In this issue
Training and Events
Skype seminar for primary care- management of lung cancer during COVID-19
Service specific updates
Guy's and St Thomas' lung nodule (virtual) clinic
Post ICU (Critical Care Recovery) Service
Evelina London Children’s Hospital: Paediatric Orthopaedic Service
Dimbleby Cancer Care
Rapid Access Diagnostic Clinic
Changes to referrals at Guy's and St Thomas'
** UPDATE** Important Change to Suspected Lower GI Cancer Referrals
Update on urgent and cancer surgery
Attending the hospital
Attending the hospital including A&E services
Changes to walk-in services
Please note, without exception, all services are running a reduced service on skeleton staff and so only urgent patients are being seen. Please only refer to a walk-in service if urgent and please consider the safety of the patient when referring.
Changes to Community Services at Guy's and St Thomas'
Community Diabetes clinic
Advance Care Planning for District Nursing patients
Neuro-rehabilitation Referrals
Advice and Guidance
e-RS
Consultant Connect
Stroke/ TIA Mobile Helpline
Important message to share with patients
Urgent Unscheduled Care
Worklist Management
Guy's St Thomas' website
Existing Referrals – New & Follow ups & Community referrals
NEW Referrals – Suspected Cancer (Two Week Wait)
NEW Urgent & Routine
Skype seminar for primary care- management of lung cancer during COVID-19

Guy's and St Thomas' would like to invite you to a one hour interactive Skype seminar with a practical overview of lung cancer cases the COVID-19 recovery phase.

 

Dr Fiona Castell and Dr Ana Montes, Consultant Oncologists, will present on the management in primary care of patients with and without a cancer diagnosis particularly those with suspected cancer in the current COVID-19 times . The session will cover also immunotherapy and chemotherapy for lung cancer.

 

Date: Friday 12 June 2020

Time: 13:30- 14.30

[ READ MORE ]
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Service specific updates
Guy's and St Thomas' lung nodule (virtual) clinic

The Guy's and St Thomas' lung nodule (virtual) clinic is available on e-RS

 

The nodule clinic is a virtual clinic for review and follow up of pulmonary nodules (in accordance with British Thoracic Society guidelines). The patients are not seen physically in clinic.

 

CT scans are reviewed by the respiratory physicians and radiologists. Patients receive the outcome of the clinic review by letter (discharge, CT follow up or clinical review) with a copy to their general practitioner.

Please note that if the nodule is a new solid nodule greater than 8mm  (not ground glass) we would advise a referral to the 2WW lung service

 

The service is currently accessible via e-RS as outlined below:

Specialty:         Respiratory Medicine

Clinic Type:      Not Otherwise Specified

Service Name: Lung Nodule Virtual Clinic - Respiratory - Guys' & St Thomas' - RJ1

Please advise in the referral where the scan was performed if not done at Guy’s and St Thomas’.

 

Please ensure that the patient is advised not to attend the hospital on the date and time booked.

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Post ICU (Critical Care Recovery) Service

Our Critical Care Recovery Clinic Service is available on e-RS for A&G and referrals.  In addition we have also set up a dedicated service on Consultant Connect - “Post ICU care”.  This is for any syndrome related issues/ complications up to a year post discharge from intensive care.  For COVID/ non COVID patients this relates to patients who have been in ICU and been discharged.

 

As there is no speciality on e-RS, the service is currently accessible via General medicine as outlined below:

Specialty:         General Medicine

Clinic Type:      General Medicine

Service Name: Critical Care Recovery Clinic Service - Guys' & St Thomas' NHS Trust - RJI

 

Please note that this service is NOT for General medicine referrals and read the DoS criteria head of referral or seek advice if unsure.

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Evelina London Children’s Hospital: Paediatric Orthopaedic Service

Our paediatric orthopaedic team continue to provide normal services for emergency or urgent musculoskeletal conditions during the COVID-19 pandemic.

  • Traumatic injuries, musculoskeletal infections and concerns regarding possible non-accidental injury should be referred via A&E or the on call Orthopaedic team at St Thomas’ Hospital.
  • Urgent conditions can be referred to the Paediatric Orthopaedics service via e-RS. We are reviewing referrals daily as per normal practice and can arrange to assess patients urgently via virtual or face-to-face appointments if appropriate. This document provides some guidance: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/C0289-specialty-guidance-emergency-and-urgent-msk-guidance-for-children.pdf
  • We are also happy to receive routine referrals via e-RS and will triage them to be seen in an appropriate timescale; please advise patients there may be a delay in them being seen. We are also able to give advice via the e-RS ‘Advice & Guidance’ system and ‘Consultant Connect’ telephone service.

