Questions and answers
This section provides answers to the most frequently asked questions from professionals.
Clinical governance- What are the clinical governance arrangements for the ISTC?
- What external and independent clinical audits are planned?
- Are all the joint replacements registered with the National Joint Registry?
- What are the surgical infection rates?
- Are patients satisfied with the service provided at the GMSC?
- Who are the surgeons?
- Who are the anaesthetists?
- How are they recruited?
- What assessment is made of the surgeons’ surgical ability and experience?
- How long are the consultants going to work at the Treatment Centre?
- Can junior doctors be trained at the ISTC?
- What sort of training is given by staff at the ISTC?
- What are the arrangements for clinical cover at night?
- What operations are they doing?
- What is the process for assessment of patients referred to the ISTC?
- What is the pathway for rehabilitation over the 6 weeks post op?
- What is the average length of stay for patients having a joint replacement?
- What sort of anaesthetic is used for joint replacements?
- What diagnostic tests are available at the ISTC?
- Who treats complications from the surgery performed at the GMSC?
- What happens if a patient does not need an operation after their outpatient assessment?
- What are the reasons that a patient might be referred back to their GP for treatment before they are admitted for surgery?
- Which patients will not be suitable for treatment at the ISTC?
- What if the patient is not fit for discharge to their home after 6 days?
- How is the pathway connected into the local social services provision?
- What happens if the patient goes to their local A&E with a problem resulting from their operation?
- What happens if the patient requires more rehabilitation after 6 weeks?
- What happens if the patient goes to their GP and is then referred to a local orthopaedic consultant after their operation at the ISTC?
- What is the breakdown of patients treated, by their ASA scores?
- What are the arrangements for the ITU?
- How is the ISTC generating the discharge letters to GPs?
- How many patients have been referred back to the GMSC for revision procedures requiring a new joint replacement to be carried out?
- What facilities are there at the Greater Manchester Surgical Centre at Trafford General Hospital in Manchester?
- How can local GPs and consultants make arrangements to visit the Treatment Centre?
- What are the cost implications for GPs?
Clinical governance
- What are the clinical governance arrangements for the ISTC?
Netcare has robust clinical governance arrangements that are as stringent as those in the NHS.
- Netcare has a corporate strategy for clinical governance that is based on best practice.
- The Medical Director is responsible for the implementation of the clinical governance strategy at corporate and local level.
- A clinical governance committee is established in every ISTC.
- Netcare reports clinical outcomes monthly to a Contract Management Board and quarterly to a Joint Service Review.
- Serious untoward incidences are reported immediately to the SHA, HCC, NPSA, NHSLA and other bodies as appropriate.
- Netcare also participates in the local clinical governance arrangements established by the SHA.
- As far as possible Netcare strives to liaise with local clinical governance arrangements within Trusts and PCTs. - What external and independent clinical audits are planned?
Netcare strongly believes in continuous quality improvements and has undertaken several audits within the GMSC. These include:
- Infection control
- Medical record documentation
- Use of prosthesis in conjunction with the National Joint Registry (NJR)
- Audit of HCC National Minimum Standards
- Use of antibiotics in conjunction with the Pharmacy Management Group of THT
- Audit of the blood conservation programme
- Audit of complications
We are discussing with our sponsors, an external audit of outcomes of major surgery in the ISTC. - Are all the joint replacements registered with the National Joint Registry?
Yes. Each arthroplasty is registered with the NJR. - What are the surgical infection rates?
Our surgical infection rates are very low at 0.3%. - Are patients satisfied with the service provided at the GMSC?
Patient satisfaction is monitored daily and on average 97% of patients have consistently rated the service as good or excellent. In total 99.7% of patients will recommend the facility to a family member or friend.
- Who are the surgeons?
Istvan Borocz (Hungarian)
Laszlo Bucsi (Hungarian)
Ferenc Dobos (Hungarian)
Istvan Doman (Hungarian)
Miklos Farkashazi (Hungarian)
Zsolt Hegadus (Hungarian)
Peter Horvath (Hungarian)
Attila Juhasz (Hungarian)
Payman Rahimi (Hungarian)
- Who are the anaesthetists?
Szilvia Balogh (Hungarian)
Istvan Batai (Hungarian)
Janos Hamza (Hungarian)
Boris Mavrodiev (Slovakian)
Radovan Nachaj (Slovakian)
Zsuzanna Scheilly (Hungarian)
Lajos Szentgyorgyi (Hungarian)
For more details, please click here. - How are they recruited?
