Flu Clinics - The National Flu Programme has changed this year. Everyone who qualifies for a flu jab will get one, but the changes mean that we need to give different jabs to different groups, and our flu jab supply will be arriving later than usual. We will be running our flu clinics late September and during October.
Please see the Flu Clinic 2018 under Clinics and Services for full details of this year's programme.
We have updated our privacy notice to be in line with the new GDPR regulations. Please access it here
The exercise challenge – will you join me?
If you have been thinking about starting to exercise or improving your fitness level, why not talk with one of us about how to approach this and what might work for you. It does not have to be couch to 5k. Remember, any exercise is better than none!
Click on link below and read about DR Ross' journey from couch to 5k!
Exercise blog Dec 2017
Our District Nursing service is currently under significant staff changes, and this means they are now operating out of Wallingford. Their voicemail number is no longer being used and patients are being asked to phone the District Nursing duty desk on 01865 903177, which will be answered by District Nursing staff between 8am and 4pm.
Self Care Week 2017
Self Care Week is an annual national awareness week that focuses on embedding support for self care across communities, families and generations.
This year’s theme was engaging and empowering people and the strapline is Embracing Self Care for Life.
TRAVELLERS PLEASE BE AWARE:
MEASLES OUTBREAK IN EUROPE AND UNITED KINGDOM
Affected countries with updates since 7 July 2017:
Bulgaria: 14 cases have been reported since 7 July, bringing the total from 1 January 2017 to 9 July 2017 to 162 cases.
Finland: On 27 June 2017, a case of measles was reported in an Italian citizen working at an international camp from 19 to 25 June 2017. On 4 July 2017, a further 2 cases linked to this camp were reported in unvaccinated siblings. On 13 July 2017 another case was linked to the same transmission chain.
Germany: 14 cases have been reported since 7 July 2017. Up to 5 July 2017, the total for was 780 cases. In the equivalent period in 2016, Germany reported 146 cases.
Italy: 155 cases have been reported since 7 July 2017. Up to 11 July 2017 there have been 3 501 cases, including two deaths. 255 cases are healthcare workers. 89% of cases were unvaccinated and 6% had received only one dose of vaccine.
Romania: There have been 156 cases since 7 July 2017. Between 1 January 2016 and 7 July 2017, there were 7 647 cases, including 31 deaths. 41 out of 42 districts have reported cases. Timis, near the border with Serbia, is the most affected district with 1 174 cases. Vaccination activities are ongoing.
Spain: Between 1 January 2017 and 9 July 2017, Spain reported 138 cases.
United Kingdom: Between 1 June 2017 and 12 July 2017, 8 cases have been reported in the Newport and Torfaen areas of South Wales. 17 cases were reported in England in the first three months of 2017. A small number of cases has been reported in Northern Ireland up to 6 July 2017. No cases have been reported in Scotland
Shortage of hepatitis B vaccines - click here for more information
Where do I go for what in the health service?
Summary of talk given by Dr Steve Ross at the Benson Community Health Fair on Saturday 25th April 2015
The Benson Patients’ Panel organised this event which included a huge variety of talks, taster sessions and stands representing a wide range of health related organisations. It was well organised and I believe useful, informative and enjoyed by all who came. We are thankful to the Patients’ Panel and all the groups that contributed to making the Fair such a success.
I was asked by the Patient’s Panel to talk on the topic of “Where do I go for what in the health service?” Though the discussion was very interactive with involvement of all who attended, the Panel felt it would be useful for a summary to be more widely available.
As I was thinking and preparing for the talk I was again amazed at what a huge range of resources and services are available in our community. The participants had between them a wealth of knowledge and experience of the health service and we used this together and built from it.
The list we came up with is by no means exhaustive but included (in no particular order):
Community nursing service – District Nurses, Respiratory Nurses, Heart Failure Nurses….
Speech and Language Therapists
Community Mental Health Teams – child and adolescent, adult, older people
Counselling – PML (surgery based) – CRUSE (bereavement) … private sector
Psychology services – Mill Stream Surgery - Talking Space and Talking Health (IAPT)
Family planning clinics
Sexual Health Services
Community Hospitals – Wallingford, Abingdon, Henley.
Minor Injury Units – Abingdon 10am – 10:30pm Tel: 01865 903476 – Townlands, Henley 9am-8pm (X ray services more limited hours) Tel: 01865 903755
First Aid Units (No Xray services) – Wallingford 08:30am – 6:30pm – telephone first 01865 903471)
Community based support groups with a number represented at the Fair eg BHF, Age UK, Alzheimers Society, MacMillan, MIND etc etc
Hospice care – Helen and Douglas House, Sobell House
GPs – Practice Nurses – Health Care Assistants
Out of Hours GP service
111 (urgent but not life threatening)
999 (seriously ill or injured and life at risk)
Weight loss programmes/supports
Smoking cessation supports
Alcohol and drug misuse services
Web based resources – NHS choices – patient.co.uk …..
