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NHS Board Meeting
23 May 2012 Paper 17
NHS Board Meeting
Wednesday 23 May 2012
Subject
Annual Reports for Ayrshire and Arran NHS
Board Area Professional Committees 2011-2012
Purpose
To update the NHS Board on the work of the
Area Professional Committees
Recommendation
That the NHS Board continues to support the
work of the Area Professional Committees
1.
Background
1.1
CEL 16 (2010) Area Clinical Forums (ACFs) stated that ACFs were now an
established and important part of NHS Boards in Scotland, reflecting the
development of integrated organisational arrangements. The purpose of the CEL
was to complement the existing guidance and ensure that NHS Boards further
develop and enhance the role of ACFs and the individual Area Professional
Committees which advise on profession specific issues. The profile and status of
the ACF had to rise in order to maximise the contribution which clinicians can make
to the planning and delivery of services across the NHS in Scotland. ACFs and
their constituent members have a key role in taking forward the key dimensions of
quality described in the NHS Scotland Healthcare Quality Strategy. Developing
ACFs within this broader strategic context aims to harness the knowledge, skills
and commitment of clinicians across NHS Scotland.
1.2
Rebuilding our National Health Service (2001) emphasised that NHS Boards should
draw on the full range of Professional skills and expertise that exists in all parts of
their local NHS system. These professions would provide advice on clinical and
other professional matters. In order that this could be achieved, NHS Ayrshire and
Arran Area Professional Committees were formed in October 2001. They have now
been established for 10 years.
2.
Current situation
2.1
The Scottish Government Health Department stipulates close involvement of clinical
staff in leading and developing services.
2.2
The Area Professional Committees are representative of a wide range of Health
professions within NHS Ayrshire and Arran, including the newly developed Area
Health Care Scientist Professional Committee.
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3.
Proposal
3.1
That the NHS Board recognises the contribution of the Area Professional
Committees.
3.2
To acknowledge the challenge that exists for those professionals who wish to
contribute to the Strategic Agenda and Organisational Development.
3.3
To continue to support the Committees‟ future work.
4.
Engagement and consultation on development of the proposal
4.1
This report has been informed by the contribution of the members of the Area
Professional Committees and has been approved by each of these Committees.
5.
Resource implications and identified source of funding
5.1
N/A.
6.
Risk assessment and mitigation
6.1
N/A.
7.
Impact assessment and consequential changes proposed to mitigate adverse
impacts identified
7.1
N/A.
8.
Conclusion
8.1
The NHS Board is asked to continue to support the work of the Area Professional
Committees and note their Annual Reports for 2011-2012 as appended.
Appendix 1
Appendix 2
Appendix 3
Appendix 4
Appendix 5
Appendix 6
Appendix 7
Appendix 8
Area Allied Health Professions Professional Committee
Area Healthcare Science Professional Committee
Area Dental Professional Committee
Area Medical Professional Committee
Area Nursing and Midwifery Professional Committee
Area Optical Professional Committee
Area Pharmaceutical Professional Committee
Area Psychology Professional Committee
Mrs Janet McKay, Chair ACF
[Angela O‟Mahony, Pauline Sharp, Professional Committee Chairs]
3 May 2012
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Appendix 1
Annual Report
Ayrshire and Arran Area Allied Health Professions
Professional Committee
2011/12
1.0
Introduction
1.1
The Committee continued to work proactively on a number of issues during what
was another challenging year. The membership was boosted towards the end of
the term with the addition of a new Committee member from Dietetics. Health Care
Directors continued to attend for part of the meeting. The Committee continued to
value this opportunity to be advised on and respond to key AHP issues such as
reshaping the Care for Older People Change Fund, Sustainable Futures, the
development of the new community hospital at ACH and the transfer of Prison
health care services. The AAHPPC Committee welcomed the Board‟s recent
proposal to alter the attendance of Directors at Committee meetings to the Director
with direct responsibility for AHPs. The Committee agreed this would help to
sharpen the focus on AHP matters.
2.0
Major Issues Discussed throughout the Year
2.1
Sustainable Futures
2.1.1 The Committee continued their representation on the „Right Staff, Right Place‟
workstream and regular updates were provided. More than half the Committee
contributed to the NHS Ayrshire & Arran CRES workshop held on 29 September
2011 and this continues to be a major item on our agenda. We have recently raised
our concerns from our colleagues about increasing issues around quality products
and treatment outcomes being threatened by the tireless quest for reductions in
procurement costs and hope that this can be addressed as timeously as possible.
2.2
Workforce Issues
2.2.1 The Committee have been encouraged by Director/Board level responses to key
professional issues concerning specific AHP disciplines. These have been raised at
the ACF and have been diligently taken to the Board by the ACF chair or the
Medical Director, or the AAHPPC chair has been advised where to take the
particular concern. Such issues have involved scope of practice in Radiography,
risk management in the transfer of prison health care and dis-proportionality of
referrals/demands on AHP services from adjacent services undergoing significant
funding initiatives.
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3.0
Advice Provided to the NHS Board
3.1
The Committee has met the on-going requirement to review and comment on all
relevant policy documents before presentation to the Board for ratification. These
have included the Communications strategy and the Tobacco Policy of which the
latter still raises concern among AHPs about policing and expectations of
responses by staff to transgressors. Currently we are engaged in commenting on
the AHP National Delivery Plan, Community Pharmacy strategy and Oral Health
strategy.
4.0
Future Plans
4.1
The Committee and AHPs in general recognise the increasing influence they are
having in the professional affairs of NHS Ayrshire and Arran. We appreciate the
investment in personal development the organisation has made, the AHP
leadership course in particular. We now aim to strengthen our existing links with the
Director, Associate AHP (acting) Director, AHP Heads and Community Health
Partnerships and are currently considering what form that should take to ensure as
effective engagement as possible.
5.0
Conclusion
5.1
A number of Committee members are due to step down at the end of March 2012
and an election process has recently taken place to identify two new Physiotherapy
representatives, two Occupational Therapy representatives and one Radiography
representative. We have not yet been able to fill the Community Physiotherapy and
Radiography vacancies, but we will consider how to take this forward to ensure that
AHPs have strong and positive representation and are able to advise and influence
the Board effectively. I will be stepping down from the Committee at the end of
March when my term of office ends. I wish my successor well in taking forward the
work of the Committee.
