CORONARY HEART DISEASE (CHD)
MANAGED CLINICAL NETWORK (MCN) PROJECT BOARD
Minutes of meeting held at 5.30pm on Thursday 2 February 2006 in the
Conference Room, Summerfield House
Present: Dr Malcolm Metcalfe, Chairman, Lead Clinician CHD MCN and
Mr Sandy Reid, Network Manager, CHD & Stroke MCN
Mr Alastair Ramsay, Public Representative
Mr Andrew Dickson, Public Representative
Ms Caroline Hind obo Prof. George Downie, Director of Pharmacy &
Dr Deepak Garg, Consultant, Dr Gray’s Hospital, Elgin
Mr Graham McKenzie, AHP
Ms Heather Kelman, General Manager, Aberdeen CHP
Mrs Irene Anderson, Asst. Services Manager, CHD & Stroke
Mr Roddie Wood, Public Representative
Mrs Christine Gray, Secretary
In Attendance: In attendance (by video link) - Dr Grays - Andrew Fowlie, General
Manager, Moray Health and Social Care Partnership and Tony Collins,
Member of Public Representative
1. Welcome and Apologies
Apologies from: Mr Clark Paterson, Mr El-Shafei Hussein, Prof. George Downie,
Ms Jackie Bremner, Dr James Black, Ms Joy Groundwater, Mr Mike Crilley, Dr
Robert Liddell, Ms Roberta Eunson and Dr Stephen Walton
2. Minutes of CHD Project Board MCN on 1 December 2005
3. Matters Arising
(a) Northern Region waiting list monies – Dr Metcalfe to report
Dr Metcalfe stated that the Scottish Executive had approved the revenue bids for
North of Scotland Region funding.
From Capital funding half a million pounds would be spent to construct two new
catheter laboratories in Aberdeen and one in Inverness basing services around
them. Plans were on target.
A discussion then followed regarding a visit by Dr Metcalfe, Sandy Reid and
Jim Black to Highland Region in December last. The minutes had not been
received from Inverness regarding this visit and it was agreed that Sandy would
pursue this matter. SR
North of Scotland Regional Development Lead
Sandy reported on this item. See Appendix 1 attached paper from David
(b) Clinical Lead for MCN
Since the last CHD Project Board meeting it now transpired that NHSG wished
the Clinical Lead for MCN post be advertised and an interview process to take
place to keep in line with correct NHSG procedures. Sandy had currently
drafted a job description. Dr Metcalfe had also heard talks that the post of Lead
Clinician be combined with a Head of Service role. Dr Metcalfe stated that it
would be too big a job to take on for one person and likely to result in a conflict SR
of interest as the MCN should not be seen to be intiately involved in one aspect
of the service. Public involvement members suggested they volunteer to write to
NHSG and express their concern regarding the double role if this would help.
However, it was decided to leave the matter at this stage, as it could just be
(c) Quality Assurance
Sandy was currently working on the Quality Assurance document. Formally this
document had not been submitted anywhere yet. Once completed Sandy would
submit the document via NHSG to Quality Improvement Scotland.
Allied to Quality Assurance was data collection. Currently there was a (Scottish
Care Information –Coronary Heart Disease) SCI-CHD Data Collection Working
Group (co-ordinated by Lynne Buttercase, Operational Project Manager, Clinical IA/GMcK
Technology Centre, Ninewells Hospital, Dundee) – the first meeting had been in
January at Stirling and the Group were looking into a database which had
compatibility with patients based in England. Currently at Aberdeen Royal
Infirmary Richard Carey had secured funding for data collection for coronary
care patients however, funding was due to run out at the end of March 2006 and
Data Collection staff could be made redundant if another source of funding was
not identified. Elgin confirmed that currently they did not collect data for acute
coronary care syndrome. It was agreed that Irene Anderson and Graham
McKenzie would meet to ascertain whether the SCI-CHD group would be
willing to give funding for data collection both at Aberdeen Royal Infirmary and
Dr Grays Hospital, Elgin.
It was also agreed that Irene would see Deepak to give him a copy of the database IA
currently used at ARI.
(d) Fraserburgh Practical Health Project
Sandy reported that he had made enquires as to how this Project was developing.
Although it got off to a slow start it was now up and running and was successful.
Based in schools in Fraserburgh to raise awareness on 4 topics: Healthy Eating,
Exercise, the Environment and the Family and the Community. The Project was
Lottery Funded and they would not be seeking future funding via the MCN.
Therefore it was agreed that this item could now be taken off the agenda. The
Project were required to submit reports on progress to the Big Lottery and Sandy
would be updated and could let the Project Board know what was happening in
future if necessary.
