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MINUTE of MEETING of the HIGHLAND
AREA MEDICAL COMMITTEE
Board Room, Assynt House, Inverness
Tuesday 06 August 2013 - 2.00 pm
Present:
Dr Miles Mack, Chair
Dr Neil Arnott (videoconference)
Dr Jonathan Ball
Mr Quentin Cox
Dr Jason Davies (videoconference)
Dr Iain Kennedy
Ms Sarah Prince (videoconference)
Dr Claire Robertson
Dr Emma Watson
In Attendance:
Dr Ian Bashford, Medical Director (from 3.30pm)
Mr Stuart Denholm, Consultant ENT Surgeon (item 4)
Dr Ken Proctor, Associate Medical Director, (Primary Care)
Dr Margaret Somerville, Director of Public Health (from 3.25pm)
Miss Irene Robertson, Board Committee Administrator
1
WELCOME AND APOLOGIES
The Chair welcomed everyone to the meeting. Apologies for absence were received from
Dr Duncan Gray, Dr Alistair Hay, Dr Andrew Macleod, Dr Chris Williams and Dr Susan
Hussey Wilson.
2
MINUTE OF MEETING HELD ON 28 MAY 2013
The minute of meeting held on 28 May 2013 was Approved subject to the heading of item
10 being amended to read ‘Non-Attendance After Inter-Consultant Referrals’.
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MATTERS ARISING
3.1
Non-Attendance after Inter-Consultant Referrals
It was agreed to discuss this issue further at the next meeting when Stephanie Adlinton,
Service Improvement Manager, Patient Services Division, Raigmore Hospital would be
present.
3.2
Rheumatology Department
It was noted there was no substantial progress to report regarding the consultant staffing
issue.
3.3
Use of locums for waiting list initiatives
The Chair updated the Committee on his further correspondence with Chris Lyons, Director
of Operations, Raigmore and ongoing activity in relation to induction and follow up
arrangements. It was agreed to keep this item on the agenda for the time being.
3.4
Return Appointments Update
The Committee noted that several departments were now using the Patient Focused Booking
system for return appointments. A number of concerns were raised:


A risk around potential delays in patients receiving appropriate treatment.
Patients who would be willing to wait a bit longer to be seen locally being offered
appointments elsewhere in order to meet targets. The service needs to be patient
focused.
The Patient Services Division does not have a clinical lead.
It was suggested these issues be raised with Stephanie Adlinton at the next meeting.
3.5
Use of Datix incident reporting system in Primary Care
The Committee was advised that the proposal to use this system in Primary Care had been
warmly received at the National Primary Care Leads Group. Dr Proctor referred to the pilot
currently underway in NHS Grampian and indicated he would be in a position to bring an
update on progress to the Committee within the next two – three months.
The Committee Noted the updates and the further actions taken/planned.
Stuart Denholm joined the meeting
4
ONCOLOGY SERVICES
The Chair welcomed Stuart Denholm, Consultant ENT Surgeon. Mr Denholm explained he
was attending the meeting to speak on behalf of colleagues, both within the Oncology
Department and clinicians whose work brings them into direct contact with the oncology
service, who were concerned about the sustainability of the service. The Oncology
Department had been under significant pressure for some time, the two main, inter-related
issues being:
1) Difficulty in recruitment to unfilled posts in radiation physics and possibly consultant
oncology posts when advertised.
2) Lack of consultant oncologist time resulting in both treatment delays and increasing
pressure on the oncology team. In addition one oncologist was due to retire early
next year, and another was on long term sick leave. This would potentially leave only
two oncologists.
An increased incidence of cancer because of the aging population and increased treatment
availability and complexity had placed increased demands on the oncology service over the
last decade, and this trend was expected to continue. Mr Denholm sought the Committee’s
support in addressing the situation as a matter of priority in order to ensure the short and
long term viability of the oncology service. Having discussed the issues the Committee
confirmed its support for the following measures:-
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
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the proposal to advertise for two consultants rather than just one to replace the
consultant about to retire;
an urgent review of the pay banding for radiotherapy planners under Agenda for
Change;
a full time direct service manager for oncology services to be appointed.
