Minutes of Better Health, Better Care, Better Value

Cowal 24/7 Implementation Governance Group

1.30pm, Thursday 31st October 2013

Meeting Room A01,Cowal CommunityHospital

1. Present:Viv Hamilton, Co-Chair & Locality Manager

Heather Grier, Co-Chair

Evelyn Hide, Community representative

Kate Stephens, Kyles Community Council

In Attendance:Alison McCrossan, Scottish Health Council

Michelle Lauffer – Minute Taker

VC:Dr Michael D Hall, Clinical Director

Charlotte Percival, CSM,NHS24,

2. Apologies:Stephen Whiston, Head of Planning,

Contracting & Performance.

Lorna Ahlquist, Cowal Community Care Forum Rep.

Caroline Cecil, Planning & PublicInvolvement Manager

Pat Tyrrell, CHP Lead Nurse

George Morrison, Head of Finance

John Huband, Medical Staffing, Inverness

Gaye Boyd, Personnel Manager, HR

William Togneri, NHS24

Viv welcomed everyone and introduced the group to Charlotte Percival whowas video-conferencing in as a representative from NHS24 on behalf of William Togneri.

Topic / Action
3. Previous Minutes
The group checked and approved the previous minutes.
4. Matters Arising
Review draft terms of reference – Page 2, paragraph 1. Michelle to ask David Ritchie for an update on the e-link for Cowal 24/7 Implementation Resource papers.Alison suggested links to twitter etc.
Heather advised that Lorna’s action regarding a further update to the terms of reference is complete.
Action Plan – page 2, paragraph 3. Heather advised Viv that the group had discussed who was ensuring everything was on schedule with timescales etc. Viv said she was working towards getting the Doctors contracts negotiated/agreed for December 2013. She said that implementation is important but the monitoring and evaluation will carry on automatically via the Operational Sub Group. Dr Hall added that one of the delays was due to recruitment issues but that should all be sorted now. Heather said she felt the Governance group should take ownership of the action plan to check the Operational subgroup is providing reports etc.
Subgroup Reports – Kate said that the Operation Subgroup’s summary report did not mention home visits and she requested that this be added.
Letter to D Leslie – page 4, paragraph 2. Heather advised the group that she did not action this. She has discussed the issue with Viv and it will be discussed later in the agenda.
Governance Checks Matrix – page 6, paragraph 2. Viv advised the group that she had met with Lorraine Paterson to discuss the governance checks matrix. It has now been clarified and amended. This will be discussed in more detail later in the agenda.
Comparison Chart – page 6, paragraph 4 of ‘governance checks matrix’. It has been agreed the group will use charts from the CHP report and Heather & Viv will give an update on this and any changes. For example – if the number of hrs Doctor is in the hospital is greater than CHP recommended.
AOCB – Prioritisation of meetings, page 6. Viv agreed group members should be advised that an end date has been agreed so it is imperative that group members attend meetings where possible as there are only a couple of months left.
Heather referred to Lorraine’s comments regarding refining membership and how NHS24 may not always be required. Heather disagreed and said she felt that NHS24 were always required as some community members are unaware of services being provided by NHS24 and also when they should call NHS24. Charlotte said there was helpful information on this and also on the ‘know who to turn to’ campaign on the internet and that she would send the internet links for NHS24 & NHS Inform to Michelle. It was agreed these should be put on the Cowal 24/7 website. Michelle will send to David Ritchie.
Heather commented that while these internet links are helpful, there needs to be an understanding that a large number of the rural older community do not always have access to the internet. Charlotte said she would speak to their communications department for contact details of a link person who can be approached for access to printed leaflets. / ML to ask DR.
ML to advise LP.
ML to include in email for next meeting.
CP to send to ML.
ML to send e-links to DR.
CP to send ML details.
5. Review draft Terms of Reference
The group discussed the draft terms of reference. Viv noted that the Operational subgroup had changed the review date to January 2014; she agreed the Implementation Governance Group’s review date should also be changed to January 2014.
Quoracy was discussed, it was agreed there should be a minimum of 5 group members. This should include 1 Co-Chair, 2 representatives from health and 1 other group member. / ML to update TOR.
ML to update TOR.
6. Sub Group Reports
New 24/7 Model Operational Sub Group
Lorraine Paterson’s October Report was distributed. Viv advised the group that she had met with Lorraine this morning and updated.
Length of stay/bed occupancy – Viv said this reduction could be due to the implementation of many improvements which were detailed in Lorraine’s report.
