinics and target clinics/hysteroscopies.

Paediatrics update

Inpatient and emergency paediatric care: As part of our system-wide response to the Covid-19 pandemic, we have temporarily moved our paediatric inpatient services to Great Ormond Street Hospital. We do, however, continue to run paediatric emergency services at the hospital in a transformed Children’s A&E department.

Paediatric blood tests: Please note that any paediatric patients who require a blood test need a patient request form to present to the phlebotomist in order for the patient to be bleed. Unfortunately, we are unable to bleed any paediatric patient without a patient request form.

Post Covid-19 Assessment Service  

A Post Covid-19 Assessment Service is being offered to support respiratory complications from Covid-19. This was established in order to follow up inpatients but is now open to GP referrals. The result of a referral may be advice back to the GP, direct access to a diagnostic test or a telephone or face to face appointment.

For queries about this service please contact northmid.postcovid@nhs.net or 0208 887 3511 / 0208 887 2780.

From Monday 4 January 2021, there will be a change to the way that GP blood test appointments are offered.

The on-site North Middlesex Blood Test Clinic will no longer offer GP blood test appointments. GP referrals will only be accepted at our community phlebotomy sites.

We currently have next day appointments available at our community based sites, Laurels and Evergreen for all Enfield and Haringey patients.

Locations and opening times for our community hubs are as follows:

Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW, 

Monday to Saturday, 8am to 5pm

The Laurels Healthy Living Centre, 256 St Ann’s Rd Tottenham London N15 5AZ,

Monday to Saturday, 8am to 5pm

All GP blood tests can be booked online northmid.nhs.uk/blood-tests

Patients can select the location, date and time at their own convenience. All patients must have a booked appointment. There is no walk in service.

Please do not advise patients to show up at North Middlesex as they will be turned away.

To book an appointment for blood tests, please go to northmid.nhs.uk/blood-tests

GPs are able to send patient request forms to a generic North Middlesex email for printing only: northmid.bloodtestrequestforms@nhs.net

From Tuesday 1 December 2020, the clinical haematology service is changing the way prescriptions are given to patients. 

Historically, patients with haemoglobin disorders (Sickle Cell Disorder, Thalassaemia) received the majority of their repeat prescribed outpatient medication from the Trust via TTA.

We are informing GPs about the most up-to-date medication list and are asking surgeries formally to take over repeat prescribing. This includes the patients’ opiates but excludes specialist drugs like hydroxycarbamide and iron chelation. The Trust will no longer provide routine repeat prescriptions, helping to avoid the possibility of double presciptions, gives you better oversight of you patients' prescriptions and means that patients can pick up medication from their local pharmacy.  

When the patient’s GP informs the service in writing that they are unable or unwilling to provide a particular prescription, the haemoglobinopathy service will continue to do so. Please forward any non-urgent queries via email to northmid.haem@nhs.net. Please also write or email if you cannot provide the patient with a prescription or if you would like us to forward relevant blood results for safe prescribing.

Urgent questions can be directed to the on-call haematologist via the North Middlesex Switchboard.

To manage any future surges in demand, we have a detailed Covid Response Plan in place which we have tested via a table top exercise. This was produced in partnership with the individual services that will be involved in the response and we have a team in place to lead the response.

We currently have two wards dedicated to treating patients with Covid-19 and we are working on creating additional capacity which will be able to support acutely unwell patients with Covid-19 as well as ITU patients.

We are continuing with our elective programme and do not currently intend to scale this back unless Covid-19 activity increases or national guidance changes.
 
We are working in partnership with the independent sector for some elective surgery, and there are plans in place with partners for mutual aid should we need to seek support for ITU capacity.

Phlebotomy

There are two community based phlebotomy hubs in operation.

A seven station 8am – 8pm Phlebotomy service at Evergreen Surgery, 1 Smythe Close, Edmonton N9 0TW. Eight phlebotomy stations at The Laurels Healthy Living Centre 256 St Ann’s Rd Tottenham London N15 5AZ.

