West of Scotland & Tayside Epilepsy Managed Clinical Network
Review & Work Plan 2012-2013
Caterina O’Connor Manager West of Scotland & Tayside MSN

History

The West of Scotland & Tayside Epilepsy Managed Clinical Network (MCN) was formed in 2004, following the Acute Services Review (1998) and the Introduction of MCNs in Scotland (MEL10 1999). The MCN has had a number of changing representatives and managers over this time but, by and large, the structure and itsfunction have remained constant.

As a result of staffing changes and changes in the NHS environment over the last 2-3years, we have engaged in a review of the function of the MCN. This has included canvassing opinion widely, through all professions and areas involved, as well as looking at what other MCNs currently do. Some of this information is summarised below.

Aim & Core Principles of the Epilepsy MCN

The main aim of the MCN is to bring together ‘‘…linked groups of health professionals and organisations from primary, secondary and tertiary care working together in a co-ordinated manner… to ensure equitable provision of high quality clinically effective services… [1]

The core principles governing MCNs include [2]

  • Flexibility – to meet ‘local’ needs
  • Clarity – management arrangements
  • Production of annual report
  • Defined structure
  • Clear statement of specific clinical/service improvements which patients should expect and clear policy on dissemination of info to patients
  • Truly multi-disciplinary – including patients & voluntary sector
  • Health professionals: practice in accordance with evidence base
  • Quality Assurance integral
  • Education, training and CPD
  • Audit data/open review of results
  • Better value for money

In 2002 these core principles were added to and now include clearer guidance on:

  • Patient involvement
  • Social care - began as a medical model, but has role in integrating health and social care including holistic needs of individuals suffering from a chronic condition. ‘Health professionals’ should be understood as including social work and other professions
  • Service Planning - should be an integral part of the local health plan and local health service delivery, a key task for that group will be to develop and oversee the section of the local health plan dealing with the condition or service to which the Network relates.
  • Quality Assurance programmes
  • Clinical governance[3]

National Developments & Priorities

The Scottish Government has completed its review of MCNs[4] in July 2012. It has again emphasised the importance of MCNs as a well -established approach to supporting and delivering high quality health care, that it is essential that each NHS Board fully supports and monitors the work of the MCNs in their area and that there is an ‘increasing case’ for MCNs to evolve into Managed Care Networks. The CEL highlighted the following areas as priorities for MCNs:

  • Clarity re Lead Clinician/Officer’s & Manger’s responsibilities and training provided
  • Defined structure which sets out service delivery and indicates how it relates to the planning function
  • Publically accessible Annual Report & Plan setting out responsibility, standards, quality improvements and outcomes
  • Use of documented evidence base
  • The MCN should be multi-disciplinary and multi-professional, it should cover local authority areas and there should be clarity about each members role
  • There should be a clear strategy for meaningful patient/service user and voluntary sector involvement and mechanisms for capturing views and experiences of service users and their carers
  • MCN should use education and training potential to the full
  • MCNs need to be fully integrated and embedded in NHS boards planning and operational service delivery and governance arrangements with clarity re reporting and agreed work plans and reports
  • MCNs should be fully involved in discussions re prioritisation of services
  • Regional MCNs should be endorsed by the Regional Planning Group and reviewed on a 3 yearly basis

Review of Epilepsy MCN

From September 2011 until January 2012 we have undertaken a review of participant’s views of the structure and effectiveness of the MCN. We have also utilised the results of the previous ‘Survey Monkey’ questionnaire. Outlined below are some of the main areas/issues raised by participants:

Function

  • What does the MCN actually do
  • How are priorities set & how are decisions influenced
  • How does it link with other MCNs
  • How does it link with Management structure in each of the Health Boards
  • How are budgets set and who makes decisions

Communication

  • How do stakeholders find out what is happening
  • How do stakeholders feed into MCN
  • Poor communication with and between subgroups

Geographic Areas

  • How does Ayrshire & Arran and Tayside NHSs take a full and active part in MCN
  • Is the name of MCN appropriate
  • Role and location of Manager

Groups & Sub Groups

  • Lack of organisation
  • Very time expensive and limited outputs
  • Short notice meetings & cancellations, organised at times key members unable to attend
  • Perception of ‘hidden agenda ’in some meetings Reluctance for chairs to have their place Lack of accuracy in minute taking (including selective recording)
  • Lack of transparency and continuity of membership including members being moved sub-group with no discussion/agreement

Website

  • Issues re development
  • How will it be managed/who has responsibility for the content & who can put info on it

Training

  • How is programme decided & who is it for
  • Need on-going training programme
  • Training arranged at short notice, training cancelled at short notice

Patient Involvement

  • How to engage with new service users including those from different backgrounds, ages, ethnicity etc.

