GP & Partner Bulletin - November 2016

Pulse 2

November 2016

Welcome to the November issue of Pulse The Pennine Acute Hospitals NHS Trust's GP and partner bulletin. Each issue will round up the latest news from inside the Trust and present it in this e-newsletter. If you would like to make any comments about this issue or if you have any suggestions for future content then please email the editor


Message from the Sir David Dalton, Chief Executive - Update site-based leadership teams

Over the past few months we have been working on our plans to establish new executive leadership teams as part of our future model for the Trust’s four hospitals and localities. To this end, we are establishing three Care Organisations to manage our four hospitals and work with partner organisations across our respective localities.

Each of these Care Organisations will have its own executive leadership team comprising a Managing Director, a Medical Director and a Nursing Director. The three Care Organisations will be: - North Manchester, Oldham, and Bury/Rochdale.

This model will help strengthen and improve senior leadership support at hospital–level, strengthen engagement with staff and clinical teams and strengthen relationships and joint working with our local care partners including our Local Authorities and local commissioners in Oldham, Bury, Rochdale and Manchester. These arrangements will also support better communication with staff to ensure everyone who works across the Trust is well-informed and able to contribute to the developments we are making on our journey of improvement here at Pennine.

Following interviews held last week, I am pleased to announce today the appointment of three very experienced senior colleagues to the Managing Director posts.

  • Steve Taylor; currently Divisional Director for Integrated and Community Services here at PAT and Director for Rochdale. Prior to this post, Steve who many of you will know was Divisional Director for Medicine and Community Services.
  • Donna McLaughlin; currently Director of Operations at Royal Liverpool and Broadgreen University Hospitals NHS Trust. Prior to this, Donna was Director of Operations and Performance at St Helens and Knowsley Teaching Hospitals NHS Trust.
  • Stephanie Gibson; currently Director of Performance and Improvement at Salford Royal NHS Foundation Trust. Prior to this Stephanie was Deputy Director of Operations and Performance, and Managing Director for Clinical Support Services and Tertiary Medicine.

The posts will provide operational and strategic leadership and management of the site-based care organisations working as a triumvirate alongside the Nurse Directors and Medical Directors. The start dates for Steve, Donna and Stephanie have yet to be confirmed.

Interviews for the three Medical Director posts will be held later this month and I look forward to being able to confirm appointments to these positions by the end of November.

Our Clinical Services Strategy is currently being developed which, together with the Trust’s Investment Plan, will describe how the Trust can stabilise and improve services and become clinically and financially sustainable in the longer term.  

The key to our future success lies in developing clear and distinct clinical service plans for each of our four hospitals, closely aligned to the development of the Locality Care Organisations (LCOs). This will include developing a positive vision for the future of North Manchester General Hospital, strongly connected to its local community with new services and facilities to improve care of people with multiple conditions and frailty.

More information about our clinical services strategy will be shared with staff over the coming months.

Appointment of three new Nurse Directors

The Trust has started the process of strengthening and improving senior leadership at hospital level and to strengthen engagement with staff and our locality partner organisations. The three care organisations will be: North Manchester, Oldham, and Bury/Rochdale. In developing these site-based leadership teams, the following senior appointments have been made to three new Nurse Director posts. The Trust would like to welcome Simon Featherstone, Nicola Firth and Tyrone Roberts who have all recently started at the Trust.

CQC Improvement Action Plan

The Trust’s Improvement Plan drawn up to deliver and support the improvements needed to stabilise our fragile services and ensure all services are safer, more reliable and more efficient and effective was signed off by the Care Quality Commission (CQC) on 17 October 2016. The plan has also been endorsed by the Greater Manchester Pennine Improvement Board, chaired by the Chief Officer of the GM Health & Social Care Partnership, Jon Rouse.

The CQC’s 77 ‘Must Dos’ and 144 ‘Should Dos’ in its report have been mapped to the themes and deliverables contained within the plan. The impact of the actions on patient care, outcomes and staff will be monitored and assessed through measurement dashboards. 15 high level metrics are linked under the five CQC domains of: Safe, Effective, Caring, Responsive and Well-Led. These high level metrics include mortality ratios, number of cardiac arrests, reported pressure ulcers, serious incidents, postpartum haemorrhage, length of stay for elective patients, readmissions, formal complaints, staffing levels and staff absence, cancelled appointments, and median time from A&E arrival to admission and to treatment. Salford Royal’s operating models will enable change to be delivered at scale and pace.

