WELCOMEWe have created this newsletter a little earlier than usual so I can’t really say welcome to Spring but you know what I mean!! We have produced this early as we really want to use everything we have to promote our Carers Event on 25th March 2020. We have loads of people coming in to support this event and we hope it will be really useful to you all.

Being a carer is one of the hardest jobs in the world and something we want to try and support. We appreciate the amazing job that many of our patients who are carers do every day. We want to try to ensure that they are aware of all the help and support available so they can access this when needed. We also want to ensure however that everyone in our community even if they are not a carer is aware what goes on locally. Some of you may have time to spare and would like to become involved in volunteering to help out at one of the local schemes. We also want to ensure that as a community we support some of our more vulnerable groups such as the homeless and our war veterans. Our new partner Dr Prasad has been working really hard on what we can do to support them and he has written a piece later on this. Lastly we want to ensure that everyone is aware of what they can do to ‘future proof’ the care they receive toward the end of their life. End of life care planning is something we should all be thinking about. Often people believe that their next of kin will be able to make decisions for them if they are incapacitated but this is not strictly true. If you want someone to make decisions on your health and welfare, or your financial affairs at a time when you are no longer able to do this yourself you need to consider registering a power of attorney (see later article).

Lastly we have a few changes to staff. We would like to welcome back Dr Louise Gardner who comes back from her trip down under and will be working here from March onwards. Drs McCalmont, Malik, Larvin, Joshua and Perrera will all be leaving us at the end of March and we would like to thank them for all their help whilst they have been here. Dr Hamer will be returning and we are looking forward to welcoming them back. We also have Drs Barry, Williams and Constantinescu and an F2 Dr Kajetan Karlikowski all starting in April.

Dr Lucy Genillard

___________________________________________________________

Spring Newsletter 2020

CORONAVIRUS

The Government list of affected places is:• Mainland China• Thailand• Japan• Republic of Korea(South Korea)• Hong Kong• Taiwan• Singapore• Macau• Vietnam• Cambodia• Laos• Myanmar• Malaysia• Northern Italy (north of Pisa)If you have returned from these specific areas:• Iran• Specific towns in the Lombardy and Veneto regions of Northern Italy • Daegu or Cheongdo in South Korea• Hubei province (returned in the past 14 days)

Even if you do not have symptoms please do not enter this building, to protect yourself and others go home and search ‘nhs coronavirus’ for advice and to access the 111 online coronavirus service or call NHS 111.

Find out more at nhs.uk/coronavirus

CORONAVIRUS

Have you been to an affected place in the last 14 days

Or

Had contact with somebody with Coronavirus

And

Do you you have any of these symptoms?

If yes, to protect yourself and others, please go home, self-isolate and contact 111 by phone or go online at:

https://111.nhs.uk/service/covid-19

DO NOT ATTEND YOUR GP OR HOSPITAL Find out more at nhs.uk/coronavirus

Planning AheadThinking about your wishes regarding how you want to be cared for at the end of your life can seem a little depressing but tackled in a positive way it enables you to have clearly documented evidence of what you want. There are many myths regarding this such as extortionate costs, having to use a solicitor and having a next of kin being just as good!!! These are not true and there are many different ways you can plan you care. Planning ahead can help you receive the care you want and can also ease the pressure on your family and friends when you are nearing the end of your life. There are lots of ways in which you can do this.

A good starting point is to perhaps think about what you would like at the end of your life. How aggressively would you like to be treated, would you want to be in hospital or supported at home. Thinking about these things and perhaps discussing with your family and friends is a good place to start. Once you have thought about this you may want to explore your options perhaps with your GP especially if you are known to be suffering from a terminal illness.

You do have the following options in recording your wishes

Advance statement- this is a written statement that sets down your preferences, wishes and beliefs regarding your future care. The aim is to guide anyone who might have to make decisions in your best interest if you were unable to communicate them. This could be given to your family but it is not legally binding.

