Community Based Hernia Repair Service
Service Quality Performance Report

April 2022 – March 2023

Introduction

Our community based Hernia Repair Service is delivered by Dr Martin White, GPER in minor surgery, who is mentored and supported by Mr Sam Dresner, Consultant General and Gastrointestinal Surgeon at James Cook Hospital, Middlesbrough. The service is provided from Arnside House Surgery, Carlisle, which has recently moved to Carlisle Healthcare South and Maryport Community Hospital.

The service is bookable via Choose and Book after a referral from the patient’s GP surgery.

Referrals to the service must meet the following evidence based criteria:

  • History of incarceration or real difficulty in reducing hernia
  • Increased risk of strangulation (high risk in female patients)
  • Inguinoscrotal hernia
  • Progressive increase in size of hernia month-on-month
  • Significant pain or discomfort sufficient to cause significant functional impairment

The risks and benefits of surgery are all fully discussed with the patient during the assessment appointment.

Waiting times

The average waiting time from referral to assessment is 4 weeks. All patients in this reporting period were assessed and treated within 18 weeks of referral. All patients are sent a comprehensive patient information leaflet on the operation and directed to the CMS website for further information.

Activity

The community Hernia Repair Service has seen a total of 583 patients in this reporting period.

Following an initial assessment by Dr White; 208 patients had hernia repair carried out.

80 of these patients had a range of co morbidities including cerebrovascular disease, ischaemic heart disease, COPD, obesity and type 2 diabetes.

  • 8 patients were referred on to other specialities such as pain management, ultrasound, x-ray
  • 103 patients were referred on for surgery under general anaesthetic
  • 177  patients were discharged back to their GP

Post-Operative Complications

  • 10 patient recorded as having a post-operative infection requiring antibiotics
  • 11 patients reported having on-going pain post operatively
  • 2 patients were admitted to hospital post operatively

Patient Satisfaction

100% of patients were forwarded a survey 6 weeks post-op questioning them on a range of subjects including the booking arrangements, scar satisfaction, effectiveness of local anaesthetic, clinic facilities, doctor and nurse manner, and overall satisfaction.

99 questionnaires have been returned to date for this reporting period. Based on the friends and family test the following numbers would recommend CMS:

Further feedback included:

  • 100% of patients felt they were treated with courtesy throughout their appointment
  • 99% of patients felt they were involved as much as they wanted to be in the their care and treatment

Patient Comments Included

  • ‘Great service and a model for other NHS services’
  • ‘Overall good. Anaesthetic was not sufficient and op had to be paused twice’
  • ‘Very good from walking in to walking out including the coffee and biscuits, thank you all’
  • ‘Excellent professional service combined with lots of reassurance in a friendly relaxed atmosphere. The team were wonderful and I am extremely grateful. Thank you’
  • ‘I think this facility is admirable and a very efficient and effective way of dealing with this condition’
  • ‘A great service, a knowledgeable and skilled team. I was considered throughout the operation and felt really at ease. I couldn’t have asked for or expected any more. As for after the op. Very little pain and no side effects or adverse reactions. The scar has heeled well and I’m now at a stage where I have basically forgotten about the op. Fully back to normal’
  • I found the team to be efficient, totally professional and sympathetic. The procedure was difficult by their admission which explained the pain I experienced during the op’
  • ‘Excellent service and after care, did have some discomfort and numbness for longer than personally expected from the advice given but nothing serious enough for follow up’
  • ‘The NHS at its best, if only the Gov’t would see money put in as an investment it save the on cost. Thanks to the success of the operation I am now considering achieving a life time ambition, a geriatric Adonis :-)’
  • ‘The surgery lasted longer than expected as it was not as straightforward as hoped. The anaesthetic kept wearing off and the procedure was painful. I wish I had gone for a general anaesthetic’
  • ‘Everyone I encountered throughout the entire process was efficient personable and inspired confidence which was not misplaced’
  • ‘No problems, great service at Maryport cottage hospital, would recommend it rather than west Cumberland or Carlisle hospital’
  • ‘More emphasis on constipation effect of taking codeine incl. feeling sickly’
  • ‘Great facility. Operation done on time. Staff great. Scar very neat and tidy. Only one thing could be improved, who serves Penguin biscuits in 2023? At least get some Hobnobs or a nice rich chocolate brownie to serve with the tea in the recovery room!’
  • ‘A really wonderful service from the NHS team, very helpful and caring staff, especially the after surgery nurse who went through everything in detail with me. Great team from my point of view.’
  • ‘The combination of painkillers that I took prior to and in the days after the operation caused pain in my stomach such that I wondered if I had an ulcer. There was no post-operative pain at all but a review on whether quite such a quantity of fairly aggressive anti-inflammatories is strictly necessary might be a good idea’
  • ‘I could not fault. The surgeons and nurses were chatty, nay humorous and made me feel at ease. They treated me as an individual, and not as a body on a production line. It was as pleasant as it could have been’
  • ‘I was extremely satisfied with the whole process and the professional way all staff involved conducted themselves. Thank you’
  • ‘Convenient and efficient without having to go to hospital’
  • ‘Very professional staff who put me at ease and with the general banter during the procedure actually made it an enjoyable experience!’
  • ‘Treated with respect by the medical staff who took time to explain the procures and who to contact post op if necessary’
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