The CQC has requested a follow-up meeting and table-top review with the Executive Team on 13 December 2016 to enable a detailed review of the progress being made around stabilising fragile services, the Trust’s mortality review project and an assessment of our winter resilience. We anticipate a follow-up inspection by the CQC across all of our sites in late Spring 2017 which will focus on those services rated inadequate and the Well-Led domain.

Stabilising Fragile Services – update 


A number of measures have been put in place to support staff in A&E to stabilise and strengthen the service. This involves enhanced GP and primary care input directly into the department, enhanced community services, and increased physio and pharmacy staff in A&E. Additional temporary A&E consultant cover from senior clinicians has also been identified from across PAHT and from other neighbouring Trusts. The Trust is also working closely with Salford Royal and CMFT on joint recruitment campaigns to design innovative and attractive consultant job plans that will help recruit to vacant positions in A&E and Acute Medicine specialties. A risk to the stability of the service remains if recruitment initiatives are not successful. We are also working with NWAS to ensure reliable pathways for high acuity patients taken directly to high acuity sites at Oldham, Salford Royal and CMFT for specialist treatment.

Maternity Services

Recruitment of additional midwives and a focus on clinical leadership continues to be the Trust’s priority for maternity services. Thirty-one new midwives started in post across the Trust’s two maternity units at North Manchester and Oldham on 17 October. In addition to these new staff (58 new midwives since April), our new management team is being supported by CMFT who are providing supplementary clinical leadership support in order to stabilise and strengthen services on the North Manchester site. The Trust, with support from Salford, has recruited additional midwifes and sickness absence rates have fallen.

Paediatric Services

A number of measures have been put in place to stabilise and improve children’s services, particularly around staffing and paediatric bed capacity at Oldham and NMGH. Six patient pathway coordinators have started on both sites to pull through and support children. A new matron for paediatrics has started in post and three paediatric nurses have been recruited from Salford Royal. The Trust is also in the process of recruiting six new consultant paediatricians; two paediatricians have commenced in post. A clinical educator for NMGH has commenced in post. 

Critical Care Services

It has been agreed to recruit supernumerary shift coordinators, with three nurses already in post. Medical recruitment of doctors continues to locum, intensivist and middle grade posts to support critical care rotas.

Nursing & Medical Workforce Recruitment

Between April and September, we successfully recruited 109 new registered nurses and 58 midwives, 36 doctors (consultants and middle grades) and 149 health care support workers. In addition, 60 newly qualified registered nurses started on 2 October. The Trust is in the process of recruiting 70 more health care support workers. In addition, a successful pilot announced recently by Health Education England will see 44 Nursing Associates start in post at the Trust in January 2017. These Nursing Associates will begin training in a new role that will sit alongside existing nursing care support workers and fully-qualified registered nurses to deliver hands-on care for patients.

Strengthening nurse leadership – 100 x Band six posts 

Following a review of nurse staffing numbers and skill mix by Elaine Inglesby-Burke, Chief Nurse, the Trust has agreed to recruit to 100 Band six senior nurse posts to improve nurse leadership, skill mix and grade mix across all of our acute wards and clinical areas. This will also reduce reliance on expensive agency staff. It is anticipated that approximately half of these posts will be filled by existing staff who will further develop their skills and careers, while at least half will prove a significant draw and attraction for new staff externally to join the Trust.

Quality Improvement (QI) Strategy

The Trust’s overarching Quality Improvement Strategy (QI) is in the final stages of development and will be submitted to the Trust Board later this month. A major component to the Trust’s Improvement Plan and QI strategy is the roll out of large scale staff quality learning collaboratives. These collaboratives aim to engage with staff to work on how we can make real improvements and how we can measure their impact on patient care. Measurement of these actions for improvements will be fundamental to ensuring sustainability and the reliability of our care. In advance of the QI strategy being finalised, the first learning collaborative has been established centred on the deteriorating patient. The Deteriorating Patient Collaborative aims to reduce the rate of cardiac arrests per (1000 admissions) and will look at the identification, observation, timely escalation and care management of deterioration in patients, including the identification and management of sepsis, particularly in elderly frail patients, and what care and treatment these patients need.

