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MINUTE of MEETING of the HIGHLAND AREA MEDICAL COMMITTEE
Board Room, Assynt House, Inverness /Tuesday 28 January2014 - 2.00 pm
Present:Dr Miles Mack, Chair
Dr Jonathan Ball
Mr Quentin Cox
Dr Jason Davies (videoconference)
Dr Duncan Gray
Dr Iain Kennedy
Ms Sarah Prince (videoconference)
Dr Claire Robertson
Dr Chris Williams
Dr Susan Hussey Wilson
In Attendance:Mr Gavin Hookway, Senior Quality Improvement Practitioner (Item 1)
Dr Ken Proctor, Associate Medical Director (Primary Care)
Miss Irene Robertson, Board Committee Administrator
Apologies - Dr Ian Bashford, Dr Margaret Somerville and Dr Emma Watson
1RAPID PROCESS IMPROVEMENT WORKSHOPS
The Chair welcomed Gavin Hookway, Senior Quality Improvement Practitioner who outlined the Rapid Process Improvement Workshop (RPIW) process, explaining that it was a rigorous five day event aimed at eliminating waste and improving flow through redesign of inefficient processes. There are three phases – (1) planning and preparation; (2) the workshop itself during which ideas are tested and rapid changes made; and (3) the follow up to sustain and make continuous improvements. The process had focussed on secondary care but was now being rolled out to primary care. The need to look at the whole picture and how all the elements in primary and secondary care are interlinked was acknowledged. There was a potential role for the Area Medical Committee, which brought together primary and secondary care, to identify areas for improvement and issues to be addressed. There were challenges in terms of capacity and cost in getting clinicians, as well as other health professionals, involved in the process. Concern was expressed about unintended consequences for other areas, hence the importance of having the right people on the workshop teams. As the workshops progress and the impact on other areas is identified the process can be further developed. The workshops undertaken to date had focussed on specific processes. A query was raised as to whether a template might be developed to track a patient through their entire journey of care starting with the initial GP consultation. This was perhaps something that could be explored, however the RPIWs were identifying certain issues; addressing these and removing waste would improve quality of care and services.
Mr Hookway went on to explain how people can get involved in the process by submitting a charter to the HQA Group for consideration, and he encouraged members to approach him if there were any difficulties in formulating a charter. It was agreed to include the HQA as a standing item on the agenda. The Committee would also continue to submit SBARs to the HQA Group as a means of identifying issues and snags and providing feedback to the organisation. One issue the Committee wished to highlight was the Patient Focussed Booking system about which a number of concerns had been expressed by both primary and secondary care colleagues. As a first step it was agreed the Chair, in collaboration with Mr Cox and Dr Kennedy, would formulate a letter to senior management conveying the concerns expressed along with the Committee’s view that the system was not fit for purpose in ensuring patient centred care.
On behalf of the Committee the Chair thanked Mr Hookway for his informative and helpful presentation and his contribution to the discussion.
The Committee:- Noted the presentation and the opportunities for involvement in the RPIW process.
- Agreed that a letter be sent to senior management conveying the concerns raised regarding the Patient Focussed Booking system.
2MINUTE OF MEETING HELD ON 26 NOVEMBER2013
The minute of meeting held on 26 November 2013 was Approved.
The Chair updated on the following matters:
Protocol for non-response to initial letters of appointment - the Chair confirmed he and Dr Williams would get together to discuss the amendments suggested at the last meeting and agree a form of wording.
Use of locum consultants for waiting list initiatives - the Chair had notified Linda Kirkland, Interim Director of Operations, RaigmoreHospital of the concerns previously raised by the Committee.
Brand name / generic prescribing - the Committee was advised this issue had been discussed by the Area Drug and Therapeutics Committee and Pharmacy colleagues would be taking it forward with the Department of Ophthalmology.
Requests for influenza vaccination - this issue had been followed up by the GP Sub Committee.
3MATTERS ARISING
3.1Committee Membership
Nominations had been sought for the vacancy arising from Dr Neil Arnott’s resignation. It was confirmed Dr Neil Wright, Craig Nevis Surgery, FortWilliamwould replace Dr Arnott.
The CommitteeNoted Dr Neil Wright would replace Dr Neil Arnott.4FOLLOW UP ON SBARs PREVIOUSLY CONSIDERED
4.1Priority Access for Veterans
It was agreed to defer this item to the next meeting which Stephanie Adlinton, Service Improvement Manager, Raigmore Hospital would be attending to update the Committee on a range of issues.
