Where you go under the knife for emergency general surgery in Gloucestershire is set change – here’s how it will affect you and what it means.

Pilot plans show emergency and complex planned general surgery (the surgery of the gut) will be moved to Gloucestershire Royal Hospital from Cheltenham General Hospital more than seven miles away.

The main Cheltenham site will only hold planned general surgery, during the day and for short stays.

General surgery relates to the appendix, liver and stomach.

In a recent inspection, health watchdog CQC found that patients are waiting too long for treatment, and rated their responsiveness as ‘requiring improvement’. The overall rating of Gloucestershire NHS Foundation Trust however was ‘good’.

The Trust said more patients will be seen, treated and go home far more quickly than at the moment. It added that the proposed changes will affect 5-6 patients a day.

Under the pilot both hospital sites will have two consultants on: one will be upper gastrointestinal and one will be colorectal. Rather than doing a weekly rota they will swap every other day.

The temporary plan will come into effect from Autumn 2019 for a year.

When the trial is over, any permanent changes will be put the public for consultation.

‘NEW WAY OF WORKING’

A spokesman for the Trust has provided the Local Democracy Reporting Service a case study on what the changes would look like.

Patients normally come in via A&E (Cheltenham General or Gloucestershire Royal) presenting with debilitating/sharp pain (in their body – top right of ribs). Assessed in A&E and if there is a suspicion of gallstones you will be assessed

by a surgeon.

Under the current on-call system our consultants are split between clinicians who specialise in lower bowel and your stomach/oesophagus. They are all GI surgeons and all can operate on anything in abdomen including gallbladder.

Assessed by surgical team headed by colorectal consultant or upper GI consultant depending on who’s on that week. If the patient comes in and it happens to be a week when the upper GI consultant is on they will most likely have their gallbladder removed. An upper GI consultant specialises in gallbladders and performs hundreds of gallbladder procedures a year. Over their career they’ll take our thousands.

Upper GI consultant will take you to the ward, they’ll give you an ultra sound scan and confirm or not whether you’ve got gallstones and they will take out your gallbladder while you are in hospital.

So, you are admitted to a bed, taken into theatre and your gallbladder is removed. The patient then has a short time recovering in a hospital bed before being discharged home.

If you come in and you’ve got a colorectal surgeon on call you then get admitted into a bed, you then wait until your pain has subsided (having administered pain killers) before the patient is asked to eat and drink.

If you can eat and drink but your pain comes back they then stop again, administer pain killers and test you again later (food and drink). They do this until the pain subsides before discharging the patient back home. They will write to the upper GI consultant and say they’ve had this patient admitted to as an emergency ‘please could you see them with a view to taking out their gallbladder because they have gallstones’.

That patient then comes back to see that consultant (upper GI) as an outpatient. That consultant then puts them on their operating waiting list until the next available slot.

Meanwhile that patient is trying to get on with their lives trying to manage that pain. If they relapse and the pain comes on again they come back in as an emergency patient and if they come in when an upper GI consultant is on rota they go through the same process again.