Coronary Heart Disease (Chd) s2

CORONARY HEART DISEASE (CHD)

MANAGED CLINICAL NETWORK (MCN) PROJECT BOARD

Minutes of meeting held at 5.30pm on Thursday 1 June 2006 in the

Conference Room, Summerfield House

Present: Dr Malcolm Metcalfe, Chairman, Lead Clinician CHD MCN and Consultant Cardiologist

Dr James Black, Lead GP, CHD MCN

Ms Jackie Bremner, Service Planning Lead, Aberdeen CHP

Mr Andrew Dickson, Public Representative

Prof. George Downie, Director of Pharmacy & Medicines Management

Mr Andrew Fowlie, General Manager, Moray Heath & Social Care Partnership

Dr El-Shafei Hussein, Consultant Surgeon, NHSG

Dr Robert Liddell, Clinical Lead, Aberdeenshire CHP, NHSG

Mr Graham McKenzie, Radiology Strategic Development Manager, NHSG

Mr Clark Paterson, Finance Manager, NHSG

Mr Sandy Reid, Network Manager, CHD & Stroke MCN

Mrs Roberta Eunson, Service Manager, Aberdeen City CHP, NHSG

Dr Stephen Walton, Head of Cardiology, ARI, NHSG

Mr Roddie Wood, Public Representative

Mrs Christine Gray, Secretary

In Attendance: In attendance by video-link Dr Grays –

Mr Tony Collins, Public Representative

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Welcome and Apologies

Welcome:
Apologies: Alastair Ramsey, Allison Geddes, David Sullivan, Gillian Lewis, Heather Kelman, Dr Mike Crilly, Joy Groundwater
2. / Minutes of CHD Project Board MCN on 4 May 2006
Agreed.
3. / Matters Arising
4. / Future Development of Community Cardiology
A presentation was given by Dr Robert Liddell regarding the future of primary care cardiology. See attached Appendix 1.
The MCN was exploring all areas of the CHD service and were interested to have an update on and potential for Primary Care Cardiology.

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4 / Future Development of Community Cardiology (Cont.)
Some of the points highlighted by Dr Liddell were:
·  Primary prevention made a difference – more emphasis should be placed in this area
·  Massive work undertaken with diabetic and hypertensive patients improved incidence of coronary heart disease
·  Statins were now very cheap – there could be a case for GPs to start being more adventurous and looking into their greater use as a preventative measure
·  Cardionetics Monitors used in Turriff Cardiology Clinics. This records for 24 hours (same as a Halter monitor) but can then be plugged into a PC and quick results were obtained. It would be useful if all Practices had these monitors and they were piloted in ARI.
·  Statistics collected suggested that Community Cardiology Clinics significantly reduced the numbers of patients being referred into hospital.
·  Cardiology Clinics could be used for additional services including having machines to perform carotid dopplers – which would encompass neurovascular work (TIAs).
Dr Metcalfe thanked Dr Liddell for the stimulating and thought-provoking presentation.
5. / North of Scotland Regional Delivery Plan
Sandy reported that he had recently attended a NoS Cardiac Services Sub Group meeting and the Grampian draft NoS Cardiac Services Regional Delivery Plan had been discussed. Progress was being made and it was hoped that the draft Plan would be submitted to the Scottish Executive within the next couple of months. / SR
6. / MCN Finances – Mr Clark Paterson
Clark re-iterated as from last meeting the funding position.
To confirm that there would be £610.500 recurring funding allocation for 2006/07, most of which was already committed.
With regards to the Cardiac Rehabilitation Project, Clark was confident that as the previously agreed top priority of the MCN he could identify funding to meet the shortfall in agreed recurring funding allocated to Cardiac Rehabilitation for continuation of the Project beyond 31 July 2007. However, there was not enough money to fund the Heart Failure Project – further discussion on this matter under item 7.
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6. / MCN Finances – Mr Clark Paterson (cont.)
There was £134,500 non- recurring monies for the year 2006/07 and this should be spent if at all possible in the year and not carried forward into the following year. It was therefore agreed to seek proposals for consideration at the next meeting as to how these non-recurring funds could be best used. These would be compared and prioritised according to their impact on patient care. / All
7. /

