London Renal Strategic Clinical Network

Transcription

1 Minutes Friday, 5 December 2014 Present: Penny Ackland (PA) Lynn Altass (LA) Peter Andrews (PA) Neil Ashman (NA) (chair) Wendy Brown (WB) John Connolly (JC) Sue Cox (SC) Michaela Dickson (MD) Neill Duncan (ND) Robert Elias (RE) Carrie Gardner (CG) Brian Gracey (BG) Rachel Hilton (RH) Jonathan Hope (JH) Daniel Jones (DJ) Chris Laing (CL) Breeda McManus (BM) David Myers (DM) Jasmine Taylor (JT) Mark Spencer (MS) Katie Vinen (KV) In attendance: Will Huxter (WH) Apologies: Jane Fryer Hugh Gallagher Sharlene Greenwood Fiona Harris John Isichei Nicholas Palmer Sue Sawyer Simon Steddon Paul Trevatt GP Strategic Clinical Networks, NHS England (London) Clinical Director, Epsom and St Helier London Clinical Lead and Clinical Director, Barts Health Specialist nurse, Imperial College Healthcare Clinical Director, Royal Free Hospital Specialist nurse, GSTT Strategic Clinical Networks, NHS England (London) Consultant, Imperial College Healthcare Consultant, Kings College Hospital Specialised Commissioning, NHS England (London) Service user Consultant, GSTT Service user (dial in) Clinical Director, St Georges Hospital Consultant, Royal Free Hospital Specialist nurse, Barts Health Service user Service user Deputy Medical Director, NHS England (London) Clinical Director, Kings College Hospital Head of Specialised Commissioning, NHS England (London) Assistant Medical Director, NHS England (London) Consultant, Epsom and St Helier Clinical Specialist Physiotherapist, Kings College Hospital Consultant, Epsom and St Helier Service user Service user Specialised Commissioning, NHS England (London) Clinical Director, GSTT Strategic Clinical Networks, NHS England (London) 1. Introductions and apologies NA welcomed members to the meeting of the London Renal Strategic Clinical Leadership Group. Apologies listed above. Neil Ashman welcomed Jasmine Taylor and David Myers to the group as new patient representatives. 1

2 2. Minutes 19 September 2014 meeting 2.1 Accuracy Accuracy no inaccuracies reported 2.2 Actions / matters arising Item Closed. ACTION (ALL): All to provide nominations to LA/MD for representatives to assist in the drafting of the renal pathway. The pathway will be used to agree outcomes for the co commissioning model. Closed. Overtaken by events covered by agenda item Commissioning 2015/16 NA welcomed Will Huxter, the Head of Specialised Commissioning, NHS England (London) to the group and WH provided further detail on the commissioning landscape for 2015/16. The Prescribed Specialised Services Advisory Group (PSSAG) had recommended that renal dialysis services come out of Specialised Commissioning. The COBIC option discussed at earlier meetings was no longer viable within the anticipated commissioning environment. The consultation (A consultation on arrangements for the transfer of commissioning responsibility from NHS England to Clinical Commissioning Groups: Renal dialysis services, Morbid obesity surgery services) exercise launched by the Department of Health on 27 November 2014 was about how and when responsibility for identified services transfers not whether services would transfer. The closing date for the consultation is 9 January LA will provide a consolidated response on behalf of the SCLG and requested any comments be with her for 24 December nsultation_document.pdf ACTION (LA): To issue link to consultation with consultation questions to SCLG members ACTION (ALL): To provide responses to LA for consolidation into formal response from SCLG by 24 December 2015 ACTION (Service users): To provide response on what they consider to be the impact of potential changes WH noted a few key questions for the group: 1) Timing Feasibility for implementation by 1 April 2015, taking into account the consultation period. In the London region there has been some discussion re future arrangements on cocommissioning (NHS England/CCGs). The goal is to provide a common response to the consultation across London from the CCGs. Even if services were to transfer from 1 April 2015 there may be some merit in CCGs operating at a pan London level. The timing of the consultation has meant that there has not been the opportunity for detailed discussion between NHS England and the CCGs. 2

