WALSALL LOCAL MEDICAL COMMITTEE

Transcription

1 WALSALL LOCAL MEDICAL COMMITTEE An open meeting of the Walsall Local Medical Committee was held in the Lecture Suite, Manor Learning and Conference Centre, Manor Hospital, Walsall on Monday 4 th February 2013 commencing at hours, that was attended by 30 people. PRESENT: Dr.A.J.Desai Dr.H.S.Syed Dr.U.Ahmad Dr.F.Mahmood Dr.A.T.Askey Dr.R.T.Cheriyan Dr.A.Ghosh Dr.A.S.Gill Dr.A.Iqbal Dr.A.S.Khan Dr.R.Kumar Dr.R.Mandal Dr.S.Manthri Dr.A.S.Suri Dr.S.J.Vaid Chairman Medical Secretary Asst.Secretary Treasurer (open meeting only) Also present: Amir Khan Dr.S.Yuen Dr.N.S.Sahota Dr.Isabel Gillis Dr.Barbara Watt Heidi Mitchell Tanya Grainger Gerry Duffy Lindsey Shields Derek Hunter Dr.I.Majid Dr.A.Muniyappa Dr.B.C.Pal Dr.R.Suri Dr.M.P.H.Vitarana Medical Director/Walsall Healthcare NHS Trust Consultant Paediatrician/Walsall Healthcare NHS Trust Associate Medical Director for Black Country Cluster Director of Public Health/NHS Walsall Consultant in Public Health Medicine/ NHS Walsall Chlamydia Screening Manager Lead Nurse for Sexual Health/Walsall Healthcare NHS Trust Health Advisor/Walsall Healthcare NHS Trust Head of Recovery Service/ Dudley and Walsall Mental Health Partnership NHS Trust Team Manager EAS/Dudley and Walsall Mental Health Partnership NHS Trust Interim Urgent Care Commissioning Manager/ Sandwell and West Birmingham CCG 1

2 Minute Secretary Carolyn Andrew LMC Executive Officer The meeting was opened at hours by the LMC Chairman, Dr.Ajit Desai, who welcomed speakers, guests and members. The Chairman went on to congratulate Dr.Isabel Gillis on her recent appointment as (Joint) Director of Public Health for Walsall. WELCOME: Mr.Amir Khan Dr.I.Gillis Dr.N.S.Sahota Heidi Mitchell Tanya Grainger Dr.Barbara Watt Gerry Duffy Lindsay Shields Derek Hunter 1) APOLOGIES Salma Ali Anne Baines Dr.A.E.Benjamin Dr.S.Handa Dr.R.Mohan Dr.L.S.Nambisan The LMC Chairman introduced Mr.Amir Khan to discuss hospital mortality rates and related issues. 2) In Safe Hands Mr.Amir Khan Mr.Amir Khan: Medical Director/Walsall Healthcare NHS Trust Mr.Amir Khan referred to the many news items in the press recently owing to the hospital mortality rates figures being published, as well as the publication of the report into the mid-staffs NHS Trust enquiry. He underlined the vision for Walsall Healthcare NHS Trust as being: To provide first class integrated health services for the people we serve in the right place at the right time Mr.Khan acknowledged that infection control was a problem in 2011/12. We have had two cases of MRSA which is within the target. Clostridium difficile we have made a great effort for last year and so far have only had 9 cases against a target of 51. GPs had played a large part in that work in terms of antibiotic prescribing. The Trust is aware that delivering a good patient experience is an essential part of providing first class, integrated health services. An extensive listening exercise had been conducted with staff and patients in order to determine the changes required to ensure a good patient experience and these had been enshrined in the Trust s promises to patients. How is hospital mortality measured? Mortality ratios a helpful measure to allow benchmarking: Summary Hospital-level Mortality Indicator (SHMI now the official, NHS hospital-wide mortality indicator for acute trusts in England). Produced quarterly by the Department of Health, covering a rolling 12 month period and including deaths in hospital and within 30 days of discharge 2