Advance decision (living will, advance decision to refuse treatment)-this is legally binding and documents the decisions you have made about what treatment you may not want (for example you may not want admission to hospital for an antibiotic drip). You must have the mental capacity to make these decisions. You may also specify that you do not want cardiopulmonary resuscitation (i.e. attempts to restart your heart if it were to stop). This statement needs to be written down, signed and witnessed. Ideally a copy of this should be recorded in your medical record

Lasting power of attorney-if you become too unwell to make your own decisions for yourself you can officially appoint someone you trust to make decisions for you. These decisions can relate to your health and wellbeing or

to your financial and property affairs. There are special rules on doing this and more information can be found at GOV.UK advice on making a lasting power of attorney.

ReSPECT form-this is a Recommended Summary Plan for Emergency Care and Treatment. ReSPECT is a process that forms a personalised record of what clinical care you would want in a future emergency. This process is between yourself and a health professional. Sometimes these will be recorded whilst in hospital and other times may be done whilst you are at home with either a specialist nurse or GP. These can be for anyone but have more relevance for patients with complex health needs, people who are likely to be nearing the end of their life or perhaps are at risk of sudden deterioration. These plans are recorded on a ReSPECT form which you should keep with you but a copy is needed for your medical record. They enable you to state what your priorities might be either focusing on life-sustaining treatment or on symptom control etc. Only one component of this is a decision on resuscitation.

More information on all of this is available at the surgery, at the carers event and on the NHS and GOV websites.

What is resuscitation?

This is also often misunderstood. Most of us have probably seen this on the TV and believe it to be a largely non traumatic and predominantly successful endeavour. We may also think if we say that we do not want resuscitation that we will not be treated properly and doctors will not be in some way bothered about us. Not true not true not true!!! To understand the decision of whether we want to be resuscitated or not we first need to understand what it is. Cardiopulmonary resuscitation (CPR) is a treatment that attempts to restart breathing and blood flow in people who have had these stop. It has several possible components such as:-

Chest compressions (pressing down hard on the chest repeatedly)

Electrical shocks to stimulate the heart (sometimes more than once)

Injections of medicine

Artificial ventilation of the lungs. These measures can cause damage to the body such as rib fractures from

chest compressions or brain damage from lack of oxygen leading to long term disability. They can also be unsuccessful. Only 2 out of 10 people survive and leave hospital after CPR. Success rates are much lower in the community.

Am I a carer?

You are a carer if you provide unpaid support to a family member, neighbour or friend. They could need support because they are ill, frail, disabled or have a mental health or substance misuse problem.

The support you provide could be: 

washing and dressing

shopping and food preparation

helping with laundry or housework

keeping someone company

helping someone take medication

emotional support or help managing difficult behaviour

keeping an 'eye' on someone to make sure they are safe. 

You are still a carer if you: 

don't live with the person you care for

are not the only person providing care to someone 

are caring for more than one person 

are not related to the person you care for.

 

Information For CarersSupport for Carers

How can I look after myself?

Try to stay healthy

Eat healthily

Get enough rest

Do regular physical activity

Look after your general health and wellbeing

Share your feelings with someone you trust

Learn a relaxation technique

Take a break

Make time for yourself

Try to be organised

Be realistic about what you can do

Make sure you have all the information you need

Information about medical treatment:

The person I am caring for wants me to know about their treatment

The person I am caring for is too unwell to make decisions, or may be

too unwell to make them in the future

The person I am caring for does not want me to know about their

treatment

Find positives in your relationship

Support the independence of the person you care for

Make a crisis plan

Support for carers

There is a variety of support available to help carers including:

Nottinghamshire Carers Hub - this provides a range of support and services for carers. If you contact the helpdesk on 0115 824 8824 you can speak to an experienced support worker who will provide a personalised service that meets your individual need. You can also email hub@carerstrustem.org.

Nottinghamshire Help Yourself - you can find out about support available in your community by using Nottinghamshire Help Yourself, which gives information about local organisations that provide a range of services.

Dementia Carer Net - if you are looking for advice, support or information about caring for someone with dementia.

Carers UK - find out more about self-help and tips for reducing stress: 

Carers Event

In partnership with

Carers Event Brierley Park Medical Centre Wednesday 25 March 2020 2.00pm to 4.00pm 

Are you a carer, or know someone who is?

