National Services Division Gyle Square 1 South Gyle Crescent Edinburgh EH12 9EB Telephone 0131 275 6575 Fax 0131 275 7614 www.nsd.scot.nhs.uk Minutes Scottish Pathology Network Steering Group Meeting Date: 21 st February 2017 Time: 11:00-15:30 Venue: Adam s Room, Glasgow Teacher Building, 14 St Enoch Square, Glasgow, G1 4DB Attendees: Dr Liz Mallon, Lead Clinician for SPAN/Consultant Pathologist, Greater Glasgow & Clyde (Chair) Mrs Liz Blackman, Senior Programme Manager, National Services Division Dr Mark Brown, Lead Consultant Pathologist, Forth Valley Dr Gareth Bryson, Lead Consultant Pathologist, Greater Glasgow & Clyde Ms Lianne Duffy, Lead Biomedical Scientist Dumfries & Galloway Ms Adele Foster, Service Manager, Dumfries & Galloway Dr Joyce Lang, Lead Consultant Pathologist, Ayrshire & Arran Mrs Claire Lawrie, Programme Manager, Information Management Service, National Services Division Mrs Amanda Malham, Lead Biomedical Scientist, Fife Dr Marie Mathers, Lead Consultant Pathologist, Lothian Mrs Debbi McEwan, Lead Biomedical Scientist, Ayrshire & Arran Mr John McEwan, Lead Biomedical Scientist, Forth Valley Dr Fiona Murdoch, Lead Consultant Pathologist, Fife Miss Emily Ross, Programme Support Officer, National Services Division Mrs Alexandra Speirs, SPAN Programme Manager, National Services Division Dr Grant Stenhouse, Lead Consultant Pathologist, Highland Dr Dave Topping, Lead Biomedical Scientist, Tayside Mrs Jackie Walker, Scientific Manager for SPAN/Lead Biomedical Scientist, Greater Glasgow & Clyde Mr Allan Wilson, Scientific Manager for SPAN/Lead Biomedical Scientist, Lanarkshire Mr David Wilson, Lead Biomedical Scientist (in waiting), Grampian Apologies: Mr Michael Burns, Lead Biomedical Scientist, Dumfries & Galloway Prof. Frank Carey, Lead Consultant Pathologist, Tayside Mrs Lynne Doverty, Lead Biomedical Scientist, Grampian Dr Sinclair Dundas, Lead Consultant Pathologist, Grampian Dr Peter Johnston, Honorary Consultant Pathologist, Chair of the Diagnostic Specialty Training Board Mr Ian King, Lead Biomedical Scientist, Lothian Dr Stamford Mathe, Lead Consultant Pathologist, Dumfries & Galloway Dr Tim Palmer, Scottish Cervical Cytology Consortia Chair, Highland Mr Andrew Soden, Lead Biomedical Scientist, Highland 1
Dr Stuart Colin Thomas, Lead Consultant Pathologist, Lanarkshire 1. Welcome, introduction and apologies Dr Mallon welcomed everyone to the first SPAN steering group of 2017. The steering group warmly welcomed Dr Mallon as the new SPAN Lead Clinician. 2. Minutes and actions of November 2016 meeting The minutes of the previous meeting were accepted as a true and accurate record of proceedings, with minor amendments to attendees. 2a. Review of outstanding actions from the previous meeting Dr Mallon reviewed the ongoing SPAN steering group actions with the group. Dr Mathers reported that discussions were still under way to explore how Renal and Liver Services could be provided through the central belt. Action: Dr Mathers Dr Mallon advised the group that she had a meeting arranged with Ms Fiona Murphy (Director, National Services Division) on 23 February 2017, to identify what the networks needed to do in future to be in a position to respond to the request for complementary diagnostic tests. Action: Dr Mallon Dr Mark Ashton, Breast QA Pathology Lead, had advised in advance of the meeting that there had not been a QARC since the last SPAN steering group, so this action had not as yet been progressed. Action: Dr Ashton Mrs Lawrie informed the steering group that the Information Management Service (IMS) was working with Scotland s Information Services Division (ISD) to look at data discrepancies pertaining to SPAN and the other National Managed Diagnostic Networks (NMDNs) Action Mrs Lawrie Mrs Lawrie further advised that IMS would undertake a scoping exercise on behalf of SPAN to ascertain the number of consultants who are due to retire. The steering group recommended that the scoping exercise be extended to include other Pathology staff. Mrs Lawrie informed the group that this would commence on 1 st April 2017. Action: Mrs Lawrie Ms Emily Ross informed the group that work had commenced creating a national Pathology distribution list, which included all staff that worked in Pathology Laboratories in Scotland. Action: Miss Ross 2
Dr Mallon informed the group that the SPAN core team had progressed the block and slide storage solution and voice recognition scoping exercises, via Lime survey. The steering group were encouraged to complete the Lime survey questionnaires as soon as possible 3. Progressing the SPAN work plan Action: SPAN Steering Group Dr Mallon invited the steering group to nominate themselves to progress and contribute to the SPAN work plan. The steering group members identified the following work streams that they would like to be involved in: Information Management Dave Topping Tayside John McEwan Forth Valley Fraser Duthie GG&C Amanda Malham Fife Gareth Bryson GG&C Claire Lawrie NSS Digital Pathology Gareth Bryson GG&C Amanda Malham Fife Marie Mathers Lothian Debbi McEwan A&A Allan Wilson Mortuary Amanda Malham Fife Dave Topping Tayside Mark Brown Forth Valley Debbi McEwan A&A BMS Dissection Dave Topping Tayside John McEwan Forth Valley Colin Moyes GG&C Amanda Malham Fife Marie Mathers Lothian Vanda McTaggart A&A Mark Brown Forth Valley Jackie Walker GG&C Horizon Scanning/ New Technologies Dave Topping Tayside David Wilson Grampian Allan Wilson Demand Optimisation Dave Topping Tayside Scottish Cancer Taskforce Liz Mallon GG&C Evaluation Panel Liz Mallon GG&C Education and Training Amanda Malham (BMS Reporting) Fife Allan Wilson Dr Mallon thanked everyone for supporting SPAN to progress the work plan and asked the steering group to encourage their departmental pathology colleagues to become involved in the working groups. Mrs Walker informed the group that as each group progressed a chair 3
