NHS GRAMPIAN

Minute of Meeting of the Area Clinical Forum held

on Wednesday 27 April 2011 at 6.00pm

in the Conference Room, Summerfield House

Present

Dr John Reid, Chair/Chair, Area Medical Committee

Mr David Corry, Vice-Chair, Area Optometric Committee

Mrs Linda Juroszek, Chair, Area Pharmaceutical Committee

Mr David Massie, Vice-Chair, Area Pharmaceutical Committee

Mrs Lynn Morrison, Chair, Allied Health Professions

Ms Jenny Gibb, Vice-Chair, GANMAC

Mrs Jenny Tait, Chair, Area Healthcare Science Forum

By Invitation

Dr Roelf Dijkhuizen, Medical Director

Mrs Elinor Smith, Director of Nursing and Quality

Attending

Dr Steve Baguley, Clinical Director eHealth – Item 2 only

Mr Graeme Smith, Head of Service Development (Item 3 only)

Ms Alison Farrow, Healthcare Science Development Lead

Mrs Rosie Gauld, Administrator to the Professional Advisory Committees

No / Issue / Action
1 / Chair’s Welcome
Dr Reid welcomed everyone to the meeting, particular David Corry and Jenny Gibb who were attending their first meeting. Introductions were made round the table.
2 / eHealth Issues
Dr Baguley gave a powerpoint presentation, a copy of which is attached to the Minute. The presentation highlighted direct and indirect benefits that could be achieved through eHealth, notably improved quality of care and use of resources. All professions could benefit from the use of Health Care Informatics but staff engagement was the key to success. Not everything was affordable and there would be a need to prioritise in order to achieve agreed objectives. A question and answer session followed. / RG
It was noted that it was relatively recently that independent pharmacy and optometry contractors had been included and progress continued to be made. The Optometrists’ electronic referral system was rather cumbersome, and it had not been easy to engage with all contractors. Mr Cassie intimated that whenever a system was changed, it involved a lot of training, but it was still a step in the right direction.
Mrs Tait stated that the Labs were involved in the paper light GP ordering and that the Healthcare Scientists was embracing the system. It was a great opportunity to think again about service redesign and more efficient working.
Mrs Smith suggested that eHealth was integral to further development of the quality agenda.
Mrs Juroszek intimated that the community pharmacists would find it useful to access the emergency care summary during OOHs. Dr Dijkhuizen stated that an agreement could be formulated and signed that it would be abided by, so that a “need to know” basis would be demonstrated.
Mrs Morrison felt that the AHPs were keen to come on board with sharing information with others and had undertaken a lot of work in the past. There were many barriers and she was pleased to hear of the solutions around these.
Mr Massie advised that within community pharmacy electronic transfer systems for prescriptions was already in operation. Once the Chronic Medication Service was fully operational the aim would be for transfer of information to GPs. The opportunity to include community pharmacists in discharge information regarding medicines could improve medicines management. Hopefully in the near future there would be the opportunity for community pharmacy to use electronic claims rather than paper.
Dr Reid advised that sensitivity around data sharing and confidentiality had to be considered. Roll-out of the programmes was dependent upon explicit consent. Dr Reid queried what ideas people had so that they could be prioritised, eg use and abuse of e-mail; passwords; how do you facilitate people logging in and logging out; audit of how many people use a specific computer.
Dr Baguely stated that his priorities were:
A way of increasing confidence that data in electronic healthcare systems was being accessed appropriately, as this would facilitate data sharing. Software for this existed and was affordable but would require significant input from HR and there was no timescale at present – possibly mid 2012.
Electronic prescribing and medicines administration. Dr Baguley confirmed that there was a prescribing model for PMS, however it was costly and it could mean prioritising that above everything else. Difficult decisions would have to be made unless the resource available to eHealth initiatives was increased.
Mrs Juroszek indicated that electronic prescribing had been key to GPs making use of electronic records. There also needed to be discussion on when the organisation would wish to stop using paper records.
It was noted that the eHealth Committee was a high level strategic forum but needed an operational view on eHealth priorities. Dr Baguley intimated that it would be of value to hear what the priorities of the ACF were. He would also like an opportunity to attend the Forum again as it was one of the key places for this type of discussion and decision-making.
It was noted that eHealth would feature on the SSRC agenda as this was seen as the most appropriate group for strategic and operational discussions, eg how does NHSG work with Scottish Centre for Telehealth and NHS24.
Dr Baguley was thanked for his useful presentation and he left the meeting.
3 / Health & Care Framework
Mr Smith gave a report on the submission to the April NHS Grampian Board meeting regarding the Health and Care Framework. The Board had approved the way forward and the development of a detailed action plan for implementation over the next 4-6 months. The Board submission was the culmination of the first stages of the process and the outcome of a major stakeholder event held on 3 March 2011.
The ACF discussed the main areas for detailed action planning i.e.
  1. Integration of care around communities: there was variation throughout Grampian and there needed to be consistency.
  2. Start to align acute services to primary care groups so starting to integrate services and care;
  3. In relation to redesign, review the need for inpatient hospital care by developing home and community-based care. There was a need to look at the level of inpatient care at ARI, Woodend, Dr Gray’s and also in community hospitals;

