Bone Infection Service
As part of the Bone Infection Service, the RNOH has implemented an OPAT (Outpatient Parenteral Antimicrobial Therapy) service which runs alongside antimicrobial stewardship. The aim of the OPAT service is to ensure that patients with complex infections are appropriately managed with discharge back into the community where possible to minimise disruption to their life.
The OPAT service has been implemented following the ‘Good practice recommendation for outpatient parenteral antimicrobial therapy in adults in the UK’, a consensus statement published by Chapman ALN et al (J Antimicrobial Chemotherapy 2012; 67: 1053-62).
The OPAT team at RNOH consists of a Consultant Microbiologist and OPAT Clinical Nurse Specialist. Although a formal OPAT Pharmacist is yet to be appointed, Pharmacy support is currently in place to help manage the medication aspects of the service.
The RNOH has a Commissioning Agreement (in the form of an Enabling Statement) in place with North and East London Commissioning Support Unit (NEL CSU) regarding the management of antimicrobial therapy in the community for patients initiated on therapy by RNOH.
As part of this agreement, the Trust is required to submit a ‘notification’ form to the relevant CCG. Where the RNOH is able to demonstrate that it will be more cost-effective for the NHS for antimicrobial therapy to be managed in the community compared with an inpatient stay the CCG should agree funding for administration in the community. The RNOH will fund the first two weeks of therapy post discharge. The remainder is requested from the relevant CCG / CSU.
The link at the bottom of this page provides the Enabling Statement.
Spinal and Long-Bone Fusion Surgery
The RNOH is the largest orthopaedic hospital in the UK and regarded as the leader in the field of orthopaedics both in the UK and world-wide. The Trust provides a comprehensive range of unique services including being one of the largest Spinal Deformity Units in Europe. Referrals to this service come from throughout the UK and internationally with the unit (comprising of 10 established orthopaedic surgeons) having a world-renowned reputation for their pioneering work. The Trust also undertakes complex limb reconstruction surgery.
The RNOH has a Commissioning Agreement in place with North and East London Commissioning Support Unit (NEL CSU) regarding the use of Bone Morphogenic Protein (BMP) as part of spinal fusion surgery (primary and revision setting) and long-bone fracture surgery.
As part of this agreement, the Trust is required to submit a ‘notification’ form to the relevant CCG. For any CCG outside of London, there is an expectation from NEL CSU that the local arrangement will be followed and funding confirmation provided within 2 weeks of receipt of the form (provided the criteria are met).
The link at the bottom of this page provides details around approval of the Business Case as well as the notification form to be used.