Clinical Services Strategy

The development of local strategic plans under GM Devolution provides the opportunity for the Trust to create a Clinical Service Strategy, including identifying service portfolios for each of our sites. This work is being undertaken with our four CCGs and Local Authorities. This emergent strategy is being co-designed with the Trust’s four local CCGs and Local Authorities through a Programme Board and will involve staff. It will link to locality plans and locality care design in each area in Oldham, Bury, Rochdale borough and North Manchester, including a Single Hospital Service for Manchester, Healthier Together, and Local Care Organisations (LCOs) in the NE sector. Our Clinical Services Strategy, together with the Trust’s Investment Plan, will describe how the Trust can move from a position of stabilising services to one of transforming services and becoming clinically and financially sustainable in the longer term. The long term solutions to stability lie in working through a clinical service strategy for each site, closely aligned to the development of the Locality Care Organisations (LCOs). This will include developing a positive vision for the future role of NMGH, connected with its local community to improve care of people with multiple conditions and frailty. The process will also determine a plan for improving accommodation on the site.

New neighbourhood teams in North Manchester – Changes to district nurse referral form

Community nurses in North Manchester are now based in four neighbourhood teams. This change is part of the exciting development of integrated neighbourhood teams, which will bring community nurses, therapists, general practices and social care together to provide joined up care and pro-actively support people at risk of admission to hospital. For discharging teams who wish to make a referral to a district nurse, please find below a link to the Trust web page, which contains a link to a revised referral form and the list showing the allocation of GP practices across neighbourhoods.

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Paediatric Education Evening for GPs - Bronchiolitis

A GP education meeting has been arranged on 30 November 2016 at 6pm at the Education Centre at Fairfield General Hospital. As the bronchiolitis season has already started, the meeting will focus on how to use the shared care pathway and also on the management of Bronchiolitis. All GPs are encouraged to attend. Astra Zeneca is sponsoring the meeting. A hot buffet has been arranged.

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New purpose-built gastrointestinal physiology unit opens at Rochdale Infirmary

A £34,000 investment by the Trust has seen a new purpose-built suite open at Rochdale Infirmary for patients with gastrointestinal problems.

The gastro-intestinal (GI) physiology unit has been officially opened after its relocation within the Rochdale Infirmary site.

Now housed in a larger purpose-built unit on level A in the Infirmary, the unit houses state-of-the-art equipment with separate rooms for undertaking upper and lower GI function tests, office accommodation and a patient consenting room. 

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Trust sees huge increase in patients taking part in clinical research

The Trust’s award-winning clinical research and development department has seen a huge increase in the number of patients taking part in clinical research over the last year.

For 2015/16 the recruitment to patient research trials has grown from 2,229 patients to 5,084 patients. When ranked according to percentage annual growth in patient recruitment, this puts the Trust in the top five Acute Trusts in England.

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New medication pilot increases nurses’ time to care at The Royal Oldham Hospital

An innovative pharmacy project which will allow nurses to spend more time providing direct patient care is already paying dividends on a ward at The Royal Oldham Hospital.

In the 12 month pilot programme two registered (GPhC) pharmacy technicians, Carly Bullough and Amanda Jackson, have been seconded to administer oral and non-invasive medication to inpatients during the weekday morning and lunchtime medication rounds in a bid to reduce missed, delayed and withheld doses.

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Breaking the symptom cycle – A patient’s story about new Expert Patient Programme launched for Rochdale borough patients

A new service provided by staff at the Trust will see patients from Heywood, Middleton, and Rochdale learning to manage their own long term conditions and/or caring situations in a more supportive way, whilst working in collaboration with local health and social care teams.

The Expert Patients Programme (EPP) is a nationally accredited programme run by people who ‘live with’ a long-term medical condition or are carers.  It is based on the idea that if people feel more in control or have the perceived ability to follow health guidelines, then they would be more able to manage their condition better on a day to day basis.

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Trust board meeting

24 November 2016

9.30 to 12.30

Room 219, Trust HQ, North Manchester General Hospital

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Putting Pathology under the Microscope - Talk & Tour

28 November 2016

14:00 to 16:00 

Pathology Lab, The Royal Oldham Hospital

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Organ Donation/Transplant Talk, Keely Hart Specialist Nurse Organ Donation

5 December 2016

14.00 to 15.00

Post-Grad Centre, North Manchester General Hospital

Reserve your place by emailing us or calling the membership office on 01706-517302

Trust board meeting

15 December 2016

9.30 to 12.30

Room 219, Trust HQ, North Manchester General Hospital

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Mortuary ‘virtual’ tour & talk, with Amanda Eckersley and Michelle Hoyle

20 December 2016

14.00 to 15.00

Seminar Room, Pathology Dept, The Royal Oldham Hospital

Reserve your place by emailing us or calling the membership office on 01706-517302

Have you read the latest issue of Pennine News, the Trust's monthly magazine for staff and stakeholders?