NHS GRAMPIAN Minute of the Hep C MCN Steering Group Meeting held on 4 th June 2009 at 10am in Conference Room, Summerfield House

Transcription

1 NHS GRAMPIAN Minute of the Hep C MCN Steering Group Meeting held on 4 th June 2009 at 10am in Conference Room, Summerfield House Present: Name Title Representing Andrew Fraser (AF) (Chair) Consultant Gastroenterologist & HCV MCN Clinical Lead Hep C Action Plan Clinical Lead/NHS Grampian Liver Service Alan Leitch (AL) Finance Manager NHS Grampian Finance Cathy Coffield () MCN Manager NHS Grampian HCV MCN Elaine Youngman (EY) Alcohol Drugs Development ADATs Officer, Aberdeenshire Fiona Stuart (FS) Specialist Pharmacist in Substance Misuse/ Hepatitis C Prevention HCV Prevention Network NHS Grampian Pharmacy Department Lead Linda Buchan (LB) Blood Borne Virus & Infection HMP Peterhead Control Nurse Linda Oldroyd (LO) Nurse Consultant Patient Safety & Experience Clinical Governance & Risk Management Unit Susan MacPhee (SMacP) Consultant in Public Health Medicine & Interim Executive Lead Hepatitis C Action Plan Executive Lead/ Public Health Tom Reid (TR) Consultant Microbiologist NHS Grampian Microbiology Lab Tracey Gervaise (TG) by Public Health Lead Moray CHSCP Video Link Lisa Allerton (LA) Hepatitis C/ Blood Borne Virus Hepatitis C MCN Project Manager Pauline Dundas (PD) Hepatology Nurse Specialist NHS Grampian Liver Service In Attendance: Emma Rochford (ER), Programme Administrator, Minute Taker Item Subject Action Apologies Amanda Croft, Divisional General Manager, Acute Sector Ambreen Butt, Consultant GU Physician, GUM Andrew Robinson, Consultant Psychiatrist Beverley Henderson, PH Practitioner, Orkney (Video-link failed) Carole Ledingham, Unit Operational Manager David Cooper, Sexual Health Managed Care Network Manager John Campbell, Team Lead Moray ADAT Karen Gunn Service Manager, Mental Health, NHSG Laura Gray, Corporate Communications Louise Robertson, Learning & Development Manager, NHS Grampian Mike Hebden, HMP Peterhead (Linda Buchan deputised) Mike Ogg Aberdeenshire CHP Pamela Molyneaux, Consultant Virologist Rhonda Kelly, AVCO Rob Laing, Consultant ID Physician Susan Stewart, HMP Aberdeen Welcome and Introduction AF welcomed everyone. Introductions around table. 1

2 12.09 Minutes of Meeting Held on 19 th February 2009 Date of last meeting changed. No further changes and minutes approved Local Stakeholders meeting date and draft programme It is a requirement of the MCN to hold an annual meeting. This has been booked for 1 st October 2009 at Thainstone House Hotel. The stakeholders meeting will include the testing, treatment and care associated with hepatitis C. The meeting will not include prevention. It was agreed that an earlier start time of 0930 for 1000am would be appropriate. Discussion of the programme/speakers. Scottish Prison Service (SPS) It would be beneficial to have representation from the SPS. A discussion was held about who to approach and what the content would cover. is to contact Stephen Heller-Murphy who is on the SPS forum for advice on this issue. LB mentioned that HMP Peterhead is to undergo regeneration in the next few years and thus it would change drastically with respect to numbers of prisoners and their expected length of stay. With regards to Hepatitis C it was felt that it would be helpful if there was a better understanding of the day-to-day management of local prisons. Substance misuse service (SMS) Similarly it was felt that representation from the SMS would be beneficial. Currently, there is not much Hep C/ SMS integration. There was a discussion about the possibility of inviting someone from another area where SMS has strong links and involvement in Hep C (Tayside) or from Aberdeen to look at the possibility of developing better links in the future. It was agreed to try and allow time for both. PD will give a HCV treatment talk at the stakeholders meeting. AF is to invite Prof Graham Foster to speak on the topic of treatment in needle exchange for the afternoon programme. The group requested that client experiences and/or voluntary sector input be included on the agenda. PD to investigate possibility of client stories. to explore possibility of asking Charles Gore to speak regarding working with voluntary organisations. to suggest alternative agenda item for voluntary sector if Charles Gore not available. PD PD AF AF/ PD/ There should be advertising of the stakeholder event in clinics and other patient venues. 2