Voluntary Organisations

  • How do we work together, clearer understanding of what 3rd sector can do and how it can augment services

Future Options (as suggested by those interviewed)

Regional issues

  • Relook at service provision & gaps
  • QIS meeting & monitoring standards training & audit
  • Services for older patients Epilepsy & bone health
  • Audits & agreeing data sets: impact of waiting lists/ pathways/ patients experiences/ GP Reviews/ A&E & receiving wards/ info provided to patients/ move to generic prescribing on seizure control
  • Service development & research
  • Need for positive examples of people living with epilepsy
  • SUDEP Guidance
  • Monitoring of epilepsy standards

Local issues

  • Pathways – referral to Glasgow & Quarriers (A&A & Tayside NHS)
  • E S Nurse provision & succession planning (Tayside)
  • Development of teenager transitional clinic (A&A)

Local, Regional & National MCNs

From October 2011 until January 2012 we have completed a ‘desk top’ review of 24 national, 10 regional and 8 local MCNs. We have also met with 6 MCN mangers (1 national, 1 regional and 4 local). Most MCNs reviewed had:

•‘Normal’ board, steering group and working group structure (some static some issue based)

•Generic issues of membership without responsibility

•Problems with ‘real’ patient involvement (though ‘neurological voices’ helping)

•Limitations of primary care involvement

•Problems in through put of work and achieving outcomes

•Issues around accreditation

•Issues with expectation of MCNs in Health Promoting Health (CEL01 2012)

This information and the good practice from these MCNs were used to inform an Options Paper for the Board Meeting on 4th April 2012

Structure & Effective Performance of the Epilepsy MCN

At the Board Meeting the structure and effectiveness of the MCN was reviewed. The following new structure was agreed:

The Board

Representation on the Board will include: Chair, Lead Clinician, representation from the 3 NHS areas, voluntary sector, primary care, patients and the MCN Manager. Links are to be made with Neurological Voices re patient rep.

Meetings of the Board will take place twice per year.

The Executive Group

Representation on the Executive group will include: Lead Clinician (Chair), representative from other 2 NHS areas, representative from voluntary sector, MCN Manager (Minutes) and 1 other representative (as agreed by Board).

The Executive Group will meet 4 times per year (2 of these to be straight after 6 monthly Board Meetings)

Specific Issues/Tasks Short Life Working Groups

Specific Issues/Tasks Short Life Working Groups will stem from the Board, agreed priorities and be overseen by Executive Group. Working Groups can also be Email Groups.

Representation, work plans and frequency of meetings will be agreed by the Executive Group.

Priorities for West of Scotland & Tayside MCN

A range of options were discussed at the Board meeting, and a range of potential areas of work outlined. It was agreed that these would then be included in a Priorities List (Appendix 1) which was circulated to a wide range of relevant individuals and organisations for consultation.

Outcome of Consultation

An evaluation of the Priorities List was undertaken and outlined below are the areas of work prioritised:

High Priority

  • Website
  • Monitoring Standards
  • Referral pathways
  • SUDEP guidance
  • Epilepsy specialist nurses – provision and succession planning
  • Re mapping of services and gaps

Medium Priority

  • Push for updated SIGN guidelines
  • Treatment guidelines
  • Training: developing modules and 1 large annual event
  • Audits and agreed data sets
  • Epilepsy & bone health
  • Teenager transitional clinic (across the MCN but priority for Ayrshire & Arran)
  • MCN accreditation
  • Involvement of primary care

Other Priorities

  • Appropriate admin support for first seizure and return clinics
  • Involvement of Third Sector

The outcome of this consultation and the priorities outlined in CEL 29 will be discussed by the Executive Group and a work plan for the next 18 months will be agreed

Caterina O’Connor Manager Epilepsy MCN August 2012

Appendix 1

Epilepsy MCN PrioritiesApril 2012

Following the Epilepsy MCN Board Meeting on 4th April it was agreed that we would ask stakeholders for their views on the priorities for the future work of the MCN.

The Board meeting agreed that getting the website up and running was a top priority. Caterina O’Connor at Saif Razvi will meet to discuss this and Caterina will pull together a short life working group to agree content for the website. If anyone is interested in being part of this group then please make yourself known.

Priority / High / Medium / Low
1 / Monitoring standards
2 / Training: developing modules and 1 large annual event
3 / Referral pathways
4 / Push for updated SIGN guidelines
5 / Treatment guidelines
6 / Re mapping of services and gaps
7 / Audits and agreed data sets
What are your priorities for audit?
8 / Epilepsy & bone health
9 / SUDEP guidance
10 / Teenager transitional clinic
11 / Epilepsy specialist nurses – provision and succession planning
12 / MCN accreditation
13 / Involvement of primary care
14 / Priority not already outlined….

[1] Acute Services Review (1998)

[2]Introduction of MCNs in Scotland {NHS MEL (1999) 10}

[3]Promoting The Development of MCNs {HDL (2002) 69}

[4] Managed Clinical Networks: Supporting & Delivering the HealthCare Quality Strategy {CEL (2012) 29}