MINUTES OF THE TWENTY FOURTHMEDICAL MANAGERS IN PSYCHIATRY INTEREST GROUP MEETING HELD ON 16 MAY 2014 IN THE MILLENNIUM HOTEL, GEORGE SQ, GLASGOW
- PRESENT
Dr John Taylor (Chair), Dr Alastair Palin (Vice Chair), Dr Roger Blake, Dr Moira Connolly, Dr Alastair Cook, Dr Ihsan Kader, Dr Linda Findlay, Dr David Gerber, Dr Morag Henderson, Dr Peter Le Fevre, Dr Tracy Sanderson, Dr Rabia Elilah, Dr Cliff Sharpand Dr Alison Thom.
In attendance
Ms Penny Curtis
Ms Karen Addie (Minutes)
Mrs Angela Currie (Minutes)
Dr Taylor asked that if members are aware of new appointments of medical managers to let Karen Addie know so she can add them to the list.
- APOLOGIES
Apologies for absence were received from: Dr John Mitchell, Dr Stella Clark, Dr Grace Fergusson, Dr Jim Crabb, Dr David Cumming, Dr Vivek Pattan, Dr David Hall, Dr Khalid Nawab, Prof Lindsay Thomson, Dr Alex Thom, Dr Morag MacLeod, Dr Claire McIntosh, Dr Rhona Morrison, Dr Olwyn Gallagher, Dr Neil Prentice,Dr Nikki Thomson, Dr Michael Smith, Dr Gwen Jones-Edwards.
- MINUTES OF THE MEETING HELD ON 30 January 2014
On page 5 paragraph 3 it was agreed to change the sentence about sensory impairment by replacing “Edinburgh” with “Lothian”.With this change the minutes were accepted as accurate.
- MATTERS ARISING
(i)Mental Health (Care and Treatment) (Scotland) Act 2003
Dr Taylor asked for an update regarding Refresher Training for AMPs. Dr Cook reported that there had been discussions between NES, the Scottish Government and the College with Prof Gillian Needham leading the discussions on behalf of NES. A useful video conference meeting had taken place 2-3 weeks ago and NES have confirmed they will take on both the initial training and refresher training. While the materials are already developed NES will need to provide an infrastructure in which a large number of AMPs can access Refresher courses and this will be quite a large scale project. NES have indicated it would be helpful to get a psychiatrist to work with educational staff in NES to develop this project. Dr Cook went on to say an Executive Committee member has volunteered but he also thought it would be useful to have amedical management lead. It was agreed Dr Le Fevre would take this on.
Dr Cook reminded members that the Refresher training is split into generic modules (half day) then optional modules on either; CAMHs, Forensic or Capacity/Decision Making (half day).
ii) Mental Health Patient Safety
Dr Taylor acknowledged this item could not proceed to a detailed discussion in the absence of David Hall but asked members if they had anything to report. Roger Blake added he would like to see this broadened to community services sooner rather than later.
(iii) Leadership and Management Training for Scottish Trainees 2014
Dr Taylor reported that this had taken place on 11th March and was well received. Some trainees had fed back that it should be available earlier in training. A further training day will be organised for next year with a date being agreed before the next meeting.
Dr Blake reported an issue raised by a colleague locally about a framework for trainees to get involved with shadowing management and other non-clinical roles and how this is dealt with in other areas.
Dr Connolly suggested the Scottish Government can offer a day or a placement to trainees wanting to learn more about policy in this way. Dr Connolly recently had a public health trainee working 3 days a week with her and 1 day with MWC. This trainee had been involved in key pieces of work during this placement.
Another trainee had worked with the group at Scottish Government looking at the Suicide Prevention Strategy and this had worked well with the trainee making good contributions to this topic.
Dr Sanderson had a trainee placed with strategic planning and this had benefited both parties.
In discussion the group agreed it was better for trainees to have specific projects to work on during these placements.
Lothian have monthly training sessions on management issues for trainees and they have also involved trainees in specific projects.
Dr Findlay talked about the NHS Lanarkshire monthly management seminar which runs from August to July.
Dr Cook reported the College in Scotland will be having 2 trainees to work on policy work with College (1 CAMHS and 1 other). That will add to options for trainees if it turns out to be worthwhile. It will be done as special interest time.
Dr Palin reported they have shadowing in Aberdeen that attracts higher trainees. For example, trainees have carried out projects on observation and anti depressant prescribing. Consultants are also interested in coming and shadowing (one came to a clinical governance group).
