NHS GRAMPIAN

Minute of Meeting of the Area Clinical Forum held

on Wednesday 30 June 2010 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 Malcolm McPherson, Chair, Area Optometric Committee

Mrs Lynn Morrison, Chair, Allied Health Professions Committee

Mrs Jenny Tait, Chair, Healthcare Science Forum

By Invitation

Mrs Elinor Smith, Director of Nursing

In Attendance

Mrs Rosie Gauld, Administrator to the Professional Advisory Committees

No / Issue / Action /
1 / Chair’s Welcome
Dr Reid welcomed everyone to the meeting. /
2 / Apologies
Apologies noted from Dr David Fowler, Dr Izhar Khan, Mrs Elizabeth Squires, Mr Richard Carey, Dr Lesley Wilkie, Dr David Cameron and Dr Roelf Dijkhuizen. /
3 / Minute of Meeting held on 28 April 2010
Copies of the Minute were circulated previously with the agenda. Approved as a correct record. /
4 / Matters Arising
Nil. /
5 / Mid Staffordshire Report – ACF Response
Copies of the Committee’s SBAR response to the Clinical Governance Committee had been circulated previously with the agenda. The report had been the focus of the Board Seminar on 25 June 2010. /
/ Mrs Smith reported that discussion had been led by Helen Robbins and Linda Oldroyd, generally around pockets where there was need for vigilance. As the Mid Staffordshire Report was focussed on nursing, Mrs Smith was keen to participate in ‘Back to the Floor’, along with the Clinical Nurse Managers. It was agreed that there was work to do regarding patient feedback, talking to patients etc. From a Board perspective, the Clinical Governance Committee received feedback about complaints, but there was a need to feed into the local management structures. There was also a clinical governance risk management form which shared a lot of experience, but this was not as comprehensive as it might be. The Organisational Development Manager was particularly interested in meeting the Committee. /
/ It was noted that the Datix system was in place to record incidents, complaints and adverse events, but this was not used in primary care. There were processes in place for sharing learning, eg the Director of Nursing signed off complaints in the absence of the Chief Executive which enabled her to know what was happening across the system. There was a need to use formal and informal networks. /
6 / CEL 16 (2010) – Area Clinical Forums
Discussion took place on this paper, copies of which had been circulated previously with the agenda. Dr Reid asked for the Committee’s thoughts and input to enable him to form a paper for the next Board Seminar. He stated that the CEL had been produced following a review of the ACF Chairs undertaken a few years ago. /
/ General discussion followed. Mrs Juroszek advised that it was difficult to get support for the Committee and the second bullet point under No 3 was highlighted, ie “arrangements for meetings ...... should recognise the need to ensure clinical professionals have the necessary time and support to make a full contribution to the work of the NHS Board.” One of the issues was the recognition that having the commitment to support the committee required finance and that an active committee required funding. /
/ Mr McPherson was of the opinion that, although it was an advisory committee to the Board, there was not much direction given as to what the Committee should be doing or producing. He was unsure whether the group should be involved in developing strategy or changing working practices. It was intimated that the role was to give advice on changing practices then advise the Board of that with a view to getting their approval. /
/ In the past there has been an executive link to the advisory structure but there was a suggestion that there should be “Executive Director sponsorship of each professional advisory committee to lend support to the work of the ACF.” /
/ Mrs Smith thought it was a useful paper in terms of reflecting on how things were done and for having the opportunity to make improvements. /
/ The Committee: had to be fit for purpose; members given the necessary time to attend; opportunities to participate, and to link with CHPs. There was mention in the paper that the effectiveness of the ACF and professional advisory arrangements were supported by ensuring the length of the appointment of the ACF chairs offers sufficient opportunity to develop and deliver a strategic work programme. This was seen as an important matter, along with trying to improve the communication strategy and supporting the work of the ACF. If it was about strategic direction, the people making the decisions should be attending meetings to advise what was required of them. There was also the question as to how the Board regarded the ACF. /
/ With regard to the composition of ACFs as set out in Annex A of the paper, Dr Reid advised that the Dental Committee had been given the opportunity of attending. Currently there were no clinical psychologists involved and it was felt that it would be a good idea to include them. /
/ Dr Reid thanked everyone for their input and he would prepare a paper for discussion at the Board Seminar. / JR /
7 / The Healthcare Quality Strategy for NHSScotland
Dr Reid wondered what the ACF could do to implement the strategy. Mrs Juroszek intimated that from a pharmacy point of view they were embracing the new contract and supporting the whole essence of shifting the balance of care. It was also about improving ways of working. It was important to consider the patients and to get the best treatment and cost-effective treatment. /
/ Mrs Smith, as the lead Director for this, intimated that she would like the ACF to really champion the strategy. The ACF and constituent bodies had a lot to contribute to the patient-centred element, where things could be improved. It was suggested that it would be useful for all the advisory committees to include the Quality Strategy on their agenda for discussion. This would have to be reported on at the Annual Review. / All /
/ The Government Health Minister was still very focussed on waiting times. /
/ The issue of care support workers was raised and, from a Board point of view, it was about sharing resources with the Local Authority. It was noted that the General Managers in the City and Shire were part of the senior team which regular met with their counterparts in the Council and used that forum to look at issues. One of the ways to use the Board was through the Non-Executive Board Members – Provost Bill Howatson, Kate Dean and Lee Bell who had connections with the Local Authorities. The CHP Committee should also be working with the Council as an operational group. /
/ The Quality Strategy has to be developed in the eKSF or built into the appraisal system where consideration of the quality of care provided was an important subject. This is already included for Clinical Nurse Managers who were having discussions about how it should be implemented. /