Come along to our Information event to find out about:

Support for carers Information regarding needs Support and benefits available Power of attorney – welfare and health/financial

And much more

Carers Support Stands Attending Organisation Purpose

Carers Trust (East Midlands)

Support for unpaid carers for a family member who is ill, frail, disabled or has mental health / addiction problems

Lifestyles Project

Support packages for people in Ashfield, Mansfield, Newark and Sherwood aged 50+ who are at risk of falls

Nottinghamshire Mind

Support for people with mental health problems and their carers

Everyone Active Leisure, gym, swim and exercise for lifestyle changeMacmillan After

DiagnosisSupport for cancer patients after the diagnosis

Hetty’s Support to family members of people with drug and/or alcohol dependency

Forget Me Not Peer support for people living with dementia and their carers, aimed at older people

End of Life Together

The service supports patients and their carer’s by working collaboratively, focusing on the individual patient’s end of life needs,

holistically.Citizens Advice

AshfieldInformation on Power of Attorney and legal issues concerning carers

Ashfield District Council

Health and wellbeing support to carers

Amazon Breast Cancer Support

Group

Help and support to those affected by breast cancer

Walking for Health

Benefits of walking on all aspects of health

AGE UK Nottm & Notts

Kirkby in Ashfield AFVBC

Services and support for veterans and services personnel in the community

Framework Housing

Association

Homelessness

NIHR Clinical Research Network

Research

Smoking Cessation

If you want to quit smoking you can make an enquiry online for self-referral to SmokeFreeLife https://www.nhs.uk/smokefree

Insight Healthcare

If you need help or counselling; you can be seen by a professionally trained counsellor at the surgery. You can also self-refer to this service. Please ask at Reception for more information.

Ultrasound

If your GP advises you need an ultrasound, ask if you can have an appointment at the surgery instead of going to the local hospital. Global diagnostics & Health Harmonie are available here at the practice and can save you a trip to the hospital. This service is available on selected dates.

On-line services are not new to Brierley Park Medical Centre and we are actively encouraging patients to sign up. The service is available 24 hours a day, 365 days of the year and it enables you to book appointments with a GP up to 4 weeks in advance and if you are on

Services available within the practice

Download the app today – search ‘SystmOnline’

The NHS app is the official public facing app to access existing patient online services such as appointment booking and ordering medication with a new

symptom checker as well enabling patients to set organ donation and Data Opt Out preferences. Later in the year it will also be the gateway to a localised

Nottinghamshire wide public app providing online services such as e-consultations, access to care plans, signposting, social prescribing, hospital information and more.

The national NHS app is being rolled out across the country with the expectation

that all GP Practices will be live by July 2019, Nottinghamshire has been chosen to

be an early adopter of the app.

Benefits

For Patients For Practice

All the features of patient online services in

an NHS official app

Staff spend less time dealing with requests

to book appointments and order repeat

prescriptions

More control over when they book

appointments, 24-hour access from

anywhere which also frees up the

practice phone line

Errors are less likely to occur when

appointments and prescriptions are

managed through the app

They can cancel more easily reducing DNA Patients can cancel appointments more

On-line services

On-line services are not new to Brierley Park Medical Centre and we are actively encouraging patients to sign up. The service is available 24 hours a day, 365 days of the year and it enables you to book appointments with a GP up to 4 weeks in advance and if you are on

NHS App

rates easily, so DNAs are reduced

They can view and order their repeat

prescriptions easily

In most cases patients can verify their

identity themselves, through NHS login,

saving practice staff time for new sign ups

NHS login means in most cases they don’t

have to come into the surgery to get access

Hay fever Hay fever is usually worse between late March and September, especially when it's warm, humid and windy. This is when the pollen count is at its highest.

Symptoms of hay fever include:

sneezing and coughing a runny or blocked nose itchy, red or watery eyes itchy throat, mouth, nose and ears loss of smell pain around your temples and forehead headache earache feeling tired

If you have asthma, you might also:

have a tight feeling in your chest be short of breath wheeze and cough

Hay fever will last for weeks or months, unlike a cold, which usually goes away after 1 to 2 weeks.

How to treat hay fever yourself

There's currently no cure for hay fever and you can't prevent it. But you can do things to ease your symptoms when the pollen count is high.