3 14.09 Progress with HCV Action Plan for Scotland Phase 2 Memorandum of Understanding with Prison: This has been signed off. Draft service level agreement (SLA) with HMP Aberdeen has been drawn up. A meeting will be held to resolve any outstanding issues. Following this, a discussion will be held with HMP Peterhead. Project Initiation Document: This has been submitted to Health Protection Scotland (HPS). This has received praise. congratulated. Communication Plan: This has been brought to the attention of the steering group and is ready to be submitted to HPS. Moray There was a meeting between, AF, PD and Dr Williams and Dr Hew. A treatment service will commence monthly from September at Dr Gray s. The MCN will also looking at other areas e.g. Huntly and voluntary sector e.g. Studio 8 as venues for testing initiatives. GPs will also be contacted with regards to increasing testing. SMS: AF and met with Karen Gunn and Simon Rayner to discuss how to integrate Hepatitis C testing with SMS and the management of clients. SMS have tested a substantial number, but it is not clear how many have been referred to specialist services or received antiviral therapy. Clinic Space: It is suggested that there are integrated agencies within any future clinic space this may include medical, social work, psychiatric, and SMS services. These are currently spread across a number of geographical locations. Discussions are ongoing. There are currently outreach HCV clinics in Peterhead and Fraserburgh community hospitals and the Homeless Practice in Aberdeen. There is not much activity at Lossiemouth Needle Exchange (NEx). FS has contacted community pharmacies there are two interested in testing others may be approached in due course. Individuals with HCV infection can be considered in 4 groups 1. known positive (+ve) and attending specialist care 2. known +ve referred but no longer attending specialist care 3. Positive HCV test but never referred to specialist care 4. Infected with hepatitis C but never had a positive test There are approximately 1400 individuals who have had a positive HCV test but have never been referred to the hepatology services (some may have been referred to the Infectious Disease clinic. GUM has proposed tracing their group 3 type patients. The group felt that a co-ordinated approach is required across Grampian and that all individuals with a positive test who are not attending specialist services should be offered the opportunity to be assessed. This would require obtaining the identity of all individuals with a positive test from the virology laboratory and the GUM clinic. SMacP said that GPs could be a useful way to trace/ contact patients as they are a relatively fixed point and would also have background knowledge. This would also raise Hep C profile in the GP community. It was mentioned that 95% of GPs did not do test for Hep C last year. Therefore and AF will liaise with GUM and laboratories to progress this 3

4 15.09 Patient Pathway See attachment. talked group through the various patient pathways that currently exist in Grampian. Standard Pathway The did not attend (DNA) rate is high. This needs to be addressed. There needs to be a discussion about how can clients can be encouraged/ reminded to attend for treatment. There is no set process within NHSG currently. There is a Hep C advice line, but test results cannot be disclosed through it. to contact Chris Morrice at Information Governance for guidance on approved methods of contacting patients prior to appointment. Prison Pathway (Aberdeen) The issue of who is providing services to released prisoners was raised. Within prison there are various reasons why prisoners do not attend appointments e.g. in court, seeing social worker or solicitor, security issues in prison, no escort available. These issues will influence the SLA. The prisoner is not always told what the appointment is for so can t make informed choice as to which to attend if there is a double booking. There was the suggestion that there may be an opportunity to learn from other specialties that treat prisoners and use this to guide Hep C testing, treatment and care. The group felt that it would be useful to have the different care pathways colour coded for clarity Testing BBV Outreach testing in Needle Exchange ongoing. Number of tests are fewer than was thought, and therefore virology laboratory funding will be used for other blood borne virus tests. PCR Testing currently carried out in NHS Greater Glasgow and Clyde, as of 1 st April 2009 they will charge for this. Feasibility of local testing is still under discussion. Awaiting additional information regarding costs from laboratory Membership: Local Authority, Social Work, General Practice, Patient involvement Local Authority Representation National scope of LA involvement report at HPS. Locally LA involvement on the steering group needs to be ensured. Also has to link into Community Planning. Need to look at CP Board to establish appropriate representation. Moray TG discussed the strategic theme groups that fall under the CPP. TG will be the lead into CPP in the interim. Aberdeenshire EY links through community wellbeing theme (chaired by Jenny Hall) It is likely that ADP will link to the CPP board directly. EY will represent the Aberdeenshire Social Work Department (on behalf of public health director) and ADP on the MCN steering group. 4

5 Aberdeen City is investigating Aberdeen City CPP structures with Chris Stewart, Noted that is was unlikely that any LA rep would have executive powers. There was a discussion on how to provide social work support to clients attending for hepatitis C testing, treatment and care. Potentially there may be scope to have a social worker with system knowledge attending the Hepatitis C clinics and seeing patients at the same visit as they receive medical care. This social worker could signpost and also liaise with the relevant social work teams. In Aberdeenshire if the client no longer has SM issues, the SM social worker no longer works with the individual which may result in no support through treatment. The group felt that there were issues and concerns with this. There is a need for a practising social worker to be part of the MCN steering group for each area. Criminal Justice also needs to be represented. LA is doing scoping work on BBV/SMS in social work. GP representation Two letters and an have been sent to David Fowler. AF will continue to address this issue. LA AF Patient representation A substantial information pack has been sent to a possible patient rep. No reply has been received as of yet. AF may contact someone else who may be suitable. Maggie Emslie may be able to help through the generic patient group Freedom of Information The steering group was informed and gave permission for the minutes of these meetings to be made available via the NHSG website AOCB EY sought views on the BBV conference in Dundee (Cares) the group felt that it is worth attending. Several of the steering group are also due to attend Meeting Dates 2009: 10 am, Conference Room, Summerfield House 8 th October 2009 Agenda Items to: emma.rochford@nhs.net 5