Diabetes Strategic Clinical Leadership Group (SCLG) Meeting minutes

Transcription

1 Diabetes Strategic Clinical Leadership Group (SCLG) Meeting minutes Friday 20 th February 2015 Present Name Role Aderonke Kuti (AK) Director; Black and Minority Ethnic Diabetes Association (BEMDA) Anna Hodgkinson (AH) Senior Prescribing Advisor; Lambeth CCG Dr Anne Dornhorst (AD) Consultant Physician in Diabetes and Internal medicine Imperial NHS Trust Efa Mortty (EM) Deputy Head of Medicines Management (Pharmacist); Haringey CCG Gemma Snell (GS) Senior Project Manager; Strategic Clinical Network Gillian Ostrowski (GO) Assistant Medical Director; South London Local Area Team, NHS England Jay Nairn (JN) Project Manager; Strategic Clinical Network Dr Jane Fryer (JF) Medical Director; South London Local Area Team, NHS England Jess Brand (JB) Project Manager; Strategic Clinical Network Jo Reed (JR) Diabetes Specialist Nurse (Renal); Hammersmith Hospital Dr Karen Anthony (KA) Consultant in Diabetes and Endocrinology; Whittington NHS Trust Lis Warren (LW) Service User Dr Mark Chamley (MC) General Practitioner; Lambeth CCG Mala Rao (MR) Consultant in Public Health, Diabetes Eye Screening Programme (DESP) Roz Rosenblatt (RR) London Regional Manager; Diabetes UK Samantha Mann (SM) Consultant Ophthalmologist (retinal Screening lead for Lewisham, Southwark, and Lambeth); St Thomas s Hospital Stephanie Singham (SS) Diabetes Specialist Psychotherapist; Guy s and St Thomas Trust Dr Stephen Thomas (Chair) (ST) Clinical Director Diabetes Strategic Clinical Network; Consultant Diabetologist; Guy s and St Thomas Trust Sufyan Hussain (SH) Darzi Fellow; Imperial NHS Trust Dr Tony Willis (TW) General Practitioner; Hammersmith and Fulham CCG; Chair of CWEHH Diabetes Strategy Group Name Dr Adeel Ansari Dr Charles Gostling Dinah Clarfelt Lesley Roberts Melissa Holloway Natasha Patel Apologies Role General Practitioner; Barking and Dagenham General Practitioner / Clinical Director Academic Health Science Network South London Practice Nurse Manager and Diabetes Specialist Nurse; Richmond and Twickenham CCG Programme Director, Diabetes Integrated Practice Unit, North Central London Service User Consultant Diabetologist / South London Academic Health Page 1 of 5

2 Dr Rajashree Baburaj Dr Raquel Delgado Richard Leigh Sara Nelson Sarah Jupp Sharon Shelley Dr Somen Bannerjee Dr Stella Vigs Zabeer Rashid Item Science Network Lead; St George s Hospital Consultant Physician and Endocrinologist; Hillingdon Hospital General Practitioner; Hounslow CCG Diabetes Specialist Podiatrist / Head of Podiatry; The Royal Free Hospital Quality Improvement Lead; Children s Strategic Clinical Network Senior Diabetes Specialist Nurse; St George s Hospital Lead Diabetes Specialist Nurse; North East London Foundation Trust Director of Public Health; Tower Hamlets Consultant Vascular and General Surgeon; Croydon University Hospital Specialist Podiatrist Diabetes; Mile End Hospital Minutes Details 1 Welcome, introductions, and apologies ST welcomed everyone to the SCLG meeting. Introductions were made and apologies were noted. 2 Minutes and matters arising The minutes were agreed without comment. GS updated the group on the status of the previous meeting s actions: The network will be running four diabetes courses for type 1 diabetes and eating disorders over the next three months. Content is still being developed and details will be circulated once ready. The Westminster report has been circulated. GS submitted to The National Diabetes Prevention Programme on behalf of the network. There were no matters arising. 3 Diabetic Eye Screening Programme Update MR updated the group on the status of the diabetic eye screening programme (DESP) re-procurement process. The holiday period was very busy due to the procurement deadlines. The Commissioners received high levels of response to the pre-qualifying questionnaire, the first stage of the tender process. The bidders that were successful at this first stage were invited to a bidders event on 12 February. The Q&A session at the event offered the bidders an opportunity to seek a number of clarifications on several aspects of the process, from the Commissioners. Final award of tenders is expected to be on 19 May, with a go live date to fall in the autumn. In parallel, discussions were underway, between the Commissioners and CCGs to explore the inclusion of OCTs as part of the DESP surveillance pathway, and to strengthen the hospital eye services contracts for the management of diabetic retinopathy to address a few prevailing concerns, such as data and information sharing with DESPs. Hospital contracts being the responsibility of CCGs, resolving these issues requires the screening commissioners and CCGs to work together. A meeting was recently arranged by the commissioners to explore these issues with CCG representatives. Almost all the SPG areas were represented at the meeting and Page 2 of 5

