London Cardiac & Vascular Strategic Clinical Leadership Group (SCLG) Minutes

Transcription

1 London Cardiac & Vascular Strategic Clinical Leadership Group (SCLG) Minutes 7 July 2015 Burfoot Court Room, Guys Hospital, Great Maze Pond, London, SE1 9RT Item 1. Welcome, introductions, apologies In attendance Huon Gray National Clinical Director for Cardiac Care for NHS England, Chair Jenna Evans Senior Project Manager, NHS England (London region) Olaf Wendler Cardiac Surgeon Philip MacCarthy Cardiologist Nick Bunce Cardiologist Iqbal Malik Cardiologist Simon Woldman Cardiologist (Heart Failure) Sue Woollard - Specialised Commissioning Anton Psaila British Heart Foundation Stuart Rowe Specialised Commissioner, NHS England (London region) Alison Blakeley London Ambulance Service Sue Sawyer Specialised Commissioner Jillian Riley Consultant Nurse Sotiris Antoniou - Pharmacist Michael Cooklin - Cardiologist Helen Williams Pharmacist Michaela Nuttall CVD Coordinator Nicola Jones General Practitioner Andrew Archbold Cardiologist Apologies Paul Trevatt - Lead, CVD Strategic Clinical Network Andrew Leatherland British Heart Foundation Lucy Grothier Associate Director Andrew Chukwuemeka Cardiac Surgeon Jane Fryer- Medical Director, NHS South-East London Obi Agu Vascular Surgeon Mark Whitbread London Ambulance Service 2. Minutes of last meeting and matters arising The minutes were agreed as an accurate reflection of discussions. HG updated the group that Jay Nairn had left the Cardiac SCN to work in the mental health SCN as a promotion. HG thanked JN for his hard work with the SCN. 1

2 3 Specialised Commissioning Sue Sawyer provided an update on Specialised Commissioning arrangements. All Trusts have been required to decide on what tariff arrangement they will continue on for 2014/15. Many Trusts has chosen to continue on current tariff arrangements which will result in no additional CQUIN money. A new cardiac surgery specification is being developed. This will consider work developed on mitral valve by the London Cardiac Surgery Advisory Group. Action Sue Sawyer to circulate new cardiac Surgery service specification. Service reviews continue to be held. The vascular services reconfiguration is ongoing with South East London currently being the focus for commissioners. Local discussions re: neuro rehab continue. Co-commissioning models are now being formed and potential QIPPs being finalised on below to above knee amputation rates. There is ongoing work with the vascular CRG on providing an open thoraco-abdominal service in London rather than sending patients abroad. As of September SS will be taking on new role as regional Programme of Care lead and will be the accountable commissioner for the cardiac CRG. The cardiac and cardiology CRG may merge. HG congratulated SS on her new role and expressed a wish for SS to continue her place on the cardiac SCLG. SS agreed to continue to join meetings and update the group. Work has commenced to consolidate 18 weeks performance measures as there is currently no incentive for trusts to prioritise patients once they have breached. This will allow trusts to focus on booking patients in chronological order. NJ commented that CCGs welcome this work. Discussion held around FT financial issues and investment in infrastructure from specialised commissioning. SS commented that demand and capacity work is under way to support these issues. SS shared a medical device alert where a Field Safety Notice has been released by Sorin the manufacturer of a heater cooler device for cardiac surgery. This advises that microbiological testing of heater cooler units is undertaken See attached. HG thanked SS for the update. M_chimaera_advice_ for_providers.pdf Air_water_environm MDA _Heat Sorin Group ental_sampling_sop.p er-coolers.pdf Deutschland GmbH Clinical Commissioning Group Update NJ provided an update. An incentive promising GP practices more GPs to provide a 7 day service is being discussed. This will be a London programme however it is currently unclear where the funding for this will come from. GP collaborates are coming together aligned with the five year forward view. A community care model is proposed for primary, secondary and social services coming together. Some CCGs have formed collaborates but a number haven t taken this on as yet. Devolution of services in Manchester is high on the agenda currently with CCGs and there are early discussions that this is being proposed for London. HG asked if GPs involved in collaborative groups are seeing an advantage. NJ responded that some GPs already worked in collaborative groups and those are still working well but others are not entirely engaged with that model of working as yet. PM asked if there is a demand for seven day primary care services in London. 2