The Evelina hip dysplasia screening service is running as normal through the COVID pandemic. As per the NIPE guidance (link below), please refer any risk-factor positive babies directly to radiology for an ultrasound scan ideally by 6 weeks of age, and any infants with abnormal examination findings urgently via e-RS. https://www.gov.uk/government/publications/newborn-and-infant-physical-examination-programme-handbook/newborn-and-infant-physical-examination-screening-programme-handbook#examination-of-the-hips

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Dimbleby Cancer Care

We are currently not providing face-to-face appointments for all our services, apart from the walk-in information nurse service at Guys’ Cancer centre. However, we have adapted our services to continue to be there for people and provide the support people need.

 

The psychological therapy, information nurse and welfare benefits services can all be conducted by phone or video depending on a person’s preference.

While our complementary therapy team are unable to provide hands-on treatments during this time, we can still support patients with our Aromastick Service and Online Relaxation and Complementary Therapy Support Service.

 

People can refer to us in the usual way either on EPR or by completing a self-referral.

 

Contact us:

·       Email: dimblebycancercare@gstt.nhs.uk

·       Tel: 020 7188 5918

 

Please note, we are not an emergency service. If your patient requires urgent medical or emotional support, please ask them to attend their nearest 24 hour Accident and Emergency (A&E) Department.

For 24 hour emotional support please call SLAM 24 hour mental health support line 0800 731 2864 or Samaritans on their new short number: 116 123.

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Rapid Access Diagnostic Clinic

We have amended our Rapid Access Diagnostic clinic on e-RS and it is now mapped to the new clinic type ‘2WW Non-specific symptoms’.  The services used to be mapped to General Medicine which has now been end-dated using transition date to allow for any patients referred under this to be processed.  All referrals for this service must be made via the new clinic type which can be accessed as follows:

 

Priority:           2ww

Specialty:         2ww

Clinic Type:      2ww Non-specific symptoms

Service Name: Rapid Access Diagnostic Service for non-specific symptoms - Guy's Site -RJ1

 

The Rapid Diagnostic Clinic (RDC) at GSTT is currently open and reviewing high risk patients. We are triaging all referrals and operating two clinic lists weekly for patients with urgent non-site specific symptoms that are highly suspicious for cancer. The current wait time for an appointment is approx.7 days. The service can be accessed on e-RS via 2WW Cancer of Unknown Primary or via General Medicine.

Please find more information on our website:

 https://www.guysandstthomas.nhs.uk/our-services/rapid-access-diagnostic-clinic/overview.aspx

You can also call the team on 07922383126 to discuss clinical cases or seek advice via e-RS.

 The RDC is also working closely with ED at St Thomas hospital to try and capture high risk patients who present as an emergency.

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Changes to referrals at Guy's and St Thomas'
** UPDATE** Important Change to Suspected Lower GI Cancer Referrals

Diagnostic capacity for suspected lower GI cancer referrals is extremely limited during the COVID-19 pandemic. Given this, any diagnostic capacity must be prioritised to patients who show the highest risk of suspected colorectal cancer, which is why the following changes, mandated by NSHE, have been made.

All patients suspected of having a lower GI cancer (i.e. meeting NICE 2WW criteria) must now have a FIT test performed before a referral should be made, except in cases of unexplained anal or rectal mass, or anal ulceration who should be referred irrespective of FIT.

 

FIT of ≥10µg/g are positive and should be referred on 2WW.

FIT of <10µg/g, FIT of <10μg/g indicate a low probability of bowel cancer (99.6% chance that the patient does not have colorectal cancer).

 

If you are still suspicious of cancer, you should consider:

1) Safety netting and review at 4-6 weeks to consider need for referral if concerning symptoms persist, either LGI 2WW if the patient meets NG12 criteria or routinely if they do not;

2) Consider an alternative suspected cancer pathway that may be more appropriate for the patients symptoms e.g. upper GI, urological, gynaecological or to Rapid Diagnostic Centre (RDC);

3) Seeking advice from a specialist via Advice & Guidance or a similar service;

4) Refer on LGI 2WW pathway but with FULL clinical information included.

 

Further information can be found in the attached one page.

The suspected lower GI cancer referral form has been updated in light of these changes. You can find a copy of this, as well as further information, on this website: https://www.healthylondon.org/resource/covid-19-cancer-referral-resources

 

DXS has also been updated with these changes.

Please don’t hesitate to contact england.tcstlondon@nhs.net if you have any questions regarding these changes.

