1. health and fitness
2. disease
3. asthma

CONFIRMED MINUTES OF FIFE RESPIRATORY MCN
STEERING GROUP HELD ON THURSDAY 5TH FEBRUARY 2015,
AT 3pm, EDUCATION CENTRE, VICTORIA HOSPITAL,
KIRKCALDY
Present:
Dr Colin Selby
Lorraine Cooper-King
Maureen Foster
Euan Reid
Heather Smith
Lorna Stevenson
Lorna Stewart
Gayle White
CS
LCK
MF
ER
HS
LStev
LStew
GW
Apologies:
Gill Dennes
Fiona Eastop
Susan Harrower
Dr Tom Hartung
June James
Anne McKean
Lorna McKenzie
Carole Smith
Dr David Somerville
Agnes Whyte
In Attendance:
Andrew Henry-Gray
Respiratory Consultant / MCN Joint Clinical Lead [Chair]
MCN Coordinator
MCN Patient Sub Group Representative
Pharmacist
Respiratory Nurse Specialist
Respiratory Coordinator, CHSS
Anticipatory Care Nurse
Physiotherapist, K&L CHP
Practice Nurse, Oakley / NHS Joint Clinical Lead
Primary Care Development Pharmacist
Specialist Stop Smoking Worker, K&L CHP
Respiratory Consultant
Physiotherapist, GNEF CHP
Paediatric Asthma Specialist Nurse
Intermediate Care Team Manager, GNEF CHP
Physiotherapist, DWF CHP
GP, Inverkeithing
BreatheEasy Kirkcaldy Representative
Admin Assistant [minutes]
Circulated to for Information
Vicki Chesher
For DWF CHP General Practice & Primary Care Clinical Group
Jim Crosbie
Chair, Respiratory Patient & Carer Sub Group
1.
WELCOME & APOLOGIES
ACTION
CS welcomed all to the meeting; apologies noted.
2.
MINUTES FROM PREVIOUS MEETING [02/12/2014]
3.
MATTERS ARISING
3.1
Over-ordering of Salbutamol letter (Min 3.1)
As discussed at previous meetings, Pharmacy colleagues drafted a letter
which Practices have been using, as they see fit, to contact patients identified
as high use of Salbutamol inhalers. The letter outlines to the patient that their
prescription for Salbutamol will be reduced to one until the patient presents to
the surgery for a review. The letter is also an attempt to raise awareness to
the patient regarding the frequency of repeat ordering. The Group agreed to
continue with the use of the letter to aid review compliance in line with the
NRAD findings and recommendations.
3.2
Fife Formulary Review (Min 3.2)
CS noted that the Fife Formulary Review will be undertaken again in Autumn
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of this year rather than every three years so that it does not become such a
huge task to undertake.
LCK noted, the CHP Lead Nurses have been informed of the new ‘preferred
inhaler devices’ flowchart for the under 5’s.
3.3
Spirometry in Primary Care (Min 5.1)
Following the query from DWF General Practice and Primary Care Clinical
Group re Spirometry waiting lists due to QOF work around COPD prevalence,
GD emailed all Practice Nurses in Fife. Out of 13 responses received there
were no major waiting time issues revealed. The MCN’s recommendation to
the GP&PCC Group was participation at Practical Spirometry sessions to
allow appropriate practice staff to be trained in performing spirometry to help
alleviate any waiting time pressures. An ad hoc session is currently being
planned for those who missed the PLT session in November 2014.
3.4
MCN Endorsement (Min 15.1)
Self assessment evidence / presentation has been accepted by the
endorsement panel. Waiting to receive formal notification from the Board.
4.
ASTHMA
4.1
Inhalers in Schools
No further feedback to date. New guidance expected from Spring 2015 as
part of the wider Administration of Medicines in Schools guidance. It was
highlighted that schools in Scotland are different to those in England and
Wales, as Scottish teachers are not covered by indemnity.
4.2
Letters of Escalating Concern – Asthma Review appointments
As discussed at previous meetings, the Group had decided that a series of
letters of escalating concern were to be drafted with the intention of capturing
those patients who consistently DNA asthma review appointments within
Primary Care. LCK presented draft templates to the group for comment.