/ It was agreed that a work programme would be a good idea and committees should consider if there were matters which the ACF should be involvdvice on. / All /
8 / Annual Review, 8 November 2010
Dr Reid reported that a venue had still to be arranged for this meeting, at which 45 minutes had been given for the session with ACF. The core agenda would provide a focus for discussion of key matters of national interest. There would also be room for discussion of purely local topics, but generic issues would be central. Four topics the Minister would wish to explore the Forum’s contribution to would include the Quality Strategy; Workforce Planning; Local efficiency savings programme; Service redesign.
Topics agreed with the Chair of the National Chairs Group were Area Clinical forum development; Developing Clinical Leadership and Keeping a Focus on patient Safety, Quality and Governance. /
/ Dr Reid asked members to consider the above issues and decide who would attend the Annual Review with him.
At this point, Dr Reid advised that he was coming to the end of his term of office at the end of August. He had discussed this with Dr David Cameron, Chairman and was now asking committee members if they would be happy for him to stay on until the end of March 2011 to permit him to lead on the Annual Review and to permit change of office to revert to the norm of 1 April.. Members present agreed that Dr Reid continue until the end of March, with an election taking place at the end of this year. / All /
9 / Current Issues from the Advisory Committees:-
9.1 AHPC
Mrs Morrison reported that there had been discussion around the SAW/SANE, linked to the AHP redesign, including having an Associate Director in post. Details had still to be thought through.
eHealth was an issue. It had been hoped to have an AHP professions IT system in place. However, the plan was now to go down the route of PMS development across NHSG. Mrs Smith felt that this was an important area to be considered. A final report had been received from Paul Allen, Head of Infrastructure. An additional community-based module was required to fit the needs of AHPs and there was a meeting of AHP representatives to identify someone to take a lead on this. It was suggested that this should be an agenda item for the eHealth Committee and Mrs Morrison would liaise with Mrs Juroszek. / LM/LJ /
/ 9.2 AOC
Mr McPherson intimated that:-
·  the AOC was grateful for the support given in implementing the Locally Enhanced Service and GP Co-prescribing. Training meetings had been held in May and June. Four conditions covered were – acute anterior uveitis; marginal keratitis; foreign body removal and herpetic keratitis. A vast majority of contractors had signed up to it. /
/ ·  There was a new access database which was easier to use. A Clinical Accord had been set up. A letter had been sent to all GP Practices explaining the new arrangements and that GPs would be asked to prescribe in collaboration with the Optometrists who have had the training. This would be done in conjunction with the Eye Department.
Rosie Gauld would ask Charlotte Ward for a copy of the LES. / RG /
/ ·  Pharmacy minor ailment scheme – not allowed to accept a referral from Optometrists. Can prescribe for conjunctivitis only.
·  PGDs which had been set up had now been abandoned because they were too costly.
·  The AOC would like to see a pilot planned for those used to the electronic database to encompass all routine referrals and get a direct referral to ophthalmology. The work that had been done in relation to emergency summaries would help a great deal. /
/ 9.3 APC
Mrs Juroszek reported the following:-
·  the final part of the CMS contract was awaited. IT was an ongoing issue and all the systems and better ways of work were increasingly depending on it. eAMS was up and running but problems continued.
·  A Community Pharmacy website was being established locally for Grampian contractors to access forms, contacts, formularies etc.
·  The government had withdrawn funding for community pharmacy clinics which were up and running, eg substance misuse clinics. /
/ 9.4 GANMAC
Dr Reid read a report which had been submitted by Mrs Squires as she was unable to attend the meeting. Issues included were:-
·  The election process would commence for a Chair of GANMAC following Fiona Mackenzie’s secondment to the Scottish Government;
·  There were still some newly qualified nurses to place and a review as ongoing;
·  A representative from the Care Home sector now regularly attended GANMAC;
·  SAW meetings/workshops had been held to review ways of working and look at a stop, start continuum;
·  SANE peer reviews continue and final models were being worked up in some areas which would result in a different establishment, skill mix and links with the SAW work which was being progressed.
·  Patient Safety Walkrounds had now been implemented in community hospitals, the first of which had been undertaken at Inverurie and Kincardine. These would be reviewed and the model progressed to all areas.
·  The majority of staff had misinterpreted the request for those interested in voluntary severance. They had not realised that funding had not been approved which had caused much anger and disappointment. Clinical managers had taken considerable time with staff to complete the paperwork and review establishments to see how they could reduce these and support the organisation in making savings. There was also the added worry that those who had expressed an interest would now be targeted. However, Dr Reid stated that Gordon Stephen, Employee Director and Chair of GAPF had given an assurance that this would not happen.
·  A potential patient safety issue had been identified by the Shire Patient Safety Group. The new Drug Kardices were now in use in some areas. However, some patients were arriving as transfers with the Drug Kardices, others were being photocopied and as they had several pages, not all named, this was deemed high risk. In some cases they were retained and a discharge summary was sent but there was then no evidence as to when the patient had last received medication. The same applied for the Patient Admission Record. /
/ Clinical Effectiveness had audited what documents were transferred with patients and this was variable and inconsistent. There was also debate about ownership and where these should be filed and traced. It was felt that as more areas started to use the new documents, the problem would escalate. They believed that there should be a Grampian-wide standard for all patient documentation and if the Patient Admission Record and Drug Kardex were intended to follow the patient, that needed to be implemented, as did the return or archiving of these records. The Patient Safety Group was raising this with Clinical Governance and felt it may be worthy of inclusion as a risk factor in the letter to the Board.