GP and Lead Clinician, Respiratory MCN (chair) Respiratory Care Facilitator, WL CHCP

Transcription

1 LOTHIAN RESPIRATORY MCN CORE GROUP Minutes of the meeting of Wednesday 18 December 2013 in Seminar Room 6, Chancellor s Building, Royal Infirmary of Edinburgh Present Dr Ninian Hewitt Ms Shena Brown Ms Laura Groom Professor Harry Campbell Ms Alyson Malone Ms Jenny Scott Apologies Dr Nik Hirani Ms Angela Lindsay Mrs Lyn McDonald Ms Kim Bracher Ms Anne Ovens Ms Gillian Sidey Ms Donna Reid Dr Peter Reid Ms Gillian Cunningham Professor William MacNee Ms Grace Hynd Ms Katie Johnston Dr Donald Noble GP and Lead Clinician, Respiratory MCN (chair) Respiratory Care Facilitator, WL CHCP Clinical Specialist Physiotherapist, Community Respiratory Team (for Ms Lindsay) Professor of Genetic Epidemiology and Public Health, University of Edinburgh Strategic Programme Manager, NHS Lothian Respiratory Pharmacist, RIE Resp consultant RIE AHP Manager, Edinburgh CHP Director of Operations, Medical and Clinical Services RNS St Johns Hosp. Chief Nurse, RIE RNS RIE RNS WGH Respiratory consultant WGH Service Manager, CTR Respiratory Consultant, RIE Clinical Nurse Manager, Respiratory (part meeting) Primary Care Pharmacist, Edinburgh LHP Resp consultant St Johns and Western General Hosp. 1. Introduction and Apologies for Absence N Hewitt welcomed those attending the meeting and introductions were made. ACTION 2. Minutes of the previous meeting 23 October 2013 The minutes of the previous meeting were approved as an accurate record S Brown enquired as to the revised membership of the core group. N Hewitt indicated membership of the group was outlined in the minutes of the previous meeting; however some members have indicated there are unable to attend meetings but wish to receive the minutes of the meetings. 3. Matters arising from previous meetings 3.1 Nebuliser Advice An updated generic guide for the use of nebulisers and nebulised medication was circulated prior to the meeting and incorporates feedback relating to national guidance. The updated guide will be discuss at the National Advisory Group meeting in February The guide indicated nebulisers should not be used in ordinary Page 1 of 5

2 circumstances and it was noted NHS Grampian are currently recalling the 3,000 nebulisers from the community. N Hewitt indicated the national guide provide a template for support the update of local guidance / protocols. 3.2 New Co-Ordinator for MCN Interviews have been held to appoint a new respiratory MCN coordinator. The post has been offered to Cat Young who currently works for NHS Health Improvement Scotland. It is hoped Cat will take up post on 27 January Lothian Oxygen Guide A paper relating to oxygen supplies and emergency use in the community was circulated prior to the meeting. This paper reemphasises LMC and BNF guidance to indicate GPs should have a supply of oxygen within practices. Practices must have access to an oximeter and ensure fire services are aware there is oxygen in the building. The guidance will be issued to general practices in the new year. S Brown requested the respiratory MCN core group is included in this communication. 3.4 Bronchiectasis Website / Self Management Plans The link to the updated bronchiectasis website will be circulated with the minutes of the meeting. N Hewitt indicated some text has still to be revised, funding to support the development has been confirmed and now moving towards the final proof. Self management plans (SMP) have been updated, the finalised plan will be circulated to the core group for reference. It was noted copies of the SMP will be sent to respiratory nurse specialists and the Health Promotion Library at Astley Ainslie Hospital stock and issue SMPs. N Hewitt indicated 4 out of 5 individuals with COPD who attend pulmonary rehabilitation classes in Edinburgh have a self management plan. Those with exacerbation of COPD also have plans. Development of the bronchiectasis patient website is still being supported by J Dalrymple and will be launched with the NHS Scotland SHOW website in early N Hewitt and J Dalrymple will agree how best to move forward in launching the website. There is an issue of posting videos on the website as SHOW cannot accommodate video and have suggested the use of You Tube, however this is not supported by NHS Lothian. A Malone suggested contacting G Cumming, innovation lead for NHS Lothian to ask if he could suggest a solution. AM 4. Pulmonary Rehabilitation (PR) Business Case N Hewitt reminded the group in September 2013 NHS Lothian s Efficiency and Productivity Group had agreed core funding for the PR service, however this was then revised as an Invest to Save proposal for review after 1 year and therefore there was no commitment to recurring funding therefore this was not supported by partnership nor Edinburgh Health and Social Care Partnership. N Hewitt attending Page 2 of 5

