SCOTTISH SOCIETY OF GASTROENTEROLOGY
MINUTES OF COUNCIL MEETING
22nd JANUARY 2010
ROYAL COLLEGE OF PHYSICIANS OF EDINBURGH
In Attendance
Dr Peter Mills
Dr Ewan Forrest
Dr John Wilson
Dr Alastair MacGilchrist
Dr Tim Reilly
Dr Jonathan Fletcher
Professor Peter Hayes
Dr James Rose
Dr Perminder Phull
Dr Ian Penman
Mr David Anderson
Dr Alan Clark
1.
Apologies
Apologies were received from Dr Kel Palmer, Dr James Cotton and Mr Grant Fullerton.
2.
Previous Minutes of Council Meeting September 2009 & Business Meeting November 2009
These minutes were reviewed and, other than some minor amendments, were approved. Dr MacGilchrist raised
the issue of a guide for local hosts of the summer and winter meetings. A booklet of “how to host the SSG” is
hopefully to be produced in time for the winter meeting 2010. It was noted that the local host from the winter
meeting, Dr Henry, had managed to obtain a very reasonable price for the abstract booklet and contact details of
this printers will be made available to future hosts. Action: Secretary to obtain information from Dr Henry
and early draft of information from Dr MacGilchrist.
3.
Matters Arising
a)
ISD Definition of New Patient
The President, Dr Peter Mills, has been actively involved in discussions with ISD regarding the classification
of patients who attend outpatient clinics after having had an upper GI endoscopy. The recommendation from
the SSG was that all outpatient endoscopy procedures should be recorded as day cases and, that new
referrals who are fast tracked to initial endoscopy, should have the subsequent outpatient consultation
classified as a new patient rather than as a return patient. The ISD Definitions Liaison Group, due to meet in
January 2010, has to formally ratify these proposals however the document from Anne Leigh-Brown who is
the Head of Data Intelligence Group at ISD can be used as justification of local hospital records
departments to ensure that the appropriate changes in classification are made. The Secretary proposes that
Ms Leigh-Brown’s document is made available to all the hospital contacts of the SSG. Action: copy of
document to be forwarded to hospital contacts.
b)
National Endoscopy Database
The Unisoft Users Group has not met for 3-months however the plan is to merge this group with the National
Endoscopy Group chaired by Dr Ian Penman composed of GRS and local endoscopy leads. The intention of this
merged group is to meet with ISD regarding the coding of endoscopies. It was felt that the Unisoft based
data is more reproducible. It is understood that the only Health Board in Scotland not using the Unisoft
database is Shetland. A comparison of ISD data and the Unisoft data will identify the disparity in endoscopy
coding. It will also allow more accurate assessment of the 30-day mortality and re-admission rates after
endoscopic procedures. However if the Unisoft data is to become available to ISD, it will also be open to the
Freedom of Information Acts and therefore the decision for such data to be made available has to be taken
at Board level.
Dr Reilly noted that the Unisoft Programme has a problem with “crashing” due to incompatibility with other
local software and this had led to a loss of confidence in the system in some areas. Similarly Dr Mills noted
that the quality of the images remained poor but again this seemed to vary between different health areas.
It was pointed out that eHealth has accepted that Unisoft is a national system and therefore should be
eligible for support from local IT. It was also indicated that the Unisoft Advisory and Endoscopy Group has a
remit to try and improve the database and, that locally the GRS lead (or delegated individual) can be
contacted regarding suggestions for the database.
Mr Anderson noted that in many areas there was a lack of Unisoft facilities in emergency theatre which leads
to a loss of recording of activity as well as meaning that clinically important endoscopic procedures are not
being recorded.
c)
Alcohol Bill
The deadline for written evidence to the Scottish Parliament was the 20th January. The SSG didn’t make any
specific submission but Dr MacGilchrist, through the Royal College of Physicians in Edinburgh, has been
involved in the drafting of a comprehensive document which has been submitted giving medical support for
the bills proposals.