and vice chair would be sought and each group would have administrative support provided by NNMS. Action: Steering Group members Mr Wilson suggested that the Horizon Scanning group should also include new technologies and be point of contact for any new products or services sent directly to NSD, which the steering group endorsed. Dr Mallon informed the group that she had meetings arranged to meet with the Regional Cancer Networks (RCN s) to explore with them what opportunities there were for SPAN and the RCN s to work more closely and collaboratively with one another. Action: Dr Mallon 4. Revised Governance Structure Dr Mallon reminded the group that one of the recommendations from the National Specialist Services Committee (NSSC) SPAN review was that all Boards nominate their Board s SPAN representatives. Members were asked to provide Ms Ross with contact names. 5. Prioritising Five year work plan ACTION: SPAN Steering Group Mrs Blackman informed the steering group that the SPAN core team were providing progress reports to the National Services Division (NSD) Review Project Board on a six weekly basis, on the networks progress against the milestones that were agreed as part of the NSSC s recommendations for ongoing designation of the network. Mrs Blackman informed the steering group that that NSD Project Board was happy with the progress that SPAN had made to date. Mrs Blackman advised the steering group that the outputs from the NSSC SPAN Strategy day had been progressed into a five year work plan, Mrs Blackman advised that the five year work plan and governance structure would be continued to be reviewed and progress would be monitored by the SPAN core team on a quarterly basis and shared with the steering group 6. Recent updates The SPAN steering group were invited to refer to the SPAN paper (SPAN-SG-2017-06) 7. Laboratories Data Improvement Group From discussion, it emerged there was a difference of opinion as to whether pathology labs were being asked to participate in Keele for the next 2 years. It was agreed the SPAN position was that Boards would continue to complete the returns to IMS for the SPAN data collection, however that there should be no requirement to also participate in Keele as this was duplication in effort. This would not have an impact on those pathology labs who wished to continue to participate in Keele. Mrs Lawrie confirmed that the Keele dashboard was a subset of the SPAN data. 4
It was agreed to pursue some clarity from the Shared Services Team. Action: Mrs Blackman 8. BMS Dissection update Mrs Walker presented the work of the BMS Dissection Short Life Working Group (SLWG). Mrs Walker advised the steering group that the group were developing a business case that would be shared with the Scottish Government. She extended an invitation to the steering group to participate in progressing the BMS dissection agenda once the current SLWG came to an end. Category % Dissection Hours done by BMS % Dissection Hours done by Medic B&C 46% 54% D&E 6% 94% Total B-E 22% 78% Mrs Walker informed the group that of the weekly hours spent dissecting specimens in Scotland, only 22% of these hours involve BMS dissection. Mrs Walker also noted a key point that the data indicated that there were approximately 55 medical hours per week involved in dissection of B&C cases. This is equivalent to 13-14 sessions, equating to 172,000 per annum. Mrs Walker also noted that the business case (once submitted) would be required to state the potential quantifiable impact on patient care, with an estimated improvement in Turnaround Times (TATs). Mrs Walker informed the steering group that the BMS SLWG had focused on areas where BMS dissection was at a good level, identifying the resource needed for a national training school and the level of support needed. This included a local training resource of: 10 hours per week per BMS for six months 10 hours per week of Consultant time for three months The working group made the following recommendations: One Board would be established as a training school to deliver theoretical training and practical training (demonstrations); and each Board would still deliver local practical training. One week training course which will include lectures and practical training. Mrs Walker advised that the steering group would be invited to contribute their views on the preferred option of a National Training School through a scoping exercise. 5
