Spring 2012 - Newcastle Hospitals

GPmatters
Update for GPs from The Newcastle Hospitals
Bringing care closer to the people who need it is a key objective
for Newcastle Hospitals and we remain committed to providing
services in various locations across the region to help make access
as easy as possible.
We offer clinics in a
range of district
hospitals and health centres
and are increasing our clinic
portfolio in GP surgeries
across the patch. In March
we opened our ENT clinic
at the Cestria Health Centre
in Chester le Street and from
April we will be offering
Dermatology clinics
throughout South Tyneside
Benfield Park Healthcare
and Diagnostic Centre
We are delighted to
announce that the
Benfield Park Healthcare and
Diagnostic Centre opened its
doors on 5 th March 2012 and
was officially opened by the
Rt Hon Nick Brown MP on
Friday 23 rd March 2012, in
the east of Newcastle. As we
continue to progress our
commitment to providing
fully integrated healthcare
in community and hospital
settings, this exciting
development supports our
vision outlined in “Better
Together” by working in
partnership with a well
established, local GP Practice
to create a state-of-the-art
health centre which offers
access to primary, community
and specialist services all
under one roof.
We hope you find our quarterly newsletters informative
but if there is any issue you would like to see featured
in a future edition, please let us know.
Benfield Park Healthcare and Diagnostic Centre
having been awarded the
contract to work with GPs.
See our quarterly article
“Care Closer to Home”
to keep up to date on where
you can find our clinicians.
Send your comments to
gpmatters@nuth.nhs.uk
Left to right: Sir Leonard Fenwick CBE,
Rt Hon Nick Brown MP, Dr Paul Netts GP, Mr Kingsley Smith OBE
From our point of view, this
new health centre is about
taking services closer to
patients, as well as providing
opportunities for primary and
secondary care teams to
collaborate on streamlining
pathways of care. More on
page 3.
Also inside...
Collaborative working
Hadrian Primary
Care Alliance
New Walk-in Xray Service
in the West of Newcastle
New Healthcentre opens
on Benfield Road, Newcastle
ENT Clinic opens at the Cestria
Health Centre
Plus...
Delivering Community
Dermatology Services
in South Tyneside
MAGIC - Shared
decision making
Developing Newcastle
Hospitals Community Health
Getting children home quickly
Be Clear on Cancer
Ensuring best 'End of Life' care
At forefront of international
ageing research
GPmatters
IssueSeven-March2012
Healthcare at its very best - with a personal touch

View from Primary Care
- Hearty Lives Newcastle
Better Together continues to get better as more people get together.
‘Hearty Lives Newcastle’
was given its official launch
at the Lemington Centre in
January this year. This project
aims to bridge the gap
between secondary, primary
and community care where
lifestyle changes can help
improve the outcomes of
clinical intervention. Funded
by the British Heart
Foundation, and delivered by
HealthWORKS Newcastle in
partnership with Newcastle
Hospitals this demonstrates
how bringing people with
different skills and
backgrounds together creates
something greater than the
sum of its parts.
A shining example of such
working in practice is a lipid
clinic run weekly at the Royal
Victoria Infirmary where
patients are given a huge
amount of information at the
initial appointment and then
required to substantially alter
their lifestyle.
About half of their excess
cardiac risk can be reduced by
- taking the ideal drug
regimen the rest is down to
diet, exercise, smoking
cessation and a whole new
way of living. With Health
Trainers available in the clinic
and following patients back
into the community it is
possible to encourage,
explain, cajole and keep those
at high risk of cardiovascular
events on the straight and
narrow. They act as
cheerleaders counteracting
shoddy articles in the tabloid
press, boosting concordance
and providing a support ‘buddy’.
It was great to hear the health
trainers enthusiastically
describe how they had been
able to change whole families’
health behaviour and gained
a deeper understanding of
the whole picture working
alongside specialists and
dieticians in the clinic.
This is a great way to work.
Local councillors certainly
got the message particularly
as to how we can use it to
close the gap in life
expectancy between Gosforth
and Byker - I expect new
projects to emerge. If CCGs
really are about working
differently in the future we
should expect to see them
embrace these ways of
working as mainstream
rather than having to rely
on charities, even those as
excellent as the British Heart
Foundation, to fill in the gaps
with projects.
