NHS GRAMPIAN
Minute of Meeting of the Area Clinical Forum held
on Wednesday 23 February 2011 at 6.00pm
in the Conference Room, Summerfield House
Present
Dr John Reid, Chair/Chair, Area Medical Committee
Mrs Linda Juroszek, Chair, Area Pharmaceutical Committee
Mr David Massie, Vice-Chair, Area Pharmaceutical Committee
Mrs Lynn Morrison, Chair, Allied Health Professions
Mrs Jane Ormerod, Chair, GANMAC
Mrs Elizabeth Squires, Vice Chair, GANMAC
By Invitation
Dr Lesley Wilkie, Director of Public Health
Attending
Mr Graeme Smith, Head of Service Development (Item 2 only)
Mrs Rosie Gauld, Administrator to the Professional Advisory Committees
No / Issue / Action1 / Chair’s Welcome
Dr Reid welcomed everyone to the meeting, in particular Mr David Massie who was attending his first meeting. Introductions were made round the table.
2 / Health and Care Framework
Copies of two papers had been previously circulated with the agenda – “Summary of the NHS Grampian Health and Care Framework”, and “Guidance for Groups to Advise on the Proposed Model of Care – Stage 2”.
Dr Wilkie updated the group on work carried out to date and advised that a major stakeholder event had been arranged for 3 March 2011. Papers had been sent to all the groups with an invitation to attend. Stakeholders would decide on the model and feedback comments. Stage 1 was asking what people thought the model of care should be, as set out in Appendix 1 of the Guidance paper. The bulk of the care was undertaken out of hospital, i.e. shifting the balance of care. Stage 2 was to ask what the model of care meant, based on clinical evidence, and clinical advice (from the ACF). The resource allocation and prioritisation group sat alongside this for making decisions based on need.
Mr Smith then tabled copies of a draft discussion paper dated 22 February 2011. The SMT had gone through it at their meeting on 26 January 2011 from which it emerged that there were issues that needed to be developed in detail and converted into an Action Plan during 2011/12. The paper explained that the first stage of the Health and Care Framework had gathered a large amount of information and proposals on how the health and care system should change in Grampian. This had been organised into a number of overarching principles and areas for further development.
Mr Smith then took members through the paper which set out the principles and areas for future development. He outlined a possible future for 2020 as a means of stimulating debate.
General discussion followed and members made various comments.
Dr Reid stated that whilst the vision was good, central targets had allowed these to be met. He thought the “circle” diagram was confusing as the current strategy suggested more outreach than inreach.
Mrs Juroszek was of the opinion that, as a general rule, people did not want to be in hospital and any return appointments, whether they be with the GP, Nurse or Consultant should be considered. If the long-term and IT issues happened, and GPs get access to track patients, they could look at the hospital notes and inform the patient. There had to be aspirations.
Mrs Squires felt that there was a need to be careful about getting productive work in place and was the key to keeping people out of hospital and maintained in their own home. Integration was the key in looking at partnerships and embedding care in the community. Those involved in community planning had their own agenda and, therefore, there was a huge piece of work to be done.
Mr Smith stated that the approach was to change in a responsible way and they were not looking at closing beds, although there may be a reduction in the number of beds.
Mrs Morrison agreed that an integrated approach was more acceptable than “shifting”. She also felt that it was interesting to see how the Framework could look, in presenting it from a futuristic point of view. She also suggested that there was a need to be consistent in use of terminology, eg “acute” care should be “specialist” care across the whole pathway.
Dr Reid felt that there were educational and skill attainment issues. He would like to set targets against them as the City was different from the Shire, eg have seen the inability to deliver care using the GPwSI model.
It was said that most GPs had worked in secondary care but not many Consultants had worked in the primary care setting, although there were good networks between the two.
Mr Massie agreed with the Vision, and his only comment around it was that it may be more powerful if it was based on patient experience. He also felt that it leaned more towards secondary care.
Further comments were:
Consider what the model would look like if someone from each professional group inputted to the vision, based on the same period of time;
Difficult to balance “wants” and “needs.”
With reference to page 3 of the draft Discussion Paper, under No 10, it was suggested that it would be useful to give good examples of service delivery outwith Grampian.
Mr Smith then left the meeting.
3 / Apologies
Apologies for absence were intimated on behalf of David Corry, Malcolm McPherson, Heather Rundle and Jenny Tait.