3 the Efficiency and Productivity Group on 18 December 2013 to discuss further and recurring funding has now been agreed. A dataset to capture admissions / readmissions is to be will be devised and further discussion to take place relating to potential prescribing efficiencies. S Brown is exploring introducing a clinical pharmacist role in PR prescribing and referred to instances of poor prescribing in primary and secondary care. She is meeting with pharmacy in January 2014 to discuss and agree a prescribing proposal. It was noted practitioners supporting PR have applied for independent prescribing status. 5. Asthma Work stream N Hewitt indicated this work stream will be progress when the new MCN co-ordinator is in post. 6. Prescribing / Education Event N Hewitt and K Johnston have met to discuss prescribing savings associated with the respiratory budget. A general practice Protected Learning Time (PTL) event targeting attendance of 2 individuals from every practice is being planned and will support education relating to 1 to 5 steps associated with treatment in line with the Lothian Joint Formulary. It was agreed this is a valuable proposal. The pharmaceutical industry are happy to support an event (with no promotion of products) if necessary. NH / KJ 7. Learnpro Spirometry The website is now complete and is being reformatted. A final proof reading will be scheduled after a meeting on 23 December The website supports short and simple navigation to the provision of information, targeted at community professionals (practice nurses, general practitioners). Patients will also be able to access the learnpro website. S Brown suggested advertising the module via the weekly PCCO newsletter and also circulate to the respiratory MCN core group for further dissemination. NHS Ayrshire and Arran have produced a video of inhaler techniques for sharing with other NHS Boards and this video will be utilised within Lothian. 8. Cough, Cancer, Detect Cancer Early (DCE) and RefHelp N Hewitt indicated the impact of the lung DCE campaign may result in a 50% increase in requirements for community chest x-ray and 30% increase in scans. He tabled a revised pathway for inclusion on refhelp relating to chronic cough, indications for DCE is new cough which is persistent for 3 weeks. It was noted consultant radiologist are able to fast track referral for individuals with suspicious chest x- ray for further scan and an appointment at a respiratory clinic. N Hewitt is liaising with John Donald, referrals advisor to update the refhelp page. It was noted small cell lung cancer is not associated with smoking. Page 3 of 5

4 A Malone suggested N Hewitt discuss the update to refhelp guidance with Peter McLoughlin, Strategic Programme Manager for Cancer who is lead for DCE in Lothian. NH 9. Efficient & Productivity Workstream Efficiency and Productivity inpatient changes have been initiated through the reallocation of respiratory nurse specialists reallocatied to the front door and wards at the Royal Infirmary. Charge nurses are rotating respiratory nurses in rotation of staff and shadowing to support removal of any professional boundaries. L Groom indicated weekly MDM meetings were taking place in hospital which also involved the doctors supporting discharge planning and this is working well. N Hewitt advised further work relating to outpatient pathway is to be undertaken with the aim to challenge GP referral to secondary care. S Brown expressed concern if referrals are reduced this may lead to a reduction in effective diagnosis. It was noted education events will be key in dissemination of information and a respiratory lead should be identified within each Health and Social Care Partnership as the MCN has not control over dissemination of information. 10. Invest to Save Project N Hewitt provided an update on the Invest to Save project, all staff are now in post, staff have applied for independent prescribing status, a psychologist is in post and seeing patients rather than providing advise, respiratory nurse specialists are based at the front door 12 hours x 5 days are picking up those attending A&E with existing respiratory diagnosis with the aim to supporting 48 hour discharge and repeat admissions. The COPD SESP will be reviewed in the next 2 weeks. This SESP has been running for 5 years and has had an impact in raising awareness of COPD. Should funding be discontinued, it is hoped the Invest to Save project will support any gap in data provision / community support for COPD. The impact of the Invest to Save project is being supported through regular reporting of Key Performance Indicators (KPIs). KPI information is available with a lag time of 3 months. 11. Any Other Business H Campbell referred a number of University of Edinburgh initiatives : Asthma UK Centre 1m grant to consider both research and evidence based medicine. H Campbell suggested a further update could be included on the agenda for the next core group meeting. National Global Burden of Disease report estimating burden of conditions such as COPD and lung cancer will be available in 2014 RSV vaccine a proposal is being developed to consider the burden Page 4 of 5

5 of bronchilolitis in Scotland and impact of vaccine in the next 5-7 years. Epidemiology Committee H Campbell will chair a committee to review the impact of the Scottish Government immunisation programmes such as shingles and flu in schools vaccinations. S Brown enquired if she could circulated the minutes of the 23 October 2013 Respiratory MCN Core Group meeting to the local respiratory partnership, this was agreed. SB Associate Medical Director St. John s Hospital S Brown advised James McCallum, Clinical Director for West Lothian Community Health Partnership will take up an 18 month secondment to the Associate Medical Director Post. 12 Date and Time of Next Meeting Wednesday, 19 th February 2014 from 2pm 3.30pm, Seminar Room 6, Chancellor s Building, Royal Infirmary of Edinburgh Under item 4, my meeting with pharmacy is to explore a proposal in line with my Nurse First Leadership programme looking at the role of clinical pharmacy within pulmonary rehabilitation and improving current prescribing. Charge nurse role was not discussed. Cheers Page 5 of 5