APPROVED
NHS GRAMPIAN
Minute of the meeting of the Area Clinical
Forum held on Wednesday 29 February 2012 at 6.00 pm in the Conference Room, Summerfield House
Present
Mrs Linda Juroszek, Chair/Chair, Area Pharmaceutical Committee
Dr Izhar Khan, Chair, Area Medical Committee
Dr Caroline Howarth, Chair, GP Sub-Committee
Mrs Jane Ormerod, Chair, Grampian Area Nursing & Midwifery Committee
Mrs Lynn Morrison, Chair, Allied Health Professions
By invitation
Mrs Elinor Smith, Director of Nursing and Quality
In attendance
Ms Jenny McNicol, Head of Midwifery
Mrs Christina Cameron, Managed Clinical Network Manager
Ms Hazel Dempsey
Item / Subject / Action1 / Chair’s Welcome
Mrs Juroszek welcomed Dr Caroline Howarth, the new Chair of the GP Sub-Committee to the meeting.
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3 / The Maternity Review
Copies of the presentation had been circulated previously with the agenda. Jenny McNicol gave the presentation and summarised the key points:
Change is necessary to provide a consistent quality of service closer to where appropriate. The aim is to deliver a safer, more sustainable service which is equitable across Grampian.
A wide range of options were considered, 11 models were scored and ranked with the majority of those consulted agreeing on the preferred option.
The proposed model will be Grampian wide and will consist of integrated community maternity teams, community maternity units, consultant units and eventually the relocation of AMH.
Homebirths will continue to be available across the whole of Grampian.
Services will be delivered in a more integrated way using teams of an appropriate skill mix. The aim is to have case loads of between 60 and 80 women to allow 30 minute quality consultations. This is aimed at improving both ante-natal and post-natal care.
Community Midwife Units (CMU)s will have 6 beds and will also provide day assessments to prevent women travelling to hospital to see consultants. The proposed location of the 3 CMUs, will be Peterhead, Inverurie and Aberdeen. These units should reduce the workload in the consultant units in ARI and Dr Gray’s. This is important to ensure the consultant units have capacity to deal with those most at risk.
The proposed service will offer women a real choice when planning their birth and should contribute to promoting normality in childbirth and reducing interventions. The skills of midwives need to be maintained by ensuring they deal with sufficient numbers and of women. Skill mix will make use of maternity assistants at band 4. These staff will be able to spend time with mothers and offer breast feeding support.
The proposed service will cost slightly less that the current service whilst employing more staff. This will be achieved by using administrative staff to ensure that midwives are not using valuable clinical time to undertake administrative tasks.
GPs currently undertake baby checks and CH wondered if there are going to be more births in rural areas would this result in additional work for the GPs. JM stated that midwives are being trained to undertake baby checks and that there was no predicted increase in the number of home births.
There was discussion around risk, however the risks around delivery in CMUs is perceived because all mothers who are screened as being at risk will have a delivery panned in a consultant led unit.
LM asked if there were any plans to consider physiotherapy involvement in order to prevent some of the post-birth problems.
IK commended the work and the fact that the plans were cost neutral. However it was disappointing that, due to the financial climate, AMH may take time to be relocated.
The CMU facility to be built in Inverurie will be combined with the Health Centre project and this is currently being looked at as one of the priorities within Primary Care.
The existing building in Peterhead will be used and upgraded to be used as a CMU.
The ACF is supportive of the Maternity review and feels the time taken to review all the options and involvement of all those providing the service has resulted in a robust recommendation.
Health Promoting Heath Service: Action in Hospital Settings
Christina Cameron and Hazel Dempsey attended the meeting:
CEL01(2012) issued on 16 January 2012 extends the aspirations and range of actions set out in CEL 14 ( 2008) and includes community hospitals in the settings targeted. The ACF is tasked with acting as champions for the actions described in the CEL and the HPHS.
A considerable amount of work is already underway within ARI but it is recognised that this needs to include other settings across NHSG. Jennifer Hall has been tasked with pulling together evidence around which recourses and strategies should be further developed and used.
ACF members felt that smoking on the Foresterhill site is a problem and whist staff should feel empowered to challenge patients, this was not straight forward. It was suggested that the no smoking policy needs to be stressed at the time of admission.
Hazel Dempsey highlighted the recent development of the fresh air garden which opened in March. This is a welcome development.
There was discussion around embedding smoking cessation into several of the MCNs. Smoking is a significant risk factor for long term conditions and strategies to support cessation must be embedded within patient pathways.
Clinicians need to have up to date materials in order to engage patients and all professionals should be able to sign post, eg an Optometrist can refer patients to a community pharmacy in order for them to be provided with support and treatment to support smoking cessation.
4 / Know Who To Turn To
Booklet has been reprinted and will be launched next week. A 10 minute DVD aimed at raising staff awareness is being prepared and this will be key in ensuring patients are given consistent advice and sign posting across the NHS.
As part of the agenda to shift the balance of care, patients need to be treated in the most cost-effective and convenient place.