Many members of the Society, including council members, had submitted the letter to their area MSP’s and
were able to engage in discussion with politicians from all parties on this subject. There is a sense that there
is hopefully a ground swell of political opinion moving towards the bills proposals. It was noted in particular
that English politicians appeared to be more in favour of the proposals, as opposed to the Scottish Labour and
Liberal Democrat Parties who have currently expressed their residence to these measures.
4.
Consultant Workload
Dr Allan Clark gave a comprehensive presentation of trends in consultant workload. This presentation will be
attached to these minutes for further consideration. The subsequent discussion focused upon the validity of the
data presented, how exactly to use the data which we have and lastly, how to link this data with manpower
planning.
It was noted that there were significant gaps in the data but ISD has not indicated any current intention to fill
these gaps. There were some remarkable disparities regarding the number of returns and inpatient episodes.
There was also discussion as to whether this data should be published. It was felt that the data should be
reviewed by council members in the first instance, and that perhaps Dr Clark should present the data to the
summer meeting of the SSG. Dr Stewart Campbell will be approached regarding integrating this presentation into
the meeting.
The feeling was that the purpose of publication would be to identify that the data itself was flawed and therefore
there needed to be an improved method of collecting consistent data throughout Scotland. It was also felt that
although some of the individual data may be inaccurate, overall trends were apparent and that these could be used
to identify areas of significant under resource. In any publication it was felt that it would be reasonable to give
some indication (or flag) the degree of confidence the council had in the statistics presented.
Dr Wilson suggested that it might be possible to offer half a salary to ISD for one year for someone to be
specifically employed to obtain details of individual gastroenterologist’s job plans with relevance to their
endoscopy and clinic commitments, and to ensure that the data collection for each Health Board was robust. It
was felt that the best way of addressing the flawed data was to work with ISD rather than in opposition to ISD.
It was also recognised that the consultant data had to be updated as there had been a series of recent new
appointments. Action: Dr Clark’s presentation to be distributed to Council members for further
consideration. Secretary to contact Dr Campbell about including a presentation on this subject at the
summer meeting.
5.
National Liver Plan
The national liver plan has been published with the recent appointment of a national liver “czar” Dr Martin
Lombard. The document presented to the council has shown a dramatic increase in liver related mortality in the
United Kingdom, however only 10% of gastroenterologists describe themselves as hepatologists and there are only
16 hepatology training slots in the United Kingdom. The impression however was that the “national liver plan” had
very much an Anglo centric focus and that it had to be put more clearly into a Scottish context. The plan has
approval by the Department of Health and therefore the Scottish government has to respond to it. The main
proposals were that each hospital should have a clinical lead in hepatology. This should be a managed clinical
network in hepatology. There should be assessment of access to any local intensive care facilities and the
relatively low transplant rate should be addressed. In addition, it was felt that other areas of concern were
access to alcohol support services and adequate pathology and radiology support services for hepatology.
It was acknowledged that the Scottish government are already putting a significant investment into chronic
hepatitis C and alcohol services. However further meetings with Aileen Keel the Deputy CMO, should continue.
There have already been approaches to the Deputy CMO by Professor Hayes and Dr MacGilchrist.
Dr Rose indicated that there should be minimum standards of care for liver patients in Scotland. The Secretary
proposed that hospital contacts be asked to answer a short questionnaire regarding liver facilities in their
institution in order to inform the discussion with the deputy CMO.
It was also proposed that Dr Martin Lombard be asked to speak at the SSG and perhaps this might be best
planned for the winter meeting being hosted by Dr Andrew Bathgate. Action: Proposed Liver services
questionnaire to be circulated to Council. Dr Bathgate to be approached to allow Dr Lombard to speak at
the Winter meeting.
6.
Scottish Inflammatory Bowel Disease Interest Group
Presented to the council were the minutes of the Scottish Inflammatory Bowel Disease Interest Group from the
30th September as well as a list of membership. It was acknowledged that Dr Gaya has been very active in
establishing this interest group with a view to creating an effective MCN.
The SSG remains very supportive of this development.
7.
SSG Website
The SSG website remains “live” although not currently up to date or effectively populated with relevant news.
