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,
Patient Perspective and Equality impact
Workforce and Training Impact
Recommendation: For information only
Submitted by: Sally Johnson
Author: Sally Johnson
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-
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
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
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
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
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
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
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.