MANAGED CLINICAL NETWORK

FOR DIABETES

Lead Clinician Diabetes – Dr Andrew Gallagher

Diabetes MCN Co-ordinator – Carsten Mandt

Diabetes MCN Steering Group

Minutes

Monday 10thSeptember 2012, 4pm

Room 2.16A, Victoria ACH

Present

Bernadette Campbell (BC) / Primary Care Support Nurse
Mary Cawley (MC) / Clinical Psychologist
Anne Cochrane (AC) / Primary Care Support Nurse
Andrew Gallagher (AG) / MCN Lead Clinician (Chair)
Helen Jack (HJ) / Dietetic Manager
Brian Kennon (BK) / Consultant
Fraser MacLeod (FM) / MCN Primary Care Lead
Carsten Mandt (CM) / MCN Co-ordinator (minutes)
George Marshall (GM) / Patient Representative
Lindsay McKechnie (LM) / Specialist Dietician
Barbara Ann McKee (BM) / Community DSN
Marion O’Neill (MO) / Health Improvement Lead
Colin Perry (CP) / Consultant
Anne Scoular (AS) / Public Health Consultant
Sheila Tennant (ST) / Prescribing Support Pharmacist

Apologies

Ian Donald / Patient Representative
Dorothy Farquharson / Patient Representative
Carl Fenelon / Clinical Pharmacist
Stephen Gallacher / Consultant
Maurizio Panarelli / Consultant Clinical Biochemist
Eleanor McColl / Service Delivery Manager, HIT
Cath McFarlane / General Manager
Alan McGinley / Diabetes UK
David McGrane / Consultant
Karen Ross / Planning Manager
David Sawers / Service Manager, DRS
Mike Small / Consultant, Gartnavel General
1. / Welcome and Apologies
Apologies were accepted from those noted above.
2. / Minutes from Previous Meeting
These were agreed as an accurate record.
3. / Matters Arising
None.
4. / Group Updates
Audit: The Audit Group have been comparing local data with Scottish Diabetes Survey (SDS) results to identify the reasons behind issues with biochemistry recording in SCI-DC Network. It has been suggested that these issues are due to a communication problem between labs systems and SCI-DC Network.
AG added that the Deputy Chief Medical Officer has written to all Health Board Chief Executives to highlight key achievements and areas for concern from the SDS in their area. A response is being drafted to detail the actions that are taken to address the issues that have been highlighted.
Ethnicity and Inequalities: BChighlighted key areas that the group is exploring basedon the initial analysis of inequalities data from the LES and KeepWell. She highlighted the links with the KeepWell South Asian project and the MELTS service. AS explained that the South Asian Anticipatory Care project has been very successful in engaging South Asian patients. A qualitative and quantitative evaluation is currently being undertaken which will inform how the project is rolled out more widely within KeepWell.
BK queried if there was a resource to have the‘keto card’ for Type 1 patients translated into other community languages. MO suggested that this could be progressed via the local accessible information officer; details are available from the accessible information website.
Inpatient: CP updated the group on progress with the Think Glucose pilot. Data so far shows a fall in the number of hypos and management of hypos has been improved. No impact on length of stay has been demonstrated. On balance the data does not yet support a business case for adopting Think Glucose Scotland wide. More funding has therefore been made available to extend the pilot by 6 months.
AG asked what the key success factors have been in the pilot to date. CP replied that senior management, especially nursing management, buy-in has been crucial. AG also queried how the approach may be adapted if Think Glucose is recommended for roll out in an amended form. CP suggested that this may include a focus on diabetes assessment early in the patient flow, safe use of insulin, insulin prescribing in the ward pharmacy domain, and amending the tools used in Think Glucose.
AS asked CP if the approach was shown to be cost effective. CP suggested that this was not entirely clear as staff costs are high on the one hand but if an impact on hypos and length of stay can be shown significant savings are possible.
CP also mentioned that work is ongoing to create a single prescription chart for GGC which would improve patient safety. Work is under way to develop a chart for NHS Scotland but output from this is still some way off so development of GGC chart in the interim was seen as worthwhile.
Patient Education: CM informed the group that the T1DM and T2DM patient education groupsare in the process of developing education pathways to describe the ongoing provision of education for patients along the T1 and T2 patient pathways.
Audit data on the current provision of patient education is also being reviewed. This has confirmed that overall attendance for DESMOND is poor. AS suggested that the reasons behind poor uptake should be explored if it is lower in GGC than elsewhere. CM pointed out that GGC is now the only area in Scotland to deliver DESMOND. AS proposed that Public Health should look into this in more detail and it may be beneficial to cover diabetes patient education explicitly in the LES review paper she is drafting.