The SSG still has an account with TAQT.co.uk (formally ChequeBase). TAQT have agreed to add relevant
documents to the website. For the website to be effective however it has to be up to date for members to
access relevant information relating to the speciality and to the society itself.
The Secretary will identify specific members of the council to provide documents for publication.
It was accepted that there would be some information which should be available to council members and perhaps
ordinary members of the society only. This would involve the creation of a password system. This might include
the minutes of the council meeting and any documents in draft form awaiting approval or comment. Action:
Secretary to approach relevant Council members for contributions to website.
8.
Future Meetings
The next meeting is to be held on Friday, 4th June at Strathclyde Hilton Hotel hosted by Dr Stewart Campbell.
Speakers include Dr David Hawkins talking about the interface between genitourinary medicine and
gastroenterology, and also Albert Breadenoord who is an international expert in GI physiology. Dr Andrew Duncan
(consultant biochemistry) has requested an opportunity to speak about a Wilson’s disease assay, and the meeting
also has facilities for a breakout session for the GI physiologists. The GI physiology component of the meeting is
to be co-ordinated by Dr Winter. The winter meeting is to be hosted by Dr Andrew Bathgate in Edinburgh. The
date suggested currently is the 16th December. There was some discussion however that this was a Thursday
which may not be particularly convenient for many members and there were concerns that the dinner may be
poorly attended. It is recognised that the winter meeting will be a joint meeting will be a joint meeting with the
hepato-pancreatobiliary MCM and, as previously noted, Dr Martin Lombard will be asked to present regarding the
National Liver Plan.
Action: Dr MacGilchrist will speak to Dr Bathgate further about the proposed date of the meeting.
9.
Research Update
Professor Hayes was able to confirm that the TOPIC study continues to be active. Recruitment has been less
than anticipated but it is hoped that with expansion to other centres, that the study will be successful. There
was a plan for a study of autoimmune pancreatitis to be carried out. Professor Hayes will contact Dr Church
regarding this study. There was uncertainty about the progress of the childhood inflammatory bowel disease
study organised by Professor Wilson. It was understood that the OASIS study did not receive adequate funding.
The HTA funded STOPAH study in alcoholic hepatitis is due to start in the near future. This is awaiting CSP and
subsequently NRS approval and support. As an eligible study, it should be able to access local R&D support for
both research nurse and pharmacy costs.
Professor Hayes noted that the NIHR CLRN research network was well established in England. In Scotland the
liver representative is Professor Hayes and the luminal gastroenterology representative is Professor Jack
Satsangi. Scotland is reasonably well represented in the database of studies largely on account of the PSC and
PBC sampling study being co-ordinated by Drs Bathgate and McGilchrist in Edinburgh. However it was felt
appropriate that the data regarding recruitment studies from Scotland should be available and may well be
suitable for publication through the SSG website.
10.
Gastroenterology Training
There has been a dramatic reduction in trainees. It is thought that over the next 5-years there will probably be
5 posts throughout Scotland per year. This year there are 3 “closed” posts with 6 applicants, with interviews due
to take place in the middle of February. It is felt there may be one or two “open” posts available later in the year.
It was emphasised the importance of keeping lapped posts open to ensure that funding remains within the
speciality.
There have been some difficulties in providing adequate endoscopy training courses for our trainees in Scotland.
One of the main difficulties is getting an adequate faculty to commit to these courses. Dr Morris at Glasgow
Royal Infirmary has suggested that each trainer should commit to 2-3 courses per year to maintain an adequate
standard.
Information regarding courses is usually available through the JAG and JETS websites. Recently both Glasgow
Royal Infirmary and Ninewells Hospital have been removed from the site as they did not have current JAG
accreditation. This is currently being addressed and it is expected that both sites will feature again on the
website in the near future.
Dr Reilly noted that funding should be available for trainees to attend course as these are mandatory
requirements. He also indicated that perhaps funding would be available to allow trainers to attend these courses.
11.
