Minutes of MCN Project Board Cardiac Rehab Sub-Group

NHS GRAMPIAN

Minutes of MCN Project Board Cardiac Rehab Sub-group held on Wednesday 14 March 2007 at 2.00pm, Meeting Room 1, NHS Grampian, Summerfield House, Aberdeen

Present: Mr Robert Paton (Chair), Public Representative, Grampian Cardiac Rehabilitation Association Mrs Brenda Anderson, Cardiac Rehabilitation Co-ordinator, NHSG Mr Neil Buchanan, Physical Activity Co-ordinator, Health Improvement Team, NHSG Dr Karen Simpson, General Practitioner Ms Joan Thain, Cardiac Rehabilitation Co-ordinator, NHSG

In attendance: Ms Lesley Smith, Physiotherapist, Cardiac Rehabilitation, NHSG Mrs Christine Gray, Secretary CHD & Stroke MCN, Westholme, Woodend

Item Actions 1. Welcome and Apologies:

Apologies – Trudie Inrig, Gordon Murdoch, Donald Pirie, Alastair Ramsay, Sandy Reid

2. Minutes of previous meeting held on 13 December 2006

Agreed.

3. Matters arising from previous minutes

Taken under main agenda 4. MCN Update

Robert gave a brief rundown of the key issues raised at the last CHD MCN Project Board meeting on 1 February, which was the first meeting that he had attended as a member.

Non-Recurring Funding – there was £81k available, which would be carried over into the next financial year. If Brenda felt the need to explore any funding she would contact Clark Paterson direct.

CHD MCN Project Board Clinical Lead - Dr Robert Liddell was now appointed as Lead Clinician from 1 January 2007.

Heart Failure Service - Bob Liddell tabled a paper for discussion on a proposed “local enhanced service” in cardiac failure to be submitted to NHSG Operational Management Team. The total amount of funding required to implement this was £550k. 2 Item Actions

A discussion followed regarding the withdrawal of the Heart Failure Nursing Service. The proposed Enhanced Service for Heart Failure would mean that GP Practices would be paid to get patients identified for beta-blocker up-titration. It was noted, however, that GP Practices could elect not to take this service on board.

Robert stated that he had recently been invited to attend a reception at the Scottish Parliament by Louise Peardon from Chest Heart and Stroke Scotland. Grampian were the only Region in Scotland without a specialist Heart Failure Nursing Service. A discussion followed which included:

 Why place the workload onto General Practitioners when the HF Nursing Service had been good?  A lot of GP Practices did not see heart failure as a priority.  The CHD SIGN Guidelines stated that each Region in Scotland should have a Heart Failure Nursing Service with a nurse for every 100,000 of the population.  Practice Nurses were reluctant to take on board heart failure after the one day course of instruction supplied by the HF Nursing Service before it ceased  Karen had been very disappointed that the HF Nursing Service had been withdrawn. She felt there had been insufficient feed-back from the MCN regarding the direction of service provision – Karen felt that the MCN wished the Service to go in a completely different direction than what was initially agreed by the Big Lottery. The HF Service had fulfilled all that was required of them and had been, in fact, very flexible in changing and evolving as they went along.  There would be more heart failure admissions to Aberdeen Royal Infirmary at a time when ARI were trying to reduce admissions and making it an acute hospital only.

Action: RP It was agreed by the group that in fact heart failure was not the group’s remit. Therefore Robert would contact Alastair Ramsay, Chairman of the CHD Public Involvement Group to see if it would be more appropriate for Alastair to take the concerns forward to the CHD MCN Project Board.

Cardiac Rehabilitation – matters raised by Robert at the Project Board are detailed below under main agenda items.

5. Sub Group Membership

To review membership at a later date. 6. Phase I

(a) Pre-operative Education Classes

Brenda reported that very good progress was being made towards commencement of these classes, although no start date was identified as yet.

