IMPROVING PATIENT ACCESS

Project: Re-engineering the urogynaecology service at University Hospital, Hartlepool

Contact: Safwat Tosson, tel: 01429-522267

The urogynaecology clinic treats women suffering disturbance in urinary bladder function. Though a Mori poll estimated that at least 3.5 million women in Britain suffer urinary symptoms, most 'suffer in silence'. Many healthcare workers are ignorant about the condition and few resources are devoted to it. It seriously affects quality of life, yet effective treatment is available. The urogynaecology service at Hartlepool General Hospital started in 1990, with the appointment of Safwat Tosson.

Referrals increased from none to 421 a year, resulting in a three-year waiting list. The service needed re-engineering to reduce waiting times and make better use of healthcare professionals' time.

Management

In this project, a urogynaecology subspecialty sister sends all patients a comprehensive questionnaire by post. The patient then attends the clinic and sees the sister, who assesses the severity of their condition. Using clear guidelines, they are then referred to the best healthcare professional to help them. This may be the consultant, a physiotherapist or a community continence adviser. Every team member is aware of their role, with regular meetings between team members. The service has been assessed by patient satisfaction surveys.

Innovations and successes

The questionnaire is written in jargon-free English and used by other units. The role of the urogynaecology subspecialty sister is unique. The integration of the various hospital and community services also breaks new ground. Waiting times have been cut from 150 weeks to six weeks, even though referrals continue to increase. The six-monthly patient satisfaction surveys show improved quality of life on discharge from the clinic.

The judges said: This project showed a good grasp of the condition's impact, and is patient-centred. Mr Tosson has valued all team members and proved that you do not have to lead from the front. The project has delivered dramatic results in terms of waiting, resource use and the patient experience.

Runner-up: Community Health South London trust, Lambeth Southwark and Lewisham local pharmaceutical committee and Lambeth Southwark and Lewisham health action zone

Project: Improving access to emergency contraception

Contact: Beth Taylor, 020-7771 5284

Aims to provide access to free emergency hormonal contraception from community pharmacies - part of a wider initiative to reduce unintended pregnancy, particularly among teenagers.

Management

The scheme uses a patient group direction that specifies the clinical criteria for the safe supply of emergency hormonal contraception. Fifty pharmacists have been trained and accredited to provide the service.

A project reference group was established with representatives of partner agencies, voluntary sector, parent and church groups.

This reported to a project management group, which linked to the HAZ. This structure was revised to include teenage pregnancy co-ordinators and representation from likely commissioners.

Innovations and successes

When the project was set up, emergency hormonal contraception was a prescriptiononly medicine. There was no legal framework for patient group directions and these had not been used in community pharmacy.

The service is open to all women under 50, and 7,000 supplies of contraception have been made.

Fifteen per cent of users are aged under 19, and 30 per cent are 20 to 24. Ninety-eight per cent of users were satisfied with the service.

The judges said: The scale of this project is very impressive. It is innovative and ahead of the game.

It has created good local networks - the engagement of a wide group of partners was impressive - and made a good effort at evaluation.

Runner-up: Bridgend local health group

Project: Teenage pregnancy: emergency hormonal contraception

Contact: Sara Thomas, 01656-766736

The project is piloting a service to improve teenagers' knowledge of, and access to, emergency hormonal contraception via trained community pharmacists, using a patient group direction.

The service started in February as a six-month pilot in 10 pharmacies. Funding has been secured to extend it to 12 months.

It will be evaluated before the service is extended to the other 22 pharmacies in Bridgend.

Management

The project is part of the health authority's sexual health strategy. It is managed by the local health group prescribing adviser and overseen by a multidisciplinary team.

Community pharmacists have been involved in developing the project, the patient group direction and training. Each is supported by a named GP. Other groups, including members of the National Assembly for Wales, have become involved.

Innovations and successes

The first pilot of its kind in Wales. Interest was such that robust procedures were needed to deal with media inquiries. There were 109 consultations in the first four months. Over half were teenagers, 13 per cent under 16. Ten per cent of clients travelled from outside the project area. Comments have been very positive.

The judges said: Enthusiastic, quick on its feet and not too bureaucratic. This project learned as it went on and picked up ideas from elsewhere.

There are good materials for users. It is inspiring to see the pharmacist move into the whole healthcare team.