LOTHIAN RESPIRATORY MCN CORE GROUP Minutes of the meeting of Tuesday, 14 May 2013, 2.00pm to 3.30pm, Seminar Room 3, Chancellor s Building, Royal Infirmary of Edinburgh Present Dr Ninian Hewitt Ms Shena Brown Ms Gillian Cunningham Ms Jane Dalrymple Ms Grace Hynd Ms Katie Johnston Ms Alyson Malone Ms Anne Ovens Apologies Professor Harry Campbell Professor Andrew Greening Ms Angela Lindsay Mrs Lyn McDonald Professor William MacNee GP and Lead Clinician, Respiratory MCN (chair) Respiratory Care Facilitator, WL CHCP Service Manager, CTR Co-ordinator, Respiratory MCN Clinical Nurse Manager, Respiratory Primary Care Pharmacist, Edinburgh LHP Strategic Programme Manager, NHS Lothian Chief Nurse, RIE (part meeting) Professor of Genetic Epidemiology and Public Health, UofE Respiratory Consultant, WGH AHP Manager, Edinburgh CHP Director of Operations, Medical and Clinical Services Respiratory Consultant, RIE 1. Introduction and apologies for absence ACTION Dr Hewitt thanked everyone for attending and apologies were received as above. 2. Minutes of the previous meeting 24 April 2013 The minutes of the previous meeting were approved with two amendments: It was noted that Ms Stears was not present at the meeting and Ms Hynd had been present. Item 4.0 COPD efficiency and productivity. Minutes should read It was suggested that it would be helpful to take advice from the heart failure nursing team and the Palliative Care MCN, and Ms Hynd will take this forward. 3. Matters arising from previous meetings 3.1 COPD self-management plan review A final draft of the revised self-management plan was tabled for reference and approved by the group. After being updated it will go to the printer and copies should be received by the Resources Centre within a month. The updated plan will also be circulated electronically to all stakeholders. 3.2 National nebuliser framework The consultation referred to at the previous meeting is still open for interested stakeholders to comment. The proposed framework was discussed briefly at the recent National Advisory Committee meeting and the general consensus was that nebulisers should only be available through secondary care. Page 1 of 5
3.3 Respiratory Learning Forum 6 September There is still an opportunity to submit workshop proposals for this event. As discussed previously Dr Hewitt has submitted Ms Stears suggestion for a workshop focussing on patient learning styles. Online registration for the event will be going live shortly and Ms Dalrymple will circulate details when they are available. 3.4 HELP COPD trial patient information leaflet Leaflets for all three CHP areas have now been approved for use. There was a discussion about how the resources might be incorporated in the NHS patient pathway and agreed that relevant contacts should be included in standardised pulmonary rehabilitation information and made available to secondary care if required. 4. COPD efficiency and productivity Dr Hewitt updated the group on this workstream. The Edinburgh CHP Invest to Save group met recently and was well-attended by all sectors Mrs McDonald is happy to hand over the secondary care group although she will continue to meet with key stakeholders individually The groups will come together and be led by a core team of four or five people with a number of small action groups taking forwards agreed pieces of work. Professor MacNee is re-organising his job plan so that he can take on the consultant role in the project (2 sessions per week). A project manager, Ms Amanda Fox, has been identified and is already working on the project on a part-time basis so work can progress quickly. Negotiations on her contract are in progress. There is someone in post on the Invest to Save project for all the proposed jobs. The total hours committed is still low but are likely to rise as detailed in the project plan. Discussions: There was interest in how equality of provision across the CHPs would be ensured. Dr Hewitt felt there was scope for the Edinburgh model to be rolled out to other areas and indeed other conditions, utilising relevant local services. Dr Hewitt briefed the group on a business case being put together for core funding of pulmonary rehabilitation following the departure of Ms Stears. The case will be supported by Ms Lynne Douglas, AHP Director. Ms Malone asked about the project manager role. Amanda Fox has started work on a part time basis and her contract is being renegotiated. She has experience of managing projects. She also suggested looking at how Dr Carter s frequent flyer data might be linked to the SPARRA data available through analytical services. Dr Hewitt has updated the draft secondary care pathway and will circulate it for comment as there are still a number of questions about patient flow. Page 2 of 5