3 The main concern is the speed of the transfer of services and the challenge will be in providing an aggregated view of London data. In addition London dialysis services are continuing to grow and it is not clear how that will be funded. The short consultation period is designed to enable the 1 April 2015 start date and to fit in with the legislative requirements. Renal services were not initially within the scope of the anticipated changes but included on recent reviews of commissioning. It is clear that if the February legislative deadline is missed then the 2015/16 target implementation date for service transfer from Specialised Commissioning to CCGs will not be met. 2) Legislative requirements The current contracting cycle will end 31 March Transfer of services from NHS England, as the contracting authority, to CCGs will require secondary legislation. The challenge is the timing of the general election in 2015 with associated restrictions on legislation and communications once the election has been timetabled. It is expected that renal services contracts will initially be with NHS England but funding will be controlled by the CCGs. 3) Impact on service provision Service providers will be required to meet service specifications and associated safeguards. Commissioning of renal dialysis will move away from provider based activity to sector/population base with potentially better opportunities for service improvements and patient outcomes. London s CCGs are already looking at how they can collaborate. NA noted that the risks are if an individual CCG decommissions and commissions renal dialysis from a private or neighbouring provider. However services cannot be moved if potential providers are unable to meet the nationally agreed service specifications. NA also noted that a lot of work had been done by JC with local CCGs in North Central London and HG in Surrey. 4. Peer Review. BM had provided a briefing (appendix 1) and some background on the proposal from the West Midlands Quality Review Service (WMQRS). Peer review would look at how well renal services are delivered by each centre across London. The proposal provided by WMQRS outlines what is included in the review as well as milestone planning dates and costs. The cost of providing the review for all 7 centres is 52k. Barts Health will be proceeding with the review but NA believes that all 7 centres would benefit from going through the process. The group has the opportunity to shape the clinically and patient led review of London s renal centres. To ensure patient involvement patient representatives will be invited to join the steering group. The ambition is that the review will provide the SCLG with the assurance that services are being delivered well and enable centres to learn from one another. The costs are relatively low at about 7k per centre. There is a recognition that resources are tight and therefore a strong business case is required. Members agreed that we should proceed but be mindful that activity should be spread across the centre rather than focused in one staff area. BM assured the group that most of the work, including preparation and writing of the final report(s), would be done by WMQRS. Should centres have problems in securing the funding a potential source may be to deliver the review as a CQUIN (Commissioning for Quality and Innovation) initiative although that brings its own challenges as initiatives compete for priority within individual trusts. ACTION (Centre leads): To confirm with NA/BM that they wish to be included in the review. 3

4 Next Steps: To set up a steering group for the review Training sessions to be planned and implemented Centres to assist with the review of Quality Standards for Services for People with Chronic and Progressive Kidney Disease which will be adapted to include aspects from service specifications and the Kidney Health Delivering Excellence ambitions. 5. Workstream Updates. Leads updated the group on the SCLG workstreams AKI CL updated members on progress with AKI workstream (appendix 2). CL and MD had been working together to put together a comprehensive plan to track progress. There was an acknowledgement that some of the more ambitious plans regarding operational pathway delivery, whilst hugely rewarding in terms of results and patient outcomes, were unmanageable within the current commissioning and financial structures. However, there were several areas where the AKI workstream could deliver results by the end of the current financial year, specifically work on e-alerting and delivering the standards including governance/local incident reporting. Work on the educational package was well underway and activities to align with the national Think Kidneys programme were ongoing. A meeting of the LAKIN is planned for late January with a view to reviewing the Terms of Reference and to ensure engagement from all trusts. In the medium/long term activities are planned around service mapping and the development of commissioner endorsed pathways and standards for a number of speciality pathways. This will be dependent on work coming from the Think Kidneys national programme as well as availability of key resources. There is a clear requirement to embed AKI expertise in critical care units. Further discussion is planned on how this should be done working with those responsible for the critical care networks. This is dependent on the outcome of current reviews taking place across NHS England CKD DJ provided members with a copy of the St George s Hospital pathway (appendix 3) highlighting changes recommended by NICE in their 2014 guidance (CG182). NA stated that Barts Health had implemented something similar and noted that this highlighted the benefits of the network in the sharing of information/best practice. ACTION (Clinical Leads): To provide copies of local CKD pathways to ND Patient Experience RE updated members on the progress of the patient experience survey. To date 31 responses have been received which have been collated into a single spreadsheet/report (appendix 4). The clinician surveys have yet to be collated as the responses from RFH and West London are still outstanding. 4

