London Cardiac & Vascular Strategic Clinical Leadership Group (SCLG) Minutes. 31 March 2015

Transcription

1 London Cardiac & Vascular Strategic Clinical Leadership Group (SCLG) Minutes 31 March 2015 Item 1. Welcome, introductions, apologies In attendance Huon Gray National Clinical Director for Cardiac Care for NHS England, Chair Jenna Evans Senior Project Manager, NHS England (London region) Jay Nairn Project Manager, NHS England (London region) Paul Trevatt - Lead, CVD Strategic Clinical Network Olaf Wendler Cardiac Surgeon Philip MacCarthy Cardiologist Nick Bunce Cardiologist Obi Agu Vascular Surgeon Iqbal Malik Cardiologist Simon Woldman Cardiologist (Heart Failure) Sue Woollard - Specialised Commissioning Anton Psaila British Heart Foundation Stuart Rowe Specialised Commissioner, NHS England (London region) Mark Whitbread London Ambulance Service Sue Sawyer Specialised Commissioner Jillian Riley Consultant Nurse Sotiris Antoniou - Pharmacist Michael Cooklin - Cardiologist Apologies Andrew Archbold Cardiologist Helen Williams Pharmacist Michaela Nuttall CVD Coordinator Nicola Jones General Practitioner Andrew Leatherland British Heart Foundation Lucy Grothier Associate Director Paul Baskerville Vascular Surgeon Andrew Chukwuemeka Cardiac Surgeon Jane Fryer- Medical Director, NHS South-East London 2. Minutes of last meeting and matters arising The minutes were agreed as an accurate reflection of discussions. Guidance for Kawasaki Disease (KD) has been drafted and expert and patient feedback has been received. The guidance suggests that one hospital in London should provide principle KD care. This site would need to have a Heart Attack Centre (HAC) and paediatric cardiology co-located. KD patients will need to a have a Patient Specific Protocol (PSP) with the London Ambulance Service (LAS). Once the KD guidance is published, then engagement will begin with cardiac centres in London. The group discussed continued involvement of the LAS with the SCLG. Mark Whitbread is happy to discuss the LAS out of Hospital cardiac Arrest report at a future meeting. He suggested that communication from Huon Gray to the Medical Director and head of 1

2 Communications at LAS would be beneficial. Action Huon Gray to write to LAS Medical Director and Head of Communication to ensure close working between the two organisations. Paul Trevatt updated the SCLG on the CVIN masterclass taking place in London in April. There is currently 90 people registered for the event and SCLG members are encouraged to register and attend. 3 Specialised Commissioning Sue Sawyer provided an update on Specialised Commissioning arrangements. All Trusts have been required to decide on what tariff arrangement they will continue on for 2014/15. Many Trusts has chosen to continue on current tariff arrangements which will result in no additional CQUIN money. A new cardiac surgery specification is being developed. This will consider work developed on mitral valve by the London Cardiac Surgery Advisory Group. Action Sue Sawyer to circulate new cardiac Surgery service specification. The Congenital Heart Services review is currently underway. NHS England is undertaking a peer review for heart transplants and non-transplant centres doing ventricular devices. The vascular services reconfiguration is ongoing with South East London currently being the focus for commissioners. Barts Heart Centre has opened and has received its first patients. The Heart Hospital will close in May Other areas of the UK are looking at the suitability for co-location of cancer and cardiac surgeries. Renal dialysis and complex obesity commissioning is moving to CCGs. Sue Sawyer presented 18 week cardiac surgery waiting data. The SCLG discussed the use of extra funding and suggested that funding should be provided earlier and be used to develop new facilities rather than to send patients to private facilities. Sue Sawyer noted that although NHS England commissions the service, additional funding to reduce 18 week waiting times had been provided to CCGs to use. Action Sue Sawyer to circulate 18 week data to members of the SCLG. 4 Clinical Commissioning Group Update Nicola Jones provided an update to Huon Gray which was read out at the meeting. The end of financial year was a busy time for CCVGs with many of them working with Trusts to determine new tariff arrangements. A lot of effort was being invested into performance management of Trusts and community services. Arrangements for commissioning of primary care by CCGs had commenced with some CCGs taking complete delegation of primary care commissioning. Most CCGs intend to take full responsibility for commissioning within 2 years. The London CCGs have agreed on funding and priorities for the Better Health for London work that arose of out Boris Johnson s London Health Commission. One component will be strategic commissioning frameworks for primary care. 5 Acute Coronary Syndrome Phil MacCarthy provided an update on the work of the ACS advisory group. The ACS group had agreed to include all PCI centres within its membership. The Brompton and Northwick Park had attended the last meeting. A prerequisite for joining the group is providing data. The next meeting is on 1 May 2015 and will discuss N-STEMI data and false activation rates. 2