3 CCGs were supportive of both objectives. As the first step, CCG representatives agreed to assess the OCT and hospital eye service activity in relation to DR in the provider contracts for which they were responsible. The Commissioners had offered their support to this data extraction. ST queried the impact of the recently agreed DESP service specification for London and the re-procurement on referrals for OCTs, and specifically what would happen to providers who do not have access to OCT.The new London DESP specification promotes use of OCT in surveillance where CCGs have agreed to fund the service as they have in certain parts of London. It is the intention of NHS England London to work with CCGs on co-commissioning arrangements which include use of OCT in the digital surveillance pathway across London. ST recommended increasing screening for high risk individuals; if capacity is created within the system, it should be used to increase screenings for high risk patients rather than as cost savings. MR mentioned that the trial in Scotland appears to have demonstrated clear benefits of a stratified risk-based approach to screening, but the method would probably need to be assessed for its generalizability to populations such as in London with high proportions of BME populations. Agenda items for ratification Detection of diabetes consensus statement AH presented the detection of diabetes consensus statement draft to the group for comments. The document was produced to combat the inconsistency of diagnosis preference across London CCGs. The statement will recommend HbA1c testing, as glucose-based testing is more difficult for younger, working age populations. Although the price of the reagent itself is higher, HbA1c testing is less expensive both in the longer term and as part of the diagnosis pathway. Currently about 50-60% of CCGs use HbA1c. Due to the difficulty defining the low risk population and lack of consensus on this issue, the group agreed that the consensus statement would refer commissioners to NICE guidance. 4 TW confirmed that the SystmOne read codes were correct. AH will make the agreed changes. Document confirmed as ratified. Action GS: Detection of diabetes consensus statement to be distributed to CCGs. Management of care case studies draft MC updated the group on the status of the draft, which is roughly three-quarters done and missing only north west London. Common themes about good practice are emerging. They include: good leadership, prioritising self-management, professional education, guidelines, use of IT. The main part of the document will detail the highperformer CCGs, followed by patient stories and local contacts. MC asked for comments before 27 February due to purdah. JN suggested that CCGs who have make sizable improvements be included alongside the high performers to avoid overuse of the same CCGs. Bexley, Lambeth, Tower Hamlets, and Islington were suggested. Page 3 of 5

4 Action: MC to collect and incorporate comments. Final document to be cascaded before 29 March. Equity of access Type 1 / pumps - recommendations Uptake of pumps remains low in London despite NICE guidance that has been in place for six years. There is a disparity in the requirements set by each CCG to enable patients to begin on a pump, and thus disparity of provision around London. Compared to the rest of the country, a higher percentage of centres in London reported they had to fill in a form for each patient to receive a pump. This recommendation document aims to improve uniformity of provision. KA discussed the draft recommendation document she produced with the group. Early feedback from commissioners suggests confusion and misunderstandings about the forms. KA requested comments. LW queried metric four and KA agreed to remove it its purpose was better represented under metric five. SH suggested the inclusion of a paediatric-focussed metric to address the transition from paediatric to adult services. SH also recommended that commissioners ensure a multi-disciplinary team is available to develop pump service. ST suggested that KA contact Brigette Vanderzanden to discuss sharing information around each CCG s requirements for receiving pumps. AD reported that in north west London while pumps are readily available, a form does need to be filled out for every patient. Action: KA to incorporate comments into final draft. Recommendations to be distributed to commissioners and providers. Equity of access Foot care JN updated the group on the foot care s work stream. A local audit of services was sent out widely to providers and commissioners, from which 10 community responses and 14 acute responses have been received to date. This will be compared to previous audits. The next steering group meeting will aim to ratify a gold standard service specification that encompasses both acute and community. The London Foot Care Network will host a foot care event on 5 March. JN welcomed the SCLG to attend. Neil Ashman, the Clinical Director of the London Renal Network, will speak on combined working. Obi Agu from the Vascular Network will also speak. ST will also be speaking in the afternoon. About 70 people have registered as delegates thus far. 5 NICE Consultation ST asked the group for volunteers to draft responses to the four NICE consultations: Type 1, Diabetes in children, Type 2, and Foot care. Type 1 The group supported the recommendation for a 24 hour helpline but felt it was unlikely to be implemented. KA and AD agreed to write this response. ST suggested that psychological support and eating disorders should be included. Page 4 of 5

5 Type 2 - AH and SH agreed to write this document. SH expressed concerns about the process through which this guidance was produced, as it did not include older drugs in its meta-analysis. Foot care ST will write this document. Diabetes in children GS will speak with the Children s SCN about formulating this response. Action: KA and AD to write Type 1 response and submit before 3 March Action: AH and SH to write Type 2 response and submit before 3 March Action: ST to write Foot care response and submit before 4 March Action: GS to speak with Children s SCN about submitting Children s responses before 5 March Any other business GS asked AK to feedback examples of good engagement with BME communities. 6 LW mentioned that she had been contacted by someone wanting to start a campaign to improve and extend best practice for children and schools to other parts of London. UCLH was suggested as having a very good service. RR offered to put LW in touch with the DUK paediatric network. ST warned the group that he had had patients who were being fined for not having an up-to-date prescription certificate exempting them from prescription charges. Spot checks are being done to ensure patients certificates are up to date, and patients can be fined 100 and be charged with fraud. Date of next meetings 20 March June September 2015 Page 5 of 5