REVIEW RECORD
CONTRACT:
CLINCAL FORUM MEETING
MONTHLY REVIEW:
20 August 2015, 16.00 – 17.30
LOCATION:
2.2 Charter House
In attendance:
Harper Brown (HB) Chair
Sheilagh Reavey (SR)
Joanne Rodic (JR)
Dr Rob Graham (RG
Andrew Knott (AK)
Dr Ian McClure (IMc)
David Halsall (DH)
Director of Planning & Procurement
Director of Nursing & Quality
Admin Support for Contract and Information
Governing Body GP
Commercial Director
Consultant Medical Microbiologist
GP
Acting Clinical Director
ENHCCG
ENHCCG
ENHCCG
ENHCCG
TPP
TPP
TPP
TPP
Pathology Clinical Director
Consultant Medical Microbiologist
Senior Contract Manager
TPP
TPP
ENHCCG
Apologies:
Dr Al-izzi (AL)
Nick Brown (NB)
Paula Simms (PS)
1.1
WELCOME AND APOLOGIES
HB welcomed everyone to the meeting and apologies were noted.
1.2
DECLARATIONS OF INTEREST
No declarations of interest
1.3
MINUTES OF LAST MEETING ON THE 20TH AUGUST 2015 AND MATTERS ARISING
Alteration: Minutes on 20th August 2015 – Sheilagh Reavey did not attend the meeting on the
20th August 2015, therefore amended to show Sheilagh Reavey sent apologies.
1.4
ACTION TRACKER
ACTION 3: REPORTING
AK confirmed that the date of sample can be taken as long as the request has come in
electronically. IM commented that if the patient takes home the urine sample and they may not
return it until later a date, therefore it would be the date on the bottle not on the form. AK
confirmed he will follow up the new request form process and confirm that it has been added to
the beaker reports. AK to liaise with RG to confirm, when it will appear on ICE by MidNovember.
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ACTION 4: REPORTING
AK commented that the Partnership’s Associate Director of Compliance & Governance confirms
that the Partnership is following RCPath guidelines for the phoning of abnormal results. The
Cambridge laboratory in August achieved 94.611% of total critical results being phoned in
August 2015. Closed
ACTION 5: REPORTING
AK confirmed that the turnaround times are in the microbiology handbook and the KPIs on page
44-47. Closed
ACTION 6: REPORTING
AK confirmed that the timetable for collection of samples is on page 8 of the handbook. Closed
ACTION 7: REPORTING
It was agreed to look at the reports from the hotline weekly and for TPP to divide the report into
categories for further analysis and the format for the report to be provided by Marion. HB
commented it would be helpful to have them RAG rated to show the individual issues are being
dealt with.
NEW ACTION 20: REPORTING /AGENDA
SR to provide a summary from the hotline for future meetings and JR to add to the agenda as a
standing item.
ACTION 8: HANDBOOK
AK confirmed that the handbook is now available. Closed
ACTION 9: REPORTING
DH commented that he is still waiting for the details of the patients and will follow this up.
NEW ACTION 21: COMMS/ POTASSIUM LEVELS
SR stated comms need to be circulated to advise potassium levels could increase for the winter
and it was agreed that DH will produce wording for the GP bulletin for November.
ACTION 10: CHANGE CONTROL PROCESS – SPECIMEN POST
AK confirmed that the Partnership is currently reviewing alternative urine collection system
being considered by PHE to determine whether alternative system will work effectively on
Partnership’s equipment. PS to re-circulate for formal sign off and to be added to the GP
bulletin for re-assurance that this is the process to be followed.
ACTION 11: CHANGE CONTROL PROCESS – SPECIMEN POST
On the agenda: 1.6
ACTION 12: PHLEBOTOMY
AK commented that the Lab Manager at the Lister, has reviewed Phlebotomy and a response
has been sent to PS. AK thinks that the model is broken and there are intentions to change the
model. A number of supermarkets have been approached for using space for Phlebotomy
rooms on their premises, as the premises can be used for a longer space of time. AK confirmed
there is a backlog with the fasting test, due to the phlebotomist times. HB commented that the
CCG needs to work with TPP regarding locality commissioning and the options for the future for
this service. It was agreed that AK will contact HB and the locality team regarding the issues.
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ACTION 14: HANDBOOK
Closed
ACTION 15: REPORTING
AK to contact Ed Bosonnet regarding SystmOne.
ACTION 16: HANDBOOK
Closed
ACTION 17: CHANGE TO STOCK ORDERING SYSTEM
The change control policy and changes to hosting arrangements for ordering pathology stock
was agreed by SR and HB for sign off and comms need to be sent to GPs. Closed
ACTION 18: DELAYED RESULTS
Item closed evidence seen.