3 Hospital Standardised Mortality Rate (SHMR) produced monthly covering deaths in hospital in a group of 56 diagnoses Numbers of deaths and the crude mortality rate Mr.Khan pointed out that there are poor underlying levels of health in many parts of the borough. In addition to this, prior to the opening of the St.Giles Walsall Hospice, there had been greater pressure on services and reliance on the hospital to provide end of life care. Mortality rates are monitored very closely by the hospital. Mr.Khan said that the crude mortality rate is decreasing and HSMR showed a gradual fall, month on month between April October The Manor Hospital is now in a comfortable position compared to other comparable providers. SHMI includes all deaths in hospital, regardless of whether they are unavoidable or inevitable such as patients who come into hospital for end of life care. The only way to bring this figure down will be when patients are provided with the right care at the place of their choice rather than bringing them to the acute hospital. Putting the Trust Strategy into action Review of every hospital death by a senior consultant Greater senior medical input on wards Increasing nursing rounds to every two hours Focus on serious respiratory conditions - Introduce a specialist respiratory consultant into the Acute Medical Unit - Care bundle for patients with serious respiratory conditions Improving palliative care and end of life care by: - Providing specialist reports seven days per week - Appointing two new consultants in palliative medicine - Further investment in hospital end of life care support Improving and delivering safe care alongside reducing mortality is the responsibility of everyone. In 2012/2013 the Trust: Had expert advice from a British Thoracic Society senior clinician to ensure that respiratory services are based on best practice Is proceeding with a major review of medical consultant workforce to increase further consultant cover, especially at evenings and weekends Is planning the launch of care bundles including for sepsis and urinary tract infection Is working on areas identified by case reviews including improving fluid balance and improved transfer and handover of patients LMC Members asked could GPs get feedback from incident reporting? Mr.Khan responded that this should be happening and agreed to address it. Dr.Amrik Gill said that the work done by the Mortality Review Group had been good and had been noted. He added that the Francis report mentioned human care given to patients and asked Mr.Khan how this could be measured? Mr.Khan said patient/relative feedback. Dr.Gill assured Mr.Khan that if primary care could help with feedback on this then they would. Dr.Isabel Gillis enquired whether the ward round standards were locally developed and was told that they are from the Royal College of Physicians. 3

4 Mr.Khan was informed by Dr.Vaid that GPs are getting requests to initiate warfarin treatment for some patients. Dr.Haris Syed, LMC Medical Secretary, agreed that this was not appropriate and a hospital consultant should initiate anticoagulant treatment. Mr.Khan asked for specific examples to be sent to him with full patient details and he promised to look into it. In conclusion, Mr.Khan asked to make a couple of announcements: (i) Monday 25 th February 2013 meeting for all BMA members at 7pm in the Learning Centre, Manor Hospital (ii) Saturday 23 rd March 2013 Charity Ball at Conference Suites, West Bromwich. Proceeds to provide artificial limbs (UK Rehab Trust International) tickets available from Amir Khan, 30 per head. The Chairman thanked Mr.Khan and asked Dr.Barbara Watt and colleagues to present their item on Sexual Health in Primary Care. 3) Sexual Health in Primary Care - Dr.Uzma Ahmad/Dr.Barbara Watt/ Heidi Mitchell/Tanya Grainger Dr.Uzma Ahmad: Dr.Barbara Watt: Heidi Mitchell: Tanya Grainger: Lead GP for Sexual Health Consultant in Public Health Medicine/NHS Walsall Chlamydia Screening Manager, Lead Nurse for Sexual Health/Walsall Healthcare NHS Trust Health Advisor/Walsall Healthcare NHS Trust Dr.Barbara Watt thanked the LMC Chairman for giving time for this item on the February LMC agenda. She reminded colleagues that she had talked at the previous LMC meeting about primary care Local Enhanced Services going to the local authority and said that the Sexual Health LES was one of them. When Walsall Integrated Sexual Health Service (WISH) was first talked about (hub and spoke model with four primary care specialist spokes originally proposed) GPs were keen to be a part of this, but expressed a desire for all practices to be offered the opportunity to provide enhanced primary care sexual health services for their patients. The Sexual Health LES had been introduced to try to make this a reality. This visit to LMC was an exercise to enquire how the LES is working and where improvements could be made. Evidence shows that when GPs screen in primary care good results are obtained. Barbara said that the team was fortunate to have Dr.Uzma Ahmad as Lead GP. Dr.Ahmad advised colleagues that she had been asked to work with the team to make a link with GPs. The sexual health agenda is not being met in primary care and Dr.Ahmad had spoken about this at locality meetings. She would continue to work as a link so if colleagues had any problems they should bring them to Dr.Ahmad. Heidi Mitchell and Tanya Grainger had come to LMC to discuss how to improve the LES. Heidi mentioned that although 2/3rds of GP practices had signed up to the LES, not all of them were actively submitting data. Tanya had been going into practices to advise about this. The team had come across some barriers e.g. access to clinicians (Practice Managers sometimes refused access). 4