5 The collation of responses had raised issues re the length of the survey, style, questions and types of answers it required. Members agreed that the target response rate of 80 completed questionnaires should be achieved prior to making a firm decision on how/if to proceed. The current plan: To convene the patient experience group in January to plan the way forward To collate the clinician responses to the survey, including chasing up responses To plan sessions/event on peer support To evaluate and include NHS England/Renal Registry work on patient participation and CKD To target additional feedback/support from the KPAs. ACTION: Completed surveys to be sent to Lynn Altass at NHS England (London Region), Southside, 105 Victoria Street, London SW1E 6QT 6. Specialised Commissioning CG provided an update on Specialised Commissioning on areas not covered under agenda item 3. a) Tariff guidance: Consultation was due to close on 24 December. There are no major changes from 2014/15. Current 2014/15 best practice tariff was based on 80% of dialysis patients in a renal centre using vascular access. Best Practice Tariff may move from vascular access to home therapies which could result in a reduction of the vascular access tariff. No AKI tariff Daniel Jones is the London South representative on Renal Dialysis Clinical Reference Group. b) CQUINs Workshop scheduled for Monday 8 December re National CQUINs, one for home therapies. 7. AOB 7.1. Terms of Reference The Terms of Reference for this group was issued and agreed in 2013 (appendix 5). Members were asked to review and consent to continuing as members or whether there was someone they considered to be more suitable. Members should also review the length of their tenure and feedback whether they consider that it should be restricted. ACTION (ALL): To review Terms of Reference and provide feedback to LA/MD in advance of the next meeting NHS British Transplant Kidney Report For information. Members were asked to consider whether informal peer review is always the solution when such reports are published and who should be notified when such reports come in. One of the key considerations is how we advise commissioners that services are safe and fit for purpose. Members should also consider how data is shared with the group, including how any variations are reported. 5

6 ACTION (ALL): To feedback views on data sharing/reporting on variations to LA/NA in advance of the next meeting. 8. Dates of 2015 meetings. 13 March June September December 2015 ACTION (MD): To send out calendar invites for next year s meetings. Summary of actions Ref Action Lead Update 1 To issue link to consultation with consultation questions to SCLG members. LA Closed. Issued 8/12/14 2 To provide responses to LA for consolidation into formal response from SCLG by 24 December ALL 3 To provide response on what they consider to be the Service impact of potential changes. users 4 To confirm with NA/BM that renal centres wish to be Centre included in the review. To provide copies of local CKD pathways to ND/LA/MD Completed electronic or paper copies of the survey to be sent to Lynn Altass at NHS England (London Region), Southside, 105 Victoria Street, London SW1E 6QT, l.altass@nhs.net To review Terms of Reference and provide feedback to LA/MD in advance of the next meeting. Leads Centre Leads RE/BM ALL 8 To feedback views on data sharing/reporting on variations to LA/NA in advance of the next meeting. ALL 9 To send out calendar invites for next year s meetings. MD 6

