National Chronic Pain Improvement Group (NCPIG)

Transcription

1 National Chronic Pain Improvement Group (NCPIG) Minutes of the National Chronic Pain Improvement Group (NCPIG) Meeting Held on Friday 6 th March 2015 at 10.30am At the Beardmore Hotel and Conference Centre, Glasgow Present: Dr Mary Harper, Chair NCPIG Ms Susan Archibald, Patient Representative Mr Adam Briggs, Policy Manager, Scottish Government Mr Paul Cameron, National Coordinator NCPIG Dr Aileen Clyde, NHS Ayrshire & Arran Ms Sonia Cottom, Director, Pain Association Scotland Ms Linda Frydrychova, NHS Forth Valley (via Video Conferencing) Dr Stephen Gilbert, NHS Fife (Chair, Learning and Development Subgroup) Dr Margaret Macleod, NHS Western Isles (via Video Conferencing) Dr John Muthiah, NHS D&G (via Video Conferencing) Dr Ravi Nagaraja, NHS Grampian (via Video Conferencing) Mrs Elizabeth Porterfield, Head, Strategy and Planning Team, Scottish Government Dr Colin Rae, NHS GG&C Ms Judith Rafferty, NHS Tayside Dr Mary Rose, NHS Lothian (Chair, Children s Services Subgroup) Ms Hazel Smith, NHS Highland Ms Heather Wallace, Chair of Board of Trustees, Pain Concern Mr John Wilson, Policy Officer, Scottish Government Apologies: Mr Ian Semmons, Action on Pain (Audio Conferencing failure) Dr Shona Smith, NHS Borders (Video Conferencing failure) Prof Blair Smith, National Lead Clinician NCPIG (Chair, Research Subgroup) Dr Lesley Colvin, NHS Lothian (Acting Chair, Research Subgroup) Ms Etive Currie, Patient Representative Dr Michael Fascia, NHS Lothian Ms Heather Harrison, NHS GG&C (Chair, Primary Care Subgroup) Mr Neil Hay, Patient Representative Ms Rachael Heaney, Patient Representative Mr Sabu James, NHS Lanarkshire Ms Lesley Platford, NHS Orkney Ms Frances Proctor, NHS Fife Ms Linda Sparks, NHS GG&C (Chair, Website Subgroup) Ms Norma Turvill, NHS Forth Valley (Chair, Self-Management Subgroup)

2 1. Welcome and Introductions / Apologies The Chair, Mary Harper, welcomed everyone to the meeting. Apologies were noted as above. 2. Minutes of Previous Meeting Mary Harper noted that Linda Sparks is the Chair of the Website Subgroup and the minute would be amended to reflect this. The minutes of the meeting held on 5 December 2014 were otherwise accepted as being an accurate record. Amend minute of 5 th December 2014 to read Linda Sparks is Chair of the Website Subgroup. 3. Matters Arising/Progress on Action Points Mary Harper ran through each item detailed on the Action Template (circulated with the agenda) and progress was noted. Elizabeth Porterfield confirmed that the action to liaise with Scottish Government colleagues regarding a possible mechanism to encourage QPI use by GPs had not yet been taken forward but would be as and when appropriate. 4. Ministerial Steering Group (MSG) Mary Harper updated the group on the first meeting held on 3 March 2015, which was chaired by the Minister for Public Health, Maureen Watt MSP. A productive meeting was reported. Attendees were - Susan Archibald and Professor Tim Eden (patient representatives from Cross Party Group), Elizabeth Porterfield and Adam Briggs (Scottish Government), Deirdre Evans (National Services Scotland, NSS) and Jane Grant (Chief Executive representative). Paul Cameron had deputised for Blair Smith. Susan Archibald confirmed her view that the meeting had been positive with a feeling that people had been listened to and provided with feedback. There was discussion on waiting times and a recognition that these were not always a reflection of the service as the waiting times related to secondary care only. The importance of the core data set had been emphasised. It was confirmed that there had been discussion on outcomes and the work on Quality Performance Indicators (QPIs). An action generated was to link QPIs to improvement and the work of the Clinical Outcomes Measures for Quality Improvement (COMQI) Group. It was agreed that a brief report of MSG meetings would continue to be provided in future. Provide brief report of MSG meetings to NCPIG 5. Pain and Patient Safety Steve Gilbert talked to the group on the paper circulated. It was a proposal that originated in the SIGN workshop of December 2013 and addressed two strands; patients experiencing unhelpful treatments and also medications, their side effects and combinations of drug treatments and their impact. Those most at risk were those with opiate dependency. Steve informed the group that there was a plan to integrate the proposal into patient safety and care. A positive meeting with NHS Education for Scotland (NES) had produced a series of actions; a letter sent to Jason Leitch, Clinical Director in the Directorate for Healthcare, Quality and Strategy in the Scottish Government, to examine the curriculum for Nursing to scope possibility of developing a pain management component and to build on NES work on medically unexplained symptoms.