4. MCN Finances – Mr Clark Paterson
Apologies were made from Mr Clark Paterson who was not able to attend the
meeting. Clark would hopefully give an update at the next meeting.
Current ARI Catheter Laboratory – Graham McKenzie reported that
refurbishment of the existing catheter laboratory at ARI would commence shortly.
Funding for this would be from this financial year. The mobile laboratory would
ARI Catheter Laboratories (x2 new) – Graham reported that three potential
suppliers had been shortlisted and had been asked to make a costing for their work
at the ARI site. They were all invited to visit ARI to give a short presentation. A
decision would be made (before the end of March 2006) as to which supplier
would be successful in securing the contract and the order placed during this
financial year. Once work on the first new laboratory had been completed, the
second new laboratory would be constructed. Dr Metcalfe pointed out that an
essential component was a system which could widely display dynamic cardiac
images from both ARI and partner hospitals. Doubt has been expressed that the
SEHD approved Kodak system is capable of doing this and Graham has been GMcK
asked to ensure that this is the case. He had emailed Scottish PACS Board
(Picture Archiving and Communication System) to ascertain those sites where this
system was currently being used and to see whether it would be worthwhile to use
Dr Gray’s Hospital, Elgin – Malcolm stated funding was available which could be
carried over into the next financial year to carry out the refurbishment work at Dr
Gray’s Hospital. Disappointment was expressed at the delays in this being
5. Charity Establishment and Events – Mr Sandy Reid and Mr Andrew Dickson
(a) Sponsored Golf Tournament – Andrew reported on his plans to hold a sponsored AD/SR
Golf Tournament. The sponsor’s competition to be played on Friday 18 August
and the qualifiers final to take place on Sunday 20 August 2006 at Westhill Golf
Club. The format for both would be shotgun start followed by meal and prize
giving. For the sponsors competition he was looking to get all 18 holes sponsored
at a cost of £250 per hole (Teams of three). He hoped to raise between £15,000 to
£20,000 and wished Grampian Public Health Department to be involved. Andrew
was liaising with Sandy on this matter and would keep the Board updated.
(b) Forming of a New Charity – Malcolm and Sandy would be meeting with Mr
Robert Paton, Chairman of Cardiac Rehabilitation Sub Group and a member of
Grampian Cardiac Rehabilitation Association on 15 February next in order to
investigate further the forming of a new charity. It was suggested that one of the
members of the MCN Project Board to be elected as a member of the Charity.
Should GCRA become the MCN charity then they would have their independence
but at the same time could link in to the MCN for suggested future fundraising
events e.g. the Easter Charity Ball etc. Andrew stated that he knew of some oil
companies who would be keen to be involved in funding raising but it was agreed
to form the new charity in the first instance.
6. MCN Grampian CHD Event – 29 March 2006
The CHD MCN Seminar would take place on Wednesday 29 March 2006 at the
Thainstone House Hotel, Inverurie from 11am to close following a two-course
luncheon scheduled at 13.15pm. Invitations had now been sent out and three
sponsors had agreed to joint fund the Seminar. The purpose of the Seminar was to
celebrate the successes of the MCN to date, facilitate further MCN networking
and agree priorities of the MCN for 2006/07.
7. Public Involvement Meeting, 20 January 2006 – Sandy Reid to report
(a) Sandy reported that Louise Peardon and Nicola Cotter from Chest Heart and
Stroke Scotland (CHSS) had been invited to a meeting on 20th January 06. Project
Board members had also been invited. The purpose of the meeting was to explore
what public involvement work was going on within CHSS and to see whether it
would be worthwhile replicating across Grampian. Key points from the meeting
included, (1) the group were now more aware of the CHSS Advice Line. (2)
CHSS were also piloting a “Hearty Voices” venture involving members of the
public being trained and given confidence to work alongside health professionals
etc. Sandy was considering for a representative to attend one of these Hearty
Voices sessions to see whether it would be worthwhile establishing in Grampian.
The outcome of the meeting was that the CHD Public Involvement Sub Group had
been re-formed and the next meeting was set for 28th February next to explore
Document – “Learning from Patients and Carers” – Irene Anderson was working
alongside Roddie Wood to take forward the comments in the document for
improvement in the CHD service.
8. CHD MCN Project Board Sub Groups
Community Cardiology Outpatient Project
David Anderson Building – clinics continued to work well. The chest pain
waiting list has now reduced to <3 weeks. Arrangements had been made on 14
February 06 to interview an interested candidate for the GP with Special interest
Kincardine – Stonehaven was on target to commence OP clinics. However there
was building work in January so clinics would commence in February. Several
GPs had expressed interest in the GP with Special Interest in Cardiology post,
which was not advertised as yet.