ACTION 19: HISTOPATHOLOGY
AK confirmed fedback. Closed
PATHOLOGY HANDBOOK
SR commented that there are no timescales on Page: 13 of the handbook and Page: 42 do not
have the critical results covered in the same way in every section. IM suggested would it help if
practices let TPP know, if the results should have been phoned through.
IM asked AK if there could be a link on ICE, which could take you direct to the Pathology and
Microbiology handbooks. It was also discussed for AK to make the Handbook labelling clearer
on the website.
NEW ACTION 22: HANDBOOK
DH to add the timescales to page 13 and critical results to page 42.
NEW ACTION 23: HAEMATOLOGIST/ MEETING
AK to invite a haematologist to the next meeting
NEW ACTION 24: HANDBOOKS
AK to add a hyper –link for the handbooks on ICE and communicate to everyone. AK to make
the labelling clearer
1.5
UPDATE ON PATHOLOGY PARTNERSHIP
AK updated the group regarding changes since 20th of August 2015 on the following:




New CEO now in place
Continuing on trajectory for setting up the 2 x hubs
Setting up Single laboratory system with better standardised information across the
board, apart from Cambridge
Working on batch reporting
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HB asked if TPP are working with ENHT regarding microbiology in particular. AK replied that
there are frustrations with the microbiology laboratory and the validation of the results, therefore
they are taking longer than they should. AK commented that ENHT have a shortage of
microbiologists, which is having an impact on the service and PHE are drafting an action plan to
be circulated by the end of the week. A large part of the action plan, is to review how the
processes are being run at ENHT for microbiology. The reviews for microbiology are to be
completed by 31st October 2015.
SR commented there are concerns over delays and the quality of the tests and these delays
could potentially be public safety issues. IM commented sometimes test results are not clear, to
whether they are pathological or not. RG commented that the test are done at Addenbrookes
and then sent to Lister but are not being received by the GPs. DH agreed that the result
process needs to be reviewed. There are two new locum consultants, who have started and
there is a new IT patch, which will help the two systems to talk to each other. Also, the new
bench validation protocols are being reviewed.
HB commented that there are issues with day to day communication, in the main cancelled
tests. HB stated that a new manger has been appointed at ENHT and more involvement is
required from the Trust and feedback needs to be shared with each other. SR commented that
ENHT are raising their own concerns regarding TPP service.
AK confirmed he will go back to PHE after this meeting and ask for the results to be sent out
invalidated and confirm the risk assessment for this by COP 21.10.15.
DH confirmed there is a new process for urine samples being implemented, which will help the
service. AK commented that they continue to struggle with clinicians at ENHT and permanent
staff are required. Ideally, the consultant resource needs to move to CUH.
AK asked if there is someone from the ENHCCG that TPP could work with regarding the issue
and trying to make this real-time, instead of following up the issues after wards. SR stated that it
is difficult as the reports received from the hotline are sent to Marion and these cannot be realtime, as times vary.
DH confirmed all information is on the Quality Management system and it is being reviewed by
Chris Noonan.SR stated the report it is a good way of capturing the way TPP are performing, as
you can see there was a blip in August on the report. DH stated that TPP have their own hotline
and managed by the reception staff, where they are not too experienced and the turnover of
staff is very high. HB stated that maybe this is an area that needs to be highlighted and
addressed between the clinicians, GPs and hotline, as operationally it needs to be GP to TPP.
HB advised the TPP quality team need to be working with the TPP hotline. SR commented a
full root cause analysis is required to review all the issues within TPP.
NEW ACTION 25: UN-VALIDATED TEST RESULTS
AK to confirm the risk assessment for sending out un- validated test results to GP practices
short term by COP 21.10.15
NEW ACTION 26: PERFORMANCE GRAPH
DH to speak to NB regarding a performance graph to be provided at next meeting.
NEW ACTION 27: TPP HOTLINE
AK to carry out a root analysis regarding issues within TPP.
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1.5
LMC LETTER
HB commented that ENHCCG had been sent the LMC letter and Cambridge & Peterborough
have been given the lead to respond to the letter.
SR has reviewed the details behind the letter but the CCG are still waiting the full investigation
back from TPP. AK commented they have not seen the letter and SR responded that TPP
should have been formally notified of the letter.
HB commented there are three main inter locking areas made up of safety & Clinical Quality,
Finance and Operations, and we have been focusing on Quality and Finance. The CCG are reassured that we have processes in place with TPP. SR commented it would be helpful for TPP
to share the feedback with ENHCCG.
NEW ACTION 28: LMC LETTER
AK to provide the feedback to ENHCCG from the LMC letter.
1.6
CHANGE MANAGEMENT PROCESS
1.6.1 CHANGE MANAGEMENT PROCESS
DH commented NB has shown him the new collection system. It is a new tube, which can show
the results straight away. The collection system is not user friendly and requires further
feedback from the surgeries. It was agreed that the practices could pilot the two different
collection systems. HB commented that there is a practice already using the new systems and
will confirm which one.