Apps – Oxfordshire choose well app etc
Major hospitals – JR, Churchill, NOC, Warneford, RBH
A&E Dept JR, RBH
We worked through some case scenarios thinking about which part of the health service would be most appropriate or how one might find out if uncertain. We concluded with a few simple questions to guide initial decision making: Is it potentially life threatening? Is it illness? Is it injury? If not potentially life threatening is it urgent? If I do not know what to do how can I find out?
The answers to some scenarios were easy:
A 70 year old man with sudden severe chest pain going into his left arm is potentially life threatening and so a 999 call is appropriate – this could be a heart attack.
A 27 year old has cystitis type symptoms. They are not severe and she has had cystitis once before. She feels well otherwise. Seeking advice from the pharmacist would be appropriate.
A 10 year old boy jumps of a swing, falls on his arm and has pain in his left arm. He is able to walk & talk. You suspect he has broken his arm. Attending the Minor Injuries Unit is appropriate.
It is 2am and your 4 year old girl has a fever and sore throat. She cannot drink as she is sick each time and you are worried she might be becoming dehydrated. Calling 111 is appropriate.
An 8 year old girl has a runny nose and sore throat, but you are worried it is not getting any better after a week and she now says that her ears are painful. Contacting your GP is appropriate.
Other scenarios were not so clear cut, but asking ourselves these questions led to an appropriate contact with the health service. The Minor Injuries Units are appropriate for injuries that are not life threatening but again for a potentially life threatening injury a 999 call is appropriate. The 111 service is appropriate for issues that are urgent but not life threatening.
There are fantastic web resources and apps with guidance and a wealth of information for use as a starting point if there is uncertainty eg:
NHS choices - http://www.nhs.uk/Pages/HomePage.aspx
Choose well - http://www.oxfordshireccg.nhs.uk/your-health/choose-well/
Patient.co.uk - http://patient.info/
Oxford Health - http://www.oxfordhealth.nhs.uk/our-services/
And remember if you are still uncertain you can always call your pharmacist or the surgery to be advised or guided to the appropriate part of the health service.
Wishing you all good health!
Dr Steve Ross
A 70 year old man has sudden severe chest pain that goes down his left arm
A 5 year old boy jumps of a swing, falls on his arm and has a severe pain in his left arm. He is able to walk & talk. You suspect he has broken his arm.
An 8 year old girl has a runny nose and sore throat, but you are worried it is not getting any better after a week
A 27 year old has cystitis type symptoms. She feels well otherwise.
A 24 year old with an infected fingernail. She feels fine otherwise
A 28 year old gets stung by a bee and has throat swelling
At 3am a 4year old boy has a fever and sore throat. He can’t drink as he is sick each time and you are worried he is dehydrated
A 80 year old is out shopping when she falls over. You notice she has a droopy left side to her face and she can’t talk properly even though she is wide awake
A 50 year old lifted a suitcase and got sudden pain in her back. She lay down for a rest and now can’t get up because the pain is too much. If she rests she is ok. Her husband can look after her overnight.
A 5 year old boy gets a bit of lego stuck up his nose and you can’t get it out. He is otherwise ok.
An 8 year old has had a sore ear for 3 days. It has just leaked a small amount of pus and he feels much better. He has eating his tea and wants to play before bed
A 24 year old stands on a rusty nail barefoot and it has cut the skin
A 35 year old wakes up after a party the night before, during which he did a lot of dancing, with a pain in his calf and finding it sore to walk
A 20 year old student has run out of asthma medication. He is well, and has no breathing problems.
A 19 year old has just come back from university. He has rapidly become unwell, unable to have the lights on in the room and has a new rash that doesn’t go away when pressed on with a glass
A 45 year old was cutting carrots, and has cut his left hand to the bone. He suspects he needs stitches.
A 6 month old baby keeps crying. You don’t know why, but are worried
At 8pm a 3year old girl has a fever. She has had a sore throat for 8 hours and you suspect she has a virus. She has had a good supper and is now wanting to go to bed
Playing football a week ago you twisted your ankle. You have walked on it normally just about. It is still sore and you are worried it might have a fracture.
Your left eye is really sore and weepy with crusted bits on the eyelashes. You feel fine otherwise
You recently had a work medical (private doctor) who tells you that your cholesterol is high and you should tell the NHS so they can treat it
You fly back from Spain where you had a lovely holiday but also broke your collar bone salsa dancing. You have the x-rays with you and a sling.
You have a splinter under your thumb nail and can’t get it out. It hurts a lot
A 50 year old man coughs up blood on two occasions in one day. He feels fine, and has never had chest problems before
A 2 year old falls off his high chair. He feels fine and gets up to play immediately. You notice that he is not using his right arm. The child is playing happily and denies pain. But he won’t let you touch the arm.
A 7 year old has had tummy pain for 2 days, but whereas it was mild before, it is severe, and he is curled up.