3 The group discussed neuropathic pain prescriptions. Steve noted that the focus would be on education regarding neuropathic pain and also the assessment and effectiveness of treatment as well. The regular patient review and assessment of patients was emphasised, especially for those patients who were struggling to move on. The patient review was seen as supporting the patient with the knowledge they needed. The group also touched on the polypharmacy model where pharmacists have training in pain management. It was noted in the discussion that chronic pain, although recognised as a long term condition, was not included in the Quality Outcomes Framework (QOF) and this represented a barrier for GPs. It was also recognised that the GP contract was due for renewal in Scotland. Steve noted that he was in touch with Alpana Mair and Graham Kramer (Scottish Government), as well as musculoskeletal (MSK), contacts to link this chronic pain work into the self-management work already being taken forward by the House of Care, the ALLIANCE and AHP colleagues. 6. National Chronic Pain Management Programme The circulated paper was noted. Susan Archibald raised the issue of independent living within the inclusion/exclusion criteria on page two. She noted that for some people who could benefit from the national programme model, an element of additional support was sometimes needed. She felt there was a risk that such patients could be excluded from the service. In addition, Susan noted that what someone in a local service experiences could potentially take independence away from them. An additional consideration were the distances that patients could be expected to travel from remote and rural areas. Mary Harper noted that as the service was near the beginning there was an opportunity to learn from the process. 7. Reports from Subgroups Mary Harper introduced the Subgroup Chairs (or their deputies) who updated the meeting on progress, summarised below: Chronic Pain in Children subgroup (Chair Dr Mary Rose) The Development of a Paediatric Pain Guideline with the Scottish Medical and Scientific Advisory Committee (SMASAC) was progressing. The first meeting of the group overseeing this work was scheduled for Monday 9 March and was expected to generate recommendations. Work being taken forward to pool information for website. Taking forward a consultation with children and young people for their views on what they want form a website. Working to secure funding from the 3 rd sector to develop an App. Taking steps to get self-management onto school curriculum. A physiotherapy needs assessment was being taken forward. Establishing where paediatric pain management is being done through SIG leads. Research (Acting Chair Dr Lesley Colvin / Dr Steve Gilbert deputising) The Scottish Pain Research Community (SPaRC) conference on the 27 March still had places for interested parties. Preliminary results from the opiate prescribing work would be presented at SPaRC and these would show variation in prescribing across Scotland. Lesley Colvin and Heather Harrison would also present on opioid prescribing to the group at the next meeting.

4 Learning and Development Subgroup (Chair Dr Steve Gilbert) Progress on patient safety was reported at agenda item 5. Undergraduate. Glasgow Caledonian University was scoping development of a pain management course. Post-Graduate. Work going forward could be developed through the patient safety approach. NHS Fife were looking at this. A productive joint meeting of the Learning and Development, Primary Care, Self- Management and Website Subgroups took place on February 20 th. It had been agreed that simple pain management education would be taken on by the Self- Management subgroup. Steve reported on a draft proposal to have pain established in the curriculum of Scottish medical schools. The Royal College of Physicians had met the General Medical Council (GMC) to discuss this, which had been positively received. The legislation example was taken from a similar model in Germany for pain management and palliative care. The group discussed the legislative approach to curricula. Steve noted that decisions on curriculum content were currently at the discretion of the GMC. It was noted that Italy had proposed to take forward the German legislation when it held the Presidency of the EU. Elizabeth Porterfield agreed to liaise with colleagues to check the status of the EU position and whether it represented a directive or recommendation. Primary Care subgroup (Chair - Heather Harrison / Steve Gilbert deputising) HealthE work. A positive development reported was the number of GPs in Glasgow engaging with the EMIS template. Greater Glasgow and Clyde and Forth Valley had independently developed this. The Faculty of Pain Medicine (FPM) has developed a pre-screening questionnaire for complex pain, aimed at identifying people in primary care more likely to develop chronicity, and wish to pilot for feasibility and impact. GP recruitment to the pilot was going ahead in NHS Greater Glasgow and Clyde and NHS Fife. An action from the subgroup was discussed to share with SIG leads, for cascade to local GPs. This agreed by the group. The subgroup was also looking at coding issues, supported by the NHS Lothian GP, John Hardman. Steve confirmed he would take the algorithm by John Hardman and apply to the EMIS template for onward referral. Supported Self-Management subgroup (Chair - Norma Turvill / Linda Frydrychova deputising) Three strands of work were reported on: collecting resources, projects on selfmanagement and activity and exercise. Resources. A template had been circulated to the subgroup asking - what resources people valued, if these were suitable for a group setting, the level of service model it fitted, whether it was a more specialised service and lastly if any evaluation or outcome measure was available. A deadline had been set for mid- April. Returns would be collated for the patient focus group. This would then be uploaded to the website for sharing. Website subgroup (Chair - Linda Sparks / Mary Harper deputising) Regular WebEx meetings were taking place with the next meeting scheduled for the following week.