7 PEER REVIEW PROGRAMME FOR RENAL SERVICES IN LONDON OUTLINE PROPOSAL Appendix 1 The West Midlands Quality Review Service was established in 2009 with the aim of helping NHS organisations in the West Midlands to improve the quality of health services by undertaking reviews of clinical services, often through peer review. The work of WMQRS is overseen by a Board and run to high standards and under strict governance arrangements. We have requested they assist us with undertaking Peer Review in our London Units if agreed. The aim of WMQRS is to support organisations to: Ensure care pathways are as safe as possible Improve the quality and effectiveness of care Improve the patient and carer experience Organise independent, fair reviews of services Provide development and learning for all involved Encourage and support dissemination of good practice Support and add value to organisations own clinical quality assurance and review systems The following core principles will govern the work of WMQRS: Peer review is clinically led and clinically credible. There will be service user and carer input throughout the review. The review will be evidence-based or, if no evidence is available, will be based on, a consensus of professional and service users views and any current best practice guidance. WMQRS will work in a supportive way to helps reviewers and organisations to improve the quality of their renal services and their own capacity to undertake clinical quality assurance. The Peer Review team will seek to minimise disruption to clinical services resulting from reviewers participation in training and reviews and from peer review visits and other clinical quality review approaches. The Peer Review will be undertaken to the highest quality standards. Expected outcomes are: Better quality, safety and outcomes. Better patient and carer experience. Organisations with better information about the quality of clinical services. Organisations with more confidence and competence in reviewing the quality of clinical services. Potential benefits of being a Peer Reviewer include: Learning about how other services are organised Sharing good practice with colleagues from other areas 7

8 Helping colleagues to improve the care they are able to offer Preparing for your own peer review visit Time spent reviewing other services also contributes towards your continuing professional development (CPD) and can be included in your CPD portfolio Next Steps - WMQRS will: Forward their proposal to the Renal CLAG Arrange Peer reviewers Training sessions (a half day training) Assist with the review of their Quality Standards for Services for People with Chronic and Progressive Kidney Disease which will be adapted to include aspects from the service specifications and the Kidney Health Delivering Excellence ambitions. coordinate and facilitate developmental and supportive quality reviews produce overviews of compliance with Quality Standards and related issues provide development and learning for all involved Compile reports underpinned by their governance structure 8

9 Appendix 2 Renal Strategic Clinical Leadership Group AKI update Chris Laing To summarise discussions, within the more formal SCN reporting structure, need to define what LAKIN will do but, almost as importantly, what it will not do. We can test opinion with group in January but broadly we felt the following (building on existing achievements) What we can do Collaboratively agreed and commissioner endorsed (a) London AKI pathway and (b) London AKI standard. The latter can include requirements on governance/ local incident reporting. This builds on existing work and we are currently updating. This can be complete by end-march. This would be supported by a London AKI online audit tool (currently being developed by Bhrigu Sood.) 2. A comprehensive educational package - web, app, online lectures, manual, power points etc. The current resource is currently being upgraded through a HENCEL grant. Likely complete end-march. To support this we will continue our annual multidisciplinary AKI academy (we ran a successful one in October much of which is going online) and may consider one-off educational events. 3. Develop and engage a network of MD endorsed trust leads who have trust responsibility for AKI (already done). 4. Develop and have commissioner endorsement of pathways and standards for the following speciality AKI pathways - HUS, myeloma and obstruction. These are very regionalised pathways with proven high impact interventions. These projects would be developed by specific working groups and supported by events. This will take 1 year and best to kick off with HUS. I have sounded out stakeholders. 5. Continue with recurrent organisational service mapping (done but needs repeating and action). The trust leads oversee this and responses. Assign exemplar status and for trusts of concern consider peer-review visits. This is our cross London health check to ensure our products are embedded and systems in place against the standard e.g. do you deliver education, have you audited, are you in a QI project etc? This can go out with pathway update so end March and is in some senses our core project. 6. Sharing best practice and information exchange - website, annual newsletter, annual event. Some thought to internal comms. 7. Commissioning advice (SCLG). If more transformational work is eventually supported the network could reasonably provide advice (e.g. commissioning new acute dialysis services in NWL). I see no sign of this currently in our present climate so not a live issue. 8. Specific work on renal unit outcomes and transfer times. We need Specialised Commissioning help with this. A CQUIN pilot here would be good and this will need some teeth. I think an annual pan London review of renal unit care of AKI is deliverable (Satish from kings has been working on a template). A London renal referral platform would remain a great legacy project (underway in NCL) but needs sustainable funding which we don't have. 9

