Derby and Derbyshire

Action Planned (AI summary) Sett Valley Medical Centre has implemented screen alerts on mother/child notes where the mother is under perinatal care and ensures these patients are discussed at monthly MDT and child safeguarding meetings. They also completed suicide prevention training and plan to request acknowledgement of referrals from the perinatal team. Derby and Derbyshire ICB is working to remove barriers to information sharing by establishing system-wide information governance agreements and applying for Section 251 agreements by Q1 26/27. The ICB will also work with partner Trusts to ensure relevant guidance on information sharing and cross-referencing mother and baby notes is provided by Q1 26/27. NHS England has invested £20 million to connect care records across England by March 2026 and is updating its Healthy Child Programme guidance to include requirements for information sharing and record keeping related to maternal and family health. Regional Chief Nurses will cascade this updated guidance to Trusts. Derbyshire Healthcare NHS Foundation Trust has audited GPs not using SystmOne and added an 'alert' to patient records for awareness. They have drafted an information leaflet for GPs about different electronic record systems and added an additional page to e-referral documents for contextual information sharing. Derbyshire Community Health Services NHS FT has incorporated guidance into their Perinatal Mental Health SOP for cross-referencing child and parent records when information is relevant to parental mental health, and implemented an auto-consultation function in SystmOne for this purpose. Locality Managers have been briefed, and a one-page document on record keeping has been shared with staff.

Action Planned (AI summary) Macklin Street Surgery will create a policy for issuing prescriptions around bank holidays, to be included in induction and locum packs with training offered to relevant staff, and will seek advice from the Integrated Care Board on managing high-risk patients and sharing learning with other GP surgeries. The DHSC outlines several initiatives already in place, including Summary Medication Reviews, a national programme for non-pharmacological alternatives, publication of a repeat prescribing toolkit, and an oversupply dashboard. They also highlight the NHS Medicines Safety Improvement Programme focusing on chronic pain and opioid reduction. Derby and Derbyshire Integrated Care Board will ensure system wide engagement and cascade through various channels including: Community Pharmacy Derbyshire Newsletter, GP Key messages delivered to practices by the ICB Pharmacy Directorate team, ICB Pharmacy Directorate Team Medicines safety messages shared with practices and Prescribing Leads Forums.

Action Planned (AI summary) Derby & Derbyshire ICB will explore developing a falls prevention service for all residents, including injurious falls, and implement options to mitigate long lies following a fall, both to be considered in the 2025/26 planning process.

Action Planned (AI summary) Leicestershire County Council will launch a new procedure in January 2025 to ensure an internal review takes place following an unexpected death, with the aim of identifying learning points or needed amendments to policies.

Action Planned (AI summary) Derbyshire Constabulary has designed and implemented a lesson plan covering concealment of items in a subject’s mouth and mandated that safety training includes a scenario covering this topic. They have also contacted the College of Policing to inform them of the concerns raised. The College of Policing is revising the Personal Safety Manual to include guidance on informing a subject about the risk to their life when swallowing drugs. In the interim, communication will be sent nationally to advise forces of this recommendation.

Action Planned (AI summary) The surgery plans to discuss the SOP during an education session, undertake quality improvement work on opioid prescribing (including patient reviews), and review the SOP in July 2025.

Action Planned (AI summary) HM Prison and Probation Service acknowledges concerns about CPR guidance and will review and revise the guidance regarding rigor mortis as a sign of death, following advice from the Resuscitation Council UK.

Action Planned (AI summary) Derbyshire County Council will undertake full width road surfacing work to be completed by 31 October 2024 to level deviations in the road surface.

Action Planned (AI summary) NICE has committed to review the current evidence relating to prophylaxis against infective endocarditis this financial year to determine whether any new information supports a further update of existing NICE guidance.

Action Planned (AI summary) CRG Medical Services will extend their foundation training course for new recruits from two to five days, starting in financial year 2024/25. Clinical Leads and senior HCPs will attend a training course on presentation skills, and new recruits will work five shifts under intensive supervision of a senior HCP. The FFLM has highlighted the coroner's report to its members, re-confirmed the importance of education and training, and is exploring additional training in the management and care of detainees dependent on drugs or alcohol. They have also published recommendations and guidance on their website to support education and training in Forensic Medicine.

Action Planned (AI summary) The Home Office is exploring with stakeholders where Government intervention could improve the criminal justice response to stalking and support for victims, including within the Victims and Prisoners Bill; officials will review statutory guidance on coercive and controlling behaviour and work with the NPCC to gather examples of best practice in policing stalking cases. Derbyshire Constabulary has updated training and guidance, reinforced requirements for record keeping, and reviewed policies regarding found weapons, including issuing specific policy relating to found weapons in October 2023.