3 The group also intend to look at protocols and clinical thresholds for left branch bundles and pathways of care within hospitals. Nick Bunce noted that the data needs to illustrate what the outcomes and issues are for HACs. Sue Sawyer highlighted the QIPP being developed to reduce length of stay in critical care. Simon Woldman suggested that patients with left bundle branch block are very sick, and that LAS coronary and electrophysiology pathways were bringing additional patients to centres that had no beds available. Iqbal Malik discussed the work to produce data on out of hospital cardiac arrests. LAS does not hold patient identifiable data once a patients care has been transferred. There is currently about 1000 patients who have had an out of hospital cardiac arrest that the group is looking for linked data for. Gavin Perkins at Warwick University has a large database of information on out of hospital cardiac arrests and Iqbal Malik is hoping that this should provide sufficient information. Huon Gray thanks both Iqbal Malik and Phil MacCarthy. He also noted that NHS England is looking to develop dashboards, called service level markers, for some conditions and procedures. Heart attack and acute coronary syndromes will be one of these dashboards. 6 Arrhythmia Michael Cooklin provided an update on the Arrhythmia Advisory Group. The advisory group had agreed that syncope would be a focus going forward. If NICE Guidance for syncope was being followed there would be savings realised and an improvement in patient care. The group are looking to develop a syncope patient pathway. The advisory group is also developing a pan-london Inherited Cardiac Conditions (ICC) pathway. Tariff arrangements for ICC are still not clarified, with some centres using their own funding and services to pay for genetic testing. Huon Gray suggested that ICC be included as standard in the 100,000 genomes project. Action - Sue Sawyer to find out if Inherited cardiac conditions are included in the 100,000 genomes project. 7 Vascular Michael Cooklin discussed a paper submitted to the SCLG. The paper is seeking endorsement of a project to establish centres in London capable of 24/7 pacing for patients with complete heart block. The project should help to provide more equitable care. Huon Gray sought confirmation that the advisory group would define quality standards for the process. He also suggested that the clinical visit suggested in the paper to validate results may be impractical with available resources. Michael Cooklin suggested that clinical visits would provide additional benefits that a selfassessment against clinical standards would not provide. He suggested that there would be less than 10 centres likely to be assessed against the standards. Phil MacCarthy noted that it could result in de-skilling of centres not endorsed as a pacing centre. Mark Whitbread highlighted that centres would need to provide 24/7 care and would not be able to close the service on weekends or at nights. Phil MacCarthy noted that the process will result in additional patients being transferred to specialist centres, however there is no acknowledgment of this process with additional funding. Stuart Rowe agreed and highlighted that there is a perverse incentive for centres to take these patients as it can result in the Trust losing money. The SCLG agreed that the project should proceed and endorsed the project. They noted that the process would not result in designation of centres, it would only be able to advise that centres could provide pacing 24/7. Obi Agu provided an update on the Vascular Advisory Group. Obi Agu presented a paper on a project to implement patient specific protocols for patients (PSP) with abdominal aortic aneurysms (AAA). 3

4 Elective AAA procedures have a mortality rate of 2-3%, while emergency procedures for ruptured AA have a mortality rate of 80%. Non-arterial centres have no vascular support. The project proposes that vascular consultants complete a PSP which is held by the patient, the consultant and is also sent to LAS. Data on exact numbers of patients affected by the project is hard to determine. Estimates have used data from HES and the London AAA Screening Programme. Huon Gray would like to see further information on the impact to patients included in the paper. Sue Sawyer agreed and though more reassurance around numbers involved in the project and impact on Trusts was needed. Action Jay Nairn and Obi Agu to include further information on impact of project to patients and Trusts and be specific about reimbursement for Trusts. The SCLG agreed the project was worthwhile to patients but wanted further clarification on why clinical threshold was 4cm instead of 5cm. Obi Agu noted that 4cm would ensure that no patients are missed due to time between screening of AAA and the demographics in London. Action Jay Nairn and Obi Agu to include explanatory text on 4cm clinical threshold for project in proposal. 8 Heart Failure The SCLG agreed that next steps for the project should be to include the areas discussed in the proposal and then write to Chief Executives of vascular centres to gain their agreement for the project. Jillian Riley and Simon Woldman provided an update on the work of the Heart Failure Advisory Group. The first meeting of the advisory group had been a round table discussion to prioritise issues in London. The advisory group is looking to extend membership to nursing, allied health, GPs and commissioners. Two key issues and priorities have been identified: o Accessing regular data from the National Heart Failure Audit to be used by Trusts for quality improvement processes. This process will also help to engage Trusts to enter data accurately. This project should be underway by April o Understanding service provision across London. Jillian Riley shared service maps produced by the advisory group. The advisory group intend to add further information on primary care, admission and outcomes. Simon Woldman noted that prevalence data is out of date and that more work needs to be done with CCGs to understand screening and data collection. The advisory group would like to turn these maps into a report on heart failure services in London which would highlight variation. The data would be of a set period in time. Information from Public Health England would also be needed. Staffing and resourcing of services would also be included. Huon Gray thanked Jillian Riley and Simon Woldman for their work and agreed that the service provision maps should be published through the SCLG. Jillian Riley also highlighted other areas of work the advisory group is undertaking including looking at care bundles and developing research projects. Anton Psaila provided an update on the British Heart Foundation s IV Diuretics in the Community project. A two year project to provide diuretics for heart failure patients. Heart failure patients currently cost 2% of the NHS budget with an average hospital stay of 13 days. The project saw monetary savings made and a saving of 140 patient bed days. The evaluation and report of the pilot has now been published is available on the BHF 4