  1. There were pathfinder projects in Inverurie and Forres: conclusions would be emerging in the next few weeks which could then be included in the Action Plan as appropriate.
  2. To seek the more active participation by individuals within communities and increase working jointly with local authorities.

  1. Aim to reallocate resources based on need and use the integrated resource framework as the guide for decision-making and allocation of resources.

  1. Creation of a new infrastructure with less emphasis on buildings and more emphasis on technology. Develop community resource centres and move away from the more traditional community hospitals setting.

  1. The Action Plan would identify the priorities and there may be the need to make fairly radical decisions about resources. Instead of spending money on buildings, put resource into IT systems to support the changes that require to be made;
  2. Building on relationships with local authorities and the third sector, currently this is variable across NHSG, but Maud resource centre was an example of what could be achieved.

Mr Smith explained that these were the broad areas to be developed in the Action Plan. Lead responsibilities would be identified in the near future and draft actions would be discussed with advisory committees over the next six months.
4 / Apologies
Apologies were intimated on behalf of Mr Izhar Khan, Mr Malcolm McPherson, Mrs Jane Ormerod, Dr Chris Provan, Mr Richard Carey and Dr Lesley Wilkie.
5 / Minute of Meeting held on 23 February 2011
Page 2 – Lynne Morrison to let Rosie Gauld have amendment
Page 2 – itreach should read inreach
Page 3 – delete second sentence of first paragraph
Following these amendments, the Minute was approved as a correct record. / LM/RG
6 / Matters Arising
Nil.
7 / Maternity Review
Mrs Smith reported that the Review had started about a year ago, following which there had been a Value Stream Analysis in August last year. There had been a meeting of stakeholders to discuss what needed to be done – three streams of work:
Developing the strategy for Board approval in December
Development of an Action Plan to look at streamlining clinics Regularising protocols and reviewing length of stay
An Option Appraisal was completed last week and models for the future provision of maternity care were being developed. There were currently four options to be submitted to the Board for their views, following which it would go out for more widespread consultation.
It had been stated from the start of the review of maternity services that it should not cost more than what was currently being spent. The models and redesign would be within the current spend of approximately £16 - 17m. Mrs Juroszek queried whether this was on par with other Health Boards. Mrs Smith advised that financial work had been undertaken recently but it was not clear-cut, but would be looked at. She did have some information about cost of delivery in different units, although different areas called things different names.
It was further explained that the plan was to take a paper to the Board in June, followed by a three months’ consultation period. The Maternity Review was one of the strands of the Health & Care Framework.
It was noted that when looking at the benefits that were required from the service, there was a total of nine and Safety and Sustainability, and addressing Health and Inequalities came higher up the list than Choice.
8 / Current Issues from the Advisory Committees:-
8.1AHPC
Lynn Morrison reported that the main item was AHP redesign work. The next meeting regarding this had been arranged for 4 May to explore the issues and agree a way forward.
8.2 / AOC
David Corry advised that the main issue was about electronic referral. Each Practice had a Practice Management System but these systems varied which was a problem. The best way forward would be to allow Optometrists to dial into the NHS network and than have live information. This would also be a simpler system. The Eye Health Network had been a big success and it was hoped that it would be developed in the future.
Mr Corry also reported that funding had been received from NES to develop a clinic centre in Aberdeen for teaching. - £142,000 for equipment.
8.3 / APC
Linda Juroszek reported that work was ongoing looking at the redesign of pharmacy and primary care.
CMS was progressing slowly at a national level, local pilots were up and running and there was good local IT support.
Problems in the supply chain remained an issue, both locally and throughout the country.
A Dispensing Doctors Decision-making Group was being set up to deal with future contractual changes.
8.4 / GANMAC
Jenny Gibb stated that GANMAC had been asked by Janet Seaton, Technical Services Manager – Datix to look at the staffing and quality of care issues around Datix reporting. It was thought that not all areas were reporting whether lack of staff was impacting on quality of care. That was to be addressed so that the same information was being recorded.
There had been a disappointing uptake of the internships for newly qualified staff. In looking at the March and September graduations from last year, many did not want internship as they had other jobs. This was being monitored and Senior Nurses were looking at innovative ways of using newly qualified nurses, but many did not want the opportunity. Dr Reid intimated from a primary care view, he had enjoyed having a development post in the Practice and it would be good to try and attract nurses into the community.