Dr Blake suggested that the BMA may be good to be involved in as a trainee. Doing so very quickly gets the trainee involved in management. It can also add value by improving interpersonal and other skills.
Rabia Ellahisaid she had undertaken shadowing opportunities with NHS management and learned about teamworking and presentation skills. She had not done clinical supervision yet.
Dr Taylor thanked members for their contributions and said he would identify alist from the minutes to be available for trainees via the website.
(iv) Workforce Planning
Dr Cook reported the College Workforce Group had met recently. The situation will change in the next year or 2 (due to Shape of Training) and it is very unclear how this will impact on psychiatry. The group agreed a census is not really needed until next year. It is clear there are some short-term issues in some areas and some specialities. The Scottish Government have a lead on implementing Shape of Training. Health Education England have published their manifesto and they are looking at changes taking effect from the August intake of2016.
The group discussed whether the College believed Shape of Training would be implemented separately in Scotland but Dr Cook was certain this is not the case. It will be implemented across the UK even if there is a YES vote in the Scottish Independence Referendum in September.
It was agreed some information on this may need to go out to members. Some of the group had been to meetings in England where they got the impression colleagues south of the Border were more informed.
(v) Managed Clinical Network for Sick Doctors Update
Dr Cook updated the group thatthe Scottish Government, via the workstream on revalidation, is taking forward the MCN which will largely involve psychiatrists, occupational health physicians and GPs, (not necessarily directly involved but to have awareness). The MCN willfeed into what happens already in the Scottish NHS, often in an undocumented or partially documented way. The aim is to get doctors into the system earlier rather than later to allow cost savings and ensure people can get access to treatment that is known to be available. Dr Cook is chairing the steering group and the College will project manage this until it is set up. NHS 24 is very positive about becoming the host Board. There will likely be an administrator and a lead clinician to sit within NHS 24. They will be a hub with three spokes across Scotland, one in West, one in East and one in the North. Psychiatrists will populate each of those hubs. There will be standardised paperwork for people doing the work and they will link up with GPs. The expectation is some people will self refer, some will come via GPs. Some may come via occupational health.
Dr Cook went on to say there is a draft email ready to go to the membership to identify those doctors who are doing a lot of this work already. Often this work is done by liaison colleagues and it may not be accounted for by managers in job planning. This should change in future with the introduction of the MCN.
In discussion, Dr Cook clarified it would need to include psychological treatments but how to do this has not been finalised. Dr Sharp said he would urge the service to be set up to be as close to any other service as possible and he would use routine training and paperwork for those to be part of MCN if they were from the Borders. Dr Cook stated that this is acceptable but also the training for those involved in MCN would mainly be around the regulatory framework.
Dr Palin raised this locally and colleagues had significant concerns regarding this development. He went on to express concern about confusing performance and health issues. There was a lively discussion about the MCN but Dr Taylor repeated that the decision has already been made to establish it and it would be good to support it and see the benefits it could bring.
Dr Connolly welcomed it and said this is about access and there is a reluctance for doctors to say they are unwell. The group acknowledged there are other health professionals with problems and Dr Cook went on to say this has been talked about in the Steering Group with agreement this will be doctors only to start with it and then it may be reviewed.The resources identified are via revalidation money so they need to start with doctors. Boards will need to find money for the people doing the work but they should understand they will also save if they can cut the number of doctors off sick for long periods.
- UPDATE FROM SCOTTISH GOVERNMENT
Ms Penny Curtis from the Scottish Government updated the group as follows:
Geoff Huggins has been promoted and is now Acting Director of Health and Social Care for the Scottish Government until the post can be recruited to and Penny is acting up on a similar basis and the Government is recruiting for her current role.
The team are in the middle of implementation visits and there is a big emphasis on the HEAT access targets which are due to deliver at the end of December. The situation is fragile on both Child and Adolescent and Psychological Therapies and there are some concerns about sustainability in those areas in the longer term. There is more positive news in that there has been an increase in the number of patients being seen, particularly within a shorter time frame.
Around the dementia target the team are particularly picking up where the Partnerships are in meeting the target for post-diagnosis support. There is also some anxiety about what happens when the change fund ends
For suicide prevention the visits are identifying self harm as a risk in itself, this is being placed within distress agenda.
The one day census of inpatient estate has been delayed until the Autumn but the team are confident they know what they want to do and the model will be tested in a small area within each Board in June.
They are looking at where Boards are in relation to first episode psychosis. This is not just about specialist separate services but embedding this work in other services.