The BMS SLWG will consider the implications of training BMS staff in D & E specimens at the next meeting. Mrs Walker noted that the group had considered what the projected time and benefits would be of releasing medical time through BMS dissection. It was agreed the future funding model might be complex, with the need to identify what additional resource is needed, such as additional BMS or consultants. How this might be front loaded to support initial training and what the long term picture is were also noted as an additional requirement. It was noted it should be cost saving (or at worst cost neutral) in the long term, as the requirement to fund additional medical sessions would diminish as medical time was freed up from Dissection; however there was a need for extra medical time upfront as an enabler. Mrs Walker concluded her presentation by acknowledging that not only was this a better opportunity for Boards to use their financial resources more effectively by employing additional technical staff to undertake these roles, it also provided medical colleagues with the opportunity and time to report cases and attend Multi Disciplinary Team (MDT) meetings. 9. PD-L1 Mrs Walker informed the group that the PD-L1 meeting took place on 11 January 2017, chaired by Prof. Keith Kerr. There was wide support for three testing centres: Glasgow, Aberdeen and Edinburgh, providing the PD-L1 test for Scotland. Merck have informed SPAN that a grace period of funding provision to Early Access Scheme will end on 31 March 2017. Mrs Walker advised that a business cases would be made at this point from the centres who were able to provide the test ( Grampian, Greater Glasgow & Clyde (GG&C) and Lothian) to ensure that all costs were equitable to the Boards requesting tests. Once a cost per test was agreed nationally the testing centres would be able to offer the test to Scotland. Mrs Walker anticipated that the business cases would request funding for a regional service, until such a time it was noted that there would be a cost pressure at requesting Board level. The next PD-L1 meeting was to be held in May 2017, however it was noted that this would follow the testing centres launching administration of the test. The steering group agreed that it would be prudent to align testing to the Regional Cancer Networks. Boards that requested a PD-L1 test would be advised to send their test to the centre that aligned with their Regional Cancer Network. Dr Mallon brought the groups attention to the letter that laboratories had received regarding the withdrawal of Birmingham from the UKAS Accreditation Scheme which will affect all health boards sending PD-L1 tests to England. 6
10. Digital Pathology update Dr Bryson presented an update to the steering group on the work of the Shared Services Lothian / GGC Digital Pathology Pilot. Dr Bryson informed the group that the pilot has secured 300,000 funding which would cover the first six months of operation, during which time Lothian and GGC would develop a business case to extend the pilot for an additional six months, which the procurement contract would support. Dr Bryson informed the group that five suppliers had expressed an interest in providing the equipment; this was now progressing to the second stage whereby a detailed specification was being issued to suppliers. Dr Bryson informed the group that there was potential to separate the reporting aspect of the LIMS from the labs aspect of the LIMS which would enable the project to progress in a more agile manner. Dr Bryson noted that there would be significant workflow advantages to GGC and Lothian and he stressed that he would like all boards to have the opportunity to see the pilot and contribute to it via SPAN. Dr Bryson advised that all future costing would be designed to be fair and equitable to all Boards. Dr Bryson informed the group that costs would include equipment, via a Managed Service Contract (MSC), and image storage. The designed solution would allow Boards to pay for a package that includes one workstation and five scanners as well as a small amount of local storage. He advised that there would then be different catalogue prices for additional equipment or more specific equipment which could be added to the standard package. Included in the cost would be the requirement of digital storage with each Board only paying a proportion of their storage costs, i.e. paying proportion dependent on the extent to which the Board wishes to have their slides digitised. The steering group recommended that it would be essential to include a cost benefit analysis; Dr Bryson advised that a benefits realisation plan had been circulated to the steering group and he would welcome any additional feedback from the group by 24 th February. Action: Dr Bryson & Mr Wilson Dr Bryson encouraged all Boards to become involved in the pilot and invited SPAN members and colleagues to visit GG&C to view the equipment. Feedback on the design of the trial to ensure that the needs of all pathology services in Scotland are incorporated was important. Dr Bryson noted that he had been liaising with Dr Carey about an event that is due to take place in Dundee. Dr Bryson noted that the trial was due to commence in summer 2017, with a report due at the end of 2017. Action: Steering Group Members 7