Dr Mike Scott, GP Clinical
Advisor can be contacted
at mike.scott2@nhs.net
Collaborative working
Healthcare is complicated.
Delivering the best care
for patients requires good
co-ordination and
communication between
primary care, hospital
clinicians and often, services
provided by the local
authority. Of course, a great
deal of all this exchange goes
on daily between individual
clinicians. But to ensure that
the patient truly remains at
the centre of everything that
we do requires timely
communication with all other
organisations involved in the
patient’s care, and we have
therefore continued to
strengthen our links and
structures to ensure effective
engagement with our
partners.
The Better Together way
of working is now very well
established and we hold
monthly meetings between
Newcastle CCG leads,
our GP Advisors and Trust
clinicians to discuss clinical
issues and pathways for
Newcastle patients.
The Trust is the main
secondary care provider for
many patients in and beyond
Newcastle, eg. urological
services, dermatology, clinical
immunology – to name a
few. To discuss these and
other clinical services and
how they might be improved
we also meet monthly, again
on a Wednesday afternoon,
with the CCG leads from
North Tyneside, Gateshead
and Northumberland. We
look forward to continuing
this work.
Dr Nick Thompson, Consultant Gastroenterologist and Assistant Medical Director can be contacted
at nick.thompson@nuth.nhs.uk
Hadrian Primary Care Alliance
Newcastle Hospitals are delighted to announce that they have entered into a partnership facilitated by Hadrian Primary
Care Alliance (HPCA) – a forward thinking federation of primary care medical practices based in and around Tynedale.
As a member of this Alliance, we will be seeking to work in collaboration with primary care in the delivery of clinical services,
education, training and research.
If you would like to find out more about this development then please contact either Bev Reid, Assistant Director,
Business and Development at bev.reid@nuth.nhs.uk or Jill Mitchell, Managing Director for the HPCA at jillmitchell3@nhs.net.
2

Western Dr.
New Walk-in Xray Service
in the West of Newcastle
The Westgate Diagnostic Centre based on the Campus
for Ageing and Vitality (former Newcastle General
Hospital) now offers a new Walk-In Service for plain film
imaging, Monday to Friday for both adults and children.
Patients can come along anytime from 9:00am to 5:00pm
without an appointment but will need an authorised plain
film x-ray request form.
To find out more information you can contact
Jean Chambers, Superintendent Radiographer on
0191 282 5624 or the Westgate Diagnostic Centre
on 0191 233 6161 and extension 22144.
Westgate
Walk-in
Centre
Lewis Drive
A1
Bank
The Beacon
Western Avenue
Agricola Road
Wingrove Road
Wingrove Avenue
Grainger Park Road
Campus for
Ageing and
Vitality
WESTGATE ROAD (A186)
Dunholme Road
Police
Station
Bentinck Road
Westgate
Diagnostic
Centre
Lynnwood Av.
Brighton Grove
Sydney Grove
Newcastle City Centre
Bowling
NSPCC
Belsay Pl.
Callerton Pl.
New Healthcentre opens
on Benfield Road, Newcastle
Heaton Medical Centre (formerly of 37a Heaton Road) now
provide GP and Nurse Practitioner services as Benfield Park
Medical Group from their new home alongside a Retail
Community Pharmacy Service and a wide range of outreach
secondary services provided by Newcastle Hospitals:
• Radiology (Plain X-ray and Ultrasound)
• Audiology Assessment and Hearing Aid Repair Services
• Pulmonary Rehabilitation
• Women’s Health
• Musculo Skeletal Clinics including: Hip and Knee
Replacement (follow-up), Rheumatoid arthritis annual reviews
• Pain Management Clinics
• Paediatric Clinics
• Podiatry
• Pre-admission Assessment Clinics
The Trust’s services will become operational over the next two
to three months and referrals are welcome from all Practices via
Choose & Book.
The Practice has established extensive links with local voluntary
groups and the wider “3rd Sector” to provide services such as
Talking Therapies, Citizens Advice and Sure Start. There will also
be support on returning to employment with a strong focus on
preventing ill health.
