NHS GRAMPIAN (NHSG) APPROVED Minute of the Hepatitis C Managed Care Network (MCN) Steering Group Meeting held on 8 th October 2009 at 10am in Conference Room, Summerfield House Present: Name Title Representing Andrew Fraser (AF) (Chair) Consultant Gastroenterologist/ Hep C MCN Clinical Lead Hep C Action Plan Clinical Lead/ NHSG Liver Service Alan Leitch (AL) Finance Manager NHSG Finance Ambreen Butt (AB) Consultant GU Physician GUM Andrew Robinson (AR) Consultant Psychiatrist NHSG SMS Cathy Young (CY) Hep C MCN Manager NHSG HCV MCN Chris Stewart (CS) Deputy General Manager CHP (Aberdeen) Fiona Stuart (FS) Specialist Pharmacist Substance NHSG Pharmacy Department Misuse John Reid (JR) GP GP Subcommittee (by teleconference) Lisa Allerton (LA) Hep C/ Blood Borne Virus Project Hep C MCN Manager Maria Rossi (MR) Consultant Public Health Medicine & Hep C Executive Lead Hep C Action Plan Executive Lead/ Public Health Pamela Molyneaux (PM) Consultant Virologist NHSG Virology Lab Pauline Dundas (PD) Hepatology Nurse Specialist NHSG Liver Service Rob Laing (RL) Consultant ID Physician NHSG Infectious Diseases In Attendance: Emma Rochford (ER), Programme Administrator, Minute Taker Item Subject Action 21.09 Apologies Amanda Croft, Divisional General Manager, Acute Sector Beverley Henderson, PH Practitioner, Orkney Carole Ledingham, Unit Operational Manager, Medical 1, Acute Sector Chris Fyles, ADP Development Officer, Aberdeenshire Fiona Thomson, Hep C MCN Workforce Development Lead. Fraser Hoggan, Health Improvement Officer ADP, Aberdeen City Karen Gunn, Service Manager, Mental Health, NHSG Linda Buchan, BBV & Infection Control Nurse, HMP Peterhead Marion Walker, HMP Aberdeen Mike Perera, Integrated Services Manager, Mental Health NHSG/ Moray Council Welcome and Introduction AF welcomed everyone Introductions around table. 22.09 Minutes of Meeting Held on 4 th June 2009 Present: Tom Reid is Consultant Microbiologist at NHSG Microbiology Lab; Item 14.09 individuals with HCV Infection 2. known +ve not referred remove not. Otherwise approved as accurate. ER 1
23.09 Progress with HCV Action Plan for Scotland Phase 2 Clinic space Seven rooms are being prepared in the Phase II development in the Rotunda Aberdeen Royal Infirmary (ARI) for Hep C services. There will be 5 sessions per week with dietetic, social work and substance misuse services in attendance as well as specialist nurses and medical staff. There will also be a Fibroscan available. It was noted that the clinics would not all be Hep C clinics as there would also be general liver clinics being held. If any other services wanted to be in attendance AF would look into this. Work has started (with 4 week leeway). Accommodation should be available from 1/2/10. Social Work support at clinic we hoping that one person full time or two part time people but as all social workers are employed by the Local Authority, we will have to discuss this further. Service Level Agreement (SLA) Scottish Prison Service (SPS) Memorandum of Understanding between NHSG SPS completed. SLA between NHSG and HMP Aberdeen and Peterhead both signed off and at Scottish Executive. PM queried whether CHI numbers for prisoners could be provided to the Lab. PD said that this had already started and that they now have access to PAS. Dr Reid queried if there was clinical guidance in the SLA to ensure adequate screening for bloodborne viruses. AF responded that there is an expectation of prison health care staff to determine the risk of BBV infection and offer universal testing/immunisation of prisoners on arrival. This is not currently being audited but may require addressing in future as part of quality indicators. In HMP Aberdeen there is an issue around high prisoner turnover. Prisoners may be released prior to any BBV test results. It is the prisons responsibility to ensure that results are given either to the prisoner or their GP. It was raised that not all prisoners are registered with a GP on release. and therefore a robust system for ensuring prisoners receive their results will need to be developed. JR asked who was responsible for treating/ supporting a patient who becomes depressed during treatment. AF clarified that in prison the patient would be seen by the prison doctor. If the patient was not in prison and already in contact with mental health services the then a referral would be to the psychiatrist involved in the care otherwise the liver service would request that the general practitioner refer to the psychiatric services associated with that practice. GP Lead Dr John Reid has joined the Steering Group as the GP Subcommittee representative. There will also be a GP lead who be have a one session per week contract and will actively participate in the MCN and encourage GPs to increase appropriate testing for HCV and onward referral of those found to be positive. This was seen as of high importance given that nationally only around 5% of GP had completed a Hep C test in the previous year. MR and Pauline Strachan are currently reviewing the job description, PS is checking the remuneration and vacancy control has the complete paperwork. CY does not foresee any problems with this. AR commented that GPs with special interest in substance misuse issues could take this on as part of their remit. There are currently 6, all employed by SMS. CY/ AF to contact Karen Gunn and Mike Perera regarding this. PM CY/AF 2
