Grampian Annual Review – 8th November 2010

Area Clinical Forum

The Grampian Area Clinical Forum wish to submit this paper, as a supportive document to a verbal presentation. The attendees representing the advisory structures in Grampian are as follows:

Dr David FowlerChair GP Sub-committee

Mrs Linda JurosekChair Area Pharmaceutical Committee

Dr Izhar KhanChair Consultant’s Sub-committee

Mr Malcolm McPhersonChair Area Optometric Committee

Mrs Jane OrmerodChair Grampian Area Nursing and Midwifery Advisory Committee

Dr John S H ReidChair Area Clinical Forum

The committee will follow the proposed agenda as proposed by the Scottish Government Health Department. The attendees hope to discuss with the representatives of the Scottish Government Department some issues relevant to the Grampian Region.

The Quality Strategy

The NHSiS Quality Strategy has been discussed in the Area Clinical Forum and subsequently in all of the constituent committees. The Committees endorse the aim of the Minister for Health and Wellbeing to have the Scottish NHS as the best healthcare system in the world. The Director of Nursing is the nominated lead Executive Director for the implementation of this strategy. Through working groups which have included the Clinical Governance Unit, implementation strategies are being developed. The Area Clinical Forum has had the opportunity of advising the implementationin a variety of clinically related groups. Future options for ensuring widespread adoption of the strategy have been discussed. The discussion of appraisal and the opportunity of utilising processes associated with the KSF as catalysts to implementation are ongoing.

Workforce Planning

The constituent committees and colleagues via the Grampian Area Partnership Forum have had input to and feedback from the workforce plans of NHS Grampian. The recent fiscal revisions and the projected budgetary calculations have enforced a revised work programme. Approximately 70% of the NHS Grampian Revenue Budget is expended on the workforce. The previous workforce planning process has evolved into Safe and Affordable Workforce and Safe and Affordable Nursing Establishment programmes. These processes have already led to change in service provision, e.g. renal dialysis delivered in the evenings and overnight being stopped. A Voluntary Severance and Voluntary Early Release programme were regretfully unattainable this year. The extension of the Nurse Development programme is welcomed as a variety of new graduates are having difficulty accessing new posts. The extension to primary care has permitted those newly graduated nurses with an interest in community care to access employment opportunities.

The Grampian Region has particular issues related to Modernising Medical Careers and the European Working Time Directive. It is hoped that there may be an opportunity to discuss some of these matters during the meeting. The shift in service provision from doctors in training to trained doctors warrants some discussion as competencies are gained in an incremental manner. It is important that junior staff have an opportunity to consolidate training by practising these competencies.

Local Efficiency Saving Programmes

The advisory committees have been supportive of the establishment of the Efficiency and Productivity Programme Management Officeto achieve immediate financial impact and the Continuous Service Improvement process to redesign towards sustainable services in the longer term. The advisory committees believe that NHS Grampian is an efficient organisation delivering service not only to the population of Grampian, but also some services to the population of Highland, Orkney and Shetland. The committees are grateful for the evolution of Scottish Allocation Formula as advised by National Resource Allocation Committee. The NHS Grampian committees believe that Grampian has moved from an 89% funding level towards 93% funding level. There is concern, however, that the NRAC recommendations will be implemented over a prolonged period of time. The committees respectfully wish to suggest that full implementation of NRAC recommendations via the expected future austerity measures may be a fair method of working within restricted budgets.

Service Redesign

The clinical community of NHS Grampian tend to have good links with the management structures of NHS Grampian and are supportive of change which is likely to benefit patient care. There have been some examples of incremental change occurring without consultation. It has been necessary to advise NHS Grampian that summation of incremental changes leads to significant change where advice may not have been sought.

Area Clinical Forum Development

CEL 16 (2010) has been an important document to reinforce the important of clinical advice within NHS Boards. The CEL has been the subject of discussion at a Board Seminar. There has been some confusion over clinical advice, which has been given by those with a clinical management responsibility, as opposed to those within formal advisory structures. These matters are being addressed within the organisation. A recent meeting with the Chief Executive, the Medical Director, the AMC Chair and the Consultant Sub-committee Chair offers an opportunity of strengthening clinical advice within the organisation.

Developing Clinical Leadership

NHS Grampian has released a number of personnel to participate in clinical leadership programmes delivered by a variety of organisations. The LMC has, for example, provided financial support for one participant on the RCGP Clinical Leadership programme. The NHS Grampian Board and the Executive Team have been supported by Ms Jennifer Mack, Organisational Development Manager. External facilitation by the Real World Group has occurred within the organisation.

Keeping a Focus on Patient Safety, Quality and Governance

NHS Grampian has complied with Dr Wood’s instruction to review service provision in line with the recommendations of the Mid Staffordshire Review. There has been an excellent clinical response to our earlier issues around clostridium difficile with significant change in antibiotic prescribing in the region. NHS Grampian has some problems with selective reporting of published reports by local news media, e.g. the recent HEI report on the Royal Aberdeen Children’s Hospital. The local press has tended to focus on the negative aspects only with the result being concern in patients who are due for treatment. The population of Grampian, however, are often active in utilising the local media to thank publically NHS Grampian personnel for episodes of care.