Dr Kennedy confirmed he would arrange for the issues to be discussed at the next meeting
of the Area Clinical Forum to be held on 8 August 2013 and he would also raise them at
Board level.
The Committee Endorsed the proposed measures to help address the pressures within the
Oncology Service and ensure its sustainability.
5
APPRAISAL AND REVALIDATION
The Chair advised he was unable to continue to be the Committee’s representative on the
Revalidation and Appraisal Steering Group due to other commitments. Pending identification
of a successor Dr Watson agreed to attend the next meeting of the group which was
scheduled for 18 September 2013.
The Committee Noted a representative would require to be identified for the Revalidation
and Appraisal Group to replace Dr Mack.
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ACCESS TARGETS: OUTPATIENTS 12 WEEKS WAITING TIME
An issue had been raised by Dr Susan Taylor in relation to patients being offered treatment
outwith their local area in order to meet access targets. It was noted that the letter to
patients offering them appointments at the Golden Jubilee Hospital did not indicate that they
can opt to refuse the offer. This issue would be raised at the next meeting as part of the
discussion to be held around Patient Focused Booking.
The Committee Agreed to consider this issue at its next meeting as part of the discussion
around Patient Focused Booking.
7
CTO ASSESSMENTS
The Committee considered an issue raised by Dr Guy Platten in relation to remuneration for
undertaking CTO assessments. Dr Proctor referred to NHS Circular PCS(DD)2006/2 which
set out the arrangements for remunerating GPs and Approved Medical Practitioners for
undertaking second medical examinations for CTOs under the Mental Health (Care and
Treatment) (Scotland) Act 2003 and which was agreed by the Scottish General Practice
Committee (SGPC). The fee of £177.18 was to have been uplifted annually however this
has not happened. The uplift of 1% this year was the first in three years. Claims for
payment of the fee should be submitted to the NHS Board. Dr Proctor advised mileage may
also be claimed; and single handed practitioners may be able to claim locum fees through
the Operational Units.
As this issue would require to be resolved at national level Dr Kennedy undertook to raise it
with SGPC.
The Committee Noted that Dr Kennedy would raise the issue of remuneration with the
Scottish General Practice Committee.
3
REVIEW OF PATIENTS’ FITNESS FOR PLANNED SURGICAL PROCEDURES
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Mr Cox raised an issue regarding patients who become unfit to undergo surgery, usually
quite near their operation date, and are taken off the list. He asked if there was some trigger
or mechanism in Primary Care to alert the GP to notify the consultant when the patient is fit
again for surgery. One suggestion was for the consultant to write to the patient asking the
patient to let them know when they are fit again. Mr Cox felt this would not be appropriate in
all circumstances, for example where vulnerable or frail and elderly patients are concerned.
It was felt this would be a growing problem as the population becomes more elderly with
more complex conditions requiring patients to attend various departments for different
elements of their treatment.
It was proposed that this issue be referred to the GP Sub
Committee for discussion and suggestions as to how this particular issue might be
addressed.
The Committee Agreed to seek the views of the GP Sub Committee as to how this issue
might be addressed.
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OWNERSHIP OF RESULTS
The Committee noted the issues raised by Dr David Gillman regarding ownership of results
and responsibility for following them up. Dr Watson indicated there was a specific issue in
relation to junior doctors who ordered tests and who had subsequently left the department
prior to receipt of results or had not given correct contact details. She advised that an
instruction is included in the induction pack for junior doctors that they should put the
consultant’s name on requests for tests and not their own name. It was also acknowledged
that junior doctors may order unnecessary tests. Dr Watson suggested there may be
opportunities for more work to be done in relation to laboratory services through the induction
process. In addition the implementation of OrderComms may help in part to resolve the
issues.
