NHS GRAMPIAN
Minute of Meeting of the Area Clinical Forum held
on Wednesday 31 August 2011 at 6.00pm
in the Conference Room, Summerfield House
Present
Mrs Linda Juroszek, Chair/Chair, Area Pharmaceutical Committee
Mr Malcolm McPherson, Chair, Area Optometric Committee
Mrs Lynn Morrison, Chair, Allied Health Professions
Mrs Jane Ormerod, Chair, GANMAC
Dr John Reid, Chair/Chair, Area Medical Committee
Mrs Jennie Tait, Chair, Area Healthcare Science Forum
Dr Izhar Khan, Chair, Consultants’ Sub-Committee
By Invitation
Mrs Elinor Smith, Director of Nursing and Quality
Attending
Dr Emily Burt, Public Health Registrar
Mr David Pfleger, Director of Pharmacy and Medicines (Item 2 only)
Mr Graeme Smith, Head of Service Development (Item 3 only)
Mrs Rosie Gauld, Administrator to the Professional Advisory Committees
No / Issue / Action /1 / Chair’s Welcome
Mrs Juroszek welcomed everyone to the meeting. /
2 / Grampian Medicines Management Workplan
Introductions were made round the table to David Pfleger.
Mr Pfleger gave an overview of the Workplan and explained that there were 47 individual work streams spread across key theme areas, eg efficiencies, waste, disinvestment. The following work streams were highlighted:-
i) medicines management support systems, eg Scriptswitch
ii) drug budget prediction for pharmacists and prescribers for the following year, assisted by internal auditors
iii) policy work around decision-making in off licence drugs and label, eg Copain
iv) prescribing reinvestment scheme to allow prescribers in primary care hit the efficiency target of 3%. Savings above that would be shared between NHSG and the CHPs. Actively looking at how to pilot that in secondary care /
/ v) efficiencies – normal logic switches; PPIs; diabetes type 2; banding of dosing; respiratory MCN and nutrition
vi) procurement – implementation of national contracts
vii) disinvestment – work undertaken around stopping supply from pharmacy; homeopathy.
It was noted that £120billion was spent on medicines per annum. /
/ Mr Pfleger would e-mail the workplan to Rosie Gauld for circulation. He asked the ACF members to look at the themes and consider what they required for next year’s Workplan. /
/ Mrs Smith queried whether enough was being done around tissue viability in terms of effectiveness and efficiency. Mr Pfleger replied positively and indicated that it was proposed to get staff more aware. /
/ Mrs Smith also indicated that she had been contacted by the Aberdeen Drugs Action Group regarding Support Workers and the use of Naxolone. Mr Pfleger reported that Naxolone had just been launched and supplies were provided through Aberdeen Drugs Action and a third sector provider. Queries should be directed to the Substance Misuse Pharmacist. /
/ The use of homeopathy was being questioned in terms of efficiency and professional views were being sought whether or not its use should be supported, and seek a response from the Board. /
/ Mr McPherson indicated that optometrists had two concerns. Firstly, regarding access to service and secondly, supply of medicine particularly at weekends. GPs were very supportive but still a “long winded” process for patients. Mr Pfleger stated that he and Linda Harper were doing work around independent prescribing. Currently there was no NHSG strategy for independent prescribers. /
/ Mr Pfleger then left the meeting. /
3 / Health and Care Framework
Graeme Smith was welcomed to the meeting and tabled two papers –
1) Health and Care Framework – Overview
2) Summary Information for the AIG meeting on 29 August 2011 /
/ Mr Smith highlighted two of the main elements of the Framework are the Decision Making Framework and Health System Descriptions. These Descriptions would take the lead from the NHS Grampian 2020 strategy and summarise how the elements of the health system should work. Mr Smith drew attention to the issue of 24-hour inpatient care and what that should be for NHS Grampian. A number of issues had been identified from the Pathfinders in Inverurie and Forres. A comprehensive audit will be undertaken across NHSG to identify how 24-hour facilities for providing care operate and to determine what the core of this might be if other services were available. /
/ Discussion then took place on the Summary Information paper which had been submitted to the Asset Investment Group on 29 August 2011. As there had been a significant change in the availability of capital funding, a radical review of the capital and asset investment plan for NHS Grampian will have to take place. /
/ Concern was expressed about the cost of replacement accommodation and decisions to disinvest will have to be made.
Mr Smith suggested that there was a need to visualise what was going to be acceptable, or not acceptable strategically in 2020. A strategic, decision-making and marketing approach was required. /
/ Mr Smith asked for the advisory structure to discuss the position and try to develop a common view. /
4 / Apologies
Jenny Gibb, Dr Chris Provan and Dr Lesley Wilkie /
5 / Minute of Meeting held on 29 June 2011
An amendment was made to Item 9.2 – AOC. The sentence should read “Mrs Juroszek had attended the meeting on 15 June 2011. During the discussion around implementation of the Health and Care Framework the possibility of optometrists undertaking retinal screening in the future was discussed.”