Netcare UK has robust recruitment processes that include the following:
- Interviews
- Formal assessments (internal and external via the Imperial College of London)
- References as per the Royal Colleges guidelines
- Checks on GMC specialist registration
- CRB checks
- Occupational Health - What assessment is made of the surgeons’ surgical ability and experience?
All consultants are on the GMC specialist register of the relevant speciality and Netcare has robust recruitment processes.
Netcare has a formal assessment of the consultants’ clinical abilities following an interview; this is done at the treatment centre.
We are working with the CMU to ensure we have implemented all appropriate means of assessing clinical abilities. Following the appointment, the consultant has a probationary period of 3 months, which allows a more in depth examination of the clinicians’ abilities. - How long are the consultants going to work at the Treatment Centre?
All of the consultants at the GMSC have five year contracts with effect from May 2005. - Can junior doctors be trained at the ISTC?
Netcare in principle supports the training of doctors at the GMSC. We are in discussions with the SHA to train junior doctors in the near future. - What sort of training is given by staff at the ISTC?
Netcare has identified CPD as absolutely essential and crucial to the delivery of high quality care. All staff has an annual appraisal and is required to undertake CPD. Specific training to staff include:
- Induction
- In-service and competency training for all staff
- Mandatory training for all staff
- Infection control - What are the arrangements for clinical cover at night?
RMOs with up to date Advanced Life Support (ALS) qualifications are on site at all times and surgeons/anaesthetists are on call 24/7.
- What operations are they doing?
- Primary hip replacement
- Primary knee replacement
- Arthroscopies
- Muscle, tendon and ligament procedures
- Other orthopaedic procedures, for example distension of joints
- Endoscopies and associated procedures
- Repair of hernia or herniotomy
- Gall bladder removal
- Skin surgery, for example marsuplialisation of skin lesions
- Breast procedures, for example biopsy, microdochotomy
- Vasectomy
- Varicose vein surgery
- ENT and other oral procedures, for example endoscope operations on the larynx, excision of tonsils
- Foot procedures
- Hand procedures
- Soft tissue or other bone procedures - What is the process for assessment of patients referred to the ISTC?
Patients are booked from the choice centre onto the Outpatient schedules of the GMSC.
- All booked patients receive a letter to confirm date of appointment and to ensure transport and care arrangements are in place.
- Netcare has a one-stop multidisciplinary assessment model where patients are assessed by an Orthopaedic Surgeon, an Anaesthetist and a Registered Nurse. If required, a physiotherapist will assess a patient, especially where there are concerns about rehabilitation. Links are also made with Social Services if appropriate.
- During the Outpatient visit, the necessary diagnostics including blood tests and radiology are performed.
- The patient leaves with a date for surgery, this might change depending on the outcome of MRSA screening (in the event of joint replacement) and urine test results. The patient is informed of this.
- If a patient has a clinical condition which contra indicates surgery then a patient may be temporarily suspended while treatment is arranged.
- The target for surgery dates is a maximum of 4 weeks after the outpatient appointment unless the patient chooses a date longer than 4 weeks.
- If any patient requires further diagnostics or care, it is arranged by referring the patient to the GP for appropriate management. We are exploring the option of direct referral for diagnostics in order to improve the patient experience through a one-stop service offering. - What is the pathway for rehabilitation over the 6 weeks post op?
The aims for rehabilitation are:
- Patient education - Precautions and contra-indications
- Family involvement
- Integrated multi-disciplinary approach
- Post discharge rehabilitation:
- What is the average length of stay for patients having a joint replacement?
- Average LOS for TKR – 5.6 days
- Average LOS for TKR – 5.3 days - What sort of anaesthetic is used for joint replacements?
We tend to use predominantly spinal or epidural anaesthesia although patients are given the choice during consultation after proper information is given to them about the risks and benefits.
- Spinal – 87%
- General – 13% - What diagnostic tests are available at the ISTC?
The following diagnostic tests are available:
Urine stick
Urine culture
Pathology:
- Group and save
- U+E and creatinine
- Random glucose
- FBC
- INR, APTT
- PO2
- Blood gases
Radiology (including MRI and CT scans Mon – Fri)
ECG - Who treats complications from the surgery performed at the GMSC?
All complications are managed at the GMSC. In the event it is not clinically appropriate to treat a complication at the GMSC, the patient is referred to the closest appropriate NHS facility.
- Managing patient expectations
- Defining short, intermediate and long term goal
- Getting the patient as independent as possible
- Identifying appropriate walking aids
- Walking safely
- Providing exercise regimen to improve muscle power and range movement
- Safe car transfers
- Safe stair climbing
- Activities of daily living
- Progress monitoring
- Identifying and devising action plan for variances
- What happens if a patient does not need an operation after their outpatient assessment?