8.5 / Healthcare Science Forum
Copies of Minutes of Meetings of the Forum held on 14 July 2009 and 17 November 2010, along with a report by Jenny Tait had been e-mailed to members. The contents were noted.
Jenny Tait reported that Alison Farrow had been in post for five months and making a significant impact. She was also establishing links with the smaller groups, particularly in the Physiological Sciences.
There was to be a meeting in Edinburgh today to look at the postgraduate trainees and groups for the Assistant Practitioner grade.
Alison Farrow advised that she was one of six posts throughout Scotland, and covered both NHS Grampian and NHS Highland. There were different management structures and single practitioners felt quite isolated. Efforts were being made to try to make them feel as part of something and looking at their needs and registration.
Regarding Early Career Development, there were places available in Aberdeen for leadership development for those Healthcare Scientist staff with a few years experience.
A Leadership Peer Review Day had been arranged for 28 April 2011 at the Suttie Centre. There were to be 18 participants, some of whom had been on the Change Weaver course run by NES.
8.6 / AMC
Dr Reid reported that a couple of letters had been received about problems with prescribing and they were being referred to the GMMG for further discussion.
8.6.1GP Sub-Committee
Elections were currently taking place.
There remained issues around the primary care premises strategy which was important if developing services in the community and seeing the 2020 vision developed.
8.6.2Consultants’ Sub-Committee
Dr Reid reported that Dr Kevin Jennings had retired and the new Vice-Chair was Mr Norman Binnie. The next meeting was on 12 May 2011.
10 / Chair’s Report
Dr Reid had been asked by the Chief Executive to pass on his gratitude to all clinicians in achieving the financial balance. A challenging budget had been set for the next year.
11 / ACF Letter to the Board
The contents of the letter dated 28 March 2011 were noted. No feedback in terms of the patient transport arrangements had been received but it was hoped that it would be possible for discussions to be undertaken with the Scottish Ambulance Service.
No issues were suggested for the next letter, but Mrs Juroszek would e-mail all members in her role as Chair of ACF as from 1 May 2011. / LJ
12 / Reports
12.1 / eHealth Committee
Copies of a Minute of Meeting dated 19 November 2010 had been circulated previously with the agenda.
Mrs Juroszek advised that the committee was quite strategic and there were not enough clinicians round the table to look at clear objective setting. There were real opportunities to make a difference and influence decisions.
No update was available regarding the PMS system. Dr Dijkhuizen stated that there had been a degree of panic that all the work was not going to get done and losing patients because no appointments could be made. It had since settled down but there was still pressure on individual members of staff. Steve Baguley was in favour of the prescribing model and there were groups within NHS Grampian that people had alluded to that would be helpful in decision-making
12.2 / Others
Nil.
13 / Minutes
13.1 / OMT – 26 January 2011
ACF Constituent Committees
13.2 / Area Medical Committee – No Minute
13.3 / Area Pharmaceutical Committee – 18 January 2011
13.4 / Area Optometric Committee – 12 January 2011
13.5 / Allied Health Professionals Committee – No Minute
13.6 / GANMAC – 11 January 2011
13.7 / Area Healthcare Science Forum – No Minute
13.8 / GP Sub Committee –17 January, 21 February and 21 March 2011
13.9 / Consultants Sub Committee – 9 December 2010 and
10 February 2011
Copies of the above Minutes had been circulated previously with the agenda. Noted.
14 / Items for Noting
Nil.
15 / Other Competence Business
15.1Psychology Advisory Committee
Elinor Smith referred to previous discussions about whether there should be a Psychology Advisory Committee. There had been significant discussions within the Area Clinical Forums in Scotland about where they should sit. They had been given the opportunity to sit within the Healthcare Science Forum but there had been no uptake. There had been no particular wish to set up a committee for psychology. Mrs Juroszek would give this consideration in a Scottish context. / LJ
15.2Work Plan for ACF
Mrs Juroszek was looking at a work plan for this committee. She had drafted a plan for the Area Pharmaceutical Committee, which she chaired, outlining what the Committee was going to look at over the next few months. She would produce a draft of what she considered the committee should be considering and circulate it to all members. / LJ
15.3Chair, ACF
As this was his last meeting, Dr Reid thanked all the members for their support over the years he had been Chair of the ACF and extended his best wishes to Mrs Juroszek who was taking on the role of Chair as from 1 May 2011.
16 / Date of Next Meeting
Wednesday 29 June 2011 at 6.00 pm in the Conference Room, Summerfield House.

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