The Committee Noted the issues and the potential to improve the position through the
induction process and the implementation of OrderComms.
10
PRIORITY ACCESS SCHEME FOR EX-SERVICE PERSONNEL
During discussion of the issue raised by Dr Ball the Committee agreed that some clarity was
required regarding the operation of the priority access scheme for veterans, in particular the
SCI referral form tick box.
The Committee Remitted to the Chair to seek clarification on the issues raised from Donna
Smith, Divisional General Manager, Patient Services Division.
11
HIGHLAND HEALTH AND SOCIAL CARE COMMITTEE
Mr Cox reported on the meeting of the Health and Social Care Committee (HSCC) held on 4
July 2013. Topics discussed included the following:
An update on the establishment of the Professional Executive Committee, its role,
remit and membership.
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The proposed establishment of a sub committee of the HSCC which it was
understood would subsume the role currently undertaken by the Improvement
Committee in relation to scrutiny and monitoring of performance against HEAT
targets and standards. A point of clarification was sought regarding future
arrangements for Argyll & Bute in this regard, as the HSCC covered North Highland
only.
Suspension of admissions to nursing homes which did not meet the required
standards and the issue of duty of care to existing residents.
An update on the financial position.
The Committee Noted the report.
12
CLINICAL ADVISORY GROUP (CAG) UPDATE
Dr Somerville updated the Committee on the topics discussed by CAG at recent meetings
and ongoing activity and developments, noting work being done on repatriating patients
currently receiving out of area care. It was agreed that the minutes of CAG meetings would
be circulated to the Area Medical Committee for information.
The Committee Noted the update.
13
AREA CLINICAL FORUM MEETING 08 AUGUST 2013
There was circulated agenda for the meeting of the Area Clinical Forum to be held on 08
August 2013. Dr Kennedy confirmed that Oncology Services would be high on the agenda.
Dr Kennedy then spoke to the circulated report of the Area Clinical Forum which had been
prepared for NHS Highland’s Annual Review on 19 July. He explained that he had been
unable to attend the event and Rev Dr Derek Brown, Chair of the Nursing, Midwifery & AHP
Committee had chaired the Forum’s session with the Cabinet Secretary on his behalf.
The Committee Noted the topics for discussion at the forthcoming meeting and the
feedback from the Annual Review.
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GP SUB COMMITTEE REPORT
(a)
Report of Meeting held on 18 June 2013
Dr Ball summarised the topics discussed which included QOF Clinical Pathways, Preoperative Assessments in Primary Care, Care at Home and Medicines Reconciliation.
The Committee Noted the report.
15
ANY OTHER COMPETENT BUSINESS
15.1
Scottish Government Show Site – Medical Recruitment
Dr Watson advised that the medical recruitment section of the Scottish Government Show
Site was being updated and she sought the members’ views on how the content relating to
posts in Highland might be improved to make it more effective in attracting recruits to the
area.
A number of suggestions were put forward; members were asked to get back in
touch with Dr Watson with any further proposals.
5
The Committee Remitted to its members to forward any further suggestions regarding the
medical recruitment site content to Dr Watson.
15.2
Death Certification
Dr Watson referred to the new Death Certification scheme which would be introduced in April
2014 noting that there were a number of issues around the process and its practicality that
needed to be addressed. Dr Bashford undertook to ascertain the position and report back to
the Committee.
The Committee Noted that Dr Bashford would ascertain the position in respect of
procedures relating to the new Death Certification Scheme.
15.3
Schedule of AMC meetings in 2014
The following dates were proposed:(Tuesdays, 2.00pm)
 28 January
 25 March
 27 May
 05 August
 30 September
 25 November
The Committee Agreed the proposed dates.
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DATE OF NEXT MEETING
The next meeting will be held on Tuesday 24 September 2013 at 2.00pm in the Board Room,
Assynt House, Inverness.
The meeting closed at 4.15 pm
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