5 The team can offer to support rolling out the LES and also share good practice. Tanya will come into the practice and work alongside clinicians. Heidi urged GP colleagues to tell them about any obstacles and what they felt could be improved on what would be the primary care wish list? She added that she was aware that there were templates on EMIS for sexual health but queried whether the correct codes were being extracted from the templates. The following issues were raised by members: Dr.Raj Kumar - The LES is time consuming but the funding for it is minimal Dr.Hewa Vitarana - There are issues with CDR Intell, it does not work and a different data collection method is needed Dr.Haris Syed agreed that there were issues with CDR Intell but pointed out that it was the data collection method they had and had to work with it. He said that the codes that CDR Intell searches on are historic so it flags up on all codes and thus generates a lot of extra work for the practice managers doing the searches. Dr.Syed also agreed that the point made about the funding was a valid one and that all work should be properly funded. GP practices are very busy and patients have to be chased up. He advocated that predefined codes were required and that CDR Intell must refine their queries. Heidi asked, as it is a particular age group that it targeted with this LES and there is the potential to stigmatise patients, would it be better to rebadge it as a lifestyle check and would this make it easier to sell to patients? LMC members felt that this might work. Dr.Narinder Sahota pointed out that the template was complex and asked if it could be simplified? Heidi asked for a screen shot of the template to be sent to her and also asked where the templates were generated from? Members advised that they were generated by Barbara Yates. Dr.S.J.Vaid - There are too many people trying to advise youngsters, if they move to a new practice they might say they have already had Chlamydia screening but the GP has no proof because of confidentiality. Heidi suggested that in these circumstances patients were asked to repeat the test in the interests of continuity of care at the new practice. She added that Walsall has a very successful Chlamydia screening programme. Dr.Amrik Gill asked Heidi whether the team had attended the Practice Managers group meetings and suggested that she contact Karen Woodcroft at Moxley Medical Centre and Jerome Emery at St.Peters Surgery. Dr.Raj Manadal pointed out that most of the time when a patient comes to see the GP they come in with a different problem and suggested holding an open day at the practice for screening. Heidi responded that she appreciated the suggestion but a specific time would have to be chosen when the patients would be available to come in and again this might stigmatise the patient. In conclusion, Dr.Barbara Watt asked whether the GP community were still committed to participating in a LES offered across all GP practices rather than moving to a more focussed hub and spoke model? All GPs present agreed that they were. 5

6 The LMC Chairman moved to the next item on the agenda, Early Access Service (EAS): Accessing Secondary Mental Health Services, and invited Lindsey Shields to make her presentation. 4) Early Access Service: Accessing Secondary Mental Health Services Lindsey Shields Lindsey Shields: Team Manager Early Access Service/Dudley and Walsall Mental Health Partnership Trust Background Lindsey explained that she had been registered as a mental health nurse for 32 years and that she was now Team Manager for the Early Access Service. Approximately 2 years ago, the Trust mapped a patient s journey through mental health services in Walsall and found there were 27 access points. The Early Access Service is a mental health service available across Dudley and Walsall and delivers a single point of entry. The purpose of EAS is to create an uncomplicated process for accessing adult secondary care mental health services. Their mission is to offer prompt multi-disciplinary assessment in order to ensure that service users receive appropriate and timely treatment. EAS operates between 9am and 5pm Monday Friday and works in conjunction with the Crisis Service out-of-hours. Staffing Levels at EAS: Team Manager Clinical Lead (Registered Nurse) 4.6 Registered Nurses (.6 also AMHP) 1Social Worker (also AMHP) Medical Staff: 2 Consultants and 2 staff grade daily on a roster basis Referral Pathway to Mental Health Services (Walsall) Is this a Mild to Primary Mental Health and Talking Therapies Moderate Mental Monday to Friday 9am 5pm Health Issue of Patient can self refer to the service (give leaflet) Low Risk? OR a written referral can be sent to: Primary Mental Health and Talking Therapies Service Dudley & Walsall MHPNHST Kingshill Centre, School Street Wednesbury WS10 9JB Level of risk should be considered on the basis of the Clients potential to cause harm to themselves or others 6

7 Is this a Moderate to Secondary Care: Severe Mental Health Referral to the Early Access Service is Monday to Friday 9am 5pm Issue or High Risk? Please send a written referral to: Early Access Service 28 Glebe Street, Walsall WS1 3NX If the referral is urgent please call: Telephone: Fax Number: Out of hours including Bank Holidays: Please contact the Dorothy Pattison Hospital switchboard on and ask for Crisis Resolution/Home Treatment Team Urgent referrals will be assessed on the same day. Non-urgent referrals will be sent a letter asking the person to contact the service within 7 days in order to arrange a convenient appointment and an assessment will take place within 15 working days (see leaflet for more detail). Who can refer to the Service? New referrals will be accepted from the following professional groups: GPs Local Police/Forensic medical examiner Local acute hospitals Dudley and Walsall Mental Health Partnership Trust Enhanced Primary Care Teams Lindsey said she was aware that there had been many issues with mental health services in Walsall and asked LMC members to identify any problem areas. Members raised the following points: Dr.Aniruddha Ghosh - The leaflet says that carers can refer to the service in hours but experience tells us that this is not the case. Lindsey EAS was set up to take primary referrals from GPs but this was not found to be practicable and a more flexible approach was required. The service will take referrals from other health professionals/social workers/children s team etc. EAS has not taken direct referrals from relatives/carers since last April. Dr.Aman Khan - When GPs try to refer to the service it is very time consuming and the Consultants ask lots of questions. There are more difficulties if you are trying to refer towards the end of the afternoon. EAS service finishes at 5pm therefore the last assessment is at 3.30pm. Staff should take the referral and ring the patient. If the patient is safe to come in the next morning then this will be arranged but if not then they will pass on to the Crisis Team themselves. 7

