Community Based Hand Surgery Service
Service Quality Performance Report
April 2025 – March 2026

Introduction

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

The service for 2025-2026 was provided in the recently 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.

The hand surgery clinic currently runs two to three sessions every month with a theatre list in the morning and assessments and reviews in the afternoon.

Cumbria Hand Surgery Service had an article published in the Journal of Trauma and Orthopaedics (December 2024) on the service we provide and the benefits of WALANT surgery techniques in a community setting and its significant cost saving to the NHS. This 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 10 weeks. On average patients in this reporting period were assessed and treated within 25 weeks of referral.

Referrals and Activity

268 patients were referred into the service: 35% by the MSK service; 55% direct from GPs and 10% from CMS.

22 of which had a procedure in the initial assessment appointment.

Following assessment 152 (57%) patients went on to have a procedure with 12 patients having more than one procedure.

128 patients had their 1^st procedure, 30 patients had their 2^nd procedure, 8 patients had their 3^rd procedure and 1 patient had their 4^th procedure with the service.

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

22 patients were referred to other care providers for treatment

14 patients were referred to Physiotherapy after their surgery

47 review appointments occurred following the initial assessment, investigations or procedure.

24 patients (5%) did not attend either their assessment, procedure or review appointment. Historically, we did not actively track patients who missed their appointments. However, over the past year, we have implemented a new tracking system to accurately monitor attendance and help us implement solutions to reduce wasted appointments and improve clinic efficiency.

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

We invited all post-operative patients who consented to text communication to complete a feedback survey.

Out of 122 surveys sent during this period, 57 patients responded, providing the following feedback.

27 questionnaires were completed and returned for Mr John Harrison within this reporting period:

Patient comments included:

• Very friendly, helpful staff.
• As I have stated this service is excellent. The treatment I have had has been exemplary. Thankyou.
• I’m definitely happy with the procedure itself, but the recovery hasn’t been as smooth as I expected. Five weeks on, the wound is healing but keeps reopening. My hand doesn’t look any different than before the surgery, and I’m still experiencing pain
• Many thanks to Mr John Harrison & team. The appraisal agreed was 80% correction. In surgery Mr Harrison & team completed a 100% correction to my right hand giving full control. I no longer hide my hand in my pocket. grateful thanks to NHS. Mr john Harrison & Team.
• Really good relaxed environment. All involved were great.
• Operation was great but the finger took a long time to get anywhere near normal and still having problems with circulation.
• Found the procedure to be done very well facilities at Locke Rd brilliant better than having to visit hospital
• The procedure was overall a good experience, I did have some pain during it but John was quick to inject more numbing to help keep me comfortable and fans were put on to help when I felt sick. They all took great care of me and my arm has been amazing since, I no longer have any of the problems I did before!
• The treatment and advice was very good and l was highly delighted with the doctor and nurses for there care and professionalism, thank you so much.
• Top quality service and staff
• I could not fault any of my treatment or the staff they were all very nice, just pleased I had it done
• Friendly and professional staff. Felt at ease. Clear information given pre and post procedure. Hopefully it’s now resolved my issue. Thank you
• Could not asked for better
• Would certainly recommend this place, all staff very pleasant and efficient, was well looked after. Thank you so much
• Mr Harrison was excellent and so were all of his support team. Please make this the standard for the future NHS

29 questionnaires were completed and returned for Mr Jagannath Chakravarthy within this reporting period.

Patient comments included:

• Very happy with the service given, and with all the staff that were present, who were professional, friendly and caring throughout.
• Clear, concise, efficient with the desired outcome.
• I am very grateful to the whole team for there professional and courteous service. Top team don’t change anything!! Sincere thanks.
• Excellent service from consultant and staff.
• Very professional, friendly and efficient service. Only problem experienced was having the stitches removed. The nurse found it very difficult and had accidentally left three stitches in. I removed these myself at home a few days later
• Overall the treatment and service was very good was made to feel comfortable and any questions answered
• The whole experience excellent
• Very impressed with Mr Jagannath Chakravarthy and his team and the short wait from initial consultation to the operation. The procedure has been of huge benefit to me and I’m very grateful for this excellent service.
• I am totally happy with my hand surgery. I have very little scarring. My surgeon did a fantastic job in my eyes.
• Really supportive office people who struggled to get a referral letter from GP surgery which delayed treatment for many weeks
• Staff were professional and friendly. The operation was over before I knew it. My only concern, was a part of one of the stitches had been left in, but was easily resolved.
• Felt at ease throughout the procedure all the staff were friendly and maintained interactions with me all the way through the procedure
• The process as a whole has been satisfactory and I’m sure that the consultant did the best he could given my particular constriction.
• I’m very pleased with the outcome of the surgery my thanks to everyone involved with my operation .
• A very professional team. Very polite. Very helpful. Felt completely safe as I was talked through the opening stages of the operation and spent the rest of the time chatting to the assistant. Truly a team to be proud of
• Was told not to work for two weeks. I had one day off then went back to the office. You could ask what type of work people do and the adjust the days off. Thank you for your excellent work. Everybody involved were lovely.