3 Item Actions (b) Patient Discharge Letters Update

To note that Robert had raised this issue at the Project Board meeting in February. To note from the last minutes, Vince Shields was going to look into the matter. However, Vince had requested Robert to identify a particular patient where there had been a problem of delay in the GP receiving their hospital discharge letter and Vince would work through the problem and report back to Robert.

After some discussion regarding this matter the group did not feel that this was the way forward in trying to resolve this issue. It was suggested that a hospital patient audit for all MI patients over a 3 week period needed to be carried out – to include all patients not in the Coronary Care Unit.

Action: Following discussion it was agreed that the group invite Vince along to the next meeting for a more in-depth discussion around resolving this matter. RP/KS/CG It was also agreed that Karen would carry out a survey at her own GP Practice to look at the discharge letters received – When was the patient admitted to hospital?/ Date Discharged from hospital?/ Date discharge letter was received at GP Practice. Karen would email the information to Christine for Robert to take to the next Project Board meeting on 19 April 07.

(c) ISD Courses for Primary Care Staff

To note that courses were being run which were not cardiac rehabilitation specific but they highlighted the need for 30 minutes exercise per day. Joan was concerned that staff were not qualified in cardiac rehabilitation after having attended the ISD Course.

Action: Joan would draw up her concerns and submit to Robert to take forward to JT/RP the next MCN Project Board meeting. 7. Phase II

Increasing workload of community nursing staff and it’s effect on Phase II patients

Robert had raised this matter at the Project Board in February. There was still disparity and gaps in the service provision. Patients from Portlethen and Stonehaven still did not have a home visit from community nursing staff. RP It was noted that Roberta Eunson was trying to resolve this matter but it was unclear what progress was being made to date. It was, therefore, agreed that Robert would again raise the matter at the next Project Board meeting. 8. Phase III

(a) Classes - To note that all classes were running smoothly. Banff remained slightly quieter but all classes were full at present.

(b) Financial Situation Update - Brenda had been assured that there would be recurring funding available to continue the Service but to date she had no budget figures.

4 Item Actions 9. Phase IV

(a) Annual Cardiac Check with GP Surgery

Robert had brought the matter to the last MCN Project Board meeting that Grampian Cardiac Rehabilitation Association (GCRA) had recently undertaken an evaluation and it came to light that 11%-20% of members were not being recalled by GPs either 6 months or annually for a CHD check-up. This matter was being investigated by GCRA.

Robert felt that on hindsight GCRA should have asked the question on GP recall much more specifically so that a more accurate account of the numbers not being recalled on an annual recurring basis should be identified. GCRA will do this at the next evaluation audit in the early summer.

(b) Big Lottery Funding

GCRA had approached the Big Lottery and they had agreed that GCRA could make a second application for funding. The application would be for funding for an expansion of the service to all parts of Grampian including Moray.

(c) Training

Robert reported that GCRA would run another training programme to recruit 12 RP more new BACR instructors. There was the inevitable fall off of current trainers due to leaving the area etc. 10. AOCB

(a) Financial Negotiations for exercise class sites – to note that Brenda was currently dealing with this matter.

(b) Cheshire Trip – to note there would be Instructors from GCRA attending this event.

(c) Future of the Cardiac Rehabilitation Sub Group – Robert felt that there was definitely a role for this group at present. It acted as a “monitoring” group. It was agreed that Robert would take any concerns raised at the group meetings in a written format to future MCN Project Board meetings.

(d) Audit of Phase IV for Clinical Governance- After a detailed discussion it was agreed that either Brenda or one of her colleagues would attend any Phase IV class where concerns had been raised over safety issues etc. and make a discrete informal check. Robert agreed that it would be fine with GCRA. This would satisfy NHS Grampian that they could confidently refer to Phase IV classes. 11. Date of Next Meeting

The next meeting would be held on Wednesday 6th June 07 at 2pm in NHS CG Grampian Summerfield House, Meeting Room 2. (venue booked along with teas)