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Update on urgent and cancer surgery

Across all three South East London hospitals, around 100 patients per week requiring urgent cancer, cardiac and other life-saving surgery are being treated at HCA London Bridge and HCA Cancer Centre sites. In order to minimise risk of COVID-19 exposure for this group peri-operatively, clinicians are asking patients and their households to follow shielding protocols for the 14 days prior to their planned admission for surgery.

 

This will include patients who have not otherwise been asked to shield by the Government or been identified by their GP as needing to shield. On these occasions, the hospital will write to the patient’s GP to inform them of our request for the patient and their household to temporarily shield, and they should be temporarily identified as shielded patients potentially requiring similar levels of Government support, e.g. for food deliveries.

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Important message to share with patients

Although people are being told to stay home to protect themselves, if you have a patient already under the care of Guy’s and St Thomas’ or who is unwell, they should continue to access the care that they need.

 

For patients with a long-term condition please ask them to keep in touch with their clinical team. They should refer to our services section on our website where more information is available, including the best way to contact us, which may include by email or telephone. We have set up dedicated patient helplines.

 

Our emergency department (A&E) including Children’s is open 24 hours a day, seven days a week at St Thomas’ Hospital.

Our urgent care centre at Guy’s Hospital is open and can provide help with minor injuries and urgent medical problems.

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Urgent Unscheduled Care

Across Guy’s, St Thomas’ and Evelina London we have segregated areas for specialists to review COVID-19 negative, suspected and positive patients who require urgent review.

Please direct patients to the Emergency Department (ED) or contact the specialist team(s) directly for your patient to be seen. 

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Worklist Management

Please monitor worklists daily on e-RS for advice responses and rejections.

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Guy's St Thomas' website

To support GPs we have updated our services pages on our website with COVID-19 specific information.  There is also a dedicated section for patients with details on how to contact us.

https://www.guysandstthomas.nhs.uk/patients-and-visitors/coronavirus/coronavirus-service-updates.aspx

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Existing Referrals – New & Follow ups & Community referrals

As of 30th March we have reduced activity across all services by 80% - to release clinical staff to support most urgent patients and growing inpatient pressures.

Patients will either:

  • Have their appointment via telephone/video consultation
  • Have appointment postponed and retained on a patient waiting list
  • be discharged back to GP with advice as appropriate

 

Please advise your patients they must not come to the hospital for an appointment unless we have specifically asked them to or they require urgent review.

 

If a patient is asked to attend a face to face appointment, please advise them that they must come for this.

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NEW Referrals – Suspected Cancer (Two Week Wait)

GPs should continue to refer a patient with suspected Cancer on this pathway. For the majority of services (except Breast and Dermatology), use the “defer to provider” functionality to generate an Appointment Slot Issue (ASI) and we will be made aware of the patient's referral.

 

All referrals are now being vetted by a nominated Consultant or Nurse Consultant to review. Referrals will be:

  • Accepted and an appointment scheduled
  • Downgraded with advice and guidance back to GP
  • Patient is query cancer but is in vulnerable group and so appointment to be deferred and patient added to waiting list for future appointment

 

** For Breast - Appointments to be booked via e-RS and clinical team will review clinic lists and reallocate to a telephone clinic appointment for those patients with a lower index of suspicion.

** For Dermatology – please continue to book face to face appointments

 

Please consider urgency of referral and ensure the patients are aware they will be on a pathway and to expect contact from the hospital within 48 hours of the referral being received.

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NEW Urgent & Routine

PLEASE ENSURE THAT YOU HAVE SOUGHT ADVICE PRIOR TO ANY NEW REFERRAL VIA CONSULTANT CONNECT OR e-RS. 

 

Please DO NOT REFER any new patients prior to seeking advice via e-RS or Consultant Connect (if available). If you need to refer post seeking advice, please use e-RS – do NOT email referrals.

 

Please inform patient’s there will be a delay for routine appointments and avoid sending duplicate referrals

 

You can attach documents to the e-RS advice request, which may include diagnostic results, scanned images (e.g. ECGs).  Providers can also respond with attachments.

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Advice and Guidance
e-RS

All of our services on e-RS are configured to accept advice requests.

 

We have now set up our Specialist Genetics and Neurofibromatosis service to accept e-RS A&G

 

PLEASE ENSURE THAT YOU HAVE SOUGHT ADVICE PRIOR TO ANY NEW REFERRAL VIA CONSULTANT CONNECT OR e-RS

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Consultant Connect

We have rapidly expanded our Consultant Connect lines – most of these are available Monday to Friday 9am to 5pm unless stated otherwise. We would encourage GPs to download the Consultant Connect app for convenient access our services.

