Matters arising.

Additional Steering Group members

Peter Twist
AN approached Peter Twist who has agreed to join the Steering Group [SG] although he will not be able to attend the monthly meetings as he already has commitments on the set meeting dates.

Message from Peter Twist below:
“As regards your request for me to become a member of your Steering Group, I regret that the remainder of the 2009 dates are already committed in my diary. However, I will be pleased to receive notes of your deliberations and provide any useful contributions by phone or email. Do remember the PPE sub committee of the London HIV consortium which I chair. I know Elisabeth will keep us updated. These are exciting times which offer us an opportunity to influence the provision of HIV care for the next decade or longer.”

Westminster GP
Thanks to RA who has identified a GP who is interested in joining the group. She is currently on leave and will be sent project papers on her return.

Westminster Primary Care Commissioner rep on the SG.

Garry Alessio has now left NHS Westminster.

Due to a lot of pressure on Westminster Commissioners at the present time [working on numerous LESs (about 31)], there will not be a commissioner on the SG for now. However, RA will liaise with the commissioners re: the project as well as feedback to the Access Choice project. [TORs attached.]

PD asked if there is a patient rep on this group and asked RA to feed back to the group that he and Gary (GW) [Wharfside patients Rep] strongly recommend that there be a patient rep on that group.

Project Manager’s Project Update
also see...

2 focus groups for GPs are planned for early December. The project manager will liaise with RA on these focus groups.

RJ suggested the project manager contact GP champions to support the recruitment process, in addition to writing to them and going through the quarterly GP meeting suggested by Dr Andrew Steeden. Both ST and EC supported this suggestion as GP champions are influential and will ensure buy in/engagement of fellow GPs.

AN to follow up with RJ and AS re: Engaging GP champions

Presentations
Paul Decle – patient rep for the Frontline