John Cleland
Chair, Area Allied Health Professions Professional Committee
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Appendix 2
Annual Report
Ayrshire and Arran Area
Healthcare Science Professional Committee
2011/12
1.0
Introduction
1.1
With the support of the Area Clinical Forum (ACF) the NHS Ayrshire & Arran Board
approved the constitution for the formation of an Area Healthcare Science (HCS)
Professional Committee on the 23rd March 2011. The Committee has corporate
office support and space on AthenA. Ten nominations for Committee members
were received in June, four from Life Science, four from Physical Science and two
from Physiological Science streams. The inaugural meeting was held in August
and a chair and vice chair were elected. There are two vacant seats from the
Physiological stream.
1.2
The Committee has met on four occasions since its inception. The focus within the
year has been on developing the Committee and how to take it forward. The
Committee has welcomed input from the Healthcare Director for Integrated Care
and Emergency Services who agreed to be the director support at Board level. The
Executive Medical Director has also been extremely supportive of the formation of
this new Committee. The Committee would welcome continued support from these
Directors throughout the coming year to help it to develop a proactive role within the
organisation.
2.0
Major Issues Discussed throughout the Year
2.1
Sustainable Futures
The Committee spent some time discussing sustainable futures and potential routes
for savings. As this is a new Committee it does not have representation on these
work streams, however the ICES Director has kept the Committee informed and
updated, also outlining the serious financial challenges facing the NHS Board.
2.2
Workforce Issues
The Committee were represented at a national workforce planning event where
board, regional and national level projects were discussed.
2.3
The Committee sought clarification on Healthcare Support Workers Mandatory
Induction Standards and that staff aspiring to registration should not be included.
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3.0
Completed / Ongoing Work from the Year
3.1
The Committee hosted a Scottish Government Healthcare Science Engagement
Event. The event was an opportunity to feed into the development of a new
National Delivery Plan for HCS and was facilitated by Scottish Government‟s HCS
Officer.
3.2
Members of the Committee participated in Career Awareness Days organised by
O&HRD for 5th & 6th year pupils from across Ayrshire.
3.3
The 2011 National HCS Award for Enhancing Quality: Delivering Results was
awarded to the Pathology Department at Crosshouse Hospital for the impact of
extended roles in specimen dissection.
3.4
A member of the Committee is working with O&HRD to ensure HCS staff details
held on the SWISS Database are accurate and up to date.
3.5
The Committee has supported the NES appointed HCS Education Development
Lead. During the year, two education and training surveys have been distributed.
There have been six Educational Awareness Events held raising the understanding
of each diverse group in HCS and also an update on the PMS system was
presented. This post ends on 31 March and the Committee would like to thank the
appointed lead for their efforts.
3.6
A HCS Cross board Training event is to be organised in conjunction with the chair
of ACF.
3.7
The Committee needs to take steps toward maintaining momentum and build on
what has been achieved this year. Further work needs to be undertaken to both
highlight the role of the Committee and to encourage feedback from the wider
healthcare science community.
4.0
Advice Provided to NHS Board
4.1
The Committee has considered all of the papers that have been submitted to the
NHS Board with particular consideration given this year to:
Workforce Plan
Staff Governance
Communications Strategy
Transfer of prison healthcare to the NHS
Local Delivery Plan
DCAQ Analysis
5.0
Future Plans
5.1
The future for the Committee remains a challenging one. The publication of a
National Delivery plan for HCS will act as a guide in taking this Committee forward
and making it more effective. Members are keen to ensure that the HCS voice
within the clinical forums is a proactive and well balanced one.
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6.0
Conclusion
6.1
The establishment of the Area Healthcare Science Professional Committee has
been an extremely positive step for an important group of staff within the
organisation. The Committee would like to thank the Board and the chair of the ACF
in particular for helping to make this happen. The Committee has provided support
to the Area Clinical Forum over the year on a number of issues. The Committee is
young and developing, however, its role is an important one and the Committee
needs to ensure that it continues to grow and provide a representative voice for the
HCS professions.
Debbi Hyslop
Chair, Area Healthcare Science Professional Committee
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Appendix 3
Annual Report
Ayrshire and Arran Area Dental Professional Committee
2011/2012
1.
Introduction
1.1
The Area Dental Professional Committee (ADPC) continues to advise the Health
Board on a wide range of issues and discuss a number of significant challenges and
developments facing the profession. Once again the Committee has had a very busy
year and, discussed, debated and provided comment on a number of relevant topics.
2.
Advice Provided to the NHS Board
2.1
The Committee heard presentations on a number of important proposed changes
and provided feedback and comment. Topics covered included:
Sustainable Futures.
Oral Health Strategy 2012-22.
NHS Ayrshire and Arran Tobacco Policy and Fresh Air Policy 2012.
Your Health- we‟re in it together.
Improving Access to Primary Care- Setting Standards across Primary Care
Services in Ayrshire and Arran.
Potential service developments in Primary Care-Primary Care provision of
specialist care.
Current and future plans for prison dental care.
2.2
The Committee also discussed and provided comments on a number of other papers
including:
Primary Care Disciplinary Performance Consultation
NHS Dentistry and the Quality Strategy
18 Week referral to treatment
Communications Strategy 2012-2014
Transfer of Prison Healthcare to NHS
Jumpstart
Autism Strategy for Scotland
Modernising Medical Careers (MMC)
3.
Committee Membership
3.1
The Committee has struggled to replace retiring and departing members. Engaging
and involving the profession is not easy, particularly in these difficult times. At
present a vacancy remains unfilled for both a General Dental Practitioner (GDP) and
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a dentist from the Managed Dental Service. In the short term we do hope to have all
available positions filled and our membership is now more representative of the
profession locally with a higher number of female members, younger members, and
members who practice in North, East and South Ayrshire.
4.
Community Health Partnerships (CHP)
4.1
At this time there are no dentists serving on any of Ayrshire and Arran's CHP Forums.