 

Please note that our Gastroenterology and Hepatology Lines are for Lambeth & Southwark

Our Elderly Care Line and Acute Medicine lines are available 24/7

 

We have set up a dedicated Post ICU care line.  This is for any syndrome related issues/ complications up to a year post discharge from intensive care.  For COVID patients this relates to patients who have been in ICU only and been discharged.

 

Depending on your area, Consultant Connect lines are available for GPs in South East London for the following specialities:

 

We have set up dedicated lines for Evelina London services which are now live as below:

Speciality

CC Coverage

Paediatric ENT

Lambeth, Southwark & Lewisham

Paediatric Allergy

All 6 SEL CCGs

Paediatric Bladder

All 6 SEL CCGs

Paediatric Cardiac Surgery

All 6 SEL CCGs

Paediatric Cardiology

All 6 SEL CCGs

Paediatric Cleft

All 6 SEL CCGs

Paediatric Endocrine & Diabetes

All 6 SEL CCGs

Paediatric Gastroenterology

All 6 SEL CCGs

Paediatric General Surgery

All 6 SEL CCGs

Paediatric Haematology

All 6 SEL CCGs

Paediatric IMMID

All 6 SEL CCGs

Paediatric Metabolic

All 6 SEL CCGs

Paediatric Neurology

All 6 SEL CCGs

Paediatric Ophthalmology

All 6 SEL CCGs

Paediatric Orthopaedic

All 6 SEL CCGs

Paediatric Palliative care

All 6 SEL CCGs

Paediatric Plastic Surgery

All 6 SEL CCGs

Paediatric Renal

All 6 SEL CCGs

Paediatric Respiratory

All 6 SEL CCGs

Paediatric Rheumatology

All 6 SEL CCGs

Paediatric Sleep

All 6 SEL CCGs

Paediatric Spinal

All 6 SEL CCGs

Paediatric Urology

All 6 SEL CCGs

Paediatrics Evelina CARS

All 6 SEL CCGs

 

 

 

Adult Services

Speciality

CC Coverage

Elderly Care - Nursing and Residential Homes

Lambeth, Southwark

Elderly Care (24/7 line)

Lambeth, Southwark

Foot Health Acute

Lambeth, Southwark

Foot Health Community

Lambeth, Southwark

Gastroenterology

Lambeth, Southwark

Hepatology

Lambeth, Southwark

Occupational Therapy & Hand Therapy

Lambeth, Southwark

Physiotherapy

Lambeth, Southwark

Adult Dermatology via PhotoSAF

Lambeth, Southwark & Lewisham

Adult Dermatology via PhotoSAF

Lambeth, Southwark & Lewisham

Gynaecology

Lambeth, Southwark, Bromley

Neurology

Lambeth, Southwark, Bromley

Rheumatology

Lambeth, Southwark, Bromley

Cardiology

Lambeth, Southwark, Bromley & Bexley

Acute Medicine (24/7 Line)

All 6 SEL CCGs

Adult Allergy

All 6 SEL CCGs

Cancer confirmed diagnosis

All 6 SEL CCGs

Cancer Genetics

All 6 SEL CCGs

Cardiac Surgery

All 6 SEL CCGs

Diabetes & Endocrinology

All 6 SEL CCGs

ENT

All 6 SEL CCGs

General Genetics

All 6 SEL CCGs

Haematology

All 6 SEL CCGs

HIV (24/7 Line)

All 6 SEL CCGs

Neurofibromatosis

All 6 SEL CCGs

Ophthalmology

All 6 SEL CCGs

Orthopaedics

All 6 SEL CCGs

Pain Management

All 6 SEL CCGs

Palliative Care

All 6 SEL CCGs

Post ICU Care

All 6 SEL CCGs

Plastics

All 6 SEL CCGs

Renal Medicine

All 6 SEL CCGs

Respiratory Medicine

All 6 SEL CCGs

Speech and Language Therapy

All 6 SEL CCGs

Urology

All 6 SEL CCGs

Vascular Surgery

All 6 SEL CCGs

 

Where available, calls will first go through to your local trust’s specialist team. If the call is not answered, it will pass to the National Consultant Network (where available) which now supports all lines throughout South East London. This will ensure as many calls as possible are picked up.

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Stroke/ TIA Mobile Helpline

The stroke team have set up a direct mobile. It is manned Mon-Fri 9-5 and they welcome all calls regarding stroke /TIA. 07825023845

 

Primary care referrals can be made by phoning TIA MOBILE or alternatively email gst-tr.gsttstrokereferrals@nhs.net (out of hours). Please see our website for the TIA pathway and GP referral form. All patients referred should receive the TIA patient information leaflet.

https://www.guysandstthomas.nhs.uk/our-services/stroke/referrals.aspx

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