MCN Workplan The MCN workplan had been circulated to the group. AF explained that it followed the usual HPS standards. HPS has asked for a workplan to cover actions 6, 8 & 10. Its aim is to clarify who is doing which aspects of work and what the timelines for completion is. AR asked if a column for completion could be added. LA will add this. Work is required to hit existing targets. The impact of H1N1 was noted i.e. professional and public campaigns have been postponed until 2010. MR had been in discussions with the Governance Board about whether target dates should be revised. It was noted that if targets are lowered/revised then there could potentially be a clawback on funding. Final comments on the workplan were to be sent to LA by the 16 th of October. SMS At present AF/CY are working with Substance Misuse (SMS) to look at promoting testing and onwards referral for Hep C. It is hoped that SMS services will work within the Hep C clinic to provide some centralisation and Hepatology staff do not have the capacity to cover all of the 27 sites where SMS is currently delivered. There is a further meeting between the Hep C MCN team and SMS scheduled for 29/10/09. AF commented that Professor Foster in his presentation last week described his service with 8 General Nurses in SMS treating 8 10 patients a year each. In NHSG there are c. 40 patients per nurse situation is more challenging here. GUM A joint initiative from GUM to trace those previously tested but not referred was discussed. PM suggested that if consent was given by patients, data from GUM could be deanonymised. AB said she would relay this to clients, although she was doubtful that they would all consent. It was agreed that this would require some funding for a person to complete the work. AB can cross-check the GUM list with AF s clinic list to see who has been referred or not. Engagement with services It is known that there are a large number of people who have tested positive for HCV in Grampian but have not been referred to specialist services. In order to offer specialist care, their identify identity would need to be known. Early discussions about how a list of these individuals could be compiled have already occurred. It is noted that HPS keep anonymised data, these may be identifiable to name. MR commented that the notification system is manual and therefore completeness should be queried. PM stated that now Lab has ECOSS all +ve results should be received. Lab results are sent to HPS as named data and HPS soundexes them for storage. She mentioned that there are two databases: Diagnosis and Clinical (on referral) PM will pass contact name at HPS to CY. It was noted that HPS uses the data for surveillance and under the Data Protection Act would not be allowed to pass named data on. MR suggested the use of the public health list, although some input from labs would be required. PM in principle supports, however a detailed query would be needed for labs to work to. LA ALL AB PM MK/PM 24.09 Local Stakeholders Meeting Stakeholder event was generally well received. Approximately 50 attended, had hoped for around 100. Attendance would probably have been better if the awareness campaign had happened. There was also some overlap with the Road 3
to Recovery event, and a National Hep C Event 12 evaluations were completed on the day. An e-version of the evaluation form has now been e-mailed to all attendees. Comments so far have been positive. Discussion around timing of next event: could be useful to tie it in with issue of annual report i.e. June 2010. The venue was considered appropriate in terms of cost and being accessible for those travelling across Grampian. Some of the negative comments included: hard to hear some of the speakers/ questions; noise from outwith room was disturbing. Considerations for next year: o Break out sessions specific areas of interest o Include prevention as part of Action Plan o Half day rather than full o Hep B o Need to decide early on guest speaker if allowed JR asked if there had not been a speaker on care pathway guidance and this may be considered for future meetings. 25.09 Testing There was a discussion around testing and protocols for which tests are performed as screening tests. There are currently different systems in place and AB also reported that Steve Baguley was in the process of designing a similar tick box style sheet for use in primary care/midwifery. JR commented that GPs and midwifes use different sheets at present for the different BBVs. AF commented that there was no reason to request HIV tests on different forms. MR is to pick this up on the Health Protection Side as the introduction of a new sheet may have impact on contact tracing. AB said that if results are positive GPs and GUM are sent notification, all clients attending GUM are consented at the time of taking the sample to be tested for the various BBVs. Hepatology Outreach in Needle Exchange Currently there is a staff shortage impacting on the continuation of this project given a recent resignation of the lead staff member. Testing was being conducted the Kessock, Drugs Action and the Foyer. PD mentioned that due to the high success rate at Kessock the team would hope to continue with this; however staffing issues were again