POST MEETING NOTE: Ayrshire and Arran have secured funding to progress a Digital Pathology Pilot. 11. Quality & Performance: A new approach to paediatric and neuropathology data Dr Bryson informed the group that he had noted an inconsistency in the SPAN data; he brought the groups attention to how Greater Glasgow and Clyde had split its dataset into neuropathology, paediatric and general pathology which had reduced the general costs for the Board, particularly Consultant costings; however costs remained proportionately higher than other Boards. Dr Bryson queried whether other health boards could consider separating their data in a similar way to enable more realistic costings to be produced. The steering group discussed the feasibility of this and it was noted that this would be challenging for some Boards to do this. It was noted that the split would only be reflected in the data for GGC. 12. Cervical cytology update Action: Information Management Service. HPV business case Mr Wilson informed the group that the Business Case for HPV as a frontline test was being presented to the Board Chief Executives (BCEs) on 7 th March; following this Cervical screening colleagues would be presenting the work to date to the Scottish Screening Committee (SSC). Mr Wilson informed the group that it was anticipated to have the full and final approval of the business case by summer 2017. Mr Wilson thanked the steering group for taking the time to read the Business Case and brief their Chief Executive in advance of the meeting on 7 th March. Current Cervical Cytology service provision Mr Wilson advised the group that Ayrshire and Arran reported that their service was relatively stable for the next twelve months. Mr Wilson informed the group that Grampian did not have capacity to provide services to Highland, which would result in the end of Service Level Agreement (SLA) between the Boards. Mr Wilson advised the group that the re-training of Raigmore staff was being explored to support the service; he acknowledged that there would be challenges in governance and UKAS Accreditation in setting up this service Mr Wilson advised that individual Boards would have to take individual responsibility for ensuring the service progressed. He informed the group that all Boards who provided a cytology service had highlighted continued sustainability as a risk on their corporate risk register. Dr Mathers advised the group that another factor that impacted the provision of the service was that Medical training had been shortened to five years and some specialties which included cytology and autopsy were available to students as opt-in as opposed to mandatory. Dr Mathers concluded that if all trainees were employed by one Board it would be easier to relocate them across Scotland. 8
It was agreed that Mr Wilson and Dr Mallon would write to the cervical screening programme on behalf of SPAN highlighting service pressures and ongoing issues. Action: Mr Wilson & Dr Mallon Mr Wilson informed the group that members of the Scottish Cervical Cytology Consortia had a meeting arranged with Ms Sarah Manson, Scottish Government on 1 st March to progress this issue with her. Action: Mr Wilson Mrs Malham suggested that it would be prudent to organise an extraordinary SPAN /Cervical Cytology meeting to identify the way forward. Mr Wilson thanked Mrs Malham for her suggestion and advised that it would not take place until a decision was known about the approval of the HPV business case. The group discussed who would organise this meeting, it was noted that this would require further discussion between SPAN and the Specialist and Screening Department. 13. Workforce Planning Action SPAN /Specialist and Screening Department Ayrshire and Arran advised that they had identified there was a limited number of medical trainees who could apply for medical vacancy posts. Mr Wilson informed the group that Dr Peter Johnston, Director Diagnostic Training Board, had advised him that there was a challenge for departments acquiring more space, equipment and resource for trainees, in addition to there being a shortage of consultants available to deliver training on-site. It was proposed to add workforce planning as a standing agenda item at least once per year. 14. Risk register Action: Ms Ross Mr Wilson brought the groups attention to the most up-to-date SPAN risk register which had been circulated with papers. In the previous SPAN meeting it had been updated to reflect the following risk:- Dr Mark Ashton (Consultant Cellular Pathologist, Highland & BSP QA Pathologist for Scotland and Big 18 member) had requested SPANs assistance in surveying the impact of England QA changes related to the Pathology delivery of the English BSP. These were to be enforced as part of the E BSP QA visits. Dr Ashton had been asked whether application of these standards would affect Scottish pathology departments if applied by SBSP QARC. Mr A. Wilson proposed adding frontline Andrology and Infertility to the risk register due to operation of this service being out of UKAS accreditation scope. This was agreed by the group. 9