4 / Minute of Meeting held on 27 October 2010
The Minute was approved as a correct record.
5 / Matters Arising
There were no matters arising
6 / Role of Advisory Structure in Management Decisions affecting Clinical Service – Update
Further to Item 6 of the Minute of ACF held on 27 October 2010, Dr Reid added that there have been pressures within the Consultant Sub-Committee and their input to the Area Medical Committee. There had also been resignations.
At this point Mrs Juroszek reminded the members that the Medical Director had indicated that he would try and arrange for Non-Executive attendance at the various constituent advisory committees. Dr Reid intimated that regular attendance of Non-Executive members of the Board should be approved by the Chairman. In the past there had been good links with them but there had been changes in the members and illness which had prevented their attendance.
It was stated that the Director of Nursing & Quality attended the AHPAC and met with the Chair to set the agenda. The Director of Medicines attended the APC, and the Optometric Lead attended meetings of the AOC.
7 / Constitutions:
7.1GANMAC
The revised Constitution had been submitted for approval. The amendments were approved subject to the following changes and comments being made.
- Nurse specialists should be included under Membership
- Noted that Private Sector related to AlbynHospital
- Noted that the Care Sector related to Care Home/Nursing Home sector.
- Under Item 6, the last sentence under Office Bearers should read “The Chairperson has a standing invitation to attend the Open Session of the NHSG Board.
- Item 6 Members – the first paragraph was contradictory
- Item 6 – Attendance – amend to read “The Chairperson of the ACF will be an invited member of the committee.
7.2AHPAC
The revised Constitution had been submitted for approval. In discussion it was suggested that the first paragraph of Item 8 – Minutes, be reworded. Following the amendment, the Constitution would be approved. / LM
8 / GMMG: Melatonin Prescribing
It was noted that the Grampian Medicines Management Committee, in conjunction with specialist consultants, and agreement by the GP Sub-Committee had recommended that melatonin should be prescribed as the branded Bio-melatonin for all patients on standard release melatonin, and had now been included in the Grampian Joint Formulary. Dr Caroline Hind was the lead on this.
Mrs Juroszek indicated that pharmacy contractors had been informed. She also felt that there should be discussion round the table about efficiencies and savings of prescribing.
It was noted that Consultants had been asked to look at the whole management of ADHD. GPs would also standardise what was prescribed which would remove pressure on the hospital. Overall, there would be a saving of around £100k.
9 / Equality of Nursing v Medical Appointments
Mrs Ormerod raised this issue because of restrictions around recruitment. Whilst there was a process, to which the nurses were adhering, it did seem that the process did not apply to medical appointments.
There were also some general issues around the appointment of advanced nurse practitioners and specialist nurses. In terms of the process and prioritisation around that, particularly in the Acute Sector, there were issues around the training of nurse practitioners and medical support nurses. There was a considerable cost aligned to the training of these staff. There had been a suggestion that money for training needed to be prioritised within the midwifery and nursing budget, but there had been thoughts about money being sidelined from general savings that could be made by not appointing medics.
Dr Wilkie stated that Dr Dijkhuizen was aware of the perceptions regarding recruitment and he was addressing the issues.
Mrs Squires added that investment in nurse practitioners could not be retained as they were being attracted to General Practices who could offer a higher salary above the recommended bandings. Nurse Practitioners were also leaving GMED to minor injury. Dr Reid reported that gradings in hospital were based on Agenda for Change and GP Practices were based on Whitley Council, and that it may be that GPs were not appointing a Partner but a Nurse Practitioner instead.
Dr Wilkie would raise the issue of the training budget with Dr Strachan, Chief Operating Officer / LW
10 / Practice Attachment of Nurses in Development Roles
Mrs Ormerod gave an update on the internship programme for newly registered nurses. A Scottish Government initiative was about to be launched regarding a period of internship to facilitate newly qualified nurses getting into employment for 22 hours per week for 11 months 29 days which satisfied the one-year guarantee and Flying Start. Each person had three choices of which Board to go to and if turned down by all three, then the reasons for this were looked at. They were not seen as part of the establishment and their salary was handled differently. Money was allocated centrally.
Mrs Ormerod further explained that the challenge for NHS Grampian from the Scottish Government was to build on work to allow newly qualified nurses to have a range of experiences, including GP Practices and Care Homes. To this end, rotations were being set up between GP Practices and CHPs, for example. Suggestions for rotations had to be submitted to Scottish Government. These could be hospital based, GP Practices or community and indications of interest were sought. It was noted that newly qualified staff could now join the Nursing Bank.
