Action Notes of the Network Joint Clinical Forum Board Meeting Held on 11Th December 2013 from 5.30 –7.15 Pm at the Royal Overseas League (Wrench Room)
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North West London Critical Care Network Confirmed notes for JCFB meeting 6 March 2014 North West London Critical Care Network Network Joint Clinical Forum Board Action notes of the Network Joint Clinical Forum Board meeting held on 11th December 2013 from 5.30 –7.15 pm at the Royal Overseas League (Wrench Room) Action Note Present Jeremy Cordingley (Chair) RBH - Royal Brompton and Harefield Hospitals NHS Foundation Trust Jonathan Handy Chelsea and Westminster NHS Foundation Trust Eve Corner Chelsea and Westminster NHS Foundation Trust Andrea Blay Chelsea and Westminster NHS Foundation Trust John Vogel Ealing Hospital NHS Trust Sohan Bissoonauth Hillingdon Hospital NHS Foundation Trust Ruth Griffin Hillingdon Hospital NHS Foundation Trust Wendy Willingham Hillingdon Hospital NHS Foundation Trust Debs Adley Hillingdon Hospital NHS Foundation Trust Nigel West Hillingdon Hospital NHS Foundation Trust Dr Mo Ali Inner NWL Integrated Care Pilot Roseanne Meacher Imperial College Healthcare Trust – Charing Cross site Steve Brett Imperial College Healthcare Trust – Hammersmith Hospital site Liz Staveacre North West London Hospitals Trust – Northwick Park Hospital site Linsey Christie Trainee - Royal Brompton and Harefield Hospitals NHS Foundation Trust Andy Dimech The Royal Marsden NHS Foundation NHS Trust Catherine Forsythe The Royal Marsden NHS Foundation NHS Trust Tessa Longney West Middlesex University Hospital NHS Trust Veronica Marsh Trainee – The Lister Hospital Angela Walsh Critical Care Network Gezz Van Zwanenberg Critical Care Network Apologies for absence Ganesh Suntharalingam – NWLHT NPH, Tim Wigmore – RMH, Rohit Juneja – RMH, Jacek Borkowski – CMH, Doris Doberenz –ICHT CXH, Elaine Manderson –C&W Heather Spurgeon – RMH, Chris Woollard-THH, Anthony Bastin – RBHT, , Katie Scales- ICHT CXH, Julie Oxton - ICHT St M, Fionna Moore LAS, Gary Wares – RMH, Barbara Thomas – WMUH, Craig Brown – RBHT, Joan Milton – NWLHT NPH, Barbara Walczynska – WMUH, 1. Welcome Who When Jeremy Cordingley welcomed all members to the Network’s Joint Clinical Forum Board. Apologies for absence were noted (See above). Jeremy also welcomed Dr Mo Ali, a GP from primary care in North West London who was joining the meeting as joint lead for the Network’s work programme on rehabilitation after critical care. 2. Agree the notes of the last meeting held on 25th September 2013 Who When th The notes of the Network Joint Clinical Forum Board meeting held on 25 September 2013 were agreed. 3. Matters arising not on the agenda Who When There were no matters arising that were not included as substantive items on the agenda 4. Update from each site/member Who When General/ patient pathways/winter issues Charing Cross – working at capacity at the moment Chelwest – staffing remained difficult with the added complication of refurbishment of the Burns unit. JMH reported that he was looking to re-instigate the TCCDG and was liaising across all acute specialities to determine membership. AW agreed to send out the Network guidance on TCCDG and would be available to support JMH with set up if required Hillingdon – RG reported that capacity discussions were on-going. Executive membership of the Page 1 of 5 North West London Critical Care Network Confirmed notes for JCFB meeting 6 March 2014 local TCCDG was again in place. Ealing – JV reported that the unit was often over capacity – there had been some recent discharge delays. Daily meetings about beds had started to happen and the effect of these on delayed discharges from ICU was being monitored. Royal Marsden– remains busy – Some movement of nursing seniors to support outreach (maternity cover). Variable agency rates and whether other units were finding it harder to fill agency shifts was raised. Royal Brompton – busy with lots of transfers. ECMO is running at approx. 1 patient admission per week. Recently the units had 2 children and 3 adults at same time which had started to affect supplies –now resolved. West Middlesex – nothing extraordinary to report, busy but steady. Grateful to network for support in making appointments Actions AW Dec 1. AW to send JMH Network TCCDG guidance 2013 2. Vacancy rates to be tabulated and sent to all Nurse leads for sense check once received. All units to GVZ March provide a return to Gezz. 2014 5. NICE CG 83 Rehabilitation after Critical illness Steve Brett and Mo Ali (GP) Who When 5.1 Network wide survey The Network wide summary survey of provision on communication with primary care, patient engagement and provision of rehabilitation had been circulated to all members for the second time. The likely standards for provision of rehabilitation after critical illness expected in the standards due in 2014-15 w. (National Critical Care Service Specification, London Standards, ICS and FICM standards) were discussed. It is anticipated that these metrics will be reflected in the commissioning intentions and built into Trust contracting discussions April 2014 onwards. It was agreed that all unit leads would use the Network wide summary to support work by the respective Trust CCDGs locally. 