Working across ward/casualty – There is now 1 rota showing the integrated Dr model. Viv advised the group that there is cover up to the middle of February, it is a great improvement. Heather asked for a copy of the rota.
Alison McCrossan asked about gaps in service in terms of integration. For example there is not the same level of service at 8pm from social work. Viv said this was an issue across the CHP. There is an OOH standby Social Work contact but theymay not be based locally, but would be available for advice.
Heather commented that all the extra responsibility seems to be on the shoulders of Health and the Local Authority should be taking a more active role and someone needs to address that. Viv said, ideally we should appoint a ‘joint’ officer but it is not a reality at the moment, Reshaping Care for Older People will drive this.
Home Visit Data
Heather reported that she had looked over the data and found the following:
Total number for Dunoon PCEC – 356 (Jan-Sep 13, 9 months)
Averaging at approximately 1 home visit a day.
Total Number for Tighnabruaich, Strachur & Colintraive etc – 53
(Jan-Sep 13, 9 months)
Averaging at approximately 1 home visit a week.
Heather noted that based on current information she has and costs of current services, 1 home visit a week seems expensive for the amount of work involved. More work needs to be done on home visit data etc. Heather asked for data on how many times the hospital Dr is required to leave the hospital on home visits.
Viv advised that in terms of rural Doctors being on call, the issue of expense comes from the possibility of being disturbed/made available. The challenge for us is to work towards a less Dr and home visit dependant model.
Heather highlighted the safety risk of Dr leaving the hospital for home visits and how this can be reduced. Viv said there was no other choice at the moment, the only other option would be 1 Doctor for the Hospital and 1 Doctor on call specifically for home visits and this is not possible at the moment.
Heather asked what the stumbling block was in relation to the ongoing negotiations with Doctors. Surely the service should be good for both patients & Doctors. Dr Hall agreed and said it is something that is faced all across Argyll & Bute and NHS Highland and hands are tied where medics are concerned. One point to note though is that when the Doctors are ‘on call’ they are restricted to what they can do on a personal basis. Heather understood and said there should be a premium for this service; the point is more why the premium has to be so high.
Dr Hall said Cowal is different in that it does not have localDunoonGPs involved in the OOH service. If they were, it would be a more encompassing model. The focus is to get a safe & sustainable model in place now and see how it develops over time.
Viv reassured the group that Dr Hall and she were pressing hard for additional services in an expanding area. The next meeting with the BMA & LMC is the 11thNovember; this will be to discuss the latest offer before it goes to the Doctors. Heather asked what if they do not agree. Viv said it would then need to go back to the Corporate team. Viv is hopeful they will see the benefits of becoming employees, such as annual leave, study leave etc.
Evelyn said it is clear there are a lot of home visits in the Dunoon area and asked if any of them could have came into the PCEC. Heather agreed a data gathering exercise is required to look into this. Evelyn asked about how NHS24 triage home visits. Charlotte replied saying any home visits would be based on clinical need and any other relevant circumstances.
Heather said she thought setting up a local triage system had been discussed. For example, rural GPs would phone patients first before doing a home visit. Alison commented on how different this would be to Dunoon, as quite often in Dunoon the patient would not necessarily know the Doctor who carried out the home visit.
It was agreed that Viv & Heather should arrange a meeting with Dr Paterson to discuss home visits.
Community & Staff Communications & Engagement Sub Group
Due to the public events, the Communications & Engagement sub group have not formally met for a couple of months. Heather advised the group that she had been unable to attend the last meeting, so there were no minutes.
Heather reported that the 2 public events were surprisingly well attended with some positive feedback from the public regarding their understanding of the current situation with rural GPs. The feedback regarding NHS24 was that a shared education program is required.
SAS – Tighnabruaich. Andy Brady’s presentation was well received. Susan from CCCF took Andy Brady’s presentation and transferred it into an easy to read document. Heather would like the same done for NHS24.
Heather noted how important it had been to have Viv & Derek Leslie in attendance at the public events and commented it should also be considered for a possible Dunoon public event.
Lochgoilhead – Protocol was discussed. An advert had been placed in the Lochgoilhead news, this provided no responses. Dennis Bolt had said if there were no changes to service for Lochgoilhead then there was no reason to have a public event in Lochgoilhead. The group agreed.