5 / Apologies
Apologies were noted from Malcolm McPherson and Fergus Mckiddie.
6 / Minute of Meeting held on 7th December 2011
The note of the meeting was accepted as an accurate record.
7 / Matters Arising
Copyright:
This remains a problem and is making journal clubs difficult.
Another key area of concern is the use of assessment tools which may have copyright. The performing Arts copyright has prevented the use of radios in ward areas.
It is unlikely the government will change the current strategy. Costs for obtaining copies of publications not readily available are being met by the Centre.
8 / Modernisation and Redesign: New Structure
Mr Graeme Smith has been appointed as Executive for Modernisation and a new staffing structure below him is being reviewed.
GS is currently undertaking a prioritisation process so there will be clarity in the organisation around what the key priorities for the future are. This is especially significant given the lack of capital funding over the next few years. There will be a requirement to disinvest in NHSG sites and review locations of existing services.
GS has enquired about involving the chairs of the advisory structure in responding to 5 questions around prioritisation. All the chairs present at the meeting agreed they would like to participate.
The ARI reconfiguration document has now been circulated and will be discussed at the next AMC.
There is anxiety amongst non-clinical staff about office space, as there will not be any offices in the ECC.
IK expressed concern at the reduction in the number of hospital beds as decanting remains a problem within ARI. Moving elderly patients around the hospital causes anxiety for the patients and their families. It is also wasteful of resource as beds have to be cleaned thoroughly every time a patient is moved.
Nursing staff find this difficult and it can be challenging to support the management of a clinical condition you are not familiar with.
IK stated that ward 30, an Ophthalmology ward is not a suitable location to decant medical patients into.
It was also highlighted that meeting the standards around care older people in acute care are almost impossible when patients are moved around. A key part of looking after the frail elderly is establishing a relationship.
Moving patients also causes distress and confusion amongst relatives.
ES suggested that she shared a couple of reports with ACF: the Annual report for Adult Protection and the minutes of the Clinical Governance Committee.
Mrs Smith left the meeting.
Detect Cancer Early
Public Health is leading on this agenda. The paper prepare by Dr William Moore was tabled. The Heat target for 2014/15 is to have a 25% increase in the proportion of cancer diagnosis and treatment during stage 1 of the disease.
There is a need to agree clinically how to achieve this. NHSG will take an MCN approach and working groups have been set up to review care pathways and develop the CGI to ensure appropriate referrals and access for patients.
There is no doubt there will be a financial challenge in order to ensure enough diagnostics are available.
Management of Waiting Times
The use of the unavailable code has been discussed at AMC and there were concerns that secretaries are being asked to contact patients 4 weeks after an appointment with a consultant has been made when it is anticipated that the waiting times will be exceeded.
Patients are being asked if they can’t be seen within a specific period of time, “are they willing to go elsewhere”. It was suggested that 70% of Max Fax patients are being asked to go elsewhere.
Dr Khan was concerned about the use of the “unavailable code”. However it was confirmed that management of waiting times within NHS was being done in line with current Government guidance.
Medical Records
Concerns have been raised about the quality of the immediate discharge letter (IDL). Dr Khan would be keen for an audit to be undertaken to check the accuracy of these letters. There are concerns as it is not clear whether the letters have been checked by a consultant or not before being sent to the GPs. The key issue is the variation across departments, meaning the GPs could not be certain if the IDL had been checked or not.
9 / Current Issues from the Advisory Committees:-
9.1AHPC
Consultation on the National Delivery plan for AHPs currently underway.
AHP redesign is progressing to the next phase looking at the uni-professional management/ leadership arrangements within sectors and across the organization as a whole. Timescales to complete this next phase are challenging but there is a desire to progress this work as quickly as possible as the AHP redesign process to date has taken a considerable length of time.
9.2 AOC
No report.
9.3 APC
The Pharmaceutical Care Service Plan for NHSG is almost ready for consultation and will be circulated to the ACF for comment.
9.4 GANMAC
The Committee was keen to develop a work plan as was suggested for the ACF. LJ agreed to finalise a plan for the coming year and share with the Committee. The members of GANMAC are going to use a prompt sheet in order to engage with their constituents and support development of nursing services.
9.5 Healthcare Science Forum
No report
9.6 AMC
Main items were raised on the agenda
9.6.1GP Sub-Committee
The issue around the shortage of child protection training is being resolved; however there are clearly not enough trainers across NHSG to support the ongoing training requirement of the GP workforce.
9.6.2Consultants’ Sub-Committee
No report.
10 / Chair’s Report
National Chairs meeting in Edinburgh is next week. Minutes of the previous meeting in December will be circulated.
11 / ACF Letter to the Board
Copies of the letter dated February had been circulated previously with the agenda.
12 / Other Competent Business
It was suggested that Graeme Smith attended the next ACF. Jillian Evans has already been invited to feedback on the in-patient bed audit. It was felt that there was overlap and appropriate to have both attend the ACF.
13 / Date of Next Meeting
25 April 2012 at 6.00 pm in the Conference Room, Summerfield House
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