8 Dr.Raj Mandal also provided some positive feedback on the service, saying that it had improved within the last two months. Lindsey acknowledged that communication with GPs was much better now but urged anyone who experienced problems with the service to contact her on the EAS number and she would do her best to resolve them. 5) Any Other Business (i) Update on NHS 111 Derek Hunter Derek Hunter: Interim Urgent Care Commissioning Manager/ Sandwell and West Birmingham CCG The LMC Chairman, Dr.Ajit Desai, welcomed Derek Hunter back to Walsall LMC for his fourth visit to update members on NHS 111. Derek apologised first of all that his colleagues, Avril Smith and Jagdeesh Dhaliwal had been unable to join him as they had prior commitments. Dr.Sirjit Bath (NHS 111 Clinical Lead for the Black Country) was also unavailable. Derek reminded GP colleagues that NHS 111 is a government initiative that has to be implemented. In 2006 a Department of Health consultation Direction of travel for urgent care had identified confusion among patients about where to go if they had an urgent healthcare need. As a result of this, NHS 111 was introduced with the intention that it would replace the NHS Direct telephone number when it was rolled out nationally. SHA clusters will need to be satisfied that roll-out is complete by April NHS Direct was the successful bidder to provide the NHS 111 service across the Black Country. NHS 111 operates to the following core principles: 1. Completion of a clinical assessment on the first call without the need for a call back 2. Ability to refer callers to other providers without the caller being re-triaged 3. Ability to transfer clinical assessment data to other providers and book appointments where appropriate and agreed 4. Ability to despatch an ambulance without delay 5. Ability to provide health information or reassurance about what to do next Successful implementation of NHS 111 means ensuring that it is an integral part of the local urgent care system. Derek said that Dr.Ajit Desai and Wendy Godwin have been deeply involved in looking at the Directory of Services (DoS) that will be used by the local NHS 111 service. The patient may be directed to a wide range of services via the DoS. Preparing for Go Live Clinical governance submission and DH Review Testing - Technical testing - Commissioner testing - DH testing A review of communications and engagement activity at the end of January 8

9 Attending events across the West Midlands and holding events in the NHS 111 call centre to engage with a wide range of stakeholders Setting up post Go Live systems for reporting, daily review of activity Derek pointed out certain Statutory Duties that NHS 111 has: The safe management of callers who contact the NHS 111 service three times or more within a four day period (frequent callers directed to see their GP within one hour) Protection and retention of information Safeguarding Children Managing repeat callers (frequent callers) Data sharing with the Health Protection Agency Care Quality Commission registration The OOH soft launch was to have been on 12 th February 2013 but this has now been delayed to a date to be advised. Derek said that he was prepared to return to LMC in March or April with a further update. LMC members raised the following issues: Dr.Avi Suri - The DoS needs to be updated regularly contact numbers etc. NHS 111 must know how to signpost patients properly. Derek assured members that Louise Brierley, from West Midlands Ambulance Service NHS Trust, is responsible for keeping the DoS up to date. The team are aware that mental health services are a particular issue. Dr.Raj Kumar - Frequent callers directed to see their GP within one hour. This could prove very difficult for single-hander GPs who may not have appointments free. Dr.Narinder Sahota agreed that this was a genuine concern and asked whether it would be an issue? Derek acknowledged that more information had been requested from DoH on this. Dr.Aniruddha Ghosh - Will information be given in languages other than English? Derek said that information would be provided in languages other than English and there were also textphone facilities etc Dr.Haris Syed - Will the local NHS 111 service book GP appointments? Dr.Ajit Desai said that this had been vetoed for Walsall at present but would probably have to be revisited. We need to see how the system works once NHS 111 is under way. 6) Date of Next Meeting: Monday 4 th March hours In the Lecture Suite, Manor Learning and Conference Centre. The open meeting was declared closed at hours by the LMC Chairman. LMC Committee members were asked to remain for the In-Committee meeting. 9