South Glos Consortium Ltd
Cardiology Review Report January 2010
Compiled by Dr Richard Berkley
This information will be available electronically on the South Glos Consortium website on: under
construction
Quick wins for practices included in this edition:
o Information and contacts for cardiology
o Please avoid named cardiologist unless exceptionally required; it is causing problems!
o Urgent referrals should be sent via Choose and Book – using fax referrals is known to
create duplicates. A faxed request will not be seen any sooner than an urgent referral via
Choose and Book.
o Beware of the dangers of creating duplicate Choose and Book referrals
o Direct access for tests is available – referral for cardiology tests at NBT can be requested
by fax or via ICE. Referrals for tests to UHB can be made using the Choose and Book
system
o Treating heart failure aggressively works. Avoid the trap of under-treatment; use the
Community Heart Failure Service to help you.
The following chart shows your practice GP referral rate per 1000 to Cardiology, NBT for 2009/10,
cumulative as at Q2. Obviously the referral numbers are still relatively small, but this graph will
become a more accurate and robust method of comparison over time. However, in the meantime, it
may indicate that your practice might be an outlier and may help inform your in-house discussions.
Please note we have been advised by the PCT to use unweighted list size population when
comparing by specialty.
Cardiology GP Referrals to NBT cumulative as at Q2 2009/10 per 1000 (unweighted)
population
10.00
8.00
6.00
4.00
2.00
1
L81642
L81029
L81649
L81127
L81047
L81130
L81042
L81134
L81639
L81055
L81050
L81018
L81079
L81036
L81026
L81024
L81118
L81632
L81046
L81117
L81106
L81063
L81014
L81052
L81103
L81048
L81028
L81019
0.00
L81657
Ref/1000 pop
12.00
South Glos Consortium Ltd
Cardiology Review Report January 2010
Compiled by Dr Richard Berkley
Background information –
The cardiologists have been keen to engage, and adjust service delivery and find new ways of working.
There have been some changes in management which has given a temporary hold up but a number of
things are in the pipeline. With the development of Yate, there are opportunities to introduce change and the
BNSSG community is working specifically on a model for community cardiology. This is looking to shift care
closer to home, streamline and simplify access to various cardiac services and work to improve the pathway
for patients needing specialist cardiac input. As part of this, the idea of helping to manage referrals to ensure
patients get to the right place first time, and also facilitating discharge, is being addressed. The timescale for
this is realistically too far away to make a difference in this financial year, but all the work that is being done
locally will also feed in to that wider process.
We have met and had email contact with the cardiologists at NBT and a number of initiatives are being
considered which will hopefully make an impact more quickly as detailed below and in the introduction.
What we can do in primary care? – well quite a lot really ……
o
o
o
o
o
o
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Please LOOK CAREFULLY at the referral criteria for the Rapid Access Chest Pain Clinic. People
have been referred there inappropriately, in wheelchairs or with atypical chest pains. This will lead to
duplication and extra charges. The conditions treated and exclusions are outlined within Choose and
Book under “Rapid Access Chest Pain Service – Cardiology” and “One Stop Chest Pain Service –
Cardiology”.
Recently an influx of patients being referred to Dr Papouchado by fax and C&B has led to a specific
pressure on his clinics. For fastest waiting times please refer generically to cardiology and DO NOT
REFER TO NAMED CONSULTANT UNLESS REALLY NECESSARY. Generic referrals are triaged
by consultants so can be directed to the most appropriate clinician
Urgent referrals should be sent via the Choose and Book system. If there are concerns that the
patient has not been booked a soon enough appointment or an expedite appointment request needs
to be made, please fax a letter detailing the clinical reasons for the sooner appointment to Mary
Harris, Out-Patient Co-ordinator at NBT – Fax 0117 323 6164. Faxing the referral will not mean that
the patient is seen any sooner than sending the referral on the Choose and Book system.
If an urgent referral needs to be faxed, please make it clear when sending the paper copy, as it is not
always clear that the action has already been taken, which can lead to duplicate appointments. The
only instance where a fax should be sent is if the patient is being seen within the next couple of days
Take care with Choose and Book, particularly if the patient is already in the system. Patients have
fed back concern and confusion when appointments are made through Choose and Book, only to
have an appointment cancelled again as they already have an appointment.
Please use the DIRECT ACCESS routes for requesting certain tests. In particular please be aware
you can request an echo directly using an X-ray form and, if you are referring for ? murmur, this might
be the best start.
Please remember to use the Community Heart Failure Service to help make an accurate diagnosis to
aid you in the management of heart failure. It is a difficult job to titrate the more sick patients, but
careful management and maximising medications and lifestyle interventions can reduce admissions
by up to 30%. A selection of patients may also benefit from special pacemakers (Biventricular Pacing)
which can have very significant impacts on patient outcomes, admission rates, death and QoL.
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How to refer to Cardiology Services
o There are two types of Chest Pain Services - Rapid Access Chest Pain Service (patient seen
within 2 weeks when they meet all of the criteria on the form) or the One Stop Service (for
patients seen within 5-6 weeks when patients meet some of the criteria).