3 NJ responded that to help reduce A&E admissions there is, but not to spread five days working over seven. Lots of practices in London already provide this service with it being tailored to local need. NJ commented that there are various incentives being looked into to bring GPs back in to practice. HG thanked NJ for the update. 5 Acute Coronary Syndrome OHCA Phil MacCarthy provided an update on the work of the ACS advisory group. The group last met in May and collected data for the last year. One Trust didn t submit due to a large service move. The invite remains extended to NSTEMI centres who also submitted data. Key points from the data included: o The hit rate has reduced over the last year from 70% to 66% o Increase in false PAMI over the last year o There is variation noted in the data. LBBB and out of hospital cardiac arrest (OHCA) are included in the data set as false activations. PM commented that the group will continue to collect this data. It provides information on patients who are directly transferred to the cath lab but do not need an angioplasty e.g. OHCA cause non MI. This is proving an issue for most heart attack centres who have non-angioplasty patients being cared for in the cath lab with no beds available internally to repatriate them to. This then causes blockages in the cath lab as uses cath lab staff and resources. PM added that level 2 beds are being blocked also and this is impacting on high level tariff activity. Trusts cardiology services are not receiving a payment for these patients as they are not having a procedure, but using cardiology resources. HG commented that the Urgent and Emergency care review may assist with some of these issues. Action HG to write to Keith Willett Action PM to share outcomes of false PAMIs Action PM to send HG paper on King s experience HG thanked PM for the update SS commented that specialised commissioning are looking at ways of co-commissioning with CCGs which would improve these patient pathways On behalf of IM, HG asked Alison Blakeley from LAS to enquire if it would be possible to have access to LAS OHCA data before it is disposed of to support the OHCA project. Action AB to enquire with business intelligence unit at LAS HQ 6 Arrhythmia MC provided an update on the Arrhythmia Advisory Group. Nick Gall is leading on developing guidelines for the management of syncope. An audit was carried out in his local area to support a business case for CCGs to fund syncope clinics. The arrhythmia group will endorse the guidance and disseminate across London. MC referred to the paper submitted to the February SCLG. The paper was seeking endorsement of a project to establish centres in London capable of 24/7 pacing for patients with complete heart block. The project would help to provide more equitable care. MC asked the SCLG for recommendations on how to gain support from CCGs on supporting the endorsement of pacing centres and the patient pathway. NJ recommended informing Strategic Planning Groups (SPGs). Action MC/JE to follow up with SPG chairs MC informed the group that an update paper on CHB and VT triaging will be going to the London clinical senate towards the end of the year. 3

4 7 Vascular 8 Heart Failure HG thanked MC for the update Update postponed to next SCLG Jillian Riley provided an update on the work of the Heart Failure Advisory Group. The 3 rd meeting was not well attended for various reasons but a useful discussion was held on the service provision mapping data. Jillian Riley informed the group that the service maps have had further data added on primary care, admissions and outcomes. This work will now include a workforce survey that can be added to the maps, taking into consideration access to psychological support for patients with HF. JR reported that the HW informed the group of new therapeutic interventions for HF patients. NICE approval will not be released until June The HF advisory group discussed whether it was appropriate for them to issues guidance on these interventions before No decision was made but it will be kept on the agenda. HG thanked JR for the update. 9. Cardiac Surgery Olaf Wendler provided an update on the Cardiac Surgery Advisory Group. The advisory group is looking to better understand why RTT for cardiac surgery is so high. A survey of facilities and cardiac surgery services in London has been undertaken. The advisory group is now going to overlay RTT data and activity data over the results. Olaf Wendler highlighted that focusing on RTT will be a focus of the group for the future. At the last advisory group the general manager from Brompton attended and gave a service managers view on 18 week issues in cardiac surgery Huon Gray suggested that the group produce a document outlining factors which are contributing to increases in surgery waiting times to help the national CRG. Action Olaf Wendler to develop document outlining factors contributing to increase in waiting times for surgery. OW asked SS if trusts receive a financial penalty for non-compliance with the IHT system. SS commented that a percentage of their budget will be withheld if non-compliant and they will receive contract query notices. HG thanked OW for the update. 10 Pharmacy update Sotiris Antoniou provided an update on prescribing data. Work has been undertaken on mapping AF anti-coagulation with NOACS and has revealed a discrepancy in practice. Also data linking AF with SSNAP data. The report shows there has been a shift to NOACS and the total number of patient s receiving anti-coagulation therapy has improved. Action Sotiris Antoniou to send report with prescribing data to the SCLG MC asked if this data was available split by primary care and acute trusts. SA commented that primary care have the greatest use of NOACs compared to acute trusts. There is a slow uptake in London currently. HG thanked SA for the update 11 Familial Hypercholesterolemia & prevention 4

5 12. AOB NJ provided an update on the Familial Hypercholesterolemia (FH) task and finish group. The group had met for a second time and had a discussion around how to encourage and inform CCGs. The group had representatives from Harefield and the Royal Free who had presented their models of care. There are a small number of pilots running in GP practices where patients are pulled from the system to enable case finding. The group would like to promote the use of FH guidance. HG thanked NJ. HG informed the group of a recent press release to refine the guidance on FH. HG informed the group that the Chief Scientific Officers at NHSE are running a programme looking to improve access to diagnostics across whole patient pathways. They are focusing on HF and FH. This work will feed into the genomes project. PHE have formed a prevention board where hypertension, heart failure and AF are on the agenda. There is a joint event being held at the Kings fund on 24 th September. SS informed the group that the renal SCN are looking at developing a collaborative commissioning model for renal patients to assist with secondary prevent No other business Next meeting: 2-5pm, 1 October