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									                      ENFIELD PRIMARY CARE TRUST

Report:         Minutes of Quality Improvement & Risk Committee

No:             EP 170/06

Date:           March 2007

The Board is asked to note the Minutes of the meeting held on 7th December,

Financial Impact:

Patient Perspective and Equality impact

Workforce and Training Impact

Monitoring Arrangements

Recommendation:       For information only

Submitted by:         Sally Johnson

Author:               Sally Johnson
                                                                      Holbrook House
                                                                     Cockfosters Road
                                                                         Barnet, Herts
                                                                             EN4 0DR

                                                              Tel:      020 8272 5500
                                                              Fax:      020 8272 5700

Minutes of a meeting of QIRC held on 7th December, 2006
Contact:                                  Tel No
Present:                Sally Johnson     M Webster          L Weeks
D Baker                 A Parsons         J Ohlson           L Walls
S Burt (obo P Kumalo)   B Stronach        Dr Durojaiye

1.0.       Apologies                                                         ACTION
           Dr B Fitzgerald; Dr A Mukhopadhyay; Dr U Okoli;
           Portia Kumalo; Kristy Leach; Steven Dixon

2.0.       Minutes of meeting of 5th October
           Accepted as an accurate record.

3.0.       Matters arising
           ESJ proposed that this would be the last QIRC meeting
           covering commissioning and provider side and from the
           new year there would be two separate QIRC meetings
           with different membership. KL was currently drafting a
           paper about this.
           3.0.       Violence to GPs
                      Sally was still awaiting a list of GPs to whom
                      this had happened.
                      Record keeping audit
4.0.       Assessment against Healthcare Commission
           Standards for 06/07
           LW and JO had met and discussed priorities. They
           were risk assessing targets and how to present to
           The two papers were to be sent to HD                      JO/LW
       Two standards had been “nearly met” and discussion
       ensued on how to ensure compliance, particularly
       through commissioned services.
       S. Beecham was currently drafting a template on
       changes and a meeting of NED domain leads was
       taking place in January.
       A draft declaration would go to January Board, with the
       final going to the March board.
       As this would all prove very challenging for the Provider
       side it was agreed that QIRC should continue in its
       existing form until the end of March to assist in meeting
       health check requirements on lst February.
       A letter would be sent to all GPs and optometrists        JO
       advising that they must comply with the regulations
       regarding disposable equipment. The operating plan
       states that EPCT would not be commissioning non-
       compliant bodies.

5.0.   Mandatory training
       No feedback as DF was not present.

6.0.   Feedback from Acute Trusts and Mental Health
6.1.   B & CFH
       C Diff – an isolation ward had been opened. AP to       AP
       check if it was a mixed ward.
       CNST assessment in January – reasonably confident
       Level 2 would be achieved.
       Breast screening services - Still no capacity plan in   UO/AP
       place. ESJ suggested that UO brief AP prior to
       meetings. She also advised that a feasibility study was
       being carried out to see if another provider could
       provide the breast-screening service. She would
       provide AP with a copy of her letter to Ruth Carnall.   ESJ

       NMUH – AP had not attended any meetings.
       BEH MHT – nothing to report.
7.0.   Children & Young People Risk Assessment / Action
       Working to build an integrated front line service by April
       lst 2007 which was proving challenging as staff do not
       wish to move from their current base. Consultation
       with stakeholders had yet to take place. There was an
       intention to reinstate the one and two year checks on
       The Clusters do not fit easily into the Children’s Area
       Partnerships (CAPs), which needed to be resolved.
       ESJ queried if this service was one the commissioners
       would wish to buy. LWI would be drawing up the spec
       and the core delivery requirements.
       By 07/08 extra income for teenage pregnancy services
       would be available.
       Working with LBE on meeting targets.
       Child protection and Safeguarding Children’s Board
       would be assimilated under this plan.
       ESJ felt major problems had been caused by moving
       services without talking to users. LWe responded that
       they had been consulted through the various
       Partnership groups, but that everybody wanted
       everything and we did not have the resources to
       provide this.
       BS also felt that there was a lack of co-operation from
       the staff involved. LWe confirmed that staff were very
       angry but she was holding regular meetings and
       managing the situation.
       ESJ asked who was responsible for pooling
       resources/budgets. LWa replied that a cross-Borough
       joint commissioning group would be dealing with this.

8.0.   NMUH – Complaints timescale for clearing backlog
       of X-rays
       In S Dixon’s absence, this item was again deferred.   SD
9.0.   SUI Schedule
       This report was tabled by AP and began as an informal
       log that had been started by UO and AP on Level 1
       incidents in primary care. AP aware that T Galloway
       dealt with other services incidents.
      ESJ and JO would prefer that all level 1 incidents be      AP/KL
      entered on one log and reported regularly to QIRC
      This to also include Child Protection cases. AP to
      discuss with KL
      AP had been trying to get more information on level 1        ESJ
      incidents from the Mental Health Trust for at least 3
      months. ESJ agreed to speak to J Newbury-Helps
      about this and also request that AP receive the report
      that the MHT receive.
      LW asked for fuller information about the                     AP
      deaths/assaults ie were they justifiable, did they cover
      both Enfield and Haringey etc?
      MW suggested that AP discuss with Imelda or Bryn
      Shaw if no clarification was received from MHT.