5.2 Digital work-up SB, AW,MA GVZ had met with the Network’s digital partner to discuss mini film outlines to support patient rehabilitation after critical illness. These will aim to bridge the flow of education, information and understanding between hospital and community /primary care teams. Work was on-going to develop understanding of the ICP and how we might support education and video material. Filming is planned for 2014 with some content to be filmed at a hospital ICU and some in the community and primary care setting . 5.3 Admission and discharge to and from critical care - notifications to GPs The progress on ensuring GPs were informed that a patient has been admitted or discharged from critical care was discussed. The aim being to ensure the critical care patient’s GP was well informed with advance notification. This would help support primary care needs where there were impacts on patient family – e.g. partners and or young children. Also to flag up that their patient was likely to be coming out of hospital in the future and would have follow up and review needs. MA confirmed that, currently, faxing information to GP surgeries in NWL was the best and most efficient method. Using NHS mail, it was possible to email to a fax number. Each ICU would need to engage their IT department about NHSnet requirements to use attachments generated on local IT such as admission or discharge summaries. RM had been working on this locally. MA reported that, as a GP, he was unable to see emails sent via acubase, hence the need for Fax. There was discussion about being consistent in labelling the fax notification sent to GPs such as Critical Care – Admission to ICU and Critical Care Survivor – Discharge from ICU MA agreed to research and supply fax numbers for all surgeries and GPs in NWL. Units would then be able to test clinical information flow with primary care colleagues locally. 5.4 Care planning in primary care for critical care survivors - design of GP clinical template in NWL Dr Mo Ali provided an introduction to primary care provision, background and some challenges for NWL 412 GP practices in NWL Page 2 of 5 North West London Critical Care Network Confirmed notes for JCFB meeting 6 March 2014 1800 GPs , each GP usually dealing with minimum of 3 trusts ICP for NWL – aims to get rid of complexity across social and health divide Post discharge medication ( need for a repeat Prescription )is the most frequent contact and often first contact for GP after discharge Scope of MDG meetings - 50,000 patients supported locally via the MDGs across west London (local and specialist) selection process used for entering this type of care planning need to determine process for critical care survivors with aim being to tap into MDGs and ICP infrastructure Ministerial approval had been given to the configuration programme SaHF. Building up programmes in primary care had already started and CC survivors to be included in this work MA outlined the current GP care planning pathway leading to the patient taking hand held records away with them. Also being built into 111 and “coordinate my care”. Opportunity to build in critical care survivors into existing plans over the next 2 /3 years MA would provide an existing template outline which the Network Rehab group will then look to amend/populate to form the core of the ICP care plan requirements for critical care survivors SB thanked MA for his presentation Discussion points raised by members Timescale: April 2014 onwards – need to have pilot of CC survivors in the ICP system Would need to select the pilot cohort of patient. How do we do this? How many? Could 3 days ventilated in ICU be a proxy? What volume of patients would this trigger? Modelling – risk with 3 day LOS – half of RBHT patients would fit criteria for example Setting goals – patient centric – what goals – top 5% of the high risk groups, ? 10,000 patients in that group? Patients in the ICP pathways already? Can we cross match existing data to find post critical care patients? Most discharged patients, discharged to own home not requiring complex on-going chronic disease management. Patients preferred seeing local primary care services and linked to GP( patient feedback data) . SB: Some patients picked up with specific CC issues such as sub glottis stenosis/contractures and get a rapid referral back into hospital. This could be better supported by education and management out in primary care with support from secondary care clinicians and shared learning through the MDGs NW raised IT systems as Hillingdon had good communication with GPs via email systems. These varied across the sector. Clinicians noted the “virtual” ward concept for cohorting patients. MA confirmed that IT systems in primary care were not yet robust across acute/primary care boundaries ; the most robust communication was via FAX UCC centres already contact GPs via secure fax on NHS net.