The Committee Chair recently attended a CHP development day in South Ayrshire
and found the CHP keen to involve the profession. The CHP Chair and the Forum
Chair plan to attend a Dental Committee meeting in the near future to better explain
the function of CHPs and hopefully to encourage ADPC Committee members to
attend their local CHP forum and represent the profession at a local level.
5.
Doctors and Dentists review body (DDRB)
5.1
Representatives of the Committee had a meeting locally with the review body to
discuss pay and conditions and morale in general dental practice. The Managed
Dental Service was also represented. Discussions were described by the DDRB as
“open and informative” and a range of topics were covered. The main focus of
discussions related to increasing dental practice expenses with no increase in NHS
dental fees since April 2010. An increasing burden of paperwork and regulation was
also reported, as was a reduction in morale across the service.
6.
Meeting with the Chief Dental Officer (CDO) for Scotland
6.1
Some representatives of the Committee met with Margie Taylor, the CDO for
Scotland when she visited Ayrshire in February 2012. The group were able to
discuss a wide range of local and national issues impacting on the profession.
Topics covered included:
Engaging and involving the profession locally.
Increasing costs and expenses in practice.
Decontamination and Local Decontamination Units (LDUs).
Increasing paperwork and regulation -particularly in relation to revalidation,
practice inspection and radiation protection.
The NHS quality strategy.
Workforce planning - particularly a worry that there may be over provision of
dental services in the near future as numbers of dentists and dental therapists
continue to increase.
7.
Improving access to Primary care – setting standards
7.1
The Committee has been involved in the development of local standards for dentistry
in the Primary Care setting. These have been produced, along with Patient Rights
and Responsibilities and should be launched to the profession and public later this
year. It is hoped that all local practices will adopt these standards.
8.
GDP prescribing
8.1
The Committee has discussed dental prescribing within the local health board
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area. The aim was to see if the introduction of free prescriptions had affected
prescribing patterns within dentistry. Particularly, to investigate if prescription
volume and costs had increased and to identify any problems relating to unusual or
excessive prescribing. The Committee hopes to have further data available for
future meetings.
9.
Continuing Professional Development
9.1
Provision of Continuing Professional Development Courses at a local level continues
to be successful. In the past year there have been many well attended courses
facilitated by the Dental Management Team and also in conjunction with the Local
Dental Committee and Dental Public Health. Subjects include:
Child Protection & Childsmile Incorporation into the Statement of Dental
Remuneration
Law and Ethics
Dental Radiography and Radiation Protection
How Clean is Your Practice – Decontamination course
Learning Disability Training
Sedation Update
Orthodontics
Further relevant courses on a range of topics have been arranged for the coming year.
10.
Statement of Dental Remuneration
10.1 The Committee noted that there had been no fee uplift this financial year, but that
practice expenses had continued to increase. In October 2011 the Statement of
Dental Remuneration (SDR) was amended to incorporate the National Childsmile
programme. This launch should mean a simpler and clearer payment mechanism for
undertaking Childsmile in dental practice. Hopefully it will encourage even more
dentists to take up the programme. This would be of benefit to all young patients
and help the Board meet the Heat target for Fluoride varnish application in two to six
year olds.
11.
SCI Gateway online referral system
11.1 The SCI gateway referral system is now fully functional and available in nearly all
dental practices in Ayrshire and Arran. It allows efficient, safe and robust referral
from Primary Care practices to secondary care, the managed dental service and
local orthodontic practices.
12.
Shifting the balance of care
12.1 There has been some early discussion about shifting the balance of care from the
hospital setting into primary care. Initial talks involve the setting up of a local
practice undertaking NHS referrals for some minor oral surgery procedures.
13.
East Ayrshire Community Hospital (EACH) Dental Project
13.1 The Committee was extremely disappointed that the dental clinic planned for the
EACH in Cumnock was unable to progress due to difficulties surrounding change of
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use within the PFI contract. The Committee noted that a considerable amount of
time and money had been invested in the project. New plans hope to provide
additional capacity within existing dental practices locally.
14.
Senior Dental Management Team (SDMT)
14.1 This year the Managed Dental Service has had to reflect and review the service
delivery in light of both oral health need and financial constraints. During 2011 the
service has lost some administration support and with the increase to the numbers of
GDPs, the service will need to evolve and change to meet the unmet needs of the
population with the introduction of the new Oral Health Strategy.
14.2 In February 2011 the Dental Management Team assumed the responsibility of the
Contractual element of Dentistry due to a restructure in the Primary Care
Management Team. This was a logical and efficient change that brought all aspects
of dental services together. The change has required a great deal of effort from the
Dental Management Team and patience from the profession as the team absorbed
the additional knowledge and processes.
15.
Oral Health Strategy
15.1 The development of the next NHS Ayrshire and Arran Oral Health Strategy was
approved by the Board in August 2011. In 2011/12 the Committee has participated,
on behalf of the profession and in collaboration with other stakeholders, in the
development of the draft Oral Health Strategy 2012-22 that will be considered by the
Board in May 2012. The Committee welcomes and fully supports the development,
subsequent consultation and implementation of an Oral Health Strategy which will
build on the excellent oral health and service improvements achieved by the
previous strategy.
15.2 In 2011/12 the Committee has also been involved in several ongoing strategic topic
areas:
Childsmile
a) the revised SDR introduction to support the General Dental Services
(GDS) delivery of twice a year fluoride varnish applications to those
children aged 3 and 4 years to contribute to NHS Ayrshire & Arran
achievement of national HEAT target.
b) awareness raising of the need to adopt the Getting it Right for Every Child
(GIRFEC) approach within dental services delivery and an understanding of
the need for dental team child protection training and a clear understanding
of local child protection process.
c) support the full roll out and embedding of Childsmile Practice Programmes
in all GDS practice delivery and as an integrated component of the
national Child Health Programme from the first 6-8 week universal Health
Visitor assessment.
Participation in 2011 review of GDS access, distribution and premises
compliance with LDU and Disability Access requirements.