Dr Reid suggested that the matter be submitted to the GP Sub-Committee Newsletter to enable it to be brought to the attention of all Practices in Grampian.
11 / Reshaping Care for Older People – Change Fund Guidance
Copies of a letter dated 25 January 2011 from the Chief Executive along with a letter dated 23 December 2010 from the Scottish Government, and attachments had been circulated previously with the agenda. The guidance required local partnerships to prepare Change Plans that set down how the funding would be used to achieve a shift in the balance of care.
It was noted that Heather Kelman, General Manager, Aberdeen City CHP had been seconded to lead the work on this on behalf of NHS Grampian. Each CHP had arranged an event to discuss this.
Dr Wilkie stated that this was to be used as a pathfinder and would form an approach to care of the elderly.
12 / Travel Claims
Dr Reid advised that all outstanding claims should be submitted as soon as possible before the end of the financial year.
13 / Publication of NHSScotland – Children & Young Person Resuscitation Policy
The Chair brought this policy to the attention of ACF members. He was not aware of any problems within the Children’s Hospital.
14 / Annual Review, 8 November 2010 – Feedback
Members had seen the letter from the Cabinet Secretary and noted the response.
15 / ACF Chair
Dr Reid advised that his terms of office as Chair of ACF would be completed at the end of March. His two, three-year terms as Chairman of the Area Medical Committee would also be completed and he had asked Dr Khan for the nomination of a Consultant to take on this role.
Dr Reid asked for members’ thoughts as to attendance at the Board Meeting on 5 April 2011 as once he demitted office he had to resign his membership with the Health Board through the Cabinet Secretary and his successor had to go through the public appointments process. He queried whether the ACF would wish him to defer his demit from office for one month until a new ACF Chair was in place. Members present agreed.
There had been two noted interests in the role of Chair of the ACF which necessitated a secret ballot. Rosie Gauld would deal with this and send out a ballot form, following which she would write to the successful candidate whose term of office would begin on 1 May 2011.
16 / Current Issues from the Advisory Committees:-
16.1AHPC
Lynn Morrison reported that the following issues had been raised-
- AHP redesign work was progressing slowly. There had been agreement to an Associate Director post and the structure had been agreed for the six Lead AHPs.
- Discussions were ongoing around SAW. Some groups within the AHP professions were not in full agreement with the proposed structures and had raised concerns around the process.
- Regarding AHP Week, it had been agreed that Executive Members of the Board would spend time with different AHP professions, and it was hoped that this would be a useful exercise. Dr Wilkie intimated that she has just spent time with a Speech and Language Therapist.
- Agenda setting meetings had now been set up with the Director of Nursing & Quality and Susan Massie who had taken on a Director role.
Dr Reid queried, on reading the Constitution and Minutes of Meetings, whether the Associate Director was expected to attend the Board in a non-voting capacity.
It was explained that the Associate Director would not have a seat on the Board because the Director of Nursing & Quality has a seat. However, the Associate Director could attend Board meetings but in a non-voting capacity. The role may also be some overlap with the role of Director of Nursing & Quality.
They would be attending AHPAC as an Invitee.
16.2 / AOC
No report available.
16.3 / APC
Mrs Juroszek advised the following:-
- There remained some IT issues with regard to implementation of the new contract. Contractors must continue to register patients but, as yet, no messages were being sent to the GP Practices. GPs could see a CMS tab in their clinical systems but it was not activated on their screens. Two early adopter sites would become operational in March, ie Linkwood in Elgin and Keith GP Practice. Once fully operational, an end of care summary would be sent to the GP who could use the information as appropriate.
- A pharmacy redesign workshop took place in January to determine how pharmacy would fit into the PCO redesign.
16.4 / GANMAC
Jane Ormerod reported the following:-
The new Nursing, Midwifery and AHP Strategy was in the process of being launched and was available electronically. The aim was to launch it in the various sectors and Lead Nurses had been asked to host a small session to talk about how the Strategy could be developed. These sessions would include the Director of Nursing & Quality speaking about her role, followed by individual members of that Locality giving a presentation on the ongoing work around the Strategy. It was also an opportunity to discuss the good work that has been undertaken and the vision for the next three years. Mrs Ormerod would e-mail the Strategy to Rosie Gauld for distribution. / JO/RG
- Membership was being looked at and GANMAC had been working with education colleagues from RGU. There were issues around communication through some of the groups and feed into these groups from clinical practice. There were now more representatives attending from RGU, therefore more opportunity to discuss the various nursing programmes
- The marketing of GANMAC was underway and a poster bringing attention to GANMAC would be sent to each Locality for noticeboards.