Action: Mr Wilson 15. Shared Services Mrs Blackman informed the group that the Laboratory Portfolio Board would be taking their proposal to the Board Chief Executives meeting on 7 th March. The next Laboratory Shared Services workshop had been arranged for 14 th March; Mrs Blackman informed that in anticipation of the governance structure being discussed all four of the National Managed Diagnostic Networks workplans had been shared with the Laboratory Portfolio Board in order for all programmes of work to be aligned. Mrs Blackman acknowledged that the data request from the Laboratory Portfolio Board to the Boards had been done in isolation from the Information Management Service, who had and could provide some of the requested SPAN data. Action: Mrs Lawrie The group discussed the requirements of completing the SPAN data set as well as participating in Keele data. Mrs Blackman noted that the SPAN data set was more robust for SPAN than Keele. There was discussion regarding the Diagnostic Steering Group s (DSGs) position on Health Boards continuing to complete Keele, Dr Bartlett s, laboratory Portfolio Board, Subject Matter Expert (SME) was of the understanding the all Boards were to continue to participate in Keele. The DSG Minutes) were reviewed in the meeting which did not provide clarity on the matter. It was agreed that Mrs Blackman would clarify the matter with Dr Brian Montgomery ( Scotland Shared Services Board Programme Director) Action: Mrs Blackman Laboratories Data Improvement Group The revised Keele questionnaire had been shared with the group in advance of the meeting; Mrs Malham informed the group that the questionnaire was now multi-disciplinary. The group fed back that they had found that the new data definitions were loose; Medical staffing was not exhaustive as it only collected Programmed Activities (PAs); Mortuary costs were not included; TATs had also been excluded and the data set only asked for the number of requests. The group noted that the finance section was straightforward and provided laboratories with the opportunity to include income generation. The group noted that Keele data did provide comparison with England, with the exception of some of the larger academic centres who had withdrawn from Keele. The group wanted to know if there was a way of ascertaining which boards still participated in Keele. Mrs Walker advised the group that she would share the 2015-16 report that included Laboratory participation. Action: Mrs Walker 16. Revised Diagnostic Steering Group Governance Structure Mrs Blackman reminded the group that the DSG was undergoing revision and development, in response to feedback that NMDNs had experienced difficulties in progressing work. 10
The revised DSG would meet quarterly. In advance of each DSG there would be an Advisory Group meeting, involving all NMDNs. This meeting would effectively set the agenda for the DSG meeting. There would also be a Ratification group who would provide a holistic service context for any proposed work. Mrs Blackman advised that there would be a standard agenda for DSG that would include a topic of the day, ensuring one meeting per year would focus on SPAN, molecular pathology, genetics and relevant screening laboratories. This, however, would not preclude SPAN bringing a Business Case or other urgent matter to any meeting of the DSG. Mrs Blackman informed the group that the revised DSG remit had been reshaped into a Terms of Reference, which included clear business processes whereby the DSG would approve the NMDN workplans and receive the NMDN s Annual Reports, enabling the DSG to become an effective decision-making body. Mrs Blackman informed the group that the DSG would now be supported by the NNMS. 17. A.O.B. Communication and Education Strategies The Communication and Engagement Strategies were presented to the group, who recommended that section 1.4 of the Education strategy be revised. The group were asked to provide Ms Ross with any further changes by 24 th February. The strategies will appear on the SPAN website once finalised Annual Event Action: Steering Group members The first SPAN Annual Event has been scheduled for 3 rd November 2017 in COSLA (Edinburgh). The draft agenda was shared with the group in the meeting for the steering group to advise if there was anything that had been omitted and should be included. Dr Mallon informed the group that there would be an opportunity for Pathology departments and the Pathology community to present a poster for the event. Dr Mallon requested that all staff should be encouraged to attend the event. Dates for Data collection Action: Steering Group members Mrs Lawrie informed the group of that the 2016-17 SPAN data collection dates would be Data Collection Spreadsheet & Data Definitions Issued: Monday 3 rd April Return date: Wednesday 31 st May 2017 Mrs Lawrie informed the group that a new approach would be taken that included an individual Board template that included figures from 2015-16 data collection. Immunocytochemistry (ICC) Survey It was agreed to reissue the ICC survey with a return date of 10 th March. 11
Action: Steering Group members 18. Date of next meeting It was agreed that next Steering Group meeting would take place on Tuesday 19 September. This would take place in a venue in Central Scotland. 12