5. Asthma 5.1 National benchmarking exercise Dr Hewitt has made an initial attempt at completing the reporting template and this has been circulated along with the agenda for reference. Ms Dalrymple will circulate it again following the meeting and members were asked to review the content and feedback on other potential evidence to include. 5.2 Asthma in schools Dr Hewitt met recently with Ms Cottrell and colleagues in West Lothian CHCP to discuss the schools service in that locality. Although using different paperwork to staff in Edinburgh, East, and Midlothian he is confident that the appropriate systems are in place in all areas. The only real issue identified is availability of spacer devices as children will often not have their own and there are infection control concerns about schools holding a communal device. Dr Hewitt will write a brief report on his findings and discuss with stakeholders how the spacer issue might be resolved. Ms Malone asked about personal liability insurance for school staff as this has been raised recently as an issue in the diabetes care. Dr Hewitt agreed to look into this to see if there are any implications which will need considered NH NH 6. Quality and Outcomes Framework 2013/2014 Dr Hewitt reported that despite earlier signs that it would be included, referral to pulmonary rehabilitation has been replaced on the QOF by oxygen saturation monitoring. This means the respiratory QOF this year will consist of: COPD: New diagnosis: post bronchodilator spirometry required Percentage of patients with o An FEV1 recorded in the last 12 months o Flu vaccination in previous flu season o MRC dyspnoea score in last 12 months o And if MRC sore 3, record of oxygen sats in last 12 months Asthma: For newly diagnosed patient 8 years, variability or reversibility confirmed in 3 months before of any time after diagnosis Those ages 14-19 years who have had a smoking status recorded in the last 12 months Percentage of all asthmatics who gave had an asthma review in the last 12 months AND that review includes assessment of control with RCP 3 questions Page 3 of 5
7. Feedback from National Advisory Group meeting 8 May 7.1 Patient self-management toolkit The self-management toolkit, being developed by CHSS, will cover three strands COPD, adults with asthma, and parents or guardians of children with asthma. A project manager, Ms Fran Bailey, is now in post having previously developed a similar stroke-related resource. A copy of the proposed subject areas was circulated for information and group members were invited to comment. Also circulated was a copy of a request for nominations for both the Project Development Steering group and volunteer authors. Ms Dalrymple will circulate this to the network and forward any expressions of interest to Ms Bailey. It is hoped the first Steering Group meeting will take place at the end of June or beginning of July and an away day will be held in September for those authoring content. 7.2 GP information technology pilot Dr Iain Small, NHS Grampian, has been asked by Scottish Government to explore the possibility of setting up an IT solution for CHD along similar lines to SCI-DC which is already in place for diabetes. He has indicated that the project will also include COPD. The starting point will be to identify a wish-list based on the data that is already collected in primary care and looking at how it might be extracted. He will be circulating a copy of this list for comment when it is available. 7.3 Sleep working group A briefing on the work of this group, which includes Dr Mackay from Lothian, was circulated for information. It was also noted that SIGN will be reviewing their guideline on the management of obstructive sleep apnoea next year as it now more than seven years since this was last done. Ms Hynd informed the group that Ms Cunningham has approached the modernisation team for support to carry out a LEAN project focussing on the sleep service patient pathway. 7.4 Idiopathic pulmonary fibrosis Feedback from the national group is that pulmonary fibrosis will feature prominently on the agenda in future. The British Lung Foundation has also identified it as one of their priority areas for the coming year which will put it in the spotlight nationally. Representatives from the Scottish Government indicated that SGHD would be happy to consider funding for work that satisfies priorities of both the government and the NAG. Page 4 of 5
8. Any other business 8.1 Scottish Pulmonary Rehabilitation Action Group conference This event will be taking place on Friday, 14 June 2013 at Forth Valley Royal Hospital in Larbert. A programme is expect shortly and will be circulated for information. 8.2 Research project Ms Hynd informed the group that Mr Andrew Deans, Research Nurse, is currently doing a project with Professor MacNee on amitriptyline. She will keep the group informed of any developments. GH 8.3 Inhaler posters Given recent changes to the formulary, Mr Deans will also be updating his Inhaler Devices poster to include new additions. The MCN will consider possible funding of printing and distribution costs when this is completed. 9 Date and time of next meetings The next meeting of the group will be held on Wednesday, 12 June 2013, 2.00pm to 3.30pm, Castle Rock, Postgraduate Education Centre, RIE Page 5 of 5