Local and regional review and development of specialist services with shift of
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balance to primary care setting.
a) National SDNAP Restorative Dentistry Services Review and Report
considered by the Committee.
b) West of Scotland (WoS) Regional Report on Restorative Dentistry Services
review and Modernised Model for Service Provision considered by
Committee.
c) Ongoing progress of the WoS piloting of Modernised Model for Restorative
Dentistry Service Provision noted by the Committee.
d) The local 18 week Referral to Treatment Dental Specialities Group has been
monitoring data. This target was achieved at the end of 2011.
The Committee has noted and supports the national and local development of
Quality Indicators for Dental Services.
Priority Groups:
a) Older People – the roll out of “Caring for Smiles” has been progressing in
care homes in South Ayrshire, with carers being trained in the provision of
oral health care to their clients.
b) Adults with Additional Needs – the “Open Wide” pilot in care homes in East
Ayrshire has come to an end and is now being evaluated.
c) Homeless People – there has been continued work with the Public Health
Nurses for homeless people to deliver oral health improvement programmes.
NHS Ayrshire & Arran were also invited to showcase the work they had been
doing in this topic area at the national launch of the “Smile4life” report.
d) Prisoners – the pilot for developing the health coach model in HMP
Kilmarnock has been started, with an initial event of “Training the trainers”.
The provision of dental treatment by the Salaried Dental Services has also
commenced.
15.3 The Future
The Committee looks forward to continuing to work closely with the CDPH Strategic
Leads for Oral Health Strategy to support the ongoing development and
implementation from 2012 onwards.
16.
Conclusion
16.1 The Committee will continue to offer professional advice to the NHS Board on the
dental health and professional service needs of the local population. The Committee
is aware of the severe financial challenges and other important issues being faced
by both local dentists and the NHS Board and will continue to support and advise the
NHS Board in its work. The Committee will continue to be involved with local and
national dental matters and ensure the representation and involvement of the
profession as a whole.
Simon J Morrow BDS
Chair, Area Dental Professional Committee
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Appendix 4
Annual Report
Ayrshire and Arran Area Medical
Professional Committee
2011/12
1.0
1.1
Introduction
The Area Medical Professional Committee met five times over the last year. The
membership of the Committee is as follows:
Hospital Sub-Committee:
Dr Ruth Adamson, Dr David Chung, Dr Paul Eynaud (Deputy), Dr Dominic
Gallagher, Dr Steven Lawrie, Mr Anthony Newland, Dr Sudhakar Unnam.
GP Sub-Committee:
Dr William McAlpine, Dr David Richardson, Dr Huntly McCallum, Dr Kes Khaliq, Dr
Chris Black, Dr Hal Maxwell
In attendance:
Dr Carol Davidson, Dr Bob Masterton, Dr Ken Ferguson,
Dr Ruth Adamson (Hospital Sub-Committee) and Dr William McAlpine (GP SubCommittee) continued to Chair the meetings on a rotational basis. Dr Adamson
also continues as the Vice-chair of the Area Clinical Forum.
1.2
The Committee continued with videoconferencing to facilitate attendance at
meetings. This has proved to be reasonably successful allowing clinicians to attend
meetings with minimal disruption to their day to day work and also facilitated the
attendance of Board officers and others attending to discuss specific issues.
1.3
The Committee has met some challenges during the year in ensuring meetings
were quorate and there appears to be difficulties for clinicians who are members of
the Committee in attending meetings. The Committee has looked for ways to
address these problems and will continue with this in the coming year.
1.4
The Committee has managed to separate operational and strategic issues with only
strategic issues going forward to the ACF. Operational issues are discussed with
the management team representative at the Committee and dealt with without going
further.
1.5
The Committee continues to inform and advise the NHS Board, through the Area
Clinical Forum, over a wide range of topics.
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2.0
Major issues discussed throughout the year
2.1
The Area Medical Professional Committee has considered the following issues
during the year, some of which are reported separately in more detail:
2.2
Sustainable Futures
2.2.1 Representatives from the Committee continued to be involved in this work attending
the various work-streams. The Committee was provided with reports throughout
the year and looks forward in engaging with any meaningful outcomes when
achieved.
2.3
Access Policy
2.3.1 The Committee continued to express concern about the introduction of this policy.
Both primary and secondary care clinicians expressed concerns about the effects of
its introduction on patients and patient services. The general practitioner members
were particularly concerned about the abruptness of some of the decision making
with reports of patients being moved to the bottom of the waiting list on failure to
attend clinics for appointments they had not been notified about. There was also
concern within the GP community about downgrading patients from urgent to
routine without notification to either the general practitioner or the patient, a problem
which had been exacerbated by the new hospital “Patient Management IT System”
which had no fix for this problem. There was also unhappiness at the GP SubCommittee about the insistence by the Health Board that some patients should
travel to Clydebank to the Golden Jubilee Hospital for treatment even if the patient
had significant difficulty in accessing this institution.
2.4
Island Health Care
2.4.1 The Committee noted the problems that the Health Board faced in continuing to
provide medical care to these distinct populations.
2.4.2 On Arran, the Committee supported the work of the Health Board in engaging with
the local general practitioners and the island population to design a service which
would meet patient needs, ensure adequate medical cover and to address the
recruitment problems that the local GP practice continued to face.
2.4.3 On Cumbrae, the Committee noted the application to open a pharmacy on the
island had led to the destabilisation of the longstanding 24/7 365 day island based
medical service provided by the local GP practice. This had now resulted in great
uncertainty about the future of the local island-based GP service both in-hours and
out-of-hours particularly when the ferry was not running. The GP Sub-Committee
was supporting the work undertaken by the Health Board in addressing this problem
and looked forward to supporting the solution once agreed.
2.5
Virtual wards and the CHP Fund
2.5.1 Members of the Committee continued to be involved in this work which had followed
the announcement by the Scottish Government to invest £70 million in the Change
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Fund. This fund was designed to encourage and promote closer working between
health and local authority partners in the redesign and development of services for
“older patients”, particularly in encouraging community based work to allow patients
to remain in their own homes avoiding hospital admissions.
2.5.2 Both the Area Medical Committee and the GP Sub-Committee were concerned
about the process around the allocation of funding for 2012-2013, the timescales
involved and the lack of clarity in the decision making process which seemed
opaque, not clearly set out to all parties and which lacked the ownership of all the
partners who had been involved in the work.