North Aberdeenshire – on target. It was planned to commence clinics at Peterhead
in April 2006. It was noted that 2 GPs were interested in the GpwSI post.
Moray – A GP had expressed interest in the future proposed Special Interest in
Cardiology post. Space still being identified.
Heart Failure Sub Group
Karen Simpson had submitted a report – see attached Appendix 2.
Tony Collins expressed concern regarding some heart failure patients being
discharged from ARI and titration of drugs not being carried out by GPs when the
MCN’s aim was for equity of service throughout Grampian. A discussion
followed. Malcolm reassured Tony that patients who remained on the lower dose
would still be gaining some benefit even though they had not been up titrated. It
was agreed however that the matter would need to be addressed. Once the Heart MM/CH
Failure Guidelines were on the website etc., education exercises with GPs could
be carried out to address this problem. It was suggested Malcolm meet with
Caroline Hind and Andrew to make GPs more aware of this matter.
Cardiac Rehabilitation Sub Group
Alastair Ramsay reported. Currently the Sub Group were looking at their aims
and goals and reviewing membership to define who should be on the “core”
membership list and who would be “volunteer” members. Alastair would be
producing a paper on the outcome to be submitted to a future Project Board
(a) BNP – Malcolm reported that on 1 February he had held a meeting with Bernie
Croal, Consultant Clinical Biochemistry, Bill Simpson, Clinical Biochemistry, a
representative from Pharmacy, Graham Hillis, Senior Lecturer in Cardiology and
Jim Black to ascertain whether it would be worthwhile instigating BNP testing –
to weigh up the costing considerations and benefits. Graham Hillis would be
undergoing a research programme to see if BNP could avoid Echo. They would
be working out the costings and look into the matter further.
(b) Echocardiograms – it was noted that requests for Echos had been increasing – in
fact Radiology requests had doubled within the last six months and there were
currently not the resources to deal with this matter. Echos were needed however
to fulfil part of the GMS contract. There was currently no answer to this problem
although BNP might be useful. Elgin currently had the same problem. Some
suggestions were to train a GP to perform Echos. Alternatively employ a whole
time Consultant (non invasive) who would specifically carry out Echos. This is
currently the favoured option and a group under the chair of Jim Black is looking
into this. A particular concern is that Professor Weir has brought his retirement
forward to end April this year which is a year sooner than expected.
(c) BHF Funding
Alastair Ramsay reported that he had approached the British Heart Foundation
requesting funding for heart failure nursing training e.g. diploma courses etc.
However his request had been turned down.
(d) CHD MCN Newsletter – January 06
Deepak Garg pointed out that the Newsletter suggested that waiting list times in
Elgin were improving whilst this was not the case.
10. Date of future meetings
Thursday 6 April 2006 at 5.30pm in Summerfield House
Thursday 1 June 2006 at 5.30pm in Summerfield House
Thursday 3 August 2006 at 5.30pm in Summerfield House
Thursday 5 October 2006 at 5.30pm in Summerfield House
Thursday 7 December 2006 at 5.30pm in Summerfield House
CARDIAC SERVICES: BRIEFING NOTE
A National Delivery Team for cardiac services has been established involving the National
Waiting Times Unit, the CCI and a representative from each regional planning group. Paul
MacIntyre a Cardiologist from Argyll & Clyde is the National Clinical Lead. The Group is
chaired by Mike Lyon from NWTU. I am the North of Scotland representative. (I believe we
should review this in the near future in the light of other regional developments in cardiac
services but there needs to be some continuity at present).
The NDT has approved the bids submitted by the NoS as set out in the attached letter. The
funding has been allocated on a non recurring basis for 2005/06 on the understanding that
recurring allocations for 2006/07 will be included in regional delivery plans.
Although specific reference is not made to it, the bids included a session for a Clinical Lead
for the NoS Network and a part-time Project Manager (to be shared with NHS Highland to
help them develop their cath lab).
The NoSPG reviewed a draft job description for the Clinical Lead at the meeting on 25
January 2006 and this will now be circulated for consultation and agreement. The
appointment will be made by the Medical Directors hopefully with Paul MacIntyre’s input as
an external assessor.
In terms of the revenue funding for 2005/06 it has not been decided how to distribute this ie
directly to individual Boards or through a host Board. Boards can however now implement
proposals in line with the bids and I will confirm the financial arrangements as soon as
In terms of capital – for technical reasons NHS Grampian will draw down the capital this
year (net of the NHS Tayside and NHS Western Isles allocations) and NHS Highland in
2006/07. Some additional capital may be available this year through slippage and if so NHS
Grampian will use it to offset costs of the Aberdeen labs which will also benefit other NoS
Boards in due course.