BSG Matters
Dr Phull presented a document on re-validation and was hoping for feedback relating to those aspects specific to
gastroenterology. There was no specific deadline for such feedback but comments would be appreciated from
council members. The re-validation document will be attached to these minutes for consideration.
Action: Secretary to ask Hospital Contacts to provide basic information regarding the availability of out of
hour’s endoscopy.
There was some discussion regarding the role of the devolution group of the BSG. It was felt however this group
had a rather indefinite role with no clear terms of reference. It was felt that further discussion was required
regarding the presence of a Scottish representative on this group but no firm conclusion was come to.
There was also some discussion regarding bowel cancer screening. It was noted that the level of support provided
to the pilot project was not available for the National Screening Programme. In particular there was a significant
lack of feedback to those colonoscopists involved in the programme. Dr Penman indicated that he would contact
the screening programme directors on behalf of the SSG indicating the societies concerns.
It was also highlighted that the deadline for BSG committee members was due on the 5 th February. Action:
Secretary to e-mail SSG members to ensure that there is an adequate Scottish representation on these
groups.
12.
National Endoscopy Issues
Dr Penman indicated that the combined JAG QIS visits were due to start initially in the Highlands and then the
Grampian regions. There have been some difficulties in getting adequate numbers of assessors although it is felt
that in the first instance that some assessors will come from England. The visits will take the form of “pre-JAG”
visits however if the unit is found to have only a few minor inadequacies then the visit will be regarded as a full
visit with the requirement for only a minor review thereafter.
There has been some discussion the quality assurance of individual colonoscopists. The remit is for endoscopy
units to be assured rather than individual colonoscopists. However some, including Professor Steele from Dundee,
have emphasised the importance of an individual’s performance. In due course this may become the standard for
assessment.
There was some concern that for some endoscopy units in Scotland there may be a lack of “drivers for change” as
there is probably not an effective sanction should a unit be found to be below standard.
13.
Finances
Dr Wilson was able to report that the society remains solvent.
There was some discussion regarding what should happen to funds derived from the sponsorship from the local
meetings. Historically the local organiser has solicited funding from pharmaceutical companies. If there was any
excess then it was accepted that this money may be used by the local organiser for a departmental or research
fund. However the SSG has always be in a position to provide funds to ensure a meeting is set up adequately
ahead of funding from pharmaceutical sponsors and would always be in a position to cover any loss.
However it was recognised that on some occasions there was a significant excess in sponsorship and the discussion
was as to whether this excess should be given wholly or partly back to the SSG. If the SSG is to take on a more
active role with more modern forms of information dissemination such as the website, then adequate funding will
be required.
Rather than increase the subscription, it was felt that perhaps some of the profit from a local meeting could be
re-directed back into the SSG account. This was felt to be more appropriate if the SSG itself was active in
helping to solicit this funding. Dr Wilson suggested this might be a role for the treasurer. A final conclusion was
not reached however the trend of the discussion was that if the SSG was to be involved in obtaining sponsorship,
it should at least benefit from a certain percentage of any excess funds.
14.
Composition of Council
There remains a vacancy for a trainee representative. Four trainees have expressed interest and abbreviated
CV’s are awaited from them before asking filler trainees to indicate their support.
Action: Dr MacGilchrist to provide a document indicating the dates that council members joined the council
as re-election may be required.
15.
AOCB
There was some discussion regarding the prescription of oral bowel cleansing. Recent recommendations have
suggested that this should not be prescribed without an up to date set of U&E’s and assessment by the
prescriber. This of course would have a significant impact upon straight to test colonoscopy. As yet a universal
solution has not been identified although one suggestion was that GP’s should be obliged to indicate the eGFR on
the referral form for a patient with GI symptoms which may require colonoscopy. Experience form Ayr Hospital
indicated that face to face pre-assessment of patients for colonoscopy did not help.
The newsletter is now available for distribution however it was felt that in the future this should probably be
done either through the website or by e-mailing members.
16.
Date of Next Meeting
As the council meeting had overrun this time, there wasn’t a full discussion regarding the next council meeting and
opinions will be solicited from council members with the distribution of these minutes.
Action: Council Members to decide date of next Council meeting.