Do

put Vaseline around your nostrils to trap pollen wear wraparound sunglasses to stop pollen getting into your eyes

shower and change your clothes after you've been outside to wash pollen off stay indoors whenever possible keep windows and doors shut as much as possible vacuum regularly and dust with a damp cloth buy a pollen filter for the air vents in your car and a vacuum cleaner with a special

HEPA filter

Don't

do not cut grass or walk on grass do not spend too much time outside do not keep fresh flowers in the house do not smoke or be around smoke – it makes your symptoms worse do not dry clothes outside – they can catch pollen do not let pets into the house if possible – they can carry pollen indoors

Allergy UK has more tips on managing hay fever.

A pharmacist can help with hay fever

Speak to your pharmacist if you have hay fever. They can give advice and suggest the best treatments, like antihistamine drops, tablets or nasal sprays to help with:

itchy and watery eyes and sneezing a blocked nose

What causes hay fever?

Hay fever is an allergic reaction to pollen, typically when it comes into contact with your mouth, nose, eyes and throat. Pollen is a fine powder from plants.

Insect bites and stings

Symptoms of insect bites and stings

Insect bites and stings will usually cause a red, swollen lump to develop on the skin. This may be painful and in some cases can be very itchy.

The symptoms will normally improve within a few hours or days, although sometimes they can last a little longer.

Some people have a mild allergic reaction and a larger area of skin around the bite or sting becomes swollen, red and painful. This should pass within a week.

Occasionally, a severe allergic reaction can occur, causing symptoms such as breathing difficulties, dizziness and a swollen face or mouth. This requires immediate medical treatment.

What to do if you've been bitten or stung

Remove the sting or tick if it's still in the skin.

Wash the affected area with soap and water.

Apply a cold compress (such as a flannel or cloth cooled with cold water) or an ice pack to any swelling for at least 10 minutes.

Raise or elevate the affected area if possible, as this can help reduce swelling.

Avoid scratching the area, to reduce the risk of infection.

Avoid traditional home remedies, such as vinegar and bicarbonate of soda, as they're unlikely to help.

The pain, swelling and itchiness can sometimes last a few days. Ask your pharmacist about over-the-counter treatments that can help, such as painkillers, creams for itching and antihistamines.

When to get medical advice

Contact your GP or call NHS 111 for advice if: you're worried about a bite or sting

your symptoms don't start to improve within a few days or are getting worse

you've been stung or bitten in your mouth or throat, or near your eyes

a large area (around 10cm or more) around the bite becomes red and swollen

you have symptoms of a wound infection, such as pus or increasing pain, swelling or redness

you have symptoms of a more widespread infection, such as a fever, swollen glands and other flu-like symptoms

When to get emergency medical help

Dial 999 for an ambulance immediately if you or someone else has symptoms of a severe reaction, such as:

wheezing or difficulty breathing

a swollen face, mouth or throat

nausea or vomiting

a fast heart rate

dizziness or feeling faint

difficulty swallowing

loss of consciousness

Prevent insect bites and stings

There are some simple precautions you can take to reduce your risk of being bitten or stung by insects.

For example, you should: Remain calm and move away slowly if you encounter wasps, hornets or bees – don't wave

your arms around or swat at them.

Cover exposed skin by wearing long sleeves and trousers.

Wear shoes when outdoors.

Apply insect repellent to exposed skin – repellents that contain 50% DEET (diethyltoluamide) are most effective.

Avoid using products with strong perfumes, such as soaps, shampoos and deodorants – these can attract insects.

Be careful around flowering plants, rubbish, compost, stagnant water, and in outdoor areas where food is served.

You may need to take extra precautions if you're travelling to part of the world where there's a risk of serious illnesses. For example, you may be advised to take antimalarial tablets to help prevent malaria.

If you're planning to travel outside the UK, you may need to be vaccinated against some of the serious diseases found in other parts of the world.

Travel

Vaccinations are available to protect you against infections such as typhoid hepatitis A and yellow fever.

In the UK, the NHS routine immunisation schedule protects you against a number of diseases, but doesn't cover all of the infectious diseases found overseas.

If you're only travelling to countries in northern and central Europe, North America or Australia, you're unlikely to need any vaccinations. But it's important to check that you're

up-to-date with routine vaccinations available on the NHS.