The new centre boasts a first class environment with high quality
facilities and offers greater convenience to users with extended
opening hours and excellent parking. We have worked closely
with the WRVS to develop an innovative, volunteer led
Community Transport Scheme for patients who experience
genuine difficulty accessing the facility by public transport. This
will become operational over the next few months.
A café will also be available to those using the site.
If you would like to find out more about the new Centre
please contact Wendy Baker, NuTH Project Lead at
wendy.baker@nuth.nhs.uk or 0191 223 1643 or Jonathan
McCutcheon, Practice Manager, Benfield Park Medical Group
at jonathanmccutcheon@nhs.net or on 0191 282 1010.
ENT Clinic
opens
at Cestria
Health
Centre,
Chester le Street
Newcastle’s ENT clinicians now offer a new clinic
at the Cestria Health Centre in Chester le Street,
giving patients an alternative location for their outpatient
appointments. The Trust has a long history of working with
the Health Centre and supports one of their GPs – Dr Adam
Douglas - who has a special interest in ENT and manages
routine conditions such as ear infections.
The new clinic, led by Mr Gerard Siou, who is local to
the area and a Consultant ENT Surgeon at the Freeman
Hospital, caters for both adults and children covering the
majority of general ENT conditions and in particular Mr Siou
welcomes referrals for two week wait cancer patients and
head and neck lumps. Also as a member of the North East
Paediatric Airway Service, Mr Siou is able to receive referrals
for children with obstructive and noisy airways problems
including paediatric head and neck lumps, liaising closely
with paediatric colleagues at the Great North Children’s
Hospital where required. There is also a comprehensive
Audiology Service at the clinic.
Mr Siou says: “We have introduced this convenient new
location for our ENT service in partnership with the Cestria
Health Centre, to provide people either living, or working
in the Chester le Street area with quick and easy access
rather than having to travel to a hospital.”
The clinic is currently available once a week every Tuesday
morning and patients can be referred via Choose & Book.
If you would like to find out more about this clinic, please
email Gerard.Siou@nuth.nhs.uk or contact Jean Applegarth,
Directorate Manager for ENT Services on 0191 244 8516.
3

Delivering Community
Dermatology Services
in South Tyneside
Newcastle Hospitals have been awarded the contract
to work with GPs and South of Tyne commissioners
to provide a new community dermatology service at four
centres throughout South Tyneside including Blaydon and
Cleadon from Monday 2 nd April 2012. Clinics will take place
four times a week staffed by an experienced Consultant
Dermatologist from the Royal Victoria Infirmary, a local GP
working as a speciality doctor and a nurse specialising in
dermatology.
These clinics will offer an intermediate level of service
between primary and secondary care keeping access time
short for patients, and provide a quick response letter to GPs
with advice for future management in primary care. Minor
procedures will be carried out in clinic and prescriptions can
be issued for up to a month where required.
MAGIC – involving
patients more in decisions
about treatment and care
Three primary care practices in the North East are working
alongside clinical teams from Newcastle Hospitals to find
the best ways of involving patients more in decisions about
their care and treatment. The MAGIC* (making good
decisions in collaboration) programme is supporting
implementation of shared decision making (SDM), offering
skills training and support methods and materials. A GP who
is involved says:
“…. my practice has changed and I’m surprised by how
little ‘sharing’ I was doing previously. I now realise that most
of my consultations focused around giving information but
not necessarily entering into discussion or eliciting patients’
values and preferences.”
A series of patient awareness-raising materials including
posters in consultation rooms and flyers in appointment
letters encourages patients to ask ‘what are my options,
what are the possible benefits and risks and how can we
make a decision together that is right for me?’
A short film featuring local patients ‘So just ask!’,
is available on Newcastle Hospitals’ website under “Patient
Guides” and in public areas in the Freeman Hospital and RVI.
It is currently running in the participating general practices:
• Collingwood Health Group in North Tyneside
• Parkway Medical Group in Newcastle upon Tyne
• Central Surgery in South Shields
4
Referral criteria include acute rashes for diagnosis, flare-up
of chronic rashes eg. eczema in both adults and children,
and advice for skin conditions not likely to need hospitalbased
care such as acne, including patients who may need
Isotretinoin.
Please note that “two week cancer wait” patients or those
likely to need secondary care, for example phototherapy or
surgery for BCC are not suitable for these clinics.