10 9. Data analysis on outcomes - we can ask trusts to provide an annual return when e-alerting fully implemented next year. We have access to HES data now and can provide our own analytics for trusts willing to provide data. What we don't/won't do Operational function - we do not directly manage pathway delivery. The regional meetings trouble shoot this but in the absence of a team we do not manage this. Similarly we do not directly manage trust implementation or embedding of our products, though we can provide challenge against the survey and support trust leads. 2. Quality improvement. By this I mean formally structured IHI style projects - PDSA, regular measurement, interventions to improve reliability. In NCL/NEL this will sit in the UCLP project. 3. Research and innovation. In an informal network this would be emphasised but I don't think we can project manage. The group wants to do this but this can sit "offline" and proceed more informally. 4. E-alerts. We did very successful work on this but this has now been superseded by the national programme safety alert 5. Primary care. This is not well developed and much coming down from the national programme so I would wait 10

11 St. George s Hospital CKD pathway Appendix 3 11

12 Management of Chronic Kidney Disease: Update December 2014 In July 2014, NICE released new chronic kidney disease (CKD) guidance (CG182). This information sheet highlights some of the changes. Are there any terminology changes? The new guideline recognizes the importance of not only the stage of CKD now called G1 to G5, (previously referred to as stages 1 to 5) but also albuminuria. Albuminuria has been given categories 1 to 3. The kidney prognosis and cardiovascular risk worsen as the (G) and (A) increase. Why have NICE recommended a change in the equation used to calculate estimate glomerular filtration rate (egfr)? NICE has recommended that the CKD-EPI equation will replace the currently used MDRD equation for egfr calculation in time. The current equation over estimates CKD in those who are close to a GFR of 60 ml/min/1.73m 2 and by using the CKD-EPI equation CKD identification will be more accurate. It is likely that many hospitals will switch to using the CKD-EPI egfr reporting but the time course to do so across London will be dependent on local information technology systems but it is anticipated this will have been achieved by the end of Cystatin C assays are suggested for some people, what should I do? NICE have suggested using Cystatin C in some patients with borderline CKD to confirm the diagnosis. This test is not widely available and currently the evidence that using this assay will alter the management of CKD is poor. Therefore, we do not suggest requesting Cystatin C levels at this time. 12

13 Renal Strategic Clinical Leadership Group Appendix 4 Patient Experience update Rob Elias 1. Clinician surveys still 2 outstanding (West London and RFH) though I have had a brief initial response from Royal Free. 2. Patient surveys Lynn and Michaela circulated an initial report including a total of 31 response (Guys 6, Kings 15 and Royal London 10). 3. At the last meeting we agreed: a) patient survey needs some amendment if it is to be used more widely; b) it's going to take time and effort to get a properly representative response; c) we should push on with doing something on peer support in the meanwhile. 4. I propose the following way forward: a) ask West London and RFH to complete clinician survey; draw up list of activities and potential areas where we can learn from one another; start to develop a 'minimum' or 'accreditation' standard for service provision regarding patient experience and involvement, perhaps in conjunction with proposed peer review. b) ask all units for one push on patient questionnaires - this could be either as they stand (so as to get a consistent set of responses before editing) or after editing the questionnaire down to make it more user friendly; c) plan a?half day session in, say, March to design a pan-london collaborative approach to peer support. 5. In order to achieve this, I suggest that we need an evening meeting of this patient experience group - along with any new patient representatives who would be willing to attend - in January. At that meeting we would need to: a) Confirm buy-in from patient and clinician representatives at each unit to ensure patient questionnaires competed. b) Agree format for continuing with patient questionnaire. c) Make plans for a peer support event in March - to include peer supporters, patients, patient experience leads, clinicians with peer support experience. d) Agree how to share work on standards. 13