apparent. There is a need to recruit and train to fill the gap. There are issues around training other staff to be able to continue this work specifically around anaphylaxis and vaccine handling. Dry Blood Spot Testing Kits are available. Sheila Cameron at the Virus Laboratory in Glasgow is undertaking validation of PCR. It is planned that DBS will be available for when it is difficult to obtain a venous blood sample. Validation was also discussed at the Governance Meeting. ve testing has been validated, +ve is looking good. PM stated that the lab could be involved in the validation phase but would not be able to take this on as an extra service at present due H1N1. MR asked if now that the H1N1 burden was in the containment phase, rather than the treatment phase whether the burden on the lab had eased but PM informed members that GPs are still sending samples and samples from the hospital had also increased e.g. 12 +ve samples this week. AF summarised that there are three main issues around DBS testing: validation of the test; recording of the results; resource required. PM had to leave the meeting due to another engagement at this point. It was agreed that it would be advantageous to get DBS testing to facilitate AF/PM 4
screening those at risk as a nurse is not required. AF commented that he is reluctant to do tests that are not being recorded on the comprehensive NHSG lab system. Other Boards are using DBS testing and their labs are recording results but the Aberdeen Lab have stated that they are not in a position to take this on despite offer of resources. It was suggested that samples could be sent to Glasgow and the results sent directly to the person responsible for taking the test. Concerns were expressed around results for Hep B & C and HIV not being recorded on the local laboratory system with this system there would be the risk of results bypassing the local lab system and sent to untrained personnel with no clinician being informed. It was felt that we needed to explore how the DBS test results could be recorded on the local laboratory system before this service is made available. Some urgency was expressed as patients/ clients have been asking why DBS testing is not available in Grampian. AF/CY Near-patient testing is being developed but this has been put on hold nationally so DBS tests can be rolled out. 26.09 Membership: Local Authority, Social Work, General Practice, Patient Involvement Local Authorities There has been no response to Dr MacPhee s letter. MR/ CY will contact. MR/CY Social Work Work is underway looking at representation from all three Local Authorities. GP Rep JR commented on the timing of the meeting. This will be changed to 11am to suit the executive group and the steering group members. Patient rep It was agreed, after debate that a patient representative would be preferable to an individual patient. Two possibilities of a patient rep source are Mainliners and Hep C Trust. Mainliners however is mainly made up of people from SMS background whereas the Hep C Trust is more open, but does not set up patient groups. A Hep C Trust representative at the Stakeholder event has offered to support the patient rep when identified. 27.09 Website Due to the public/ professional awareness campaigns being postponed it was felt necessary to have something available and visible regarding the Action Plan and progress being made. It is being hosted on Hi-Net http://www.hinetgrampian.org/hinet/5298.html and is basic at the moment. Plan is to move to a stand-alone website in the future. CY would welcome any comments on or suggestions for content for the website. JR felt that GPs would not use the site unless guided to it and a link to the site from the Grampian GP Intranet would be a good way to access it. Suggested also mentioned at training events or as part of the professional awareness campaign. 28.09 NHSG Health Plan CY stated that this was now a three year plan (had been one year) and had been sent to the Board on 6 th October for consultation in December. The Plan was circulated and CY asked for comments to be sent to her by 6 th November ahead of the Exec Group meeting on 12 th November. Looking for individual and MCN responses and will cover NHSG and partner agencies. All 29.09 AOCB CY asked for it to be noted that she had been appointed Manager of the Sexual Health MCN, but as yet the time split for each was not known. AF commented that 5
he had expressed his displeasure and that he had not been consulted. MR said she was disappointed as the funds had been ring fenced for hepatitis C alone, although CY would be spending the majority of her time on Hep C. AF also commented that maturity of the MCN should have been a consideration. CS said that CY had been put in a difficult position, but should be assured that she had the Group s support. AF reported to the Group that the Exec Group meetings would now be held monthly and last two hours and the Steering Group quarterly meetings would now start at 11am for two hours. PD asked for an update on the nursing posts, this is to be discussed with the Executive Team. Clarification is required on type, length of contract and banding of posts 30.09 Next Meeting Date: 18 th February 2010 11am Meeting Room 2 (TBC) Apologies, video/teleconference requests and any agenda items to: emma.rochford@nhs.net 6