- A piece of work was underway regarding the Senior Charge Nurse programme. A motivational away day was being arranged for all Senior Nurse Charges. Part of that event would include changing the mindset around the role of community hospitals.
- The Lead Nurses had met with Ros Moore, Chief Nursing Officer regarding placements for Student Nurses. A crisis was looming in April/May as it was expected there would be a bottleneck of students and not enough placements for them. Work was ongoing to try and solve this.
16.5 / Healthcare Science Forum
No report available.
16.6 / AMC
16.6.1GP Sub-Committee
In the absence of Dr Provan, Chair, Dr Reid reported that work was ongoing regarding community nursing redesign. Also, four Clinical Leads had been appointed and would take forward work in terms of the City redesign.
16.6.2Consultants’ Sub-Committee
In the absence of Dr Khan, Chair, Dr Reid reported that the following issues had been discussed:-
- Availability of junior staff to support Consultants to do their clinics
- Out-of-Hours
- Change in the awards system regarding discretionary points
- Emergency Care Centre and the requirement to staff the HDU. Ten nurses were being trained but it was felt that about 30 would be required
17 / Chair’s Report
Following Dr Reid’s discussion with individual members of the ACF, he had raised the issue of AberdeenHealthVillage previously because, when the significant financial constraints were announced, this initiative had not been considered. He had concerns around the methodology regarding the funding through Hubco as there would still be a shortfall. Also, money spent on developments could have an adverse effect on other budgets.
Dr Reid would also like to see data regarding the number of patients likely to be seen to assess health gain. He was giving members an opportunity to challenge the approach he had taken on it.
Mrs Juroszek felt that the estimate of numbers depended upon how other services were redesigned.
18 / ACF Letter to the Board
Copies of the letter dated 28 November 2010 had been circulated previously with the agenda.
A suggested item for the next letter to be submitted to the Board Meeting in April was patient transport, in particular the frail elderly who might, for example, have to attend hospital in Inverurie, and were paying privately. This was of particular relevance in relation to shifting the balance of care. / JR
19 / Reports
19.1 / eHealth Committee – Minute of 20 August 2010
Mrs Juroszek reported that PMS was now operational. There were huge issues around eHealth as there were no financial resources available.
Trakcare would be the tool used by nurses and AHPs, and which could be accessed by GPs as read-only. It was noted that no training would be provided.
Dr Wilkie indicated that these issues were being addressed during walkrounds.
It was suggested that Steve Baguley be invited to a future meeting. / JR
19.2 / Others
Nil.
20 / Minutes
20.1 / OMT – 25 August, 29 October and 22 December 2010
Noted.
ACF Constituent Committees
20.2 / Area Medical Committee – No Minute
20.3 / Area Pharmaceutical Committee – 7 September and 23 November 2010
20.4 / Area Optometric Committee – 1 September 2010
20.5 / Allied Health Professionals Committee – 9 September and 11 November 2010
20.6 / GANMAC – 14 September and 9 November 2010
20.7 / Area Healthcare Science Forum – No Minute
20.8 / GP Sub Committee –20 September, 25 October, 15 November and 20 December 2010
20.9 / Consultants Sub Committee – 9 September, 14 October, 11 November and 9 December 2010
Copies of the above Minutes had been circulated previously with the agenda. Noted.
21 / Items for Noting
21.1Workshop – “Primary Health Care Services within Unified Health and Care in Scotland”, 16 December 2010
21.2ICP for Children and Young People
22 / AOCB
22.1Vice Chair, GANMAC
Mrs Squires intimated that her term of office as Vice-Chair of GANMAC came to an end on 31 March 2011. Therefore, this was the last meeting of the ACF that she would be attending.
Dr Reid thanked her for her contribution to the meetings and wished her well in the future. It was noted that an election was presently taking place to appoint her replacement.
23 / Date of Next Meeting
Wednesday, 27 April 2011 at 6.00 pm in the Conference Room, Summerfield House.
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