On integration, Penny was interested in feedback on this, particularly on accountability.
The new Mental Health Bill is being introduced at the end of May. It has not been announced which Parliamentary Committee will be doing the scrutiny of this but it is more likely the Bill will be considered after the referendum.
The group members fed back on integration:
Cliff Sharp reported that in the Borders they are just getting their structure established and they know who the key people will be but not much information has filtered down to frontline staff. He was aware colleagues working in acute care are largely oblivious to it and don’t understand the implications of it. He remains optimistic that it will be change for the better and pointed out that within mental health and intellectual disability services a lot of work has already been carried out in relation to integration. He was concerned at the management on both sides being wary of each other and hoped there would be a growing trust between them as the partnerships work together and this would improve patient care.
In Ayrshire mental health is in one of three health and social care partnerships and John Taylor now reports to the head of one of the partnerships. One issue they have agreed is that all of the beds will be managed by one partnership and staff will also be managed within one partnership.
Peter Le Fevre stated that Lothian is mostly gravitating towards one partnershipwithWest Lothian remaining as it is currently. East and Midlothian only have a small number of consultants.They will have firm lines to local management but a dotted professional line to the secondary care system and medical director. Peter went on to say he envisaged a lot of work to make this a success.
Alastair Cook reported that Lanarkshire has a similar situation with small steps being taken towards understanding. There has been one appointed Chief Officer and one is currently out to advert. There will be some strategic and professional linkage in the middle accountable to the Board.
Alastair Palin informed that Grampian has 3 local authorities and they are all different and they are still discussing how things will be configured.
Roger Blake gave an update for Tayside and said they had done this for years with older people services so are experienced in setting up the structure.
The group noted that there is a further consultation out on the draft Public Bodies Bill. Karen Addie said this would be sent out to members for comment by email.
Cliff Sharp asked Penny if any of the integration schemes set up don’t fulfil the intended purpose, will the Government have a role in intervening? Penny replied that in her view they should be challenged.
Alastair Cook commented that it feels very directionless at the moment yet it is a huge change. Tracy Sanderson commented that for local services, where things aren’t working well, this is an opportunity to get new solutions and improve things.
Finally, Alastair Cook said that in relation to the Mental Health Act, he wondered whether it is reasonable to have MHOs employed by the same organisation? John Taylor replied they need a professional link, but you can employ them, and if you take them out of teams, it can be disastrous.
As this would be Moira Connolly’s last meeting as Principal Medical Officer she thanked the group for being so supportive during her secondment and she was sure the same support would be offered to her successor. Penny Curtis added that she had been very grateful for Moira’s input and hard work during the three years.
- LEADERSHIP AND MANAGEMENT COMMITTEE (UK)
No report available.
- ANY OTHER COMPETENT BUSINESS
(i)Mentoring Working Group
John Taylor provided an update. A group has been set up by the College in Scotland to look at this. The group has only met once and established that some of the Faculties have mentoring in place and automatically identify a mentor from different health board areas for new appointments. There will need to be involvement from TPDs and External Advisors in future so people appointed to consultant posts will get information about how to find a mentor. Some people will identify their own. The group proposed that the College will hold a list of mentors for those people who struggle to get one. The College role will not extend beyond making sure the list is up to date and perhaps provide some information on mentoring via the website and email. It is a particular issue for new consultants and specialty doctors, trainees generally are provided for by educational supervision. The group were supportive of the proposals from the Working Group and agreed it is an area where some work is needed.
(ii)Job Advertisements
Ihsan Kader raised the issue of not being allowed to put advertisements in the BMJ anymore and felt some potential applicants, particularly from outside Scotland, were not seeing adverts.
The group noted the adverts go on the SHOW (Scottish Health on the Web) website with the exception of 2 specialties, Radiology and Accident and Emergency.
John Taylor suggested asking the Government to consider this again as Psychiatry recruitment is so poor and some services, particularly in the north of Scotland, are precarious as a result. It was agreed to ask the Management Steering Group via the Medical Directors group to consider this again. Peter Le Fevre suggested perhaps the BMJ could run a regular advert directing people to the SHOW website who may be unaware of it.
The group moved on to discuss more general issues around recruitment.
Alastair Cook talked about START which is the Scotland-wide strategy for attracting more trainees and is run by NES. John Colvin is part of the steering group for it, he works in Scottish Government and he has a role to attract more senior staff to Scotland. Alastair went on to say involving Chief Executives is crucial to improving recruitment and they had been integral to a programme of improving attraction for the north of Scotland and it had helped.