Enhanced Services at Leatside Surgery, Totnes

The information that follows concerns services we provide over and above what the NHS considers to be essential. We have agreed with our local Primary Care Trust (PCT) that we will provide these services and receive funding for doing so.

Access to general medical services

The NHS Plan stated that “by 2004, all patients will be able to see a primary care professional within 24 hours and a GP within 48 hours”. By agreeing to undertake this enhanced service we committed ourselves to meeting these targets. The following conditions apply:

Childhood immunisations

This service rewards the Practice for ensuring that as many children as possible receive immunisations (click here for more information on the immunisations given). The NHS believes that this service provides a cost-effective means of ensuring children are protected from serious diseases. The funding we get depends on the percentage of children that receive the full course of immunisations.

Influenza immunisation

The purpose of this service is to provide for the vaccination of people aged over 65 or in other groups considered to be most at risk from this disease. This is to reduce the serious morbidity and mortality from influenza by immunising those most likely to have a serious or complicated illness should they develop influenza. This can avert the need for people to go to hospital. Click here for more information on influenza immunisations. To secure funding we must ensure at least 70% of our patients aged over 65 receive the immunisation.

Minor surgery

The purpose of this service is to encourage Practices to take on a wider range of surgery thus reducing the need for people to go to hospital. Some minor surgery, such as cryotherapy to remove warts and so on, is seen as a routine part of our service and so would not be included here. This service is intended to fund more invasive treatments such as joint injections, the excision of lumps and other procedures such as the injection of varicose veins and piles. In order to qualify for funding for this service we have to demonstrate to our PCT that all staff involved are properly qualified; we have appropriate facilities and equipment; and we meet certain standards to assure the quality of the surgery done.

The table below gives a full list of the minor surgery procedures we undertake together with details of the people who do it and how you can make an appointment. The list includes all activity whether or not it is part of this enhanced service.

What	Who
Cryotherapy – use of liquid nitrogen to ‘freeze off’ things on your skin eg warts, veruccas and occasionally moles	Doctors and nurses – please book with reception asking for a cryotherapy appointment
Cautery – use of heat to burn things off your skin. A local anaesthetic will often be required. Used for the same sorts of things as cryotherapy and often for bigger moles	Discuss with doctor before making appointment
Curettage – scraping things off your skin. Used as an alternative to methods mentioned above. Often followed by cautery because of bleeding	Discuss with doctor before making an appointment
Injections of muscles tendons and joints – most commonly used in joints particularly the shoulder and sometimes the knee. Useful for things like tennis elbow	Discuss with doctor before making an appointment
Invasive procedures including incisions and excisions – used for things deeper under the skin like cysts and other lumps. Will need a local anaesthetic.	Discuss with doctor before making an appointment

Anti-Coagulation Monitoring

Through this service we have undertaken to monitor people receiving the drug Warfarin. It is used to prevent blood clotting in patients with a variety of problems such as Deep Veined Thrombosis or who have recently had a heart attack. Whilst it is a very effective drug in these conditions it can also have serious side effects, eg severe haemorrhage. By undertaking certain blood tests locally we are able to monitor the effect Warfarin is having on patients and so prevent the serious side effects. These tests are carried out by our nurses in routine appointments.

Intra-Uterine Contraceptive Device Fittings

Minor Injury Services

The purpose of this enhanced service is to encourage Practices to undertake this work to help relieve pressure on A&E departments in large hospitals. We are funded specifically to deal with injuries that are less than 48 hours old. Injuries that are older than this are seen to be part of our routine and ongoing work. We are able to deal with cuts capable of closure by simple techniques; bruises; foreign bodies; recent eye injuries; small burns and scalds; and many other problems.

Near Patient Testing

The treatment of several diseases within the fields of medicine, particularly rheumatology, is increasingly reliant on drugs that, while clinically effective, need regular blood monitoring. This is due to the potentially serious side effects that these drugs can occasionally cause. It has been shown that the incidence of side effects can be reduced significantly if this monitoring is carried out in a well organised way, close to the patient’s home. The particular drugs we are funded to monitor are: Penacillamine, Auranofin, Sulphasalazine, Methotrexate and Sodium Aurothiomalate.