There was some discussion around missed appointments in secondary care
following an A&E attendance and NRAD recommendations for patient followup. CS suggested that this would be a matter worthy of further discussion.
LStev raised an issue in relation to literacy levels of patients. The Group were
informed that the language used in the draft letters (as with much of NHS
correspondence) can be shown to have a comparative reading age of 15-16
years old; whereas the average reading age in Scotland is around 11 years
old. Therefore, there is a potential need to simplify correspondence for target
patients. LStev to send LCK links re tools for rewording. Letters to remain as LStev/
drafts for now.
LCK
4.3
Collated Asthma Priorities
The group were asked to read/check the document and to comment or follow
up any action points.
ALL
4.4
C&YP Asthma Sub Group
Following discussions within the C&YPAG it was suggested that the Group,
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as it currently stands, be disbanded and brought into the main MCN Steering
Group meetings. LCK has shared this proposal with the members of the
C&YP Asthma Group who were not at the last meeting but has received only
one response. The MCN SG agreed that twice a year the C&YP Asthma Sub
Group would appear on the MCN agenda for them to discuss and take
forward specific items. General asthma will remain as a standing item on the
MCN bi-monthly agenda.
The role & remit of the MCN Steering Group is to be amended to reflect the
changes noted above and brought back to the Group for agreement.
LCK
5.
COPD
5.1
ISD Data
Definition of “episode” and “continuous inpatient stay” was clarified.
ISD have provided figures from the other Boards for comparison. LCK will
bring to next meeting.
LCK
6.
BRONCHIECTASIS
Nothing to discuss.
7.
HOME OXYGEN
Nothing to discuss.
8.
NATIONAL ADVISORY GROUP (NAG) UPDATE
LCK attended the most recent NAG meeting and reported back to the Group.
 Asthma Priorities Self-Assessments
11 out of 14 Boards returned the Self-Assessment (this included NHS Fife).
These are being shared with the Cabinet Secretary with a view to guidance
and possible support on taking priorities forward.
 Improvement Plan
The Improvement Plan is in final draft and will be circulated for comment.
Funding will be available, via the Scottish Government, to take forward
improvement projects that if successful, could be rolled out to other Boards as
a national approach.
 Interstitial Lung Disease (ILD)
George Chalmers, Consultant Respiratory Physician, Glasgow Royal
presented information on IPF in Scotland and the Scottish ILD Group. It was
noted there is only one ILD Specialist Nurse in Scotland.
Dr Selby advised he is part of the Fife Multidisciplinary Team for this disease
group, participating in bi-monthly meetings and quarterly teleconference MDT
meetings.
Prescribing restrictions of Pirfenidone were then discussed.
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 NAG Learning Forum
The next Learning Forum is planned for Friday 4th September 2015, Stirling
Management Centre. The programme will be shared in due course.
 ‘My Lungs My Life’
Website is due to launch in June 2015. Advertising materials will be available
to Boards and it is expected local MCNs will take forward advertising the
resource in their local areas. National advertising will also be undertaken.
 Sleep Guidelines
Following comments received, the guidelines and patient information leaflets
are now in final draft. Hard copies of both documents will be available to all
Boards. Group agreed only electronic copies of the documents would be
required.
9.
EDUCATION & DEVELOPMENT SUB GROUP
Main focus of the Group currently is planning the Non-Malignant Palliative
Care Study Day (28th April 2015).
Programme contributors currently
confirmed are Professor Robin Taylor, Dr Lindsay Murray and Dr Steinunn
Boyce.
The Group has reviewed their progress against 2014/2015 actions.
The Education Catalogue has been reviewed – no amendments required.
Areas of education focus for 2015/16 will be Anticipatory Care Plans;
Bronchiectasis; and Idiopathic Pulmonary Fibrosis.
The PLT sessions on ‘Knowing Your Asthma & COPD Inhalers’ and
‘Respiratory Fife Formulary Changes in Context’ (03/02/2015) were very well
attended, especially by Community Nursing staff.
10.