4.2Waiting Times for Radiological Investigations and Reporting Delays
The Committee agreed to forward the SBAR submitted by Dr Catherine Higgott to Gavin Hookway as a potential issue for consideration by the HQA Group. A copy of the report out of the RPIW undertaken on the Radiology service would be circulated to the Committee members.
4.3Requests for work from GPs outwith GMS
The Chair referred to the circulated SBARs from Dr Janet Nicoll, GP, Brora & Helmsdale regarding requests from secondary care colleagues to undertake a range of work including pre-operative assessments and blood tests without prior discussion and agreement, and the impact on GP workload and resources. Dr Nicoll also felt that the increased trend in patients being followed up by nurse practitioners by telephone was adding to the expectation that blood tests would be done by the primary care team. She suggested a possible solution might bethe establishment of a servicefunded and delivered by secondary care at multiple locations across Highland, for example in GP surgeries. It was felt that while some practices may be interested in such an arrangement it would not be attractive to smaller practices.
Also circulated was a letter issued byNHS Lothian’s Divisional Medical Director to consultant colleagues regarding communication between primary and secondary care. Firstly where patients are advised test results will be available through their GP when secondary care have initiated the investigation. The letter made clear thatthe clinician initiating the investigation was responsible for notifying and actioning the results. A second point raised in the letter related to information contained within Intermediate and Final Discharge Letters requesting GPs to undertake follow up actions without prior discussion and agreement. There was also circulated a letter from a GP in the Lothian areato a secondary care colleague declining a request to follow up an investigation initiated in secondary care. It was agreed to copy the Divisional Medical Director’s letter to Dr Roderick Harvey, Associate Medical Director, RaigmoreHospital and ask him to consider issuing a similar letter to secondary care colleagues in North Highland which the Chair would co-sign if required. The position in Argyll & Bute CHP was more complex because of its relationship with NHS Greater Glasgow & Clyde.
4.3Out of area referrals
The Chair reminded the Committee of an issue raised by Dr Neil Arnott regarding patients being referred out of area for surgery and subsequently not being operated on because of the high level of risk involved to the patient’s safety. Dr Arnott highlighted the need for communication between the referring surgeon and the operating surgeon both before and after operation to improve continuity and patient safety, stressing that the decision to refer out of area had to be a clinical decision, based on robust and accessible pre-operative assessment. Equally important was ensuring the patient was informed as to the likelihood of the operation being carried out and being given an explanation as to why an operation is cancelled. It was noted there had been some improvement in the position.
4.4Non-response to offers of an initial appointment
This would be discussed at the next meeting.
Noting the updates, the Committee Agreed the further actions to be taken.5THE FRANCIS REPORT
At the last meeting of the Area Clinical Forum on 28 November 2013 it was agreed that a response to the Francis Report be requested from all the Professional Advisory Committees for collation and presentation to the Board as a completed document from the Forum. A set of questions had been circulated to assist the Committee in compiling its response. Discussion followed during which a number of issues were raised, in particular the important role of rural general hospitals and their sustainability. Noting the views expressed the Chair proposed to draft a response which he would circulate to the members for comment and agreement.
The Committee Agreed that the Chair would prepare a draft response for the members’ consideration.6ELECTRONIC CORRESPONDENCE TO PATIENTS VIA EMAIL
The GP Sub Committee’s representative on the eHealth Strategy Group had notified it of a proposal put forward at a meeting of the Group on 31 October 2013 that all clinical letters should be sent to patients by right and that a trial be initiated of sending patients copies of letters by email. The GP Sub Committee had raised a number of issues which would require to be addressed before any changes in practice could be implemented and had agreed to refer the proposal to the Area Medical Committee. It was noted that a formal proposal was to be submitted to the GP Sub Committee in due course for consideration.
Members agreed that while standard working was desirable to avoid confusion and ensure consistency of practice, there was need for flexibility within the system to take account of patients’ requirements and how they would like to receive correspondence. The Committee also had reservations about all clinical letters being copied to patientsgiven the purpose of these letters, who they are intended for and the specific language and terminologythat may be used within themto communicate particular points.
The Committee Agreed that further information was required to enable informed discussion to take place and would await receipt of the formal proposal.7PATIENT FOCUSSED BOOKING
Covered under item 1.