Both hubs are open to Enfield and Haringey patients.

Appointments are all bookable by Swiftqueue only and there is no walk in service available at either hub.

GPs will now be able to send Patient Requests Forms to a generic North Middlesex email: northmid.bloodtestrequestforms@nhs.net

The telephone number for the service is: 07483 903 704

Please do not hesitate to contact the service if required as we are committed to working together to ensure that we address the current waiting list challenges.

ECGs

From Wednesday 8 October 2020 GPs were able to book ECGs for patients through e-RS using clinic code AHPOE.

Due to infection prevention and control constraints we are not able to offer a walk-in service at present, and current capacity is for 20 pre-booked slots per day compared to 30 slots a day pre-covid.

The location will be the anticoagulation building which has the advantage of a separate entrance from the main site.

Referral Assessment Service for general gastroenterology referrals

From Monday 12 October 2020 all referrals for general gastro will receive a consultant triage and where appropriate and where sufficient information has been given in a referral, patients will be referred straight to a diagnostic test.

Patients and GPs will receive a letter detailing the intended management plan and requested diagnostic. This should reduce the likelihood of previous experiences, of being held on a waiting list for a consultation before any diagnostic tests are carried out.

GPs should advise patients that referral to North Mid gastroenterology department may not result in an outpatient consultation and that a hospital specialist will respond once they have received a referral, to determine if a patient needs an outpatient consultation by telephone or face to face or whether a diagnostic test appointment needs to be made.

GPs should continue to refer via ERS. 

For all enquiries please email northmid.gastroenterology@nhs.net or call 020 8887 4559.

Changes to children’s A&E

We’re pleased to announce that we opened our new children’s A&E last month following a £1.2million investment.

The investment means that we now have a new dedicated space for children who need mental health support, a doubling in capacity of resuscitation care and a new breastfeeding room. It will also mean we can significantly improve patient experience through the new Changing Places toilet facilities, for children who not able to use the toilet independently, a new relatives room for those waiting while their loved one receives treatment and a separate entrance to the department.

North Mid pilot for 111 First supports London-wide roll out

Following a successful pilot at North Mid, there has now been a London-wide roll out of ‘111 First’, which sees Londoners asked to ring 111 before going to an A&E department.

The scheme aims to help direct patients to the most appropriate urgent or emergency service for their needs, and reduce the need to spend unnecessary time in A&E waiting rooms. If A&E is the right place for their care, NHS 111 can book them a time slot to attend, and North Mid has two slots for these ‘heralded patients’ every hour between 8am – 8pm. 

Clinical strategy launch

A number of our local GPs contributed to our new Clinical Strategy which can be found on our dedicated page.

In this document we outline our plans against five clinical chapters:

• Cancer services
• Children and Young People
• Maternity services
• Planned care
• Urgent and Emergency Care

We look forward to working with you to implement these plans over the coming years.

Green light for reshaping elective orthopaedics in north central London

The NHS in north central London will create two new centres for planned orthopaedic surgery.
 
Two partnerships for orthopaedic surgery have been formed by local NHS Trusts: UCLH and Whittington Health will work together to provide inpatient and day surgery across the partnership. North Middlesex University Hospital will work with the Royal Free London, with inpatient surgery at Chase Farm and day surgery at both sites. Outpatient appointments and joint school will also happen across these hospitals.
 
This means that from January, you will need to have conversations with your patients about which partnership they will want to be treated at.
 
For more information about this, please visit the North Central London Partners website.

 

From Wednesday 8 October 2020 GPs were able to book ECGs for patients through e-RS using clinic code AHPOE.

Due to infection prevention and control constraints we are not able to offer a walk-in service at present, and current capacity is for 20 pre-booked slots per day compared to 30 slots a day pre-covid.

The location will be the anticoagulation building which has the advantage of a separate entrance from the main site.