Community Based Hand Surgery Service
Service Quality Performance Report

April 2022 – March 2023

Introduction

The Cumbria Hand Surgery Service was developed in partnership with the Queen Elizabeth Hospital, Gateshead in 2016.

The service for 2022-2023 was mainly provided at Arnside House but more recently the service has moved to the newly built Carlisle Healthcare South in Carlisle and is bookable via NHS eReferral and direct referral from the MSK service.

The service is led by consultant colleagues, Mr John Harrison and Mr Jagannath Chakravarthy, who are both dedicated hand and upper limb surgeons at the Queen Elizabeth Hospital.

The conditions seen include:

  • Dupuytren’s contracture
  • Thumb base arthritis
  • Cubital Tunnel syndrome (ulnar nerve entrapment at the elbow)
  • De Quervain’s tenosynovitis
  • Hand swellings including ganglions
  • Carpal Tunnel Revision

Since 2016, all the surgery is performed under local anaesthetic using WALANT techniques (Wide awake local anaesthetic no tourniquet). If this is not possible due to other health problems or the complexity of the surgery, patients can opt to have their surgery under general anaesthetic at the Queen Elizabeth in Gateshead or in Cumbria.

All surgery is subject to strict criteria for treatment following the current evidence based guidelines.

A study of 25 consecutive fasciectomy patients in 2018-19 confirmed the excellent clinical outcomes for the service and a significant cost saving to the NHS. This has now been published in the Bone and Joint Journal in September 2020 and will hopefully lead to positive improvements to the way of working nationally for patients with these conditions (smaller teams, improved patient experience, lower infection rate).

Our Hand Surgeons

John Harrison specialises in surgery of the upper limb, having done a fellowship at Wrightington Hospital and practices the latest evidence based treatments. John regularly treats professional sportspeople from Football, Rugby, British Superbikes, and Team GB Rowing. He has published and presented his work nationally and internationally. His research has directly led to the development of replacement joints for the elbow and wrist, and he has published a new technique for the treatment of exercise induced compartment syndrome of the forearm.

Jagannath Chakravarthy originally trained in Birmingham before moving North in 2012. He also specialises in shoulder, elbow and hand surgery, introducing awake shoulder arthroscopy in Gateshead. He is keen to be able to offer the same level of service to Cumbrian patients in Cumbria.

Waiting Times

The average waiting time from referral to assessment is 16 weeks. All patients in this reporting period were assessed and treated within 33 weeks of referral.

Referrals and Activity

305 patients were referred into the service: 55% by the MSK service; 39% direct from GPs; 6% from CMS.

Following assessment 193 (63%) patients went on to have a procedure with 12 patients having more than one procedure.

40 patients were referred across to the QE in Gateshead for their operation.

84 patients were reviewed following the operation.

The activity is split between both surgeons as follows:

Total procedures carried out by the Cumbria Hand Surgery Service for this period are as follows:

With the procedures completed by both surgeons as follows:

Patient Satisfaction

27 questionnaires were completed and returned for this reporting period:

Patient comments included:

  • Having experienced an operation previously on my other hand I was astounded by the improved experience. Less fuss, fewer visits, less discomfort, faster recovery. I’d like to record my appreciation and gratitude to the surgeon and the delightful nurses assisting him.
  • My appointment was made so relaxing all the staff were lovely could not ask for better service. Thank you to all the staff.
  • Amazing facility, wonderful staff, incredible surgeon skills. I would look forward to another, if I had a third arm…thanks.
  • This is the second time I have used this service, (different hand) and on each time I have found the service at every step of the way to be excellent. Mr Harrison himself was very personable and easy to converse with, and even came to the waiting room in person to greet and escort me. I cannot praise the whole service highly enough. Thank you.
  • The staff were excellent, I was very nervous and they put me at ease, chatting to me to take my mind off the procedure. Everything was the best it could possibly be.

55 questionnaires were completed and returned for this reporting period.

Patient comments included:

  • Having worked previously in the NHS for 40+ years I can say that throughout the whole process my treatment was excellent. Thank you all.
  • I was extremely satisfied with the treatment quick seeing time and all of the staff and consultants at CMS. I’ve had a lot of operations with CMS all of which have been successful and I cannot thank them enough
  • The procedure was efficiently carried out in a very pleasant environment, staff were professional, pleasant & courteous throughout! All in all, it was very well done, so thank you all concerned.
  • The entire course of the process was very well managed and straightforward to deal with. The staff were all first rate and helpful, and, so far, the surgery has been a success. Many thanks. Just need the other hand done as well!!
  • I was treated with great care and much kindness throughout the whole procedure. The personalities of those involved were delightful and highly professional. They inspired total confidence. I am very grateful to the service as a whole as I have now been operated on by both consultants. Thank you so much for enabling me to have the operations.

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