MANAGED CLINICAL NETWORK

FOR DIABETES

Lead Clinician Diabetes – Dr Andrew Gallagher

Diabetes MCN Co-ordinator – Carsten Mandt

Diabetes MCN Steering Group

Minutes

Monday 12th March 2012, 4pm

Conference Room 2.16A, Victoria ACH

Present

Anne Cochrane / Primary Care Support Nurse
Ian Donald / Patient Representative
Dorothy Farquharson / Patient Representative
Andrew Gallagher / MCN Lead Clinician (Chair)
Helen Jack / Dietetic Manager
Brian Kennon / Consultant
Carsten Mandt / MCN Co-ordinator (minutes)
Fraser MacLeod / MCN Primary Care Lead
George Marshall / Patient Representative
Heather Maxwell / DSN, Gartnavel
Cath McFarlane / General Manager
Lindsay McKechnie / Specialist Dietician
Barbara Ann McKee / Community DSN
Yvonne Neilson / Health Improvement
Kenneth Robertson / Consultant Paediatrician
Alison Stewart / Consultant
Sheila Tennant / Prescribing Support Pharmacist

Apologies

Mary Cawley / Clinical Psychologist
Bernadette Campbell / Primary Care Support Nurse
Carl Fenelon / Clinical Pharmacist
Stephen Gallacher / Consultant
Alan Hutchison / Consultant Clinical Biochemist
Michele Mackintosh / Dietetic Manager
Eleanor McColl / Service Delivery Manager, HIT
Alan McGinley / Diabetes UK
David McGrane / Consultant
Colin Perry / Consultant
Karen Ross / Planning Manager
David Sawers / Service Manager, DRS
Anne Scoular / Public Health Consultant
Mike Small / Consultant, Gartnavel General
1.  / Welcome and Apologies
Apologies were accepted from those noted above.
2.  / Minutes from Previous Meeting
These were agreed as an accurate record.
3.  / Matters Arising
ID enquired if there had been an update on the evaluation report for the My Diabetes My Way pilot. AG confirmed that a report had not yet been published.
4.  / Group Updates
Audit: Due to the last meeting being cancelled there was no update for this group.
Ethnicity and Inequalities: CM provided an update, highlighting that the group is carrying out a baseline audit of inequalities data from the LES. Based on this audit they will then review the work plan and focus on the key priorities that the data analysis has highlighted.
YN raised that the group is also looking at the potential use of decision aids to support patient education through the identification of key messages, with a view to piloting this in one area or one discipline.
BK mentioned that there is a need to develop a standardised programme of patient education on foot care. BK and YN will liaise to look at foot care education as a possible pilot.
Inpatient: AG pointed out that there has been good progress with the Think Glucose pilot although there are concerns over staffing at the Victoria to support the pilot there.
He mentioned that work is ongoing to agree a local amendment to the DKA protocol to make it more flexible and fit for the GGC context. This is led by Colin Perry and David McGrane.
The inpatient group is also progressing work on a hypoglycaemia protocol, along with an e-learning package.
A Safer Use of Insulin e-learning package has been made available nationally. BMcK suggested that insulin management training should be mandatory given the high level of insulin errors. She pointed out patient safety work that Clinical Governance are taking forward to address insulin errors ,which could provide an opportunity to get mandatory insulin management training rolled out. AG and CM will liaise with Clinical Governance to look at the possibility of mandatory insulin management training for doctors and nurses.
IT: AG pointed out that implementing SCI-Diabetes before the summer will not be practical due to SCI-DC’s revised development timescales. He added that implementation plans are being developed and project management support is being looked for a GGC-wide implementation of the new system.
BK asked that if there is a delay with SCI-Diabetes the MCN should reiterate the need to secondary care colleagues to use SCI-DC Network in the interim to record foot screening information and improve foot risk stratification rates for Type 1 patients. This was agreed. CM will raise this in the next MCN Key Messages.
Patient Education: CM informed the group that the new T1DM and T2DM patient education groups have now been convened.
BK pointed out that the work of the T1DM group needs to take into account the provision of structured education for the prospective pumps patients that are suggested in CEL 4 (2012).
PFPI: ID mentioned that there was a need to develop a more focused work programme for the PFPI group and engage a wider group of patients and carers. To this end, it has been proposed to identify 4 topics from the MCN work plan that would be appropriate for more focused patient and carer input and then hold an event for members from the wider HSD Forum to discuss how patients can become involved in progressing these topics and engage new patients and carers. Currently two topics have been suggested: patient education and inpatient care. ID invited suggestions from the group for two further topics.
Primary / Secondary Care Interface: FM informed the group that following Anne Scoular’s nursing home needs assessment discussions are ongoing with the nursing home practice to identify who is best placed to address the key gaps in the current provision of diabetes care in nursing homes.
BK pointed out that there is a significant challenge around identifying nursing home patients in the first place to then ensure that they receive appropriate care.
FM also highlighted work to develop a standardised process for the initiation of GLP-1s in the community. This work does not include producing guidance when a GLP-1 is appropriate or which GLP-1 should be chosen as this is covered in the revised diabetes management guidelines. ST flagged up the issue of reviewing patients on a GLP-1 to assess its effectiveness. This has also been addressed in the revised guidelines.
Scottish Diabetes Group: AG mentioned that there had been further discussion at the SDG to add pumps and consumables to the drug tariff. No decision has been taken yet. / YN