14 Renal Patient Survey: Summary and Recommendations. Background. The patient experience survey was launched as part of the Patient Experience work of the London Renal Strategic Clinical Leadership Group (SCLG). The survey was prepared by a small team led by Rob Elias, consultant nephrologist at Kings, including patient and clinical representatives. Patients were advised that their responses would be anonymous and that their responses would assist in setting the agenda for the work of the SCLG. The responses would assist the group in identifying areas where patient experience is excellent and make sure that good practice is shared. The survey would also assist in identifying areas of particular concern, focussing efforts on improving them and help in identifying ways of measuring patient experience which would be helpful and relevant to patients. The first issue of the survey was a pilot with distribution to a limited group before embarking on large scale distribution. This would enable questions to be refined to ensure further surveys were both relevant to patients and provided meaningful responses to meet the overall objectives of the survey outlined above. Summary 1. Overall we received 31 responses. The total from each hospital was: Guys 6, Kings 15 and Royal London 10, 5 of which were satellite units. Participating sites. 2. The age and gender profile of respondents corresponded that of the Clinical Commissioning Groups. There were 21 male respondents and 9 female. 1 did not wish to say. 14

15 Age and gender analysis of survey responders Age and gender analysis of London's CCGs RRT patients 15

16 3. The ethnicity profile is outlined below of the 31 respondents participated in or were aware of patient groups. On the whole their experience of these groups was a positive one. 5. In terms of treatment the majority (10) of the respondents were being seen in clinic with Advanced Kidney Injury. There were 2 transplant patients, an additional 5 on peritoneal dialysis of which 2 being seen in clinic with Chronic Kidney Disease. 2 of the patients are on haemodialysis, one of which is home dialysis. 7 of those surveyed were on nondialysis care pathways with 4 being treated for reasons other than Chronic Kidney Disease. Conclusions and Recommendations. On the whole the patients have a positive experience of renal services across the three participating units. Of particular note was the view that the service provided by the nurses across all the units was excellent. Despite transport being high on the agenda when in face to face contact with patients and patient associations, there was only one comment about transport. One of the most appreciated areas of patients treatment was the efforts the team went to in trying to coordinate medical/hospital appointments to minimise patient visits. Should the team wish to poll a more extensive group the survey requires the following changes to be made: - Tightening up of questions to enable the use of drop down menu to provide automated collation of responses. - Fewer questions to ensure a higher response rate. A reduction in the number of questions may enable the surveys to be completed as interviews by staff members/representatives again ensuring a higher response rate. 16

17 Renal Strategic Clinical Leadership Group (SCLG) Terms of Reference (ToR) Appendix 5 Background Strategic Clinical Networks (SCNs) are a new type of healthcare network hosted by NHS England and will adopt a whole-system approach to change management working with providers and other stakeholders across complex pathways of care as well as offering specialist advice to commissioners on standards and variations in service. Using the NHS Change Model as the framework for development SCNs will support change management and quality improvement thought innovation and transformational leadership. Each SCN has an expert Strategic Clinical Leadership Group (SCLG) chaired by a clinical director. The SCLG will be the expert vehicle for driving forward change and improvement in the SCN and a source of strategic advice and knowledge to NHS England, the Clinical Senate and other bodies and organisations. Purpose The SCLG provides a forum for multi-professional Renal clinicians to meet and share their specialist expertise, clinical experience, and strategic knowledge in an impartial and bi-partisan manner. The SCLG will act as the clinical expert arm of the SCN and exist to provide collective knowledge and strategic leadership on behalf of the SCN community. Role - To provide objective, evidence based solutions on major clinical strategies areas which address quality and safety issues in London free from organisational partisanship. - To provide a space where clinical leaders can meet to share collective knowledge on renal clinical issues, both to each other and to relevant stakeholders. - To support and expert advise to clinical pathways spanning organisations and localities. - To encourage collaboration, participation, joint understanding and a holistic view of London s health system. - Where appropriate maintain the legacy programmes that have been inherited from previous structures closing or adapting to future work as necessary. Key Functions Quality and performance - Direct clinical conversations on performance in London; provide expertise of key indicators and outcomes that measure improved patient care. - Support health organisations across London to develop and make recommendations for strategy and vision and future alignment with national and local priorities. Patient Involvement and advocacy - Demonstrate evidence of patient / carer and public involvement. - Develop systems for accessing patient / carer and public involvement (this may range from service users being members of the SCLG to working with the voluntary sector to developing an external patient platform / panel). - Work with a PPI manager / lead from the SCN team to work with the SCLG around patient / carer and public involvement. In absence of any formalised systems having been established the PPI manager / lead will be the proxy for patient voice / representation. - Review and audit patient / carer and public involvement within an identified time frame and feedback results to the SCN Oversight Group. The PPI / manager / lead will be responsible for this. 17

