Minute of Meeting of GANMAC Held On

APPROVED

NHS GRAMPIAN

Minute of Meeting of GANMAC held on Tuesday 12 January 2010 at 9.00 am in the Seminar Room, Summerfield House, Aberdeen

PRESENT Ms Fiona MacKenzie, Head of Nursing – Acute Services Mr Sean Coady, Acting Lead System Manager – Moray CH&SCP Mrs Linda Harper, Associate Director of Practice Nursing/Lead Nurse G-Med Mrs Sheila Irvine, Professional Development Educator (on behalf of Jane Ormerod) Ms Mary Mcauley, Head of Nursing (Paediatrics, Children & Young Adults) Ms Julie McNutt, Service Manager – Aberdeen City CHP Mrs Linda Oldroyd, Nurse Consultant Patient Safety and Experience

ATTENDING Mrs Rosie Gauld, Administrator to the Professional Advisory Committees

Item Issue Action No

1 Apologies

Apologies were intimated on behalf of June Brown, Shona Nairn and Jane Ormerod

2 Note of Meeting held on 10 November 2009

One amendment was noted. Under “Clinical Governance” – CQI, Jane McEwing should read Jane Ewen. The Note of Meeting was then approved as a correct record.

3 Matters Arising

3.1 NMC

It was noted that any referrals to the NMC should be notified to the Director of Nursing so that she was aware of what was Next going on. This would be discussed at the next meeting as Mrs Agenda/ Squires was unable to be present at this meeting. ESq

3.2 Non-Medical Prescribing

Linda Harper reported that she was to be giving a presentation at the Nursing & Midwifery Strategy meeting on Friday.

There were issues around nurse prescribing and there was a need to define the training required and what medications they would be asked to prescribe. Medical support nurses and cardiac nurses are prescribing but the pharmacist checks that it is correct. However, the person who writes it up and signs it has prescribed for the patient.

Mr Coady felt that non-medical prescribers were mainly within the community and were specialist nurses, ie early discharge support nurses, there were not so many in Acute. Proposals have been received from the GPs with regard to Health Visitors and what they are prescribing and a request for them to look at minor illness. However, this would involve a big piece of work. Currently Health Visitors are asking GPs to prescribe instead of prescribing it themselves. A number of Practice Nurses have completed the training.

It was noted that there were currently 35 pharmacists trained to prescribe, 100+ nursing staff, and Optometrists could undertake a Course at Caledonian University, Glasgow

Mrs Harper stated that Health Boards should have some form of CPD or peer group support for their staff and a web page had been arranged for CPD. The Acute Sector had had one meeting in December and a further meeting had been requested and arranged for February. Legal issues arise at the meetings and the Legal Adviser had been asked to do a session at the Peer Group in February to the Acute Sector.

A Conference had been organised for 21 April 2010 in conjunction with RGU. A speaker had still to be arranged as the original personal had cancelled due to other commitments. LH Mrs Harper to contact Sally Lawton for contacts.

Ms McKenzie would ascertain from nurse managers in the Acute Sector what was required. Finding that the junior FMcK doctors are less able to prescribe. In relation to the HAI agenda there is an expectation that the Senior Charge Nurse will have a role in monitoring the prescribing of specific drugs..

Mrs Harper would let Rosie have a copy of her presentation to LH/RG forward to GANMAC members.

Linda Oldroyd suggested that Jennie Ross, Medication Safety officer should be involved as there was no inter-professional learning. Medical staff had no expertise being developed within prescribing.

In relation to incidents many were related to prescribing where medical staff were involved and often the errors were compounded by nurses administering incorrect prescriptions.

2 There was a need to ensure that safe ways of working were put in place.

Jane Ormerod looking at escalation in terms of late responses and serious complaints in relation to medication safety incidents.

Mr Coady drew attention to Item 6.3 of the OMT Minute of Meeting held on 28 October 2009 regarding the “high” risk of medication incidents. It was noted that a report, with solutions and a way forward would be taken forward by Ms Jennie Ross, Medication Safety Officer, with Andrew Fowlie. It was suggested that Ms Ross be invited either to GANMAC or the Senior Nurse Group.

It was suggested that the issue of medical staff should be raised at the Education and Training Committee, recognising in a lot of areas that nurses take responsibility for prescribing. The policy allowed for one to administer a medication. Mrs Harper would circulate a paper about checking LH medications to GANMAC. It was noted that there were no audits undertaken around medics prescribing v nurses prescribing but Stirling University had issued a report on prescribing, published in October last year.

3.3 HAI

The Chair reported that following the Report on Leading Better Care issued last October, Eleanor Murray, Unit Nurse Manager had taken up the work of HAI in the Acute Sector and was carrying out environmental audits. The Action Plan and model of working with the Senior Charge Nurses in relation to this would be replicated by General Managers in other areas. Jane Ormerod looking at the portfolio of evidence gathered by the Charge Nurses.

Environmental audits were showing that the kitchens were areas of concern. Ms McKenzie had met with Pamela Harrison because infection control was not fully integrated and there was a need to be more involved. A database had been set up showing how audits were improving. Un unannounced visit by the HIE was expected.

The Director of Nursing had received funding to support Charge Nurses to focus on the HAI aspect of their role and each sector would have funding for someone two days per week.. Mr Coady felt there would be benefit from having these people and was looking at Senior Nurses to do a piece of work and give the role some credibility as there were strong candidates who would be keen to take up the two days a week

3 work.

It was noted that, based on the Action Plan, Eleanor Murray would be seconded from the Acute Sector to other areas to provide guidance and support.