AG / CM
CM
All
5.  / Transitional Care
ASt informed the group about changes regarding transitional care arrangements. The paper that had been tabled describes the situation as it has been over the past year when joint transitional care clinics were in operation at all adult diabetes centres with input from paediatrics. However, since then suitable space has been identified at Yorkhill. It is therefore proposed that in future transitional care clinics will be run at Yorkhill, with input from adult services. KRob added that Christine Gallacher is in the process of drafting a paper outlining the new model.
Ongoing issues regarding the treatment of DKA in the under 16s were also discussed. KRob highlighted the importance of ensuring that for any patients under 16 who present at adult A&E with DKA paediatrics are consulted before any action is taken. He is in the process of writing to all A&E consultants to get agreement to change working practices accordingly.
6.  / Foot Care
BK highlighted the key challenge of meeting the national 80% target for patients having a foot risk score recorded on SCI-DC Network. He presented a draft outline of an expectation of care for diabetes foot care. The proposal is that as of 1st April 2012, specialist podiatrists will focus on educating and upskilling non-podiatrists to take on the screening and risk stratification of low risk patients. The expectation is that the risk stratification will be carried out via SCI-DC Network, which provides consistent, automated risk scoring. As of 1st October 2012, specialist podiatrists will then no longer carry out any foot screening of low risk patients and focus on higher risk patients and those with active foot risk. He asked that the group review the draft document and feed back any concerns or comments by 23rd March. This was agreed.
FM pointed out that there had been a perception in primary care that the proposal was equivalent to a withdrawal of podiatry resource as some GPs feel that moving away from the previous “one- stop shop” model diminishes the service offered to patients. However, it is clear that rising patient numbers render the continuation of the “one-stop shop” model impractical.
The group agreed that the model of care document should be disseminated via CHCP Directors and Clinical Directors.
YN asked what information was available for patients to highlight the planned changes. BK replied that currently no patient information was available.
FM suggested that Practice Nurses will advise patients directly on the changes. As such it may be useful to have something available in the LES screens that could easily be printed off. BK will produce a patient leaflet.
BK also highlighted that there was an opportunity for the foot group to work with the Ethnicity and Inequalities group to improve the provision of foot care to vulnerable at-risk groups of patients, e.g. patients in nursing homes. / All
BK
7.  / Patient Information Audit
YN updated the group on progress with collating written patient information along the diabetes patient pathway. Most of the information resources have now been collated. The next step is to arrange a meeting with representatives of all stakeholder groups to identify what is core information to put the agreed core information forward for quality assurance. YN proposed taking this forward via the patient education groups.
BK highlighted the importance of not producing leaflets where national leaflets already exist. AG queried if national leaflets would need to be reviewed at all as they should be quality assured at national level. YN replied that national leaflets should be looked at so that any amendments that are required to meet accessible information standards can be flagged up nationally.
8.  / Dietetics Redesign
The group agreed that any further work on dietetics redesign needs to be taken forward in the context of meeting the demands of CEL 4 (2012) for increased pumps provision. Please see discussion under agenda item 9.
9.  / Pumps CEL 4 (2012)
The group agreed that the targets set in the CEL will be very challenging to meet and the implementation of the CEL is likely to have a significant impact on secondary care diabetes services as a whole. There was agreement that the suggested costs for patient education and staffing in the CEL were underestimates.
HM raised that the previous pumps business case described clearly what level of dietetic and nursing input was required to increase pump provision. CMcF mentioned that she will meet with CM and KR to review the existing business case.
AG pointed out that Catriona Renfrew, Director of Corporate Planning and Policy, is in the process of setting up a planning group to formulate a GGC response to the CEL. She has asked for MCN representation to go on this group. KRob expressed concerns that this group has not yet been convened, in particular as timescales for feeding back to the Scottish Government are very short. AG will contact Catriona Renfrew for an update.
BK raised concerns that the Scottish Government may be selective in how the funding for pumps in 2012/13 is allocated, based on Health Boards submitting credible action plans in response to the CEL. He suggested that it will be beneficial to focus on paediatrics in year one to allow time for staff in adult services to be upskilled to support pump starts. Given financial constraints it may be likely that all staff will have to be upskilled a level to free up experienced DSN time to take on pump initiation.
HM queried if there may be scope to involve community DSNs in this. BMcK suggested that this could be looked at although the existing workload of community DSNs is already very challenging. / AG
10.  / AOCB
None.
11.  / Dates of Future Meetings
11/06/2012, 4pm, Gartnavel General, Board Room
10/09/2012, 4pm, Victoria ACH, Conference Room 2.16A,
10/12/2012, 4pm, Gartnavel General, Board Room

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