The patient is appropriately informed as to the reasons why they do not need surgery. Information as to why the patient does not need surgery is also provided to the PCT and GP. - What are the reasons that a patient might be referred back to their GP for treatment before they are admitted for surgery?
Some of the reasons why a patient may be referred back to the GP are:
- Infection
- Hypertension
- Renal failure needing dialysis
- Blood results – further investigations and/or treatment needed
- Cardiac problems that need treatment before surgery
- Influenza
- Severe chronic obstructive airways disease
- Any condition, chronic or acute, that is a contra indication for surgery or where a patient may need ITU facilities after surgery - Which patients will not be suitable for treatment at the ISTC?
Some of the patients who may be excluded include:
- Children under 18 years
- Known MRSA positive
- ASA 4 (incapacitating systemic disease or multiple unstable co-morbidity)
- ASA 5 (emergency surgery)
- Pregnancy
- Taking Warfarin
- Possible malignancy
- Bleeding disorders, including thrombophilias such as haemophilia or Christmas disease
- Previous PE/DVT - What if the patient is not fit for discharge to their home after 6 days?
The following measures are taken for those patients who need a longer period of stay. No patient will be discharged if they are not clinically fit to be discharged home.
- A longer stay is arranged within the GMSC
- Intermediate care is arranged, if required, in an intermediate care facility - How is the pathway connected into the local social services provision?
Arrangements are in place where patients can be referred to PCT Social Services if required. Referral protocols are in place for such. - What happens if the patient goes to their local A&E with a problem resulting from their operation?
We are treating NHS patients only and patients treated at NHS A&E can be transferred back to the GMSC for re-admission and treatment of surgical complications directly related to their surgery. - What happens if the patient requires more rehabilitation after 6 weeks?
Arrangements are made through the GP and PCT for continuous treatment by the local community services. - What happens if the patient goes to their GP and is then referred to a local orthopaedic consultant after their operation at the ISTC?
Netcare will always be happy to receive the patient back at the GMSC. However, we do feel that the patients should be given a choice whether they want to return to the GMSC or if they want to be treated in their local hospital. We accept referrals from local orthopaedic consultants. - What is the breakdown of patients treated, by their ASA scores?
ASA scores are recorded in the patients’ notes and we are in the process of analysing this. This will be made available as part of a comprehensive clinical outcomes report for year one of clinical activity. - What are the arrangements for the ITU?
We have nurses trained in critical care and out anaesthetists are all trained in intensive care. A Service Level Agreement is in place with Trafford General Hospital for inpatient critical care support. An SLA with the Greater Manchester Critical Care Network is in place to transport patients for critical care. - How is the ISTC generating the discharge letters to GPs?
A format was agreed with the CMU for all GP communications. A full time medical secretary is employed to type all GP letters and discharge summaries. If appropriate, staff are encouraged to contact GPs’ directly to discuss any urgent issues. - How many patients have been referred back to the GMSC for revision procedures requiring a new joint replacement to be carried out?
We have, in total, three revision operations over the last 14 months (May 05 to July 06) In the same period, we have conducted over 1000 replacements.
- What is the process for follow up after surgery?
Patients are handed over to the local community health services for:
- Nursing home visits plus physiotherapist visits for up to 6 weeks
- Beyond this patients are cared for based on further clinical needs
- 2-6 week follow-up for minor surgery
- 12 month follow-up for major surgery (joint replacements)
- Outpatient assessment for all surgery at 6 weeks
- Annual outpatients assessment follow-up for major surgery (joint replacements) - What is the protocol for 12/12 follow up?
All patients are being contacted by telephone and appointments offered. A nurse and surgeon assessment of the patient, including completion of the Oxford score. An x-ray is reviewed by the surgeon.
- What facilities are there at the Greater Manchester Surgical Centre at Trafford General Hospital in Manchester?
- Outpatient department
- Day ward (six beds)
- In-patient ward (42 beds)
- Theatre (three Laminar flow)
- Radiology (including MRI and CT scan)
- Pathology
- Physiotherapy and Occupational Health
- Pharmacy - How can local GPs and consultants make arrangements to visit the Treatment Centre?
Netcare welcomes visits by consultants and GPs to the ISTC. You can make an appointment by contacting the Medical Director, Dr Eduard Lotz on 0161 746 2828. - What are the cost implications for GPs?
As this service has been commissioned by the PCT, it has already been funded. There should therefore be no cost implications for GPs.