You may be at more risk of some diseases if you’re travelling in rural areas, staying in hostels or camping, on a long stay trip or visiting relative or friends.

If you have a pre-existing health problem, this may make you more at risk of infection or complications from a travel-related illness.

Some vaccines need to be given well in advance to allow your body to develop immunity and some vaccines involve a number of doses spread over several weeks or months.

If you are planning to travel please call into the surgery at least 8 weeks before your planned travel date to collect a travel form so your vaccine history can be checked against the area

you are travelling to see which, if any vaccinations you need.

An appointment will then be made for you with one of the nurses for any vaccines you may need and general travel advice. You may also be offered any missing does of your UK

vaccines if you need them. If you have any records of any previous vaccinations please bring these to your appointment.

The practice is signed up to provide free NHS travel vaccines, which include tetanus, diphtheria and polio as well as hepatitis A and typhoid. These vaccines are free because they protect against diseases thought to represent the greatest risk to public health if they were

brought into the country.

You may also need protection from malaria in certain countries and the nurse will be able to advise you if this is needed. You will have to pay for malaria tablets are these are not free

on the NHS.

Some countries or types of travel require higher risk vaccines that are not available on the NHS. The nurse will inform you which ones you may require and direct you to more specialised travel centres that can offer you more in depth advice on travel and the

vaccinations you may require.

The cost of these travel vaccines that aren't available on the NHS will vary, depending on the vaccine and number of doses you need. Vaccines you will have to pay for include; hepatitis

B, Japanese encephalitis, meningitis vaccines, rabies, tick borne encephalitis and yellow fever.

Other things to consider when planning your trip is your age and health, you may be more vulnerable to infection than others and some vaccines cannot be given to people with

certain medical conditions.

If you are pregnant, you think you might be pregnant or breastfeeding you need to speak to your GP before having any vaccinations. Most vaccinations are safe to be given while you are pregnant or breastfeeding will cause problems for the baby, but there are some you

cannot have and your GP will be able to advise you further on this.

Asda 01623 516222

Peak Pharmacy (Huthwaite) 01623 554370

Boots (Idlewells) 01623 554094

Superdrug (Idlewells) 01623 557144

Gilbody (Skegby)

10th April 2020 Closed Good Friday11th April 2020 Closed Saturday12th April 2020 Closed Easter Sunday13th April 2020 Closed Easter Monday14th April 2020 Open 07:00 – 18:30

Pharmacy Contacts over Bank Holiday

Surgery Easter/Bank Holiday Opening Times

Please contact 111 for any medical advice and contact 999 in an emergency

Paperless Prescriptions – EPS4

On 12th March 2020 Brierley Park will move entirely to using electronic prescriptions. This is mandated by NHS England, will help the environment (saving paper and ink), and release Doctors’ time.

You can help this transition by picking a pharmacy. Instead of coming into the practice to collect a paper prescription when you request your medication this will automatically go the pharmacy of your choice. This not only saves doctors time but also saves you time as you go direct to the pharmacy and your prescription should be ready and waiting for collection. If you don’t Pick a Pharmacy, or need to use a different pharmacy than the one you have nominated, you will get a Prescription Token. This looks like your usual paper prescription but has a barcode for the pharmacy. This does not need to signed by your Doctor.

To ensure the process is efficient, it is important that requests for medications are submitted with at least 48 hours’ notice. Please note it will no longer be possible to sign late-requests the day while patients wait. Urgent requests will normally be dealt with electronically by the On-Call Doctor at fixed points in the day and

patients will need to liaise with their chosen pharmacy or collect a token from the practice at the end of the day.

For more information please visit www.nhsbsa.nhs.uk/prescriptions or speak to one of our reception staff

We would also urge all our patients to sign up for the NHS App as this allows you to request your prescriptions on-line as well as being able to book, cancel appointments etc.

