ENFIELD PRIMARY CARE TRUST Report: Minutes of Quality Improvement & Risk Committee No: EP 170/06 Date: March 2007 Summary: The Board is asked to note the Minutes of the meeting held on 7th December, 2006 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 Web: www.enfield.nhs.uk Intranet: nww.enfield.nhs.uk MINUTES 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 (Chair) 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 Ongoing 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 Board. 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 Trust 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 Plan 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 children. 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 period. 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 meeting. 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 Connections. 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 period. 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 examined. 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 date”. 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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