PALLIATIVE CARE eLEARNING
The group have been working with Jackie Ballantyne to ready the Palliative
Care eLearning (LearnPro) package and the launch is set for the Study Day
on 28th April 2015.
The package will differentiate between palliative and end-of-life care.
11.
PHARMACY / PRESCRIBING
11.1
Prescribing Update
ADTC approved the updates to the Fife Formulary in December 2014.
Seretide 250 Evohaler data from the Acute Division shows a decrease in
usage, although possibly not as rapidly as might expected.
ER discussed brand prescribing of inhalers, and the potential for confusion if
the brand name and inhaler device type were not specified, e.g. salbutamol
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dry powder inhalers. Article required for next newsletter encouraging
practitioners to prescribe generically, with the exception of e.g. Salbutamol ER/LCK
DPI > prescribe Easyhaler®Salbutamol.
ER advised, following concerns raised (nationally), GSK have revised the
colour of the Relvar® Ellipta® inhaler device from blue to yellow. The
formulation of the medicine and the functionality of the inhaler remain
unchanged.
12.
LUNG HEALTH / CANCER
Nothing to discuss. It was noted that Smoking Cessation can now request a
radiograph and a pathway is in place.
13.
PULMONARY REHAB
Pulmonary Rehab programme continues to run in each of the three CHP
areas. Recurring funding has been identified to support Pulmonary Rehab.
Within GNEF, previously temporary posts will now become permanent.
14.
SLEEP APNOEA SERVICE
Sleep guidelines discussed previously. Nothing more to discuss at present.
15.
WORK OF THE MCN
15.1
Newsletter
LCK distributed a draft of the newsletter to the group and invited comments.

Acetylcysteine – addition to article
As well as consideration of stopping this medication, could refer to
secondary care as new treatment options/opportunities.

Add PACT and SPOA email referral links to Pulmonary Rehab article.

Brand Prescribing
Salbutamol dry powder should be prescribed by Brand.
15.2
Workplan Update
Not discussed. Carry forward to next meeting.
16
PATIENT SUB GROUP
The Patient Sub Group has met twice since the Steering Group last met. The
Patient Sub Group has been concentrating and updating the work plan. They
have reviewed the original 29 items: completed actions have been removed.
The Patient SG plans to engage with the BreatheEasy Support Groups and
will present the completed actions.
The work plan for 2015-2016 includes both outstanding and new actions and
is more focussed in terms of achievability.
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The role and remit was reviewed and changes agreed. The MCN will receive
a copy of the annual workplan and the MCN Lead Clinicians will receive
copies of the meeting minutes.
MF announced that she is regrettably stepping down as a member of both the
Fife Respiratory MCN Steering Group and the Patient Sub Group. The
Patient Sub Group is taking forward ideas for further recruitment to the Group,
including a ‘register of interest’.
LCK happy to be link between the two groups for time being.
CS gave thanks to MF on behalf of the Respiratory MCN Steering Group and
recognised her contribution to the Groups.
17
MEMBERSHIP
Dr Priyadharshan will be stepping down from the MCN. There is a need to
review membership. It was suggested that it would be valuable to have more
Practise Nurses involved. The Group agreed to wait until the new Health &
Social Care structures were in place before progressing with this.
LCK
18
AOCB
LS advised staffing / cover issues within the DWF Anticipatory Care service.
It was noted this is a DWF service only and not equitable across Fife. It was
suggested the MCN could take this issue forward as part of the 2015-2016
action plan.
LCK
DATE OF NEXT MEETINGS
Wednesday
Thursday
Wednesday
Thursday
Wednesday
1st April 2015
4th June 2015
5th August 2015
1st October 2015
2nd December 2015
3.00 pm
3.00 pm
3.00 pm
3.00 pm
3.00 pm
Board Room, Hayfield Clinic, Kirkcaldy
Discussion Room 1, Education Centre, QMH, Dunfermline
Staff Club, VHK, Kirkcaldy
Discussion Room 1, Education Centre, QMH, Dunfermline
Staff Club, VHK, Kirkcaldy
Circulated:
Fife Respiratory MCN Steering Group Minutes 05/02/2015
Originator: A Henry-Gray
V1.1
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Last Updated: 14/04/2015