The Minute was then approved as a correct record. /
6 / Matters Arising
Regarding dispensing doctors and new guidelines around the Pharmacy Practices Committee, it was noted that a group had been formally constituted from the LMC and were meeting on 21 December 2011. Dr Reid felt that the AMC should also be involved.
Mrs Juroszek would ask David Pfleger to contact Dr Reid. / LJ /
/ 6.1 ACF Work Plan 2011-2012 – Draft
Mrs Juroszek stated that this was a live document for members/advisory committees to feed into and comment on. Although the ACF was not an operational group, but needed to be aware of work ongoing and what was required in terms of advice and working differently. Mrs Smith commended Mrs Juroszek on her paper and suggested that the Clinical Governance and Risk Management Unit might be able to assist further. /
/ 6.2 AOC – Diabetes Retinal Screening
It was noted that the Scottish Government had allocated funding to Optometrists to buy cameras which were compliant with the current screening. The electronic referral system would be developed which would allow Optometrists to gain access to SCI-DC to view images taken by retinal screening and know when patients last attended. /
7 / Annual Review – 1 November 2011
Copies of an Outline Agenda and arrangements for the day were tabled. This year the ACF and GAPF have to have a joint meeting instead of separate meetings as in previous years. The allocated time has been reduced to one hour. It was noted that the over-arching theme of the Annual Review was how Boards were placed to deliver the six Quality Outcomes. /
/ Mrs Juroszek was meeting with GAPF to discuss the format of the meeting. It was noted that it would be worthwhile having a balanced number of members of each group in attendance. Mrs Ormerod intimated that there was Staff Side representation on GANMAC and discussions around quality and workforce were good examples of the two working together. /
/ Mrs Juroszek would keep the group informed and would welcome support at the Annual Review from members of the ACF. /
8 / SBAR Report on the NHSG Clinical Process Documents Review Group
Copies of the paper dated 12 July 2011 by Michael Coulthard, Clinical Governance Co-ordinator had been circulated previously with the agenda. Mrs Ormerod advised that she Chaired the group which had been in place for some time. Its purpose was to review clinical procedures, policies and guidelines. Originally it was an Acute based group but it was proposed to roll it out Grampian-wide. /
/ The group was a virtual group which met face-to-face twice a year and consisted of two GPs, clinicians, pharmacists and a public representative and looked at all documents which were circulated through the Clinical Governance and Risk Management Unit. /
/ Mrs Ormerod was looking for comments, advice and suggestions from the advisory structure around the process and support for the wider roll-out of the document across Grampian. It was hoped that she could attend all the advisory committees. /
/ Mrs Tait explained that the Labs were CP accredited and occasionally they would ask for proof of documentation which was often out of date. There was now user information on the Intranet which was updated monthly and a draft copy kept to hand. They were signed and approved electronically. From an accreditation point of view they were getting the NHS policies quickly. /
/ Mrs Ormerod advised that there was a fast-track system and a documented timeframe. The Review Group had a range of expertise but not were not clinical experts and could not comment on clinical content. /
/ Mrs Smith stated that the Marsden Manual which outlined clinical processes was available on-line. The content was largely related to nursing but was relevant to other disciplines. She suggested that the Manual should be promoted in conjunction with the Review Group. /
/ It was noted that the ACF agreed with the principles of the paper submitted. /
9 / Mid Staffordshire NHS Foundation Trust – Follow-up Actions
Copies of a letter dated 4 August 2011 from Elinor Smith, Director of Nursing & Quality, and enclosures had been circulated previously with the agenda. She requested a written update on a number of actions which had been identified in the SBAR dated May 2010. /
/ One of the actions was related to record-keeping, and it was intimated that there was some evidence about access to documents when patients were admitted and referral letters not available. The culling of records was of particular concern as there were significant numbers of requests for GPs to provide information on past conditions, as the hospital records had been destroyed. This issue had been discussed many times but despite clinical advice, NHS Grampian had continued with the practice. /
/ The Mid Staffordshire report referred to incomplete records and no record being made. It was stated that there was guidance on how long specific records had to be kept, eg ECGs had to be kept for 12 years. /
/ Lengthy discussion took place. There were two issues – culling of records and standard of record-keeping. /
/ Mrs Smith stated that a number of groups had discussed the Mid Staffordshire Report and gave commitments that they would undertake certain actions and checks were now being made with regard to whether the actions had been carried out. /
/ Dr Reid stated that there was no clear audit to show how patient care was being affected by the culling of records, lack of notes, inappropriate notes, or treatments being affected by notes not being available. Mrs Smith suggested that discussion take place with Janet Seaton to ascertain what information was being recorded on Datix. / LJ /
/ Mrs Smith also intimated that record-keeping audits had been undertaken with support from clinical governance, based on NMC guidelines. In terms of medical record-keeping in RCH, an audit had shown elements of good practice, but improvements were needed. It was felt that the whole issue of records needed to be considered. /
/ The Chair agreed that it was still a work in progress. /
10 / Current Issues from the Advisory Committees:-
10.1 AHPC
Lynn Morrison advised the following:
· AHP redesign is ongoing
· Susan Carr had been appointed Associate Director
· A management restructure paper was being considered by the professional groups, CHPs and Sectors for feedback to Mrs Smith by the end of September
· Consideration was to be given to the eHealth Strategy in relation to the AHP Strategy. There was pressure from the Centre around data gathering for AHPs across Scotland. Meeting planned shortly. /
/ 10.2 AOC
Malcolm McPherson reported the following:
· IT was high on the agenda. There was a meeting of the national IT Integration Steering Group between Optometrists, Community and Eye Clinics in the hospital sector on 27 September 2011 in Stirling /
/ · There were now two rooms available in the Eye Clinic, equipped by NES for training. Two sessions per week for Optometrists, staffed by a Consultant.