We plan to deliver a programme of education to help
improve local dermatology care and hope to recruit local GPs
(now out to advert on NHS jobs) to work in the clinics where
we hope they will develop their knowledge by using
teaching opportunities.
We look forward to working together to develop this new
model of care for people in South of Tyne with skin conditions.
Patients can be referred to this clinic via Choose & Book.
For more information about this new service,
please contact Dr Janet McLelland, Clinical Director
and Consultant Dermatologist at
janet.mclelland@nuth.nhs.uk
Ask 3 Questions
Sometimes there will be choices to make about your healthcare. If you are
asked to make a choice, make sure you get the answers to these 3 questions:
Dr Dave Tomson,
MAGIC primary care
lead, worked with
programme colleagues
to develop EMIS codes
that record shared
decision making activity
– these are now
available to all EMIS
users. One practice
has focused on linking
shared decision
making with the
management of longterm
conditions.
Other work shows
potential to streamline care
pathways from primary through secondary care.
Evidence shows that patients do want more involvement
in decisions about their treatment, and that shared decision
making has clear benefits for all. There is more work to be
done, and MAGIC Phase II is set to launch in May 2012.
If you want to know more about sh ared decision making
and how it can benefit you and your patients, contact
carole.dodd@nuth.nhs.uk
what are my
options?
what are the possible
benefits
and risks?
how can we make
a decision together
that
is right for me?
?
We want to know what’s important to you
www.making-good-decisions.org
* The MAGIC programme is supported by The Health Foundation.
http://www.health.org.uk/areas-of-work/programmes/shared-decision-making

Develo ping Newcastle
Hospitals Community
Health
Compact between Newcastle Hospitals
and Newcastle City Council for Community
Services
Newcastle Hospitals has always valued close partnership
working with key partners such as GPs and Newcastle
City Council and these are particularly important as we
continue to progress our transforming community services
agenda. To underpin our commitment we have recently
agreed a ‘Compact’ with the City Council, describing how
we will work together, alongside a vision of what we aim
to achieve.
The ‘Compact’ states that we will “work together for the
benefit of adults and older people in the city who require,
or may require, health and social care services and support”
and offers a “framework for partnership working to
encourage integrated decision making, innovative,
effective and user focussed service provision, achieve
mutual outcomes and make effective use of resources.”
Cathy Bull, Director of Adult Social Care explains “There is
a noticeable momentum for change in Newcastle to
improve integrated working across health and social
care. The Compact represents the Council and Newcastle
Hospitals’ joint commitment to change and service
redesign. We look forward to being part of new ways
of working and are very pleased with the progress being
made.”
This means joint health and adult social care services that:
• Are easy to access
• Provide timely and integrated care to help people to
remain at home and avoid hospital and long-term care
• Promote independence
• Support people to manage and direct their own ongoing
health and social care needs.
We will continue to work together at all levels to help
develop our joint services and find ways of supporting front
line staff to deliver better and more integrated care.
Integrated
continence
pathways in
Newcastle
Provision of well coordinated
continence care
is a specific recommendation
in a number of recently
published national policy
documents. With the merger
of Newcastle’s acute and
community continence
services in April of last year,
our staff have grasped the
opportunity to bring about
improvements by developing
a range of work streams to
ensure delivery of effective
and efficient continence care.
A proactive working group
involving a wide range of
stakeholders, including GP
colleagues, has facilitated
many improvements such
as a single point of referral
to standardised continence
assessment, diagnostic
facilities and specialist staff
ensuring that the right
treatment plans are offered
rapidly for bladder and bowel
dysfunctions.
Integrated working also
allows our staff to identify
opportunities for earlier
interventions, such as
establishing treatment
programmes, reducing and
preventing the onset of
urinary tract infections and
aiming towards prevention
of stress incontinence by
actively discussing bladder
health care with young
women and teenagers.
Working closely together
will help reduce emergency
admissions associated with
catheter care and ensure first
line approaches are explored
before pursuing surgical
intervention. In the same
vein, following conservative
treatment led by a nurse or
physiotherapist rather than
long term use of containment
products is much better for
the patient and means cost
benefits to the organisation –
a ‘win – win’ situation for all.