The 2005/06 funding is allocated on the understanding that there will be no patients outwith a
16 week target for coronary artery bypass by 31 March 2006. We should be able to achieve
this through the NoS arrangements but if not we may need to use Golden Jubilee.
Funding for 2006/07 will only be made available against a Regional Delivery Plan yet to be
developed. There was a good deal of discussion about the content of a Regional Delivery
Plan at the last NDT. From a NoS perspective I felt there was a danger of it becoming overly
prescriptive and bureaucratic and in an attempt to influence the content and process I have
agreed to produce a template/guidance note for the next NDT meeting in late February. I will
need help and intent to consult/involve/share drafts widely.
Similarly, there has been much discussion regarding modelling capacity and demand and
various suggestions about national approaches. We have already done much good work in
the North to underpin the business case for the cath labs and Ros Watkinson will therefore
develop a spec for the individual work and offer some direction for the other two regional
The CCI want to establish a “national collaborative” for cardiac services appointing a
National Programme Manager and 3 Regional Facilitators. The line taken so far is that we
have not supported this approach for the North of Scotland. Experience suggests the
Collaborative model is somewhat rigid and bureaucratic and we would prefer a more flexible
approach that recognises different areas are at different stages of development. We would
welcome the additional capacity/resource but would suggest that would be better used to
support our existing local and emerging regional networks. There is a danger of duplication
Given the work that has been done at local and regional level, we are in a strong position to
influence the national agenda. It is important that we keep the momentum and begin thinking
about proposals/content of the Regional Delivery Plan for 2006/07. I will try to keep the
lines of communication open through briefing notes such as this for the local networks and
the regional cardiac services sub-group.
Finally the NoSPG agreed that Roger Gibbins will convene a small sub-group of the planning
group to sign off the cath lab business case in the interests of time and momentum.
30 January 2006
Cardiac Failure Subgroup Report for MCN Meeting 2 February 2006
Gradual increase in referrals over the last few months, although the referral numbers from A.M.U. and Woodend
Hospital have been limited. Both Karen Secombes and Dr Hannah are arranging further presentations in both these
areas to address this. All areas have copies of referral pathways and contact numbers. Monitoring of referrals
Community clinics have been established in Kincorth, Peterhead and Fraserburgh. Progress has been made in
developing peripheral clinics in Aboyne, Banchory, Stonehaven and Bucksburn. Room availability is a significant
issue in Stonehaven due to the number of peripheral clinics running at Kincardine Hospital. The long term aim is to
try and develop the cardiac failure clinics to run along side the peripheral cardiology clinics, if feasible.
Patients have often been admitted to hospital and their cardiac failure mediation has been stopped, especially
beta-blockade. The group are looking at developing medication cards to be put on their hospital records to highlight
the patient’s involvement with the cardiac failure team.
The vacancy for a nurse in the city has been filled and Caroline takes up her post on 7th Feb. 2006.
Cardiac Failure Guidelines
The guidelines require a couple of minor changes before they will be approved by the guidelines and policy group.
The aim is to look at developing a web based resource which will be accessible by both primary and secondary care.
Ideally the guidelines would be located with the other clinical guidelines on the Grampian intranet, although there
is currently funding issue with NHSG and no further information is being developed in the clinical guideline pages.
In the interim, the guidelines with be placed on the MCN website and an electronic copy will be forwarded to all
The cardiac failure nurses are all continuing with the diploma course in Glasgow.
The nursing team are meeting in February to develop a strategy for Primary care education. Some G.P. Practices in
rural areas are not involved in protected learning time, and this needs to be taken into account in the strategy.
Grampian is proposed to become the centre of excellence in telemedicine and the group will be looking at ways that
we could use this technology in developing the service. This may involve both education sessions and/or patient
Within General Practice many of the key clinical areas are linked with the new GP contract. Currently, the only
indicators for cardiac failure are running a register, ensuring diagnosis confirmed on echocardiogram and the use
of ACE-I/AG-2. Currently, there is limited information on how this will change in the next few years. The Group is
aware that there are many patients with cardiac failure who are stable and therefore currently not reviewed by
the cardiac failure nursing team and have not been commenced on beta-blockade. This is potentially a large
workload. There is also some concern around titration of medication when patients have been discharged or seen
at clinic. The Group will be looking at care pathways which might help address these issues.
The Group is looking at ways to link with other nursing teams, including palliative care and cardiac rehabilitation, to
provide a more integrated care pathway for the patient.
Dr Karen Simpson