item 4.2 Perth & Kinross Acute & Primary - NHS Tayside

PERTH & KINROSS CHP
ACUTE AND PRIMARY CARE INTERFACE GROUP
Action Note from the above meeting held on Tuesday 17 April 2012 at 3.15pm in the
Boardroom, Perth Royal Infirmary.
Present
Mrs Angela Ferns, Primary Care Manager, P&K CHP Primary Care
Dr Kenneth Fowler, Consultant Radiologist / Tayside Radiology Clinical Leader. Perth
Royal Infirmary
Dr John Harper, Lead Consultant Physician, MFTE, Perth Royal Infirmary
Dr Neil McLeod, Lead GP, Perth & Kinross CHP
Dr Morag Martindale, Lead GP, Perth & Kinross CHP
Mr Bill Nicoll, General Manager, Perth & Kinross CHP
Apologies
Dr Alan Connacher, Consultant Physician, Perth Royal Infirmary
Mr Jamie MacLean, Consultant Orthopaedic Surgeon, Perth Royal Infirmary
Dr Stuart Johnston, Lead Consultant Physician, Perth Royal Infirmary
Dr Alison Morrison, MacMillan Consultant in Palliative Medicine, Perth & Kinross CHP
Dr Andrew Russell, Medical Director, NHS Tayside
Mrs Julie Flynn, Head of Primary Care, Perth & Kinross CHP
Dr Alan Shepherd, Consultant Physician, Perth Royal Infirmary
Dr Werner Pretorius, Consultant Psychiatrist, Murray Royal Hospital
Dr Brian Singer, Consultant Orthopaedic Surgeon, Perth Royal Infirmary
For Information
Mrs Evelyn Devine, Head of Older People Services, Perth & Kinross CHP
Ms Siobheon Reid, Lead Clinical Pharmacist, Perth Royal Infirmary
In Attendance
Mrs Louise Paton, PA to the General Manager & Clinical Director
Dr Morag Martindale in the Chair
1. Welcome and Apologies
Dr Martindale welcomed everyone to the meeting. As the meeting
was again inquorate, Dr Martindale took the opportunity to discuss
various issues, which have been recorded under agenda items and
Any Other Business.
2. Draft Minute of 20 March 2012
To be carried forward to next meeting. LP
3. Matters Arising
3.1 4/4.1 / Feedback from Previous Work/Primary Care –
Test Results –Should GPs have the contact details for Specialised
Nurses?
Additional discussion on patients being asked to contact GPs for test
results brought agreement that this direction to patients was not
ideal .The main issue is responsibility for advising of test results,

particularly for imparting bad news, when the GP contacted by the
patient may not be the patient’s GP, and crucially therefore, does not
know the patient.
3.2 5.5/1 Areas for Improved Liaison between GPs and Consultants
/Discharge Letters
Dr Martindale had taken the GPs views on discharge letters to the
FY1 meeting on 4 April. She resumed the discussion on this key
issue at this meeting.
Siobheon Reid advised on the latest EDD (Electronic Discharge
Document) which is currently held as the final discharge letter. It
appears that when the pharmacist signs off the patient’s drug list a
copy of the discharge summary is forwarded to the patient’s GP.
However, if the patient’s discharge is then delayed, it is no longer
the final letter, thus highlighting the difficulty in identifying the final
letter, which incorporates vital information on the patients’ drugs for
the GP. A discussion took place on the naming/marking of
discharge letters and the alternative documents/systems in place
which contain accurate drug information. This issue will remain on
the agenda for the immediate future as we monitor and modify the
document.
4. DVT
A discussion around DVT protocol was sought by Dr Martindale from
her clinical colleagues, together with their thoughts around the
introduction of a new drug, Rivaroxiban which is replacing Fragmin
and may replace Warfarin in some cases. DVT pathways exist for
Angus (rural) and Dundee (city). Perth and Kinross is the only CHP
to have both urban and rural areas and so one system may not be
suitable for all patients.
Discussing same/next day scans, Dr Fowler confirmed that 7 days
scans are for In-patient Services only, not GPs use.
Siobheon Reid confirmed that Rivaroxiban(20mg 2 x day) is being
introduced as the new acute/first drug for DVT in Tayside. Change
over from Fragmin is not anticipated to cause any difficulty for
patients, and it was agreed, the new drug will be easier to take and
manage. The future supply of Rivaroxiban in the community is being
discussed.
Colleagues concurred with their approval of the new drug – passed
by the SMC – as being easier to use, and will be the new standard
acute DVT drug across Tayside.
Ms Reid will keep Consultants and GPs abreast of the guidelines
and introduction on the drug, which is expected to be in use in Perth
Royal Infirmary within a month. Full information will be
communicated to clinicians, and GPs advised of changes to
patients’.
5. Out-Patient Prescriptions
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Dr Martindale raised her concerns on the patient instruction on the
out-patient prescription envelope regarding the current timescales in
which drugs can be collected. Patients frequently present at their
surgeries on the same day as their out-patient appointment to
request a prescription for the drug recommended by their specialist.
This can cause some confrontation. It was suggested that the
wording on the envelope could be changed to make it clear that the
prescription could be collected within 2 working days. Because there
are proposed changes to out-patient communications it was felt that
it may not be sensible to make this change.
Siobheon Reid to discuss with SCN Joan McKenzie, Outpatient
Department.
6. Post-operative Advice
Following surgery, patients are provided with leaflets on potential
post-operative expectations/situations, and advice on what to do in
the event of feeling unwell etc. Dr Martindale pointed out when
patients phone in post-operatively, this information would be most
useful to GPs. SCN Alison Robertson, Ward 1, would be able to
assist.
7. AOCB
7.1 Draft Minute of 18 January 2011
To be carried forward to the next meeting.
7.2 Terms of Reference
To be carried forward to the next meeting.
7.3 Acute & Primary Interface Group
Asked about the time and frequency of the meetings
scheduled for this group, colleagues confirmed their approval
of the current arrangements.
7.4 Stroke
Bill Nicoll spoke of delays reported in scanning and
thrombolysis in acute settings. In response, Dr Harper spoke
of the endeavours of Dr Priya Nair, SPRI, MFTE, to motivate
A&E staff to minimise delays, but would discuss this possible
logistical matter with her.
Also all GPs should be aware of the Stroke Pathway for
Perth Royal Infirmary, It was suggested that this would be a
good topic for PLT training, and should include practice
receptionists.
8. Date of Next Meeting
8 May 2012 at 3.15pm in the Boardroom, PRI
Please forward any agenda items to mmartindale@nhs.net.
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