For more information about our Continence Services
please contact either Jackie Rees, Nurse Consultant
Continence Care at Jackie.rees@nuth.nhs.uk or
0191 223 1323 or Alyson Laws, Specialist Nurse
for Continence in the Community at
alyson.laws@nuth.nhs.uk or 0191 238 0010.
Working with GPTeamNet
A recurrent feature in feedback we receive from GPs is to make
it as easy as possible to refer patients to our services. We are
working with the GPTeamNet service to provide practices with
up to date information about referral routes and clinics including
service descriptions, contact details, referral forms where
appropriate and guidelines.
GPTeamNet is an information management system currently used
across the following Clinical Commissioning Groups and member
practices in the North: Newcastle Bridges CCG, CareFirst CCG,
Engage CCG, Durham Dales, Easington and Sedgefield CCG,
Durham North CCG and Northumberland CCG.
There are a number of clear benefits using the GPTeamNet
service, the most obvious being immediate access to relevant
and current details of all services in one place, but we hope that
5
by providing as much information as possible on this portal,
there will be a reduction in duplicated effort and information
but more importantly, patients will always be referred to the
right service first time round.
At this stage we are piloting the service information in our
“Urgent and Open Access Clinics Bulletin”, working with
colleagues in the Newcastle Bridges CCG to help establish the
services they would like to “subscribe” to. As this project
develops we will look to build upon the information we provide.
We will keep you posted on further developments but
in the meantime if you would like to discuss this in more
detail please contact Bev Reid, Assistant Director for
Business and Development at bev.reid@nuth.nhs.uk
or on: 0191 223 1001.

Serving the North East
GNCH GP Event Update
On 14th December 2011, the
Medicinema at the Great North
Children’s Hospital (GNCH) again played
host to over 40 GPs from both North and
South of Tyne for a Child Health Update.
This was a repeat of our extremely successful
event held earlier in the year and is part of
our continuing commitment to the
educational development of all health
professionals in our region. Attending
GPs heard interactive talks on recent
NICE guidance, child health surveillance,
paediatric allergy and rheumatology, as
well as a safeguarding update and an
opportunity to explore our fantastic new
facility. Feedback from the day was
Getting children
home quickly
Ensuring children get back to normal
home life quickly after a stay in hospital
is a priority for our service and an initiative
to prevent delays in discharges - in particular
during the winter months - has been a key
workstream for our staff.
To help relieve bed pressures at Great North
Children’s Hospital during busy winter
period, a dedicated discharge zone was
developed. This provides children who are
ready go home with a dedicated area in
which to receive quick, patient-centred
attention including:
• a copy of the GP letter
• any prescribed ‘take home’ drugs with
information about how to take their
medication
• symptoms to look out for and any
actions to take when they get home
The service is run by a qualified Children’s
Nurse supported by a Health Care Assistant
who are members of our award winning
Children’s Acute Nursing Initiative (CANI)
team. By engaging directly with ward level
nursing and medical staff they ensure the
children and their carers have the most up
to date information.
This new approach was initially set up as a
overwhelmingly positive and included
comments such as:
“Excellent, engaging speakers”
“Very helpful, practical information”
“Really good informative day”
We plan to follow this with an annual
update in a larger venue and will
advertise this widely later in 2012.
For more information,
please contact Mark Anderson,
Consultant Paediatrician
Mark.anderson7@nuth.nhs.uk)
pilot in 2010 to review and improve current
practices and bring about more effective and
cost efficient use of the paediatric acute
inpatients beds as well as providing a better
service for our young patients – put simply,
everyone benefits.
This service is based on Ward 2 at the Great
North Children’s Hospital and is open from
8:00am to 4:00pm Monday to Friday.