10.   Monitoring of SAB System
      AP was monitoring this system to seek assurance that
      the system was running effectively and was robust.
      Information had been shared with patient services.
      Patient safety would become a standard item within
      QIGS. AP had received feedback from some 30% of
      independent contractors, possibly because there was
      less ambiguity about what was required.
      AP proposed to next scrutinise Estates and Facilities.        AP

11.   Qtr 2 Incident Report
      MW apologised that she had sent the incorrect paper.
      She felt the department should be more pro-active on
      chasing responses.
      LW advised that her staff had completed Datix forms,
      but they were not shown on the register which made
      her question if they had been sent forward.
      MW went on to report that there had been a slight
      increase in incidents in Learning Difficulties service,
      which she was informed was due to change of clientele
      Dr Durojaiye asked if an assessment was carried out
      on the level of incidents, matched against patients.
      S Burt replied this was not always easy as many things
      change when new clients arrived.
      ESJ asked that new arrivals be plotted for a short            BF
        SB advised that links had been made with comparable         BF/SB
        services to benchmark the level of incidents and this
        would be reported back to QIRC.
        MW suggested she run reports on individual clients for       MW
        the LD service to examine in detail
        Slips, Trips and Falls had reduced.
        Forest Group Practice – had problems with phone –            JO
        only one line available. JO would check with other
        practices to see how they overcame this.
        BS queried the fraud incident on the report and MW           MW
        advised she would bring the full report to the next
        Incident of sexual abuse in Learning Difficulties –
        Police did not wish to take any action at this time. Both
        clients had seen Consultant Psychiatrists and were
        continuing to be seen. The alerting system was felt to
        work well.
        AP suggested a link with NPSA be established as part         AP
        of one of our compliances in the Safety domain. Also
        proposed there be a patient safety section in Primary
        She felt it would also be helpful to compare local
        number of incidents with national numbers.
        There had been an access problem at Enfield Island
        Village when the ambulance could not get through the
        barrier – seeking resolution.
12.     Reports from Sub-Committees on unacceptable
        risks (15+)
12.1.   Locality - Enfield North
        LJ reported there had been no meeting since the last
        QIRC. However, there was still disquiet about the
        removal of HVs with the high possibility that children
        may not get their vaccinations.
        ESJ repied there was a system that highlighted if a
        child had not been vaccinated so there should be no
        fears on this matter. She felt the GPs were perhaps
        annoyed that there had been insufficient consultation
        prior to the changes to the service and that this was
        their main concern.
        The Trust was seeking to target the most vulnerable
        children, not just hold clinics for the sake of it.
        JO pointed out that there were also staff shortages in
        the service that was exacerbating the problem.
        LD was continuing to collect evidence of abuse for          LD
        Sally to take forward with the Police.
        JO requested a list of the practices that had advised       LD
        they would not be using disposable equipment.
12.2.   Locality – Edmonton
        FPCC - JO felt that the risk rating of 12 against the
        telephone problems was too low. A patch had been
        installed but this had not solved the problem.
        There had also been a power outage during which
        vaccines had been lost, as the new fridges were not
        capable of maintaining temperature over an extended
12.3.   Locality – Southgate
        No-one in attendance to report.
12.4.   Learning Difficulties
        Incidents in this service had been discussed earlier in
        the meeting.
        Member of the public assaulted – Sally felt that the       SB/BF
        comment about “not following Trust policy but
        apologising immediately” was an incorrect
        interpretation of the policy. To be investigated.
        Broken front door at Warwick – ongoing.
12.5.   Children & Young People
        Largely discussed earlier (see point 7)
        A nurse had now been appointed for Waverley School.
12.6.   Clinical Audit & Effectiveness Group
        Still risks around record keeping training but hopefully
        this was improving.
12.7.   Corporate Risk Group
        Has been disbanded.
12.8.   Health & Safety
        Risks around premises move and potential injury to
        staff. Two porters would be engaged if necessary.
12.9.   RASH – ESJ asked that it be minuted that this report        JB
        was never available in time but always tabled.
         JO felt the register was very negative as did BS. She      JB
         asked if it was suitable to submit to the Healthcare
         Commission in its current state and suggested it be
         written more appropriately.
         Access to services continues to be a problem due to
         lack of staff and telephone. PK working with Dr Pitroff
         to produce a paper to present to Directors.
         HIV services – concerns that positive results were
         being found at maternity clinics, but if the pregnancy
         was terminated there was no follow-up for the mother.
         ESJ felt this showed a requirement to change the
         service as we need to match the service provided to
         demand. SB advised Care Pathways were being
         Condoms – AP was asked to check with Sexual Health         AP
         team where supplies of these should be sent as there
         was a stock-pile in stores that may shortly be “out of
         48-hour target – where services have a target to deliver   ALL
         it should be reported within the risk register and
         identified risks clearly grouped within it.

12.10.   Infection Control
         No report received and no-one in attendance to report

13.0.    Clinical Governance Annual Report
         The report was taken as information. AP thanked all
         those who had contributed.

14.0.    Date of next meeting
                     12.30pm -lst February 2007.

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