To refer to the Rapid Access Service, please send the referral via Choose and Book
(enter a priority of 2WW and a problem of “Chest Pain”).

To refer to the One Stop Service, please send the referral via Choose and Book (enter
a priority of “Urgent” and a problem of “Chest Pain”).
PLEASE NOTE EXCLUSIONS FROM THE RACPC, patients sent here who are unsuitable will
end up having duplicate appointments which is unsatisfactory for the patient - and costly!
RACPC exclusions are as follows:
 Atypical chest pain or deteriorating angina (refer to Southmead General
Cardiology Service)
 Acute MI or unstable angina (refer as emergency admission)
o Community Heart Failure Service is currently not available on Choose and Book, please
continue to fax referrals. Referral criteria is attached with this newsletter.
Community Heart Failure Service – Fax 0117 908 2310
o Secondary Care Heart Failure Clinic is now available on Choose and Book. To access the
service, please enter a problem and select the following service:
Secondary Care Heart Failure Service - Heart Failure Service - Southmead - RVJ
o Palpitations Clinic is now available on Choose and Book. To access this service, please
enter a problem of “palpitations” on Choose and Book and select the service:
Palpitations Clinic - Cardiology - Frenchay - RVJ
o Syncope Clinic is now available on Choose and Book. To access this service, please enter a
problem of “syncope” on Choose and Book and select the service:
Syncope Clinic - Cardiology - Southmead - RVJ.
o Community Heart Failure Service, Cardiac Genetics, Transient Ischaemic Attack (TIA) and
Diagnostic Tests/Pathology are the only clinics not available on the Choose and Book system
What can NBT do to help us? - Again a lot of goodwill has been shown
o We are working on discharge and clinic letters, with our main focus being on reducing follow
up rates
o Improved information flow from RACPC (Rapid Access Chest Pain Clinic) should be ready
any time with computer printouts rather than handwritten info
This sounds like a lot of work but it is vital we work together trying to streamline referrals, reduce
unnecessary ones and manage follow ups alongside our secondary care colleagues.
Please can you discuss the contents of this report at your monthly meetings
and work within the suggested changes – thank you!
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Contacts for NBT Cardiology Consultants

For general advice please contact NBT switchboard and ask for Cardiology Specialty Registrar:
NBT SWITCHBOARD:
0117 970 1212 or 0117 950 5050
Cardiologists based at Frenchay
Dr Philip Boreham:
0117 340 6652 (PA/Sec)
philip.boreham@nbt.nhs.uk
Dr Ben Farrow
0117 340 3109 (PA/Sec)
benedict.farrow@nbt.nhs.uk
Dr Mark Papouchado
0117 340 6510 (PA/Sec)
Available: Fridays a.m.
(do not email)
Cardiologists based at Southmead
Dr Paul Walker
0117 323 5288 (PA/Sec) paul.walker@nbt.nhs.uk
0117 323 4310 (direct)
Available: between 12 – 1 p.m. most days
Dr Andrew Skyrme-Jones
0117 3232 5548 (PA/Sec) andrew.skyrme-jones@nbt.nhs.uk
Dr Shahid Aziz
0117 323 5366 (PA/Sec)
shahid.aziz@nbt.nhs.uk
When attempting to contact consultants, it is likely you will be able to speak directly with
them at the above times. If you leave a message, please give a mobile number for the return
call. If this is not possible, please state a time when you will be available to speak with the
consultants to save them the rigours of our switchboards and reception staff
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