VOICE – Heather, Lorna, Susan & Alison have started to populate for the Communications & Engagement plan. Alison suggested it would be useful to store NHS24, SAS & CHP information on VOICE so that other areas (such as Islay) can access the information. Susan from CCCF continues to update VOICE, this is ongoing.
Funding for CCCF – Heather commented on the amount of work being done by individuals for Communications & Engagement and asked about resources
Press – The ‘day in the life..’ was discussed with the local press. Lorraine had said the local paper had implied there may be costs involved. Viv advised the group that she had spoken to David Ritchie regarding getting a commitment from NHS Highland Communications department, and had asked him to liase with the local press. Viv asked that David Ritchie be copied into all emails & correspondence regarding the Communications & Engagement sub group. It was agreed the Communications & Engagement sub group would work on the information for the press.
Medical Negotiations/Workforce Sub Group
Viv advised the group that Dr Sabbenini (salaried GP) had been in post since 30th September, although did not come onto the rota till the start of November. Dr Aaron Donald (rural fellow) is on the rota from 10th October to February 2014; he also works with Kyles Medical Centre and has inductions with Dr Paterson. Dr Clive Mast is due to start in March 2014. This has helped and will help to reduce the use of locums.
BMA/LMC negotiations – Viv advised the group that herself, Dr M Hall, George Morrison & John Huband from Medical Staffing had spent a couple of hours going over the rejection and pulling together the next proposal. She believes it to be a reasonable offer with clear identified benefits, involving some compromise on both sides. / ML to send HG the rota.
LP/Operational Sub group to provide this data for the next meeting.
VH to action for next meeting.
VH/HG to arrange meeting with Dr Paterson.
NHS24 to work with Susan at CCCF.
C&E Subgroup to cc DR & to work on info for press.
7.Governance Checks
Governance Checks Matrix – Has been simplified and reviewed by Lorraine Paterson & Viv. The reviewed copy was distributed to the group. Lorraine felt there may be further discussion when it is sent back to the Operational sub group.
Communications & Engagement – Alison asked about getting the information out to staff. Viv commented that Angela Lord is representing all staff when she attends the Communications & Engagement sub group. It was agreed some awareness raising was required for staff. Viv commented that it would be useful for staff to see Lorraine’s summary reports.
Viv also advised the group that Angela Lord was her representative on this group and should be able to help the Communications & Engagement sub group with accessing statistics etc. Alison wondered if there be a leaflet on noticeboards or emailed to staff. The group agreed the Communications & Engagement sub group should work on a checklist/guidance protocol for staff/practitioners to follow when taking part in public events.
Evelyn highlighted that Lorna would not be with CCCF for much longer and someone else would need to be appointed. This should be added as a risk to CCCF, Michelle to update matrix.
The group also agreed that something should be sent to Mamie in Communications department of NHS Highland as there has been nothing regarding the Cowal area in the last two issues of the NHS Highland Newspaper. / C&E subgroup to work on checklist/guidance.
ML to update matrix.
VH to contact Mamie at Comms Dept.
8. After Action Review – Alison McCrossan, Scottish Health Council.
Alison advised the group that following the presentation to the Core Team in June/July,the independent chair model (i.e. Heather & Lorna) was now being looked at in other areas.
Practice Participation Group in Strachur – Meeting to take place on 11th November. Currently 23 people on the list. Looking at how that model will work with PPF & CHP.
Integration - Working with Eileen Wilson & social work regarding how Community Engagement strategy can be improved. Also working with Alison McRory & Fiona Sharples regarding RCOP (Reshaping Care for Older People) Meeting has been postponed till Jan/Feb 2014.
PPF Development Day – Leads from across Argyll & Bute to meet and discuss how to move forward in terms of integration & Communications & Engagement. The next PPF meeting is taking place on 19th November.
Alison said the Communications & Engagement sub group need to think about mapping resources, e.g. voluntary organisations, local authority etc. Alison also said she may need a steer from Viv regarding the next step regarding this. For example report templates etc. / VH to discuss with AMcC.
9. AOCB.
Nothing to report.
Date & Time of Next Meeting
The next meeting will take place at 1.30pm on Wednesday 11th December 2013 in Meeting Room A01. VC facilities are available.

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