18 Clinical Leadership - Offer strategic leadership on renal issues pertaining to London and be a source of legitimate specialist expertise on policy, operational, commissioning, and workforce matters. - Serve as clinical champions on future service re-design. - Make recommendations as required and be able to produce evidence based oral updates and written reports to internal and external stakeholders. Partnership and networking - The Renal SCLG will work in partnership across the other CVD SCLGs and identify areas for shared working. CVD Clinical directors will be encouraged to meet (as a minimum at least twice a year) to update each other to outcomes, progress and challenges. - The Renal SCLG will develop partnership working with other strategic clinical networks including Maternity and Children s services and adult mental health, dementia and neurosciences. Shared projects will be identified and agreed. - The Renal SCLG will develop working relationships with the other Renal SCLGs across England and share best practice and information. External links may be established by the clinical directors, associate director, and other members of the SCN team. - The Renal SCLG will develop strong working partnerships with the Clinical Senate; the three academic health science networks (AHSNs), local area teams and LETBEs. Where ASCNs clinical priorities overlap with that of the SCLG it would be useful for the SCLG to identify an AHSN link from within its membership. Commissioning - Provide expert advice into key aspects of commissioning plans, including service changes. - Consider how quality and safety are maintained within commissioning services. - Develop strong working relations with the various CCGs, the London clinical commissioning council, and specialised commissioning. - Establish clear routes to and from the Renal National Clinical Reference Groups (CRGs) and identify a link person to develop closer working with the CRGs. Accountability and Governance SCNs are non statutory bodies. However, they are able and charged with adopting whole system approaches to healthcare design, working with commissioners and providers to reduce service variation as well as with providers across complex pathways of care. Each SCN has a clinical expert group, the SCLG, which will act as a vehicle for change and pathway improvement. The expert groups are chaired by clinical directors. Subsequent outcomes, work plans and results from these groups are routed up through the London Strategic Clinical Network (SCN) Oversight Group. The SCN also has a strong relationship with the London Clinical Senate which provides an assurance function. SCLG management Chair The chair of the SCLG will be the SCN clinical director. SCLGs will be encouraged to appoint a vice chair (although this is not mandatory) to help support the chair and co-ordinate duties in the absence of the chair. If neither is available the SCN team prior to the meeting will identify a chair in discussion with the clinical director. Membership Membership is mostly drawn from the clinical community and comprising of clinicians who are able to offer strategic leadership and vision at a London / national level and who are driven to improve renal outcomes across London. Individuals who are not clinicians should be able to display skills, knowledge and experience to complement membership. The size of the group will vary on the speciality, as a suggestion numbers should be between

19 Members represent collective interests rather than individual organisations. Members must complete a declaration of interest form. Members cannot send deputies as substitutes. Attendees Attendees will be invited by the chair. Attendees may be invited on a temporary or a more regular basis. In the likelihood of the SCLG needing to vote on an issue attendees will not have voting rights. Frequency Meetings will take place as determined by the membership but quarterly will be considered the minimum. Quorum A quorum for meeting will be 50% plus one person for majority, including the chair. Participation It is expected that members will commit the time necessary to read the SCLG papers and attend the meeting (and in doing so be supported by their employing organisation). Members are expected to attend a minimum of 50% of meetings during the course of the year. Attendance below this will be monitored and may be addressed individually by the chair. Outcomes Each SCLG will be expected to develop a work plan which will be signed off by the group. The work plan will be presented to the SCN London Oversight Group for agreement. The work plan will be informed by national, regional and local strategies. SCLGs may wish to pursue individual work plans or develop one jointly as a CVD platform. SCLGs will be expected to develop work streams to address actions identified in the work plan. Terms of Reference Terms of Reference will be agreed by the SCLG and presented to the SCN London Oversight Group for approval. The ToR will be reviewed annually and refreshed as necessary. 20 September