A 30 year old has had vague abdominal pains for 2 weeks. She doesn’t know what is causing it
A 55 year old falls of his bike at 30 miles/hour. He felt ok at the time and just managed to cycle home, but the next day when he wakes up his right leg is sore and he can’t walk. His wife can drive him if needed.
A 5 year old child is found with a bottle of calpol and the lid off. You suspect she has drunk some.
You see a 28 year old collapse and have a seizure. He is groggy but recovering. This has never happened to him before. You do/advise what?
A 38 year old playing football, falls over, and can’t walk on his ankle. He is concerned it is broken
A 38 year old is hit on the head playing rugby. He was unconscious for 30 seconds, and is now behaving strangely.
A 3 year old touches a fire guard and has deep blisters on both hands
A 35 year old walks into a lamp-post and thinks he has broken his nose
Expectations - prescribing drugs and referrals by Dr Peter Rose
People often come to see their doctor with an expectation of what they want to happen or what might happen. For example this might mean an expectation that a test will be done, a drug prescribed or a referral made to hospital. It is quite hard for both parties when there is a mismatch in these expectations. We felt it would be useful to discuss these issues with you in this first newsletter.
One of the commonest times when this mismatch happens is when a patient feels their infection needs an antibiotic but the doctor recommends that no treatment is appropriate. One patient commented to one of us recently that they felt we were the meanest practice when it came to prescribing antibiotics and this person felt that people’s health would suffer as a consequence. It is true that we do prescribe fewer antibiotics than many other practices in Oxfordshire. Over many years we have kept within the drug budget set by the PCT. We are proud of this fact and do not feel that we ever withhold a drug to the detriment of someone’s health.
So why is this practice prescribe a low prescriber of some drugs? We take a lot of care as a practice in making decisions about prescribing drugs and for each decision we will consider a number of factors: drug safety, drug tolerability, drug effectiveness, drug price and simplicity of use by the patient. We are particularly aware of the guidance that we receive from experts about when drugs are likely to benefit you. There has been increasing evidence over the last ten years or so that for most acute infections, even when they are bacterial in origin, there is no significant benefit in prescribing an antibiotic. In most cases (ear infections, cough, conjunctivitis) there is only minimal reduction in the length of time that a person has to put up with symptoms and very little difference in the possible complications of these infections. For example 15 ear infections would need to be treated with antibiotics to cure one more child within a week of diagnosis. 7 cases of conjunctivitis would need to be treated to get one more better within 5 days of diagnosis and over 80% of cases are better within a week of diagnosis without any drug treatment.
In addition, the benefits of any drug have to be weighed against potential side effects. All drugs, even antibiotics, do have side effects and it does not seem sensible to subject people to these side effects when very little benefit accrues. In terms of antibiotics probably one of the most important side effects is the development of resistance by some bacteria to the antibiotic. This is an increasing problem and new antibiotics are not currently being discovered to take the place of the old ones. Internationally, Holland prescribes fewer antibiotics than the UK, and the Dutch are no less healthy than we are! We need to be very careful with antibiotic use so that when people get life threatening infections like pneumonia or septicaemia we can be certain that the antibiotics will work and this means cautious use, weighing up benefits against harms, for less serious infections.
It is not only the area of drugs where NHS resources are precious and need to be used carefully. We increasingly use more blood tests and scans to make diagnoses but again there can be unforeseen consequences of overusing tests: for example, we may turn up unexpected results that can cause anxiety. Tests that use radiation can cause harm: for every 3000 CT scans done in the NHS will cause one extra case of cancer.
However, in areas where there are proven benefits from drugs, for example prescribing tablets or insulin for diabetes or inhalers for asthma and chronic bronchitis we are high prescribers of these drugs compared with other practices. This is because there are proven benefits of controlling these diseases optimally and we are convinced of these benefits to you.
The other main area where expectations may not be fulfilled is in referral to hospital. The NHS can not afford to offer all treatments to all patients that are possible. Resources for the NHS are increasing but the number and cost of new treatments are increasing faster. Decisions not to refer are usually based on guidelines sent to us from the Oxfordshire Health Service; it is our role to implement these guidelines for the community. Oxfordshire has led the way in looking at this difficult area and has a very sophisticated system of assessment of hospital treatments and new technologies to decide which are beneficial and which we can afford. Some of these decisions are made locally but others are made by the National Institute of Clinical Excellence (NICE). NICE decisions to ration treatments often hit the news. We feel these decisions often protect people from over treatment with ineffective treatments.
We are not perfect, we may not always be right and we hope we are always flexible when this is appropriate. We do strive in all circumstances to explain to you why we cannot fulfil your expectations both in prescribing and referral decisions. We hope that if you personally have been in one of the situations discussed above you have found these explanations satisfactory. However, if you do not feel convinced by our explanation, we are always happy to discuss these decisions further, so please ask again!
Dr Peter Rose