Heart Failure Project

The situation regarding the Heart Failure Nursing Service was discussed in detail.
The MCN had received two letters: one from Dr Karen Simpson and one from Dr Andrew Hannah, both supporting the Heart Failure Nursing Service. Also support for continuation of the Service was given by the Cardiac Rehabilitation Sub Group. However, the Chairman wished it to be known that the MCN were not withdrawing money from the Service. The fact was that monies originally promised by the Scottish Executive for continuation of the Service once the Big Lottery funding came to an end were now no longer forthcoming, and the MCN Project Board had previously decided that it was not the top priority for any recurring funding available.
It was highlighted that should the Service cease to exist as presently configured, it was essential that the nursing skills of the staff were either retained and/or passed on. Therefore, for the remaining time the Service was in operation the focus was on increasing the skills of Primary Care staff.
It was agreed that a plan of action needed to be agreed as a way forward with this situation and this included:-
·  The MCN core team to take the matter to the CHPs (City, Shire and Moray) to ascertain whether they were willing to ‘buy into’ the Service
·  Identify funding for staff education so that the Primary Care nursing staff had more skills in dealing with heart failure patients
·  Alastair Ramsey was seeking non-recurring funding for staff training from the British Heart Foundation
·  Currently maintain Service as it stands until the MCN core team ascertained the thoughts of the CHPs.
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CHD MCN Project Board Sub Groups

To note that reports on CHD Sub Groups would be discussed at the next meeting due to time constraints.

Community Cardiology Outpatient Project

South Aberdeenshire – Although clinics originally commenced in Stonehaven in January 06, they had temporarily been re-located in Aberdeen due to issues around identifying clinic slots. However, after much discussions and re-arranging of schedules, they were due to re-commence from 20th July 06 in Stonehaven..

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CHD MCN Project Board Sub Groups (Cont.)

North Aberdeenshire – Clinics were due to commence on 9th August 2006 in Peterhead. The first two to three months would be in a temporary location until the more permanent location was ready.
9. / Charity Establishment and Events
No positive replies from Golf Clubs regarding the Golf Tournament had been received to date other than Westhill. However, Andrew was working away at promoting this event.
Details regarding the Ceilidh and tickets would be available from Andrew at the next Project Board meeting in August. / AD
10 / MCN Lead Clinician
The MCN Lead Clinician post had been advertised and the outcome should be known at the next MCN Project Board meeting.
11. /

AOCB

Robert Liddell requested MCN non-recurring monies (£2,000) for additional capacity at Turriff. This was agreed and Robert would contact Clark Paterson regarding this matter. / RL
12. /

Date of future meetings

Thursday 3 August 2006 at 5.30pm in Summerfield House
Thursday 5 October 2006 at 5.30pm in Summerfield House
Thursday 7 December 2006 at 5.30pm in Summerfield House
Thursday 1 February 2007 at 5.30pm in Summerfield House
Thursday 19 April 2007 at 5.30pm in Summerfield House

Appendix 1

PRIMARY CARE CARDIOLOGY

What’s The Potential ?

n  Primary Prevention

n  Diagnosis and Treatment

n  Think Holistically

- Individual Patients

- NHSG System

Where are we now ?

CHD mortality is falling

But with current emphasis

on secondary prevention

disease prevalence will

increase …

Primary Prevention Strategies

n  Improved Social Conditions

n  Healthier Lifestyles

n  Medical Intervention

- Treatment of HBP and Diabetes

- Statins for primary prevention?

Diagnosis and Treatment

Cardionetics Monitor

Outcomes of ETTs, Turriff Patients

What else could the clinics do?

n  Educational role for local PHCTs and Drs in training

n  Direct route of access to angiography and other cardiac investigations (eg perfusion scanning)

n  Could send only selected ETTs for second opinion

n  GPs could do echos and provide more “clinical” echo reports

n  Neurovascular work – TIAs

n  Combined cardiopulmonary assessment

Thinking Holistically - Individuals

n  Practice nurses are key to CDM (supported by Drs)

n  Need to be able to combine management of all common chronic conditions (cardiac, COPD, HBP, Diabetes etc)

n  Older/Frail patients may benefit from having chronic conditions managed by DN teams

n  Taking age into account is not ageism….

Thinking Holistically - Systems

n  Use local generic PCTs rather than specialist outreach

n  Use staff, buildings and equipment for more than one purpose

- Echocardiography – General Ultrasound, Carotid Scans, DVTs, Obstetrics

- Treadmills – Physio, Rehabilitation, Podiatric gout analysis, lung function testing

- Cardiac Rehab – Pulmonary Rehab, Falls Programme, Osteoporosis, General Fitness e.g. Diabetes

Questions ?

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