2.5.3 The view was expressed at the GP Sub-Committee that this scheme simply was
transferring funding from the Health Board to local authorities to plug funding gaps,
was not investing to any significant extent in existing community based health care
services and confirmed the view of the Committee that Community Health
Partnerships were not at all interested in supporting the work undertaken by the
primary health care team who provided the greatest part of the work in looking after
their patient population‟s health needs.
2.6
Community Health Partnerships (CHPs)
2.6.1 The Committee noted with interest the announcement by the Scottish Government
to overhaul Community Health Partnerships with the intention of closer integration
of health and social care for patients. The Committee is keen to be involved in
discussions about this locally to try and help the Health Board learn from the
mistakes of previous local and nationally determined re-organisations which would
ensure the voice of local clinicians working at the “coal face” was clearly heard in
the development, structure and functioning of the next generation of CHPs. Both
the Hospital Sub-Committee and the GP Sub-Committee continue to believe that
the current “top-down” management driven model with minimal clinical involvement
and a byzantine Committee structure has been a complete failure and needs to be
replaced.
2.7
Patient Management System
2.7.1 This new IT system which has been installed in hospitals throughout NHS Ayrshire
and Arran was discussed on a number of occasions at both the Area Medical
Committee and the Hospital sub-Committee. The Committee noted that the
introduction of this system had proved challenging to clinicians throughout the
organisation with clinical governance issues, training issues and problems with outpatients being particularly problematic. The Committee continue to express major
concerns that these have not been fully addressed and wish to continue to work
with management to ensure these problems are resolved at an early date to
minimise disruption to the smooth running of clinical services and to ensure
seamless patient care.
2.8
Significant Adverse Events (SAE)
2.8.1 The Committee noted during the year that a new reporting process for Significant
Adverse Events had been discussed at the Staff Governance Committee. The
Hospital Sub-Committee had been concerned that a new SAE process had been
introduced without input from the professional advisory structures. In light of
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subsequent events with the issue of the management of SAE within the Health
Board becoming very topical and a matter for national concern, the Committee
hoped that the professional advisory structure would be fully involved in the
decision making process in the future.
2.9
Prison Health Service
2.9.1 The Committee continued to support in principle the proposal to subsume the
Prison Health Service into the local NHS. It maintained its belief this will provide
both a better services to this vulnerable group of patients and also provide better
links between clinicians working in the NHS and prison service. Concern continued
to be expressed in the costs associated with this change and the Committee
confirmed its view that existing services should not be put at risk if the Scottish
Government did not fully fund this change.
2.10
Tobacco Policy
2.10.1 The Committee could not believe this was still an active issue. It continued to fully
endorse the Board‟s intention to make all NHS facilities smoke free. The
Committee believes that the Health Board should be fully committed to ensuring
that smoking is not tolerated on any Health Board premises and believes that the
examples of “smoking shelters” which are easily visible on Health Board property
set a bad example to patients. The advice of the medical director to the Health
Board on this subject was fully supported by all of the Committee.
3.0
Completed/on-going work from the year
3.1
The main areas that will be continuing into next year will be financial constraints,
change to services, mental health developments, Primary Care Strategy
development and 18 weeks referral to treatment. There can be no doubt that the
financial pressures which have hit other parts of the public sector are very clearly
now being felt by NHS Ayrshire and Arran and it will be a challenge in the coming
year to maintain the high level of service in an era of a declining budget (in real
terms) and declining workforce.
3.2
It will be essential to maintain good communications between the various Area
Professional Committees and any considered change to services must involve the
professional advisory structure at an early stage to ensure robust professional
involvement. CEL (2010) 16 is being used as an opportunity by the Health Board
and the professional advisory structure to allow for new engagement and
partnership working and this must continue in the coming year. The Area Medical
Committee is fully committed to this agenda and looks forward to its involvement in
this work.
3.3
The Committee welcomes the continued involvement of the Executive Medical
Director along with his team and the Director of Public Health at their meetings.
4.0
Advice provided to the Board
4.1
In addition to work described above, the Committee provided advice in a number of
strategic areas where the Health Board had been asked to provide comment.
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5.0
Future Plans
5.1
The Committee will continue to raise matters it considers pertinent for ACF and
NHS Board discussion.
5.2
The Committee will continue to scrutinise NHS Board papers and advise
accordingly through the ACF.
5.3
Stronger links with senior managers are welcome and early discussion of any
proposed change in services would be beneficial in the light of financial constraints.
5.4
The Committee will continue to deal with appropriate operational matters that arise
within its remit.
6.0
Conclusion
6.1
The AMPC has had another busy year and feels it has contributed positively to the
development of services for patients within NHS Ayrshire and Arran.
Dr Ruth Adamson / Dr William McAlpine
Co-Chairs, Area Medical Professional Committee
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Appendix 5
Annual Report
Ayrshire and Arran
Area Nursing and Midwifery Professional Committee
2011/2012
1.0
Introduction
1.1
The Area Nursing and Midwifery Professional Committee has met on six
occasions throughout the year. The focus within the year has been on
developing the committee and how to take this forward. The Committee has
welcomed input from the Associate Nurse Directors for Mental Health and
Community. The Committee would welcome continued support from the
Associate/Assistant Directors throughout the coming year to help it to
develop a proactive role within the organization.
2.0
Major Issues Discussed throughout the Year
2.1
A key issue of discussion for the Committee over the last year has been the
Community nursing review and the developments around advanced nursing
practice in the community, community wards and long term condition
management, with the Committee providing professional input to this
process at numerous points in the process. The Committee has been keen
to discuss the implications of these changes for all nursing groups and have
provided considered clinical and professional opinions. The change within
community nursing teams remains an important issue for nursing and will
remain on the work plan for the coming year.
2.2
The issue of advanced nursing practice and its impact on quality of care
was also an issue discussed during the year. This included discussions on
developments within the advanced nurse practitioner team and their impact
on patient safety.
2.3
The Committee spent some time discussing sustainable futures and
potential routes for savings and the impact of any change on nursing and its
constituents.