5 Linda Sparks had developed a timetable for different material being considered, with initial feedback received. The Managed Knowledge Network (MKN) site was to be a closed site and used as a resource for discussion within and between the subgroups, with an Athens password required. This would allow papers to be approved then uploaded to public website. Mary emphasised that non-nhs members of CPIG and subgroups (e.g. patient members) could be given an Athens password. Support for the website would be provided by Nigel Gammage, Deputy Director of IT at Dumfries and Galloway. An had been circulated in February to the SIG leads with guidance and letter asking for a named individual for website uploads in each board. / Elizabeth Porterfield Liaise with colleagues to check the status of the EU position regarding legislation on medical school curriculum. Action Point(s): Heather Harrison / Secretariat Share the Faculty of Pain Medicine Pre-Screening Questionnaire with SIG leads. For cascade to GP colleagues. 8. Monitoring Reports Mary Harper reminded the group that monitoring reports should be no more two pages in length and not drafted in less than font 10 to support accessibility. a. Coordinator s Report Paul Cameron asked the group to be clear in their examples of good practice and add details of problems and issues now that reporting arrangements for the Ministerial Steering Group were in place. b. Board Reports The circulated Board reports were noted. c. Third Sector Reports The circulated papers, containing reports from the ALLIANCE, Pain Association Scotland and Pain Concern were noted. Heather Wallace informed the group that Pain Concern had identified barriers to self-management and would take forward a solution with Scottish Government colleagues. Heather also noted that the Pain Concern radio shows had some good programmes scheduled for the future. d. Waiting Times Report The Waiting Times report was noted. Paul Cameron also highlighted the comments facility on the Waiting Times report. Adding a narrative to this would be welcomed, particularly as resource challenges could arise as projects reached their final phases and a new financial year approached. This was seen as an opportunity for SIGs to link to their local data teams to take this forward. The group discussed timescales for waiting times data reporting and a suggestion was made to share the ISD timetable to support SIG reporting. Mary Harper reminded the group that each board had a SIG lead to support the nomination of an individual to sense check and comment on the Waiting Times paper.

6 Colin Rae raised an issue with his version of the Waiting Times report. The data boxes had not displayed correctly and Secretariat agreed to re-send for his attention. Action Point(s): Mary Harper / Secretariat Circulate ISD letter previously sent to Waiting Times leads and highlight Board data contact for SIG leads. Re-send Waiting Times reports to Colin Rae. 9. AOCB Mary Harper spoke about the agenda for the next meeting of the group on Friday 5 th June. Lesley Colvin and Heather Harrison were scheduled to present on prescribing trends. In addition it would also mark one year on from the publication of the NHS Healthcare Improvement Scotland (HIS) report, Chronic Pain Services in Scotland: Where are we now. Mary asked the group for their views on placing a discussion of the report s recommendations on the agenda for the next meeting to assess the current position. Mary emphasised that it was in the group s remit to look at these recommendations and to sense check them in the current context of the group s priorities and to reflect the changes in the chronic pain landscape over the last year. Mary also highlighted that in the HIS report, some recommendations were for the Health Boards. This would need to be addressed as there was an expectation in some quarters that the NCPIG would deal with all matters contained in the report. It was agreed to place the recommendations as an agenda item at the next meeting. The issue of the NHS Lanarkshire Lignocaine cases discussed at the recent Cross Party Group (CPG) meeting and the challenges it could present was raised. Elizabeth informed the group of the Scottish Government s role and confirmed that these cases and the issues they raised were local and fell to be addressed locally, which was happening. They are therefore separate and distinct from the business of the group. Steve Gilbert also informed the group that he was taking forward a joint meeting on work and benefits and chronic pain and was progressing this with Work Scotland. Place the NHS HIS report recommendations on the agenda of the next meeting of the group on Friday 5 June. 10. Date of Next Meeting Friday 5 th June 2015 at am at the Scottish Health Service Centre, Edinburgh, EH4 2LF. Future Meetings Friday 11 th September 2015 at Scottish Health Service Centre, Edinburgh, EH4 2LF Friday 12 December 2015 at Scottish Health Service Centre, Edinburgh, EH4 2LF