Looking beyond the GP surgery – research, teaching and partnering with the community

As you may know, Brierley Park Medical Centre is a Level 2 Clinical Research Network (CRN) National institute for Health Research (NIHR) accredited practice. This means that we are approached by researchers, mostly based at Universities, to help with finding out more about our patients’ health. We have come a long way since doctors simply followed their senior colleagues and did what they were taught at medical school. We are constantly learning new things and keeping ourselves updated about the latest medicines, treatments and technologies that will help our patients feel better and live longer. Currently, our practice is working towards becoming a level 3 research practice, which means we are working to promote the importance of research to neighbouring GP surgeries and plan to take on more research than we already do. Patients who take part in research studies tend to report feeling healthier and appreciating the importance of research. One of our staff recently told me that her family member was in a research study years ago and still values the chance to have taken part in that research study. So being part of research can having lasting positive effects for patients and families.

Research is not just about finding new medicines. It is also about stopping, thinking and reflecting on how we do things and whether they work. We have trainee doctors (from at least a year of experience of working as a doctor since medical school through to nearly qualifying as a GP). One of our doctors recently started an initiative to increase the numbers of patients being referred for exercise on prescription. Another is working on how to identify homelessness. When we plan care for our patients, we find it helps to think of whole groups of people. For example, we have recently applied to become accredited as a ‘Veteran friendly’ practice and Nikki Palmer (our registered nursing associate) will join Julie Edwards (our deputy practice manager) in leading this initiative. Our aim is to learn as much as we can about how to care for our patients and how to improve what we do. General Practice delivers 90% of patient contacts in the NHS so it needs to be up-to-date and cutting edge.

Many people who live outside of big cities, especially beyond London and the South East, have a lower chance to be involved in research. For research studies to be meaningful, it is very important that the people who take part represent the whole of the population. Therefore, we hope to see more research being done at Brierley Park Medical Centre in the future and look forward to developing our education and research locally.

Dr Vibhore Prasad

GP Partner and NIHR Academic Clinical Lecturer at King’s College London.

Support for our Homeless Population

Tonight, thousands of people will sleep rough on the streets of England and in Nottinghamshire alone, it is estimated that 1276 people have no permanent home. At Brierley Park, we are looking at how we can better identify this vulnerable population and what extra support we can provide.

Firstly we recognise that whilst rough sleeping is the most "visible and extreme" aspect of homelessness, in reality it is the tip of iceberg. The “hidden homeless” includes people who become homeless but find a temporary solution by staying with family members or friends, living in squats, sofa surfing or other insecure accommodation. These people can be harder to identify, so it’s vital that if you or someone you know needs support with this, let someone in our team know.

Experiencing homelessness can have a negative impact on both your physical and mental health, so it’s important that people are able to access support. Registering with a doctor normally requires several forms of ID or paperwork to ensure we can keep up-to-date records for the right person, however, if you do not have access to these we can still register you free of charge. If you need support with filling out the forms, please ask one of our receptionists and if you prefer we can always discuss any issues in a confidential room. There is also no requirement for patients to prove their immigration status in order to register at a GP practice.

Patients who are homeless go through great difficulties to get to the practise and may not be able to come as often as others. In recognition, we will always try to book double appointments, especially if it is the first one and if they have complex health problems.

We are currently collating a list of local services and charities which can help so do ask and our staff can signpost and help get you in contact with teams to help regarding housing, benefits, drugs and alcohol support etc.

No one’s health should suffer because of who they are or where they live and here at Brierley Park, we are working to improve equality by ensuring access to support and treatment for this vulnerable population is easier.

Hi there,

You will have seen Dr Genillard’s article in the newsletter, which gives information about our Carers Event in March. I know from personal experience how physically and mentally draining it can be when caring for a loved one, alongside the demands of running your own life. Often, the very last thing that you have time for is to try to find out what help there is out there.

It’s easy to think that carers are those who are looking after a partner or elderly parents, but there is a wide spectrum of people across all age ranges that care for people on a day to day basis. It’s not just the effects of ageing that calls for caring and we were keen to get together as many organisations that we could, in order to cover as many carers as possible. These will cover many aspects of caring, including young carers, carers affected by the effects of substance dependency, homelessness and armed forces veterans, as well as ones dedicated to the effects of illness and the elderly.

If you are caring for someone, or want to know more information on an aspect of care, then please take a few minutes out of your hectic life and come along to the event on the 25th March 2020 from 2.00pm to 4.00pm at Brierley Park Medical Centre.

Kind regards

Steve Wright – Chair of the HIP Group – Patients Participation Group for Brierley Park Medical Centre