The Chair reported that the funding for NHS Grampian was in the region of £79k. 10% of that is removed by finance to cover on costs. A band 7 was deemed as an appropriate grade to undertake this role.

Mrs Oldroyd intimated that there was a move to develop a Nurse Consultant post in Infection Control.

Need to review the number of Nurse Consultants there were FMcK within NHS Grampian overall as opposed to Nurse Managers Ms MacKenzie would speak to Pamela Harrison re Infection control nurse consultant.

Mr Coady drew attention to the Infection Prevention and Control Policy and stated that there was no focus on what medical staff should be doing.. It was noted that the document was to be signed off the following day, therefore Mr Coady would send comments to the General Manager – Moray CH&SP suggesting that it required to be more robust more SC specific.

4 GANMAC Constitution

4.1 Attendance Management 4.2 Person Specification

Due to time constraints, it was agreed to set up a short life working group to take this further. Mary Mcauley agreed to lead the group which would include Linda Oldroyd, Jane Ormerod and June Brown or Jenny McNicol. The group would MM report back at the next meeting.

5 Corporate Governance

5.1 Staff Governance

5.1.1 Project Initiation Document – Defining a Safe, Affordable Nursing Establishment for NHS Grampian (SANE)

Copies of the document had been circulated previously with the agenda.

The Chair had written to Mr Alan Gall, Project Director

4 acknowledging the necessity for such a project given the current financial constraints within the health service and the requirement to work within funding allocations, and was a positive way forward. She also stressed the role of GANMAC which was to give objective and critical opinion from the nursing, midwifery and health visiting professions within NHS Grampian and looked forward to receiving the report prior to its wider distribution.

General discussion took place and it was noted that paediatrics was not included and there was no GANTT chart on what was to be achieved. The list of key stakeholders was noted and although the GAPF and ACF were not decision-making groups they would be involved in an advisory capacity. It was noted that the patient was missing from the list of stakeholders and there had to be some commitment to the public that each redesign project would include a member of the public. The Chair would speak to Amanda Croft, FMcK Assistant General Manager and Project Manager.

5.2 Clinical Governance

5.2.1 Care Quality, Governance & Professional Practice for NHS Scotland

Copies of the document had been circulated previously with the agenda. The paper highlighted issues that required to be integrated, and these were ongoing.

Regarding the patient experience programme, wards were being utilised as part of the patient safety roll out.

Mrs Oldroyd advised that there were lots of options available around collecting and using patient experience but guidance was required. Within PDPs and Senior Charge Nurse roles there was a commitment to carry out some patient experience work. A Toolkit was being developed and was almost complete. There was also the Better Together In-Patient Experience tool available on the website to be used. It had to be ensure that there was a link with Jane Ormerod who was undertaking work on enhancing the patient experience.

Any comments on the paper should be sent to the Chair who would forward them to the Director of Nursing as requested. FMcK

As Head of Nursing, Ms McKenzie would be taking a lead role in this and the issues around Releasing Time

5 to Care. There were concerns by the Senior Charge Nurses (previously Ward Managers) about the amount of work to be undertaken and issues over responsibility. It was not an option within the Acute Sector – it had to be done.

PricewaterhouseCoopers had directed a review of Band 8s and above within NHS Grampian and there was a need look at the issues around Releasing Time to Care and the nursing structures. It was stated that Nursing had to take a lead on this.

5.3 ACF Letter to the Board

Ms MacKenzie reported that the last letter had been submitted to the Board with reservations from herself and Elizabeth Squires. The letter contained reference to a complaint by the Consultants about the nursing documentation. However, no approach had been made to Ms MacKenzie or any other senior member of nursing staff prior to this and, therefore, she was unaware of any issue that had arisen.

It was suggested that an item about SANE should be included FMcK in the next letter.

5.4 Area Reports

. Linda Oldroyd reported that a Press Release had gone out about the In-Patient Survey, advertising around the patient stories aspect. The contact details of the person and any identifying data was removed from the letters and it was difficult not being able to contact the person who had uploaded the story. Any story about delays; diagnosis; appointments were welcomed. Linda Oldroyd and Helen Robbins were looking at ways of managing the stories and devising a chart to sort them out. Comments had been sought by Karen Barry about the current system and there was an ability to feed back to Ms Barry on the Better Together website.

. Julie McNutt reported that the General Manager – Aberdeen City CHP was keen to change ways of working within the nurse management team and a workforce redesign had been ongoing for some time. Work would continue throughout the year. Community Nursing Teams would be changing, for example.

. Sean Coady asked whether GPs had been requesting to form a federation as in the Highlands and which Elgin was looking into. No-one was aware of any request for this.

6 . Linda Harper stated that she would be attending the Health in Support Committee meeting to discuss out of hours care in rural settings on Tuesday 19 January 2010.

. Mary Mcauley intimated that:-  this was the last year of funding for the National Delivery Plan for Children.  The AHP and nursing bids had been agreed to develop the role in children’s speciality;  Expanding nursing and medical provision for HDU care  Raeden under redesign and Gail Thomson to Chair a group on the future Complex Needs redesign;  Emergency Care Framework – had a presentation from NES – put some recommendations to SPENS – no additional funding. No final decision on how it was going to be continued throughout Scotland.

6 NHS Grampian Board

Nil to report.

7 Other Competent Business

8 Items for Noting

Approved Minutes:

8.1 OMT – 27 May; 25 June; 26 August and 28 October 2009

8.2 ACF – 1 July and 30 September 2009

Copies of the above Minutes had been circulated previously with the agenda.

9 Date of Next Meeting

Tuesday 9 March 2010 in the Seminar Room, Summerfield House.