Community Based Hand Surgery Service
Service Quality Performance Report

April 2020 – March 2021

Introduction

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

The service is mainly provided at Hilltops Heights Community Clinic and also more recently at Arnside House 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

All the surgery is performed under local anaesthetic.   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).

There had been a suspension of hand clinics for a short period during the early stages of COVID in 2020 but additional safety protocols and safeguards were introduced to ensure the gradual re-introduction of services over the remainder of the year.

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 4 weeks. All patients in this reporting period were assessed and treated within 18 weeks of referral.

Referrals and Activity

198 patients were referred into the service: 72 by the MSK service; 118 direct from GPs; 8 from CMS and 0 RAF.

Following assessment 116 (59%) patients went on to have a procedure with 7 patients having more than one procedure.

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

21 patients were treated with a steroid injection on the same day as the assessment.

41 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:

The Cumbria Hand Service had a total of 6 DNA during this reporting period – 3 assessments, 1 procedure and 2 reviews.

Patient Satisfaction

34 questionnaires were sent out and 27 have been returned to date for this reporting period:

Patient comments included:

  • Well organised and carefully managed, professional surgical procedure.
  • First class service – no problems or complaints throughout.  All the staff were very nice.
  • A follow up call may have helped.  I was dependent on practice nurses for information and I don’t really have confident in them as rule.
  • Very professional and friendly service.
  • I was treated with courtesy throughout and I was kept at ease during the procedure.  A very professional service which I would not hesitate to recommend to everyone.  My finger works properly again! Many thanks to you all!
  • Mr. Harrison and the team made me feel very comfortable before and during the operation.  Still amazed at the return of my hand back to looking as it should before the deformity.  Once again many thanks to you all.

Patient comments included:

  • Satisfied completely – staff very pleasant and made me feel safe and relaxed.
  • The service from start to finish was excellent – Thank you.
  • I am glad I had it done, my use of my hand is loads better. Treatment was very good by staff and doctors.
  • The service from start to finish was excellent – Thank you
  • I was very satisfied with the whole procedure.  The staff and doctor were lovely throughout the operation and my ring finger is now straight, thank you
  • I cannot speak highly enough of everyone I came into contact with during my operation and for my aftercare.
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