For further information about
this service please contact Emma
Willey, Senior Sister at
emma.willey@nuth.nhs.uk or
Jocelyn Thompson, Community Matron
at Jocelyn.Thompson@nuth.nhs.uk
CHILDREN’S
SERVICES
We offer an
extensive range of
Children’s Services
including:
Local
Community/general Paediatric
medicine
Dermatology
Paediatric Emergency
Medicine
Regional
Burns & Plastic Surgery
Child Development Centre
Endocrinology
ENT
Forensic Medicine –
North and South of Tyne
Gastroenterology
General Paediatric Surgery
Immunology
Nephrology
Neurology
Oncology
Ophthalmology
Orthopaedics
Paediatric Intensive Care
Respiratory
Rheumatology
Regional/National
Cardiology & Cardiothoracic
Surgery
National / International
Cardio Pulmonary
Transplantation
SCIDS - Severe Combined
Immunodeficiency Syndrome
Bone Marrow Transplantation
for Immunological Disorders
6

Be Clear on Cancer –
Beating Bowel Cancer
In January 2012 the Government launched its first sustained
national advertising campaign - Be Clear on Cancer:
Bowel Cancer - to alert patients to the symptoms of bowel
cancer. In pilot sites during early 2011 there was a
significant rise of nearly 50% in suspected bowel cancer
referrals - about one extra patient per practice per week -
so we can all expect to see an increase in referrals.
We anticipate most extra referrals will come in via the
Cancer Waiting Time (CWT) or two week pathway, as
a faxed referral and the number received will be closely
monitored with additional clinics and endoscopy lists
provided to ensure all cases are met within capacity. All
referrals will be rapidly triaged to the nurse specialists for a
decision on outpatient review or straight to colonoscopy and
New Acute Oncology Service
Patients always have direct
access to clinicians at the
Northern Centre for Cancer
Care (NCCC) if acute
problems arise. However,
many patients present to the
Emergency Department and
Assessment Suite at the RVI
with acute complications of
their condition or side effects
of their treatment, and people
with previously undiagnosed
cancer also come to us as
emergencies. To ensure we
can rapidly respond to these
patients’ needs, we have
developed a new Acute
Oncology Service (AOS).
Establishment of this new
service follows the 2008
NCEPOD report into 30 day
mortality post chemotherapy
which found that around
half of admissions were under
non-oncologists. As a result,
the National Chemotherapy
Advisory Group
recommended provision of an
AOS in all hospitals with acute
admissions, to ensure early
oncology input.
The new team of Dr Chris
Jones, Macmillan Consultant
in Acute Oncology, and
Macmillan Nurse Practitioners,
Celia Murch and Julie-Ann
Huggan, now provides this
service, initially generously
funded by Macmillan Cancer
Support.
7
our newly appointed colorectal surgeon, Mr Ben Griffiths,
now in post at the RVI, will be able to field some
of the initial increase in clinical activity.
For more information about
the “Be Clear on Cancer:
Bowel Cancer” Campaign go
to www.nhs.uk/bowelcancer
or www.bowelcanceruk.org.uk
nhs.uk/bowelcancer
If you would like more information about our bowel
cancer services, please contact our Clinical Lead for
Gastroenterology, Dr John Mansfield at
john.mansfield@nuth.nhs.uk
Prostate Brachytherapy – planting the seeds for a better treatment option
Prostate seed brachytherapy is one
of three NICE approved treatment
options for early, localised prostate
cancer, and an increasingly popular
alternative to radical surgery and
radiotherapy. Seeds - tiny capsules,
the size of a grain of rice - containing
the radiation are passed through fine
needles and positioned directly into the
prostate gland. The treatment has a low
complication rate, and following a single
overnight stay, most men find they are
able to return to pre-treatment activities
within a couple of days.
Consultant Clinical Oncologist,
Dr John Frew, was appointed to lead the
service and has developed a one-stop
assessment clinic where treatment is
discussed in detail, and all necessary
pre-operative evaluations completed.
Ideal referrals include patients with
active lifestyles* who are not suitable
for major surgery and who wish to
maintain sexual function*, and patients
with smaller glands without severe
urinary symptoms.
Newcastle Hospitals has invested in
the very latest technology (a top of the
range ultrasound scanner and
radiotherapy planning software) to
ensure the implant process is performed
to the highest standards.