2.4
The Committee discussed the patient experience work and how this can be
taken forward in a meaningful way which impacts on nursing practice and
was keen to help take this work forward.
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2.5
The Committee discussed gender based violence and the issues for nurses
around implementation of current and future policy.
3.0
Completed / Ongoing Work from the Year
3.1
In the past the Committee has expressed a desire to be more proactive
rather than reactive, during this year steps toward this have been taken by
improving recruitment and attendance at the Committee and by widening
the representation. Further work needs to be undertaken to both highlight
the role of the Committee and to encourage feedback from the wider
nursing community. The Committee has focused on several important
issues for nursing as mentioned, however this proactive approach is a work
in progress and there is a need to further develop systems to support an
ongoing proactive Committee. This is the main challenge for the coming
year.
4.0
Advice Provided to NHS Board
4.1
The Committee has considered all of the papers that have been submitted
to the NHS Board with particular consideration given this year to :
o
o
o
o
o
o
o
o
4.2
Community nursing review
Sustainable Futures
Tobacco policy
Sexual Health Strategy
Quality Strategy
Change fund
Clinical Governance
Transfer of prison healthcare staff.
Presentations to the Committee took place at most meetings. These
included:
o
o
o
o
o
Community Nursing Review
Improving patient experience
Advanced level practice in nursing
Tobacco policy
Sustainable futures.
5.0
Future Plans
5.1
The future for the Committee remains a challenging one. As stated earlier
there is ongoing discussion as to how the Area Nursing and Midwifery
Professional Committee can be more effective. This will be carried forward
into this year with a focus on key areas such as the implementation of the
community wards, change fund, advanced practice, sustainable futures and
the potential developments within health and social care and their impact on
the nursing profession. Members are keen to ensure that the Nursing voice
within the clinical forums is a proactive and well balanced one.
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6.0
Conclusion
6.1
The Area Nursing and Midwifery Professional Committee has provided
support to the Area Clinical Forum over the year on a number of issues.
The Committee has grown in strength over the last year, however, the role
of the Committee is an important one and the Committee needs to ensure
that it continues to grow and provide a representative voice for the
profession.
Janet McKay
Chair, Area Nursing & Midwifery Professional Committee
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Appendix 6
Annual Report
Ayrshire and Arran Area Optical Professional Committee
2011/12
1.0
Introduction
1.1
The Area Optical Professional Committee (AOPC) has found this last year a little
more challenging than previously in the face of serious financial challenges,
reduced funding and increased cost saving, which is unfortunately now a fact of life
in the NHS and the Committee has not been immune from it. However challenging
times can also result in increased innovation in the use of the resources that we still
have, and the Committee has been trying to achieve this as much as possible.
Activities for the past year are described in more detail below.
1.2
The AOPC currently comprises of:
Alan Beck (Chair)
Helen Scott (Vice Chair)
Kenneth McPhee
Catherine Taysum
John Watt
Peter Carson
David Bonellie
Douglas Orr.
The Committee has met at eight weekly intervals to coincide with NHS Board
meetings.
2.0
Items Discussed throughout the Year
2.1
One Stop Cataract Referrals
2.1.1 We recently implemented a re-design of the successful and long running one stop
cataract/post-operative review service. In general, Optometrists felt the service
was working well and changes were limited to paperwork changes and clarifying a
few long-standing areas of confusion in terms of referral process. The newly
designed paper referral forms should be available shortly. We would like to thank
Dr Alan Gaskell for his support through this re-design project. Mr Srinivasan has
been working through the waiting list of optometrists wishing to be accredited to
provide this service, and is making good progress here. We would like to thank Mr
Srinivasan for his continued support with this.
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2.2
Glaucoma Direct Referral and Establishment of Shared Care Pathway
2.2.1 Unfortunately limited progress was made with establishing shared cared for
Glaucoma patients in a primary care setting. There is definitely an appetite in the
community to take on this work. However, time and financial factors are still
holding us back for the foreseeable future.
2.3
Bridge to Vision
2.3.1 The Bridge to Vision Service continued to provide Learning Disabled adults with
enhanced community based Optometry care. It is hoped that promoting the service
in other areas will encourage and assist other optometrists to provide optometry
services to patients with learning disability.
2.4
Diabetic Retinopathy Screening
2.4.1 The Diabetic Retinopathy Screening service carried on as usual throughout the
year and continues to provide the only community based optometry DRS service in
Scotland.
2.4.2 An increasing number of optometrists have now completed the DRS City and
Guilds course and many others are working on it at the moment. We continue to
take part in the six monthly EQA scheme, and results in this are steadily improving
each time it is carried out. The Clinical lead, Dr Varikarra, also holds two training
afternoons a year. Attendance at at least one of these meetings is compulsory.
2.5
Eye care services review (Scotland) and local LVA provision
2.5.1 The new LVA service, which was instigated by the eye care services review 2006,
has been running successfully since July 2010. This service is more efficient and
accessible to patients than the previous low vision service and has proved popular
with both clinicians and patients. With an ageing population and increasing levels
of low vision in the community this service will continue to benefit those patients
with visual impairment living within Ayrshire and Arran.
2.6
Meeting Attendance
2.6.1 The AOPC has representation on the Primary Care Steering Group, Area Clinical
Forum and the North and South Ayrshire Community Health Partnerships. There is
also an optometry representative on the East Ayrshire Community Health
Partnership who feeds back to the AOPC. The Diabetic Retinopathy Screening
Managed Clinical Network locally and the DRS Collaborative Executive Committee
at a national level have AOPC representation as has the Bridge to Vision Sub
Group. There is also representation on the NHS Education for Scotland Advisory
Committee, the local Ophthalmology Care Pathway Group and the local Clinical
Governance Committee. In addition, one of our Committee members (our previous
AOPC Chairman) Peter Carson, is chair of Optometry Scotland.
2.7
Wet Age Related Macular Degeneration
2.7.1 The fast-track Wet AMD Service in Ayrshire and Arran, as in the rest of Scotland, is
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proving very successful at treating what was previously a condition that caused
blindness. Due to the nature of the ongoing treatment and monitoring that is
required for these patients, a pilot service to share some of the ongoing monitoring
work by providing community optometry based optical coherence tomography has
been running in a local optometry practice. This pilot will shortly come to an end
with around 100 patients being involved. The results will be published in several
journals and it is hoped further work can be undertaken in the future in this area.