BK added that patient education needs to be evaluated more rigorously to provide assurance that it is effective in making patients understand the key components of good diabetes care.
BM pointed out that the provision of ongoing education for Type 2 patients is a significant part of ensuring effectiveness.
Primary / Secondary Care Interface: FM informed the group that work to look at Type 1 patient care is currently on hold until the implementation of SCI-Diabetes as SCI-Diabetes is expected to address the data inconsistencies between SCI-DC Network and Clinical that had previously affected this work.
Jean Hannah is progressing work to define a template for a diabetes review of patients in residential care. AS mentioned that South Glasgow is reviewing the model for nursing home care generally, which should be linked to Jean Hannah’s work.
Guidance on the process for initiation and follow-up of GLP-1s is being drafted.
Staff Education: CM updated the group on the development of diabetes staff training. This has been running very successfully but promotion of courses has not been sufficiently effective. BK suggested that motivational interviewing should be part of the course curriculum. MO pointed out that a 1 hour session on motivational interviewing techniques is already being delivered through the health improvement team.
Transitional Care: BK pointed out that space is now available at Yorkhill to providetransitional care clinics with input from both paediatric and adult teams. However, while adult consultant input has been identified, there is still a question mark over adult DSN and dietitian input. LM confirmed that support for transitional care is a priority for dietetics.
Also, it has been suggested that it would not be possible to sustain separate transition clinics for each adult centre. Instead the proposal is to have north and south transition clinics although this model has not yet been agreed by all services in GGC. It was agreed to highlight this with Cath McFarlane. / AS
BK
5. / SCI-Diabetes Update
CM informed the group that the first phase of the SCI-Diabetes ‘road rest’ has been completed successfully. The second phase is now under way. User training is being arranged to take place during October with a view to going live with SCI-Diabetesin November, assuming a satisfactory outcome of the ‘road test.’
6. / Expectation of Footcare
BK updated the group on the response that had been received from the LMC regarding the expectation of care document and proposed changes to the delivery of diabetic foot care. He highlighted the key concerns that were raised by the LMC and asked for comments on how to respond to these concerns. He will also raise these issues at the next MCN Foot Group meeting for comment. Based on these discussions BK will draft a response back to the LMC.
Key issues include the use of SCI-Diabetes for recording foot screening and the potential roll out of a joint retinal and foot screening service although funding of such a service is an issue as funding for foot screening and risk stratification is provided to general practice as part of QOF. AS suggested that there are new negotiations for a Scottish QOF, which provides an opportunity to perhaps include such a joint screening service and stipulate the use of SCI-Diabetes for recording foot screening.
AC pointed out that Practice Nurses have voiced concerns over the lack of time to carry out foot screening. She will raise this at the Practice Nurse Forum. She also asked if there was an expectation that community podiatrists would carry out opportunistic screening. BK confirmed that this is the case. / BK
AC
7. / Patient involvement Event
GM provided a summary of the planning to date for a joint event between the MCN and DiabetesUK, focussed on achieving better, wider engagement of patients and carers in the MCN. CM added that initial discussions of the possible programme centred on workshops being themed around key priorities from the MCN wok plan. Latterly, it has been suggested to focus the programme on the Clinical Services Review and the discussion of the emerging new model for diabetes services in GGC. The group endorsed this approach.
8. / Clinical Services Review Update
AG mentioned that a process mapping session took place to start developing the key themes and possible solutions for a new diabetes service model to feed into the overall Clinical Services Review (CSR). The various CSR workstreams have now also presented their case for change. On the basis of this the detailed models will need to be developed over the coming months. The MCN will continue to feed into the chronic disease management work stream.
9. / AOCB
BC informed the group of work on a polypharmacy strategy, led by Noreen Downes. She will share the draft strategy via CM for comment.
MO flagged up that a review of community weight management services is now being undertaken. She asked the group to forward any issues or comments on weight management services to be fed into this review. / BC/CM
10. / Dates of Future Meetings
10/12/2012, 4pm, Gartnavel General, Board Room

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