8PHYSIOTHERAPY POST-KNEE REPLACEMENT SURGERY
The Committee considered the SBAR submitted by Dr Catherine Higgott in relation to knee replacement surgery with rapid discharge. Some patients had expressed concern about carrying out the post-surgery exercise regime correctly. Dr Higgott suggested a domiciliary physiotherapy visit one week post-discharge would provide the necessary reassurance for those patients who had concerns. The Committee suggested that the issue raised and the recommendation be referred to the Head of Orthopaedic Services for consideration.
The Committee Agreed to refer the SBAR to Mr Andrew Kent, Head of Orthopaedic Services for consideration.9REMOTE AND RURAL ISSUES
As agreed at the last meeting this was now a standing item on the agenda. The issue of sustainability of community and rural general hospitals was highlighted.
10AREA CLINICAL FORUM
10.1Area Clinical Forum (ACF) Development Plan
There was circulated the ACF’s Development Plan for 2013 – 14. The Committee noted the actions identified for the Forum’s constituent professional advisory committees and their chairs; these included identifying and escalating matters of clinical and strategic concern to the Board through the ACF. It was also suggested that the advisory committee chairs attend a meeting of one or more of the other advisory committees to promote good working relationships and gain an insight into the issues and challenges facing the different health professional groups.
10.2Agenda for meeting to be held on 30 January 2014
The Committee noted the circulated agenda. Two presentations were planned – one on the Director of Public Health’s Annual Report and the other relating to Health Psychology in NHS Highland. Clinical representation was being sought from the ACF for the Health Promoting Health Service Network.
The Committee:- Notedthe Area Clinical Forum’s Development Plan 2013 – 14 and the actions and recommendations arising therefrom.
- Noted the topics for discussion at the meeting of the Forum to be held on 30 January 2014.
11HIGHLAND HEALTH AND SOCIAL CARE COMMITTEE
The Committee received the report of the meeting held on 9 January 2014. Topics discussed included the following:
- It was intended to Webcast future meetings.
- Possible major service redesign across Badenoch & Strathspey and Skye, Lochalsh & Wester Ross.
- Care Homes – quality of care; notification of closures.
- Police Scotland - Custodial and Forensic Services: these services will be transferred to NHS Highland in April 2014. A risk has been identified in relation to the resource allocated to NHS Highland to deliver the service. Dr Proctor will update the Committee as required.
The CommitteeNotedthe report.
12CLINICAL ADVISORY GROUP
There was circulated for information the draft minute of meeting held on 5 December 2013. It was noted a consultant vacancy would shortly arise on the Group and expressions of interest were invited from the consultant members of the Committee to fill this position.
The CommitteeNotedthe draft minute. Members interested in joining the Clinical Advisory Group to contact Dr Margaret Somerville, Director of Public Health.13GP SUB COMMITTEE REPORT
(a)Reportof Meeting held on 10 December 2013
Dr Ball summarised the topics discussed:
- Presentation by Dr Anne Pollock, Clinical Lead, Area Blood Sciences Service, NHS Highland on the accreditation of blood sciences services and implications for service users following a recent assessment.
- Presentation by Katherine Sutton, Associate Director, AHPs regarding the national AHP Musculoskeletal redesign programme and its implementation within Highland.
- Care Homes – standards of care, suspended admissions.
- Scottish Patient Safety Programme in general practice.
- Prescription for Excellence and potential significant impact on general practice.
The Committee Noted the report.
14ANY OTHER COMPETENT BUSINESS
14.1NHS Highland Policy for Obtaining Consent for Clinical Procedures and Healthcare Interventions
This Policy was currently being updated by the Clinical Governance Support Team. As part of this work a revised consent form had been prepared on which the Team would welcome the Committee’s comments. The Committee agreed to seek clarification as to how widely the consent form had been distributed for consultation to ensure input from all relevant clinicians, specialties etc. The Committee suggested the form would require to be circulated to general practices as well, a number of which undertook minor surgical procedures, while noting the form was not suitable for this particular purpose. During a brief discussion of the form the need for the reference to CJD was queried. It was also suggested that in the section relating to additional procedures there should be separate boxes for the two options.
The Committee Agreed to seek clarification with regard to the distribution of the consent form to ensure all relevant parties had an opportunity to comment on its appropriateness.
15DATE OF NEXT MEETING
The next meeting will be held on Tuesday 25 March 2014 at 2.00pm in the Board Room, Assynt House,Inverness.
The meeting closed at 5.20pm
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