people
case study
Can you tell me how the practice became involved with offering carpal tunnel release operations? One of our GP partners is a qualified surgeon and his special interest is in minor surgery. He was already offering minor surgeries, such as vasectomies, injection and banding of piles and excision of skin lesions under the secondary care procedures in primary care scheme. When practice- based commissioning was introduced, practices were encouraged to consider what services could be done in primary care that are normally carried out in hospital. Dr Ragaii Loka, our GP surgeon, thought the practice could also offer the carpal tunnel release operation in addition to other minor surgeries already carried out. We looked into the possibility of offering the procedure and reviewed the data of the number of carpal tunnel release operations that have been carried out at the local hospital over the previous three years. We came up with a business case to put forward for practice- based commissioning that illustrated how we could provide this procedure at less than half the cost. The practice’s case was successful but was put on hold due to PCT funding issues. We resubmitted our case the following year, this time under a new initiative, the QIPP scheme. One of the stipulations was the qualified surgeon must have a local consultant to provide clinical supervision, who must be accredited with a GP special interest qualification. In addition, by then all minor surgery settings had to be upgraded to the required NHS standard. This involved adding a new air conditioning and extraction unit to meet the criteria. We received the go-ahead under the QIPP scheme and started offering the carpal tunnel release operation at the practice in September 2010.
How many operations has the practice carried out to date? We expected at first to receive just one-third of procedures from the local acute trust. Our forecast was to do 80 procedures in the first year, 100 in the second year and 120 during the third year. We are now into the end of our second year and have carried out just over 120 operations. The practice now has two GP surgeons, which offers a better business continuity plan if anything crops up. Previously when Dr Loka was the only qualified surgeon, we may have had to suspend the practice’s carpal
tunnel release service if he was unavailable through illness. Our second GP surgeon, Dr Davies has a special interest in carpal tunnel syndrome. Both surgeons operate on alternate Fridays at the practice.
Have any changes been needed to offer the service at the practice? As the GP workload is quite heavy, to make the service possible, we had to look at how to cover Dr Loka and Dr Davies’s patients when the two surgeons are performing operations. We have employed a salaried
fast facts
L to R: Dr Richard Davies, Olivia Bassett, Helen Gilbert (lead practice nurse), Chris Stride (CTR administrator) and Dr Ragaii Loka in the minor surgery suite.
Practice Bideford Medical Centre Patients 1,520 Clinical staff 10 GP partners, two salaried GPs, two GP registrars, six practice nurses, two minor illness nurses, and five healthcare assistants Non-clinical staff 15 receptionists, senior receptionist, reception manager, practice administrator, IT manager, deputy practice manager, medical typist and finance assistant PCT Devon (Northern Locality) CCG New Devon CCG Practice manager Olivia Bassett Time in role 18 years Background Originally from Hong Kong, Bassett previously worked as a chartered accountant before moving to Bideford Medical Centre 18 years ago. Since July 2012, she has been giving management support to another local practice. She has been actively involved in commissioning in the last five years and has sat on the North Devon Locality Commissioning Board as a practice manager board member until September 2012, when the new commissioning board was formed without a practice manager seat.
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