2.8
E- referral scheme
2.8.1 The sum of £6.3 million has been allocated nationally to set up E- referral schemes
between optometry practices and secondary care. NHS Ayrshire and Arran have
put in a tri-partite bid with Greater Glasgow and Clyde and Lanarkshire Health
Boards for funding.
2.8.2 The scheme will use SCI gateway with access via virtual private network (VPN)
tokens. This has the advantage of improving the quality of referrals to HES and
allowing fundus images and field plots to be attached.
2.8.3 Ayrshire and Arran plans to implement electronic payments to practices from PSD
by March 2014. The advantage is in streamlining the system and increasing
accuracy of submissions and speeding up the payment process with less
manpower required at PSD for handling rejections etc.
2.8.4 Much work has occurred In this area and we are now ready to implement a pilot
scheme in six practices over Ayrshire. At the moment NHS IT are providing training
to the optometrists in these practices, and we hope to begin the pilot early in March.
If this system is as successful as we hope it will be rolled out to all practices by
March 2014
2.8.5 The Committee would like to thank Ayrshire and Arran NHS IT for their help so far
and also the Optometric Adviser, Cath Taysum, for her hard work in liaising with the
HES in order to create the three referral templates that are to be used in the pilot.
3.0
Conclusion
3.1
The Ayrshire and Arran Area Optical Professional Committee has once again been
busy both providing professional advice to the local NHS, carrying forward current
local eye care strategies, and implementing new strategies as required by the local
population. Though reduced NHS funding has limited our activities to an extent (as
with all health board departments) we are still very happy with the support we have
received from the local health board and hope to continue to carry out our aims of
improving eye care in Ayrshire and Arran.
Alan Beck
Chair, Area Optical Professional Committee
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Appendix 7
Annual Report
Ayrshire and Arran Area Pharmaceutical
Professional Committee
2011/12
1.0
Introduction
1.1
The APPC has 12 members (six Community Pharmacists, six NHS Employed
Pharmacists). To ensure that the widest range of views is being obtained and that
communication across all sectors of pharmacy in Ayrshire and Arran were
improved, the Committee had previously co-opted the Chair of the Community
Health Partnership (CHP) Pharmacists group and has the Director of Pharmacy as
an ex-officio member. The Committee welcomed Anne Shaw who is in attendance
at meetings as Primary Care Contracts Manager for Pharmacy, following a reorganisation of Primary Care.
1.2
In addition to its general advisory role, the APPC has a statutory function to advise
the NHS Board with regard to pharmacy contracts in association with the National
Health Services (Pharmaceutical Services) (Scotland) Regulations 1995. Further to
that statutory role, the Committee also appointed contractor and non-contractor
members to the Pharmacy Practices Committee (PPC), a Committee that holds the
delegated authority of NHS Ayrshire and Arran in relation to the granting of NHS
pharmacy contracts within Ayrshire and Arran.
1.3
The APPC has met every eight weeks in line with NHS Board meetings.
2.0
Major Issues Discussed throughout the Year
2.1
Contractual - Control of Entry – changes to regulations from 1 April.
2.2
Changes to NHS Pharmaceutical Services in Scotland.
2.3
Pharmaceutical Care Services Plan.
2.4
Reshaping Care for Older People Change Fund – The Committee fully
supports this agenda and has received regular updates in relation to
Pharmacy bids.
2.5
Minor Ailment Scheme – there was local discussion around referrals between
Pharmacy and Optometry then a national agreement was reached at the end of
2011.
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2.6
Substitute Prescribing – regular discussions in relation to Methadone dispensing
service and impact on community pharmacy.
2.7
Sustainable Futures –The Committee was represented at 23 August CRES cost
cutting workshop and continues to discuss and provide input.
2.8
Patient experience in primary care – there has been regular discussion throughout
the year and the Committee is currently considering a rights and responsibilities
leaflet to be advertised in pharmacy practices.
2.9
Supply of medicine issues – there has been regular discussion following concerns
about supply, particularly in early 2011.
2.10
Transfer of prison healthcare – The Committee gave advice in the run up to the
transfer and continues to follow progress.
2.11
Copyright – this was discussed at length following the removal of NHS Scotland‟s
licence as it has particular implications for providing advice on medicines, many of
which are supported by clinical papers.
2.12
The Committee received the following presentations:
- developments in the Board on continuous clinical improvement
- the Falls Pathway Invigor8
- the Jumpstart scheme to maintain a healthy weight in children
3.0
Completed / Ongoing Work from the Year
3.1
Reshaping Care for Older People Change Fund – regular updates in relation to
Pharmacy bids.
3.2
Sustainable Futures - The Committee has had regular discussion on the Board‟s
financial situation, particularly as medicines are a high cost area for the Board.
3.3
Minor Ailment Scheme –referrals between Pharmacy and Optometry following
national agreement reached at end 2011.
3.4
Substitute Prescribing – there has been regular discussions in relation to
Methadone dispensing service and impact on community pharmacy.
3.5
Patient experience in primary care – there has been regular discussion throughout
the year and the Committee is currently considering a rights and responsibilities
leaflet to be advertised in pharmacy practices
3.6
Supply of medicine issues – the Committee continues to monitor this situation.
4.0
Advice Provided to NHS Board
4.1
The APPC contributed to a range of consultation papers from the NHS Board over
the year along with discussion of and advice on other national consultations.
4.2
The APPC fulfilled its role in acting as a Statutory Body in providing advice on all
pharmacy contractual issues and made representation to the Board‟s Pharmacy
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Practices Committee where appropriate. Over the year, the APPC were asked to
provide input to approximately six applications for new contracts, relocation of
premises and variation to contracted hours.
4.3
Other advice provided was in response to draft NHS Board papers.
4.4
The APPC also provided advice through its membership of other advisory groups
throughout NHS Ayrshire and Arran including the Pharmacy Practices Committee,
the Drug and Therapeutics Committee and the Area Clinical Forum (ACF).