5 website. 9. Cardiac Surgery Olaf Wendler provided an update on the Cardiac Surgery Advisory Group. The advisory group is looking to better understand why RTT for cardiac surgery is so high. A survey of facilities and cardiac surgery services in London has been undertaken. The advisory group is now going to overlay RTT data and activity data over the results. The advisory group has developed local guidance on mitral valve surgery provision and training. The advisory group had endorsed this guidance. The advisory group is also looking at aortic dissection and is asking cardiac surgery centres in London for data on aortic dissection procedures. Olaf Wendler highlighted that focusing on RTT will be a focus of the group for the future. Huon Gray suggested that the group produce a document outlining factors which are contributing to increases in surgery waiting times to help the national CRG. Action Olaf Wendler to have the Cardiac Surgery Advisory Group develop document outlining factors contributing to increased waiting times for surgery. 10 Pharmacy update Sotiris Antoniou provided an update on ways that specialist pharmacists have been engaging with CCGs. Previously the London Cardiac and Stroke Networks offered a structure to engage with PCTs and CCGs. The networks included reference groups where consensus statements for prescribing were developed. The network medicines management groups were then able to ratify guidelines and statements. Joint prescribing committees then implemented guidelines. Often guidelines and statements were discussed at presented at CCG and PCT protected learning time for GPs. Sotiris Antoniou suggested that he bring prescribing data from the London Procurement group database on prescribing trends to the next SCLG. Iqbal Malik suggested that data and information on anti-coagulation would be helpful. Huon Gray supported this and noted that any data specific to a condition would be helpful. Action Sotiris Antoniou to provide report with prescribing data to the SCLG for next meeting. 11 Familial Hypercholesterolemia 12. AOB Jay Nairn provided an update on the Familial Hypercholesterolemia (FH) task and finish group. The group s initial priorities were to undertake more research into funding and tariff arrangements for FH services. The group agreed three options to investigate: o undertaking a pilot to search general practice databases for FH patients; o developing guidelines for CCGs and practices; and o undertaking an awareness campaign. Representatives from the two FH services funded by BHF in London have been invited to the next meeting. Huon Gray thanked the group and suggested that there is already much material available and duplication was not needed. He suggested a short document for GPs would be welcome. The British Heart Foundation has a new round of funding for FH services and 40-50% of the country will now have access to a FH service. Huon Gray would like to see London lead on developing further services. A new shared care pro-forma for commissioning of services is now available. Anton Psaila noted that British Heart Foundation has released updated statistics on cardiac disease in UK. 5

6 Iqbal Malik highlighted that the review of the congenital cardiac services finished in December 2014, however a response is not expected until after the election. Action Log Number Action Responsible 1 Write to LAS Medical Director and Head of Communication Huon Gray to ensure close working between the two organisations. 2 Circulate new cardiac surgery service specification. Sue Sawyer 3 Circulate 18 week data to members of the SCLG. Sue Sawyer 4 Find out if Inherited Cardiac Conditions are included in the Sue Sawyer 100,000 genomes project. 5 Include further information on impact of AAA PSP project to Jay Nairn and Obi Agu patients and Trusts in proposal and be specific about reimbursement for Trusts. 6 Include in AAA PSP proposal explanatory text on 4cm Jay Nairn and Obi Agu clinical threshold for project. 7 The Cardiac Surgery Advisory Group to develop document Olaf Wendler outlining factors contributing to increased waiting times for surgery. 8 Provide report with prescribing data to the SCLG for next meeting. Sotiris Antoniou Next meeting: 7 th July