A demo is required and the suggestion was to take the two options to a LMC meeting. SR
suggested RG and IM piloting the two options at their practices for one week, but RG would
rather wait for feedback from the other practice already using it.DH to speak to NB to clarify
compatibility and DH to post samples to IM.
NEW ACTION 29: NEW COLLECTION SYSTEM
HB to found out which one of the practices, is using the new collection system.
NEW ACTION 30: NEW COLLECTION SYSTEM
RG to suggest a demo for the new collection system at the LMC meeting for a slot for next year.
NEW ACTION 31: NEW COLLECTION SYSTEM
DH to post samples to IM and bring samples to the next meeting.
1.7
1.6.1 BATCH REPORTING
AK commented that the major issue is taking profiles and the clinical comments are going
against the first profile, the problem is the translation engine. The system is being fixed a week
tomorrow and then a further two weeks are required for testing with a target date of 6th Nov
2015.
There is a problem with Tquest with the comments not showing on the report, which is being
fixed at the moment. IM commented that he tried to download the results from ICE and got a
batch report instead. AK suggested that the comments may not be in the correct place and the
system needs further testing.
SR commented that comms need to be clear with all GP practices and that TPP are testing
systems.
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NEW ACTION 32: BATCH REPORTING
AK to send out comms to GP practices that TPP are testing the batch reporting system.
1.6.2 COMMUNICATION OF SEVERELY ABNORMAL TESTS
SR commented that it needs to be clear regarding the communication and an audit is required.
NEW ACTION 33: AUDIT/ SEVERELY ABNORMAL TESTS
AK to carry out an audit regarding communication for severely abnormal tests.
1.6.3 DELAYS IN MICROBIOLOGY
Covered above
1.6.4 DUPLICATE RESULTS
Covered above
1.6.5 DELAY IN HBA1C
DH commented that the turnaround time is 4 days and there have been no results older than 2
days. Closed
1.6.6 ELEVATED POTASSIUM LEVELS
Covered above
1.6.7 USER GUIDE HANDBOOK
Covered above
1.6.8 DELAYS IN HISTOPATHOLOGY
DH confirmed the Histopathology results from ENHT have improved. RG asked how much they
are delayed by. SR confirmed this is tracked through the cancer pathway.
1.8
RECALL & OOH UPDATE
The group reviewed the action tracker for OOH.
ACTION 1: AK confirmed Lister have authorised access to ICE. Closed
ACTION 2: PS to update at the next meeting.
It was agreed to bring the action tracker to the next meeting to update the actions.
NEW ACTION 34: OOH ACTION TRACKER
PS to bring the OOH action tracker to the next meeting to update the actions.
1.9
FEEDBACK MEETING WITH MARTIN DUKE
IM updated the group regarding the visit from Martin Duke about the visibility of TPP screen.
Sometimes, when you are talking to the help desk, you are viewing different comments. IM
suggested that when you go into patient notes, there is a choice between Cambridge and Lister
and it would be helpful to have a default option.
NEW ACTION 34: UPDATE FROM MARTIN DUKE
AK to confirm update from Martin Duke regarding changes to the TPP screen at GP practices.
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2.0
ANY OTHER BUSINESS
TESTS
RG commented that there is a faecal occult bloods test for detection of bowel cancer as per
NICE guidelines. DH said there is another testing that could be discussed at the cancer board.
It was confirmed, it will be discussed at the internal cancer group and DH to send information
regarding costs etc. for the tests to RG.
NEW ACTION 35: TESTS
RG to feedback to Mark Andrews regarding and feedback to TPP. EG. Faecal calprotectin
IM commented that Martin Duke would welcome feedback regarding tests on the front page and
SR suggested discussing this at the LMC meeting.
DH commented there is a test called ELF for hepatology referrals, which is better than the
Alt/AST ratio test for liver fibroi and can share the business case with the group. It was
suggested to raise this at the ENHT clinical forum.
NEW ACTION 36: ELF TEST
DH to share the business case with the group for the ELF test.
NEW ACTION 37: ELF TEST FOR HEPATOLOGISTS/ CLINICAL FORUM
HB to add ELF test for Hepatologists to the Clinical Forum agenda.
CHANGE CONTROL POLICY & CHANGES TO HOSTING ARRANGEMENTS FOR
ODERING PATHOLOGY STOCK
The change control policy and changes to hosting arrangements for ordering pathology stock
was agreed by SR and HB for sign off and comms need to be sent to GPs.
NEW ACTION 38: MEETING INVITE
JR commented to invite Narzia Hussain from ENHT to the next TPP meeting.
DATE AND TIME OF NEXT MEETING
26th November 2015, 3.30 pm to 4.30pm, Fountain 2.1, WGC.
Apologies to be sent to Joanne.Rodic@enhertsccg.nhs.uk
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