4.5
The APPC will continue to provide professional advice to the PPC on
applications made under the new Control of Entry regulations.
5.0
Future Plans
5.1
To continue to give advice and insight on all aspects of the provision of pharmacy
across Ayrshire and Arran, in particular where it impacts on the patient journey and
how this can be improved.
5.2
To explore opportunities for joint working and understanding with other health care
practitioners, as illustrated in the work of the A&E re-direction pilot and
Pharmacy/Optometry referrals under the Minor Ailment Scheme, across both acute
and community settings
5.3
To continue to engage in national strategies (such as the Independent Prescribers
Strategy, Better Health Better Care, Scotland‟s Dementia Strategy) as well as local
plans to facilitate Shifting the Balance of Care by closer working between health
and social care professions.
5.4
To work closely with key stakeholders to ensure Pharmacy‟s continued input in
initiatives such as the Change Fund.
6.0
Conclusion
6.1
The APPC has continued to work well over the past year in a number of important
areas and looks forward to engaging with and supporting the NHS Board in
2012/13.
6.2
I will be leaving the Committee at the end of March due to other work commitments
but I wish my successor well in the role. I would like to thank Morag McConnell,
Vice Chair, Diane Lamprell, Professional Secretary and Angela O‟Mahony,
Committee Secretary for their valuable input and support.
Graeme Bryson
Chair, Area Pharmaceutical Professional Committee
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Appendix 8
Annual Report
Ayrshire and Arran Area Psychology
Professional Committee
2011/2012
1.0
Introduction
1.1
The Area Psychology Professional Committee has met on six occasions during the
Committee year 2011/2012.
1.2
The year has seen three changes in the membership of the Committee. Emma
Riley, Vice Chair and Clinical Health Psychology representative left her post in
December and we recruited Marisa Forte to the latter role. The role of Vice Chair
remains vacant. One Adult Mental health post and the Older Adult post were up
for election and we have recruited Carol Overend and are retaining Pamela
McColm to these posts.
1.3
The Committee has representation from all psychology specialties within NHS
Ayrshire and Arran and members of the Committee continue to work hard to
ensure that all constituents have a voice and that best practice and evidence
based advice is provided to the Health Board. The Committee disseminates and
receives information to and from the Psychology Service Clinical Governance,
Research and Strategy group and APsyPC feedback is a standing item on its
agenda. There is recognition that a small number of accredited therapists are
employed out with the Psychology service and measures have been put in place to
provide them with representation through the Committee.
2.0
Major Issues Discussed Throughout the Year
2.1
Applied Psychologists and Psychology in NHS Scotland
The Committee had discussions about this CEL and welcomed many of the
recommendations. It was felt that the multi professional focus taken in document
was reflective of the skill mix within the Psychology Service. The development of
the roles of Clinical Associate in Applied Psychology was promoted and this was
happening in Ayrshire and Arran. The challenge of developing roles in the current
economic climate and with the pressure to meet HEAT targets was discussed. It
was highlighted that discussions about changes in roles would need to take place
with referrers, related services and the general public.
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2.2
ACF/APsyPC Development
Janet McKay, Chair of ACF, attended a Committee meeting to present her vision
for the ACF and to discuss with the Area Professional Committees how they could
support this. In light of the ACF development day it was felt that a similar event for
the APsyPC would be beneficial. At this day agreement was reached on being
more proactive and shifting the focus of meetings to strategic matters rather than
on responding to board papers. Changes in the organisation of the meetings were
agreed to support this.
2.3
Child and Adolescent Mental Health Services
The Committee discussed concerns about the development of the above service.
It was acknowledged that considerable investment had been made in the service
and that this had had a positive impact on access to it. Concerns focused on the
potential for an imbalance in the skill mix of the teams and a dilution of
psychological interventions as a result.
2.4
Assessment of Capacity
The Committee were supportive of the Scottish Government proposal to broaden
the list of professionals able to issue certificates in assessments of capacity.
Clinical Psychologists were often involved in the neuropsychological assessment
of the individuals and it was felt that this would recognise their role in the process
and make it more efficient. Also the Committee emphasised the need for
assessment of capacity to be a multi-professional assessment. Concerns were
raised about a potential increase in demand for this given the scarcity of the
resource.
2.5
Psychology Posts
The Committee have been aware of the psychology posts that have been frozen
and welcomed the release of these in helping meet the challenging access to
psychological therapy targets.
2.6
Sustainable Futures
The Chair and Vice Chair of the Committee attended the sustainable futures event
and were involved in the discussions about meeting the financial targets and the
difficult decisions that this would entail.
2.7
Transfer of Prison Health Services to NHS Ayrshire & Arran
The Committee discussed concerns about the lack of psychology provision to the
prison population. It was felt that this was a significant gap in the service and the
demands of meeting it would be great given the likely complexity of the problems
in terms of co-morbidity.
3.0
Advice Provided to NHS Board
3.1
We have continued to provide NHS Ayrshire and Arran with comments informed by
the psychological evidence base and the professional perspective.
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3.2
We will continue to provide a link between constituents represented by the
Committee to the Health Board.
4.0
Future Plans
4.1
The Committee will continue to inform NHS Ayrshire and Arran of psychological
evidence base which must inform care at all levels of service and across all
physical and mental health specialties. There is no health without psychological
health. In particular the Committee will be emphasizing the role of behaviour
change in physical health. We will also highlight the associated training and
competency needs of both the specialist and non-specialist workforce.
4.2
The Committee will continue to develop mechanisms to assist all levels of the
organisation to use evidence based psychological practices.
4.3
Succession planning will remain a high priority for the Committee due to the ever
changing demands of the members‟ roles and mobile nature of the workforce.
5.0
Conclusion
5.1
The Committee would like to thank all those who have contributed to the
Committee throughout the year with special thanks to Emma Riley and Cathy
Kyle.
5.2
5.3
The Committee continue to be indebted to Pauline Sharp and colleagues for the
high standard of administrative support and guidance provided to the Committee.
The Committee would like to thank those who have assisted and informed the
work of the Committee.
Kevan Fulton
Chair, Area Psychology Professional Committee
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