Universityt Hospitals Sussex NHS Foundation Trust
NHS / Health Body
Action Taken
The Trust introduced a new e-RS system for managing referrals, a consultant-led advice and guidance service for GPs, and consultant-led triage for outpatient clinic referrals. They are also working to manage demand across sites and recruiting substantive consultant neurologists. (AI summary)
View full response
Dear Ms Schofield
RE: Inquest touching upon the death of Mr Nicolas Pennicott
In April 2023, the Trust provided information to the Coroner about developments in neurology services since Mr Pennicott’s death (letter dated 12 April 2023). At the end of the inquest, you asked for an update at the end of July 2023 on measures the Trust intended to introduce but were not in place or fully in place in April 2023. I am writing to provide you with that update on the development of neurology services at Worthing and St Richards Hospitals.
The service introduced the new e-RS system for managing referrals on 2nd May 2023.
Advice and Guidance service for GPs
• The Trust now has 3 consultant sessions per week for neurology consultants to provide advice and guidance for GPs. This is a new facility which was introduced in May 2023, for GPs to access advice prior to or instead of referring for an outpatient clinic
• GPs can select the advice and guidance dropdown option when they are using ERS to refer patients. We are now receiving up to 10 requests per week so are confident that GPs are aware of this service and able to access it
• A wider communication with primary care updating on developments has been written to increase awareness amongst GPs of this facility and we expect this to be shared in the primary care newsletter published by the ICB in August
• This will include an update to the Directory of Services for neurology clearly identifying the advice and guidance facility along with other specialist clinics provided
Triage for outpatient clinic referrals
• Patients referred for outpatient clinic are triaged by a consultant neurologist and categorised by clinical urgency based on the information provided by the GP
• The triage criteria were updated as planned in May 2023. We have introduced a pre-screen to assist the consultant triaging and ensure any patient already known to the service is made known. The consultant is triaging by urgent, 2 week wait cancer, first seizure or routine. For urgent referrals, the consultant is indicating the maximum number of weeks they would expect the patient to be seen within
• We have introduced regular monitoring of the waiting list, with reviews of urgent patients waiting to be seen to allow appropriate prioritisation within available clinic capacity
• Implementation of the e-RS system has reduced the previous delay to uploading referrals for consultant triage
Waiting times for patients referred to outpatient clinics
• We have now employed a locum consultant neurologist to support the service and provide additional outpatient clinics and consultant triage. This arrangement is ongoing
• We have engaged Elective Services to provide additional outpatient capacity to address waiting times for new patients and anticipate that these measures will reduce waiting times for all patients. Elective Services are providing in excess of 600 outpatient appointments over a 12-week period
• We have advertised for substantive consultant neurologists. The advert closes on 26th July and we look forward to shortlisting any applicants
• We are implementing changes to manage the demand for new outpatient appointments across the 3 sites within the Trust to reduce the maximum waiting time for patients across Sussex., offering patients appointments at alternative sites to reduce waiting time
Neurology workforce review
• There remain significant pressures on the neurology medical workforce with national and local consultant shortages
• We continue to develop our model of advanced clinical practice in neurology with a team of clinical nurse specialists working in general neurology as well as in specialist areas, including headache, epilepsy and Parkinson’s disease. We have developed a proposal to increase the capacity of the services that ACPs are providing and expect to deliver this in the second half of this financial year
Advice and guidance for hospital consultants
• A Standard Operating Plan (SOP) is in place for the Emergency Department / Emergency Floor consultants to access advice from a consultant neurologist on weekdays. At weekends, advice can be sought from the on-call neurology teams at Southampton General Hospital or Royal Sussex County Hospital
• The department uses an electronic referral form that initiates a review by a consultant neurologist. During the week, this should be provided on a same day basis. If there are staffing constraints on a specific site then cross site solutions such as telephone advice are available. There is a consultant neurologist on call daily across the Trust. There is a regular ward review service for patients on the wards at St Richards Hospital and Worthing Hospital, by a consultant neurologists
RE: Inquest touching upon the death of Mr Nicolas Pennicott
In April 2023, the Trust provided information to the Coroner about developments in neurology services since Mr Pennicott’s death (letter dated 12 April 2023). At the end of the inquest, you asked for an update at the end of July 2023 on measures the Trust intended to introduce but were not in place or fully in place in April 2023. I am writing to provide you with that update on the development of neurology services at Worthing and St Richards Hospitals.
The service introduced the new e-RS system for managing referrals on 2nd May 2023.
Advice and Guidance service for GPs
• The Trust now has 3 consultant sessions per week for neurology consultants to provide advice and guidance for GPs. This is a new facility which was introduced in May 2023, for GPs to access advice prior to or instead of referring for an outpatient clinic
• GPs can select the advice and guidance dropdown option when they are using ERS to refer patients. We are now receiving up to 10 requests per week so are confident that GPs are aware of this service and able to access it
• A wider communication with primary care updating on developments has been written to increase awareness amongst GPs of this facility and we expect this to be shared in the primary care newsletter published by the ICB in August
• This will include an update to the Directory of Services for neurology clearly identifying the advice and guidance facility along with other specialist clinics provided
Triage for outpatient clinic referrals
• Patients referred for outpatient clinic are triaged by a consultant neurologist and categorised by clinical urgency based on the information provided by the GP
• The triage criteria were updated as planned in May 2023. We have introduced a pre-screen to assist the consultant triaging and ensure any patient already known to the service is made known. The consultant is triaging by urgent, 2 week wait cancer, first seizure or routine. For urgent referrals, the consultant is indicating the maximum number of weeks they would expect the patient to be seen within
• We have introduced regular monitoring of the waiting list, with reviews of urgent patients waiting to be seen to allow appropriate prioritisation within available clinic capacity
• Implementation of the e-RS system has reduced the previous delay to uploading referrals for consultant triage
Waiting times for patients referred to outpatient clinics
• We have now employed a locum consultant neurologist to support the service and provide additional outpatient clinics and consultant triage. This arrangement is ongoing
• We have engaged Elective Services to provide additional outpatient capacity to address waiting times for new patients and anticipate that these measures will reduce waiting times for all patients. Elective Services are providing in excess of 600 outpatient appointments over a 12-week period
• We have advertised for substantive consultant neurologists. The advert closes on 26th July and we look forward to shortlisting any applicants
• We are implementing changes to manage the demand for new outpatient appointments across the 3 sites within the Trust to reduce the maximum waiting time for patients across Sussex., offering patients appointments at alternative sites to reduce waiting time
Neurology workforce review
• There remain significant pressures on the neurology medical workforce with national and local consultant shortages
• We continue to develop our model of advanced clinical practice in neurology with a team of clinical nurse specialists working in general neurology as well as in specialist areas, including headache, epilepsy and Parkinson’s disease. We have developed a proposal to increase the capacity of the services that ACPs are providing and expect to deliver this in the second half of this financial year
Advice and guidance for hospital consultants
• A Standard Operating Plan (SOP) is in place for the Emergency Department / Emergency Floor consultants to access advice from a consultant neurologist on weekdays. At weekends, advice can be sought from the on-call neurology teams at Southampton General Hospital or Royal Sussex County Hospital
• The department uses an electronic referral form that initiates a review by a consultant neurologist. During the week, this should be provided on a same day basis. If there are staffing constraints on a specific site then cross site solutions such as telephone advice are available. There is a consultant neurologist on call daily across the Trust. There is a regular ward review service for patients on the wards at St Richards Hospital and Worthing Hospital, by a consultant neurologists