“We have brought together
colleagues from Acute
Medicine, the Emergency
Department, Palliative Care,
Oncology and Haematology
to provide the best possible
service for patients with acute
cancer-related problems”,
says Dr Jones. “By providing
oncology advice and support
as early as possible in the
patient’s presentation, we
aim to reduce the severity
of complications and length
of stay in hospital. We can
also arrange fast-track
oncology outpatient
appointments to avoid the
For further information or to refer a
patient please contact Dr John Frew
at John.frew@nuth.nhs.uk
Prostate Brachytherapy Team
*Studies have shown that prostate brachytherapy impacts less on patient quality of life than other treatment options, eg. incontinence and sexual dysfunction.
need for admission. Whilst
this service isn’t directly
referable by GPs, we wanted
to let them know of our
existence and how we are
making improvements for
the benefit of acutely ill cancer
patients.”
If GPs need any advice at any
time regarding an acutely ill
patient, please contact the
Consultant Oncologist on
call at NCCC via the hospital
switchboard
0191 233 6161.
For more information about our AOS please contact Dr Chris Jones,
Macmillan Consultant in Acute Oncology at Christopher.jones3@nuth.nhs.uk

Ensuring the best ‘End of Life’ care
- first line opioid of choice to change
Subcutaneous injection of strong opioids is the preferred
route of administration of analgesia in palliative patients
where the oral route is not appropriate eg due to vomiting,
difficulty swallowing, or at the end of life. For many years,
diamorphine has been the preferred parenteral opioid
of choice.
However, during 2004, supply problems with diamorphine
injection arose, and clinicians switched to a variety of
alternative injectable opioids. When the supply problems
resolved, many switched back to diamorphine, but others
continued to use injectable morphine. (The cost of injectable
morphine is currently one quarter of the price of injectable
diamorphine). This has led to both being used across
the region, across primary and secondary care, and is felt
to represent a significance governance risk, especially when
patients transfer between different care settings.
Recognising these risks, palliative care clinicians across the
North of England Cancer Network (NECN) have agreed that
current practice should be revised, and propose that
morphine should be considered the first line opioid of choice
for use subcutaneously, (as well as orally) across primary and
secondary care. The NECN palliative care guidelines are
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currently being updated (due to be published April 2012)
and will include these recommendations.
The date of the proposed switch across the region is 1st May
2012. Specialist palliative care teams will be liaising with local
prescribers to inform them. The Newcastle community specialist
palliative care team will be sending out more information to
Newcastle GPs and community nurses about the switch. Local
pharmacies and out of hours service providers eg. NDUC, are
also being informed. There will be planned education sessions,
which will explain this in more detail.
These sessions will also highlight other changes in these
updated NECN palliative care guidelines including guidance
for management of anxiety and depression in palliative
patients, glucose management in those on steroids,
management of diabetes towards the end of life, and
management of symptoms at the end of life in those with
significant renal impairment or failure. There will also be an
updated opioid conversion chart.
8
For more details, please contact Dr Alexa Clark
Consultant in Palliative Medicine at
alexa.clark@newcastle-pct.nhs.uk
Newcastle at the forefront of international
research into ageing
Longstanding collaborative working between Newcastle
Hospitals and the Faculty of Medical Sciences at
Newcastle University (also known as Newcastle Biomedicine)
has generated an outstanding reputation in many research
areas, and resulted in the development of a Biomedical
Research Centre (BRC) in Ageing on the Campus for Ageing
and Vitality some five years ago.
The BRC was required to apply for renewal of its status last
year and the review panel was so impressed with its track
record that Newcastle’s application was not only successful,
but resulted in an overall award in excess of £21million over
the next five years.
These world-class NIHR research facilities place Newcastle
in an excellent position to tackle an ambitious goal - to
comprehensively address the complex health care needs of
the older person. Work will start in earnest from April this
year and focus on three areas of biomedical research:
• the ageing brain (dementia and stroke)
• the ageing body (liver, heart and metabolic disease)
• the ageing limbs (musculoskeletal disease)
By developing new tests (biomarkers), researchers and
clinicians hope to establish ways to make an early diagnosis
of age-related diseases and monitor the effects of new
treatments. This will enable us to achieve our over-arching
aim of developing “personalised medicine for the older
patient”, where the needs of the individual drive provision
of healthcare to improve the quality of our later years.
If you would like to find out more about the
BRC and its work, please contact Professor
Patrick Chinnery, Wellcome Senior Fellow in
Clinical Science and Professor of Neurogenetics
at patrick.chinnery@newcastle.ac.uk