· Arising from a meeting of the Eye Health Network the previous evening, it emerged that people were having difficulty obtaining certain medication because of short supply. /
/ 10.3 / APC
Nothing to report. /
/ 10.4 / GANMAC
Nothing further to report. /
/ 10.5 / Healthcare Science Forum
Jenny Tait reported that:-
· There was a meeting to be held on Thursday 27th October in the Boardroom, ARI from 10-12pm regarding the update of "Safe Accurate and Effective", the Scottish Government Action Plan (2007) for Healthcare Science. Dr David Stirling, the Scottish Government Chief Healthcare Scientist would be presenting his proposals with feed back from those attending. A VC connection for NHS Highland would also be available
· There were issues around workforce planning, particularly in relation to training for the smaller Healthcare Science groups.
· An AGM for the Healthcare Science Forum had been arranged for 27 October 2011" /
/ 10.6 / AMC
The meeting on 1 August 2021 had been cancelled.
10.6.1 GP Sub-Committee
Dr Reid advised that the main issues were:
· The Quality Improvement Programme.
· Premises – number of developments not happening because no funding available
· Training for child protection issues – need to expand Levels 1-3 training. No facilities for GPs to undertake Level 3 training. /
/ 10.6.2 Consultants’ Sub-Committee
Dr Khan advised that:
· The last meeting had been held in the ECC
· There was no 24-hour, 7 day a week on-call in Radiology Intervention
· A report was awaited on reconfiguration with the development of the ECC. /
/ 10.6.2.1 Monitoring of Drugs in Primary Care
Dr Khan highlighted a new drug used by Cardiologists, but not prescribed for many patients in Grampian. One of the liver function tests needed to be carried out on a weekly basis and the view of the Consultant Sub-Committee was that this was a clinical practice and was in line with the health plan ideal. If this procedure was carried out by GPs in primary care, then it would come under an enhanced service and there was a process in place for this. Mrs Tait stated that if the procedure was carried out by the primary care sector, then this would have an impact on the Labs. /
/ Mrs Juroszek suggested that there was a need for a more formalised interface to agree the way forward. In the meantime, it was Dr Khan’s intention to write to the Chair of the GP Sub-Committee. / IK /
11 / Chair’s Report
The Chair would submit a written report to all members.
The meeting then concluded at 8.15 pm and the following items noted. /
12 / ACF Letter to the Board
The letter dated 22 July 2011 was noted. /
13 / Reports /
/ 13.1 / eHealth Committee – Minute of 13 May 2011 /
/ 13.2 / Others /
14 / Minutes /
/ 14.1 / OMT – 25 May 2011
/
/ ACF Constituent Committees /
/ 14.2 / Area Medical Committee – No Minute /
/ 14.3 / Area Pharmaceutical Committee – 10 May 2011 /
/ 14.4 / Area Optometric Committee – No Minute /
/ 14.5 / Allied Health Professionals Committee – Minute 12 May 2011 /
/ 14.6 / GANMAC – Minute of 10 May 2011 /
/ 14.7 / Area Healthcare Science Forum – No Minute /
/ 14.8 / GP Sub Committee – Minute of 20 June 2011 /
/ There were no issues arising from the above Minutes. /
/ 14.9 / Consultants Sub Committee – 9 June 2011 /
15 / Items for Noting
15.1 Health Promoting Health Service: Revised programme of Activities for NHS Board
15.2 Mental Welfare Commission for Scotland Guidance – “Right To Treat?” – Delivering physical healthcare to people who lack capacity and refuse or resist treatment /
16 / Dates for Meetings of ACF in 2012
Dates were noted as follows:-
7 December 2011
29 February, 2012
25 April
27 June
29 August
31 October
5 December
All meetings arranged for 6.00 pm in the Conference Room, Summerfield House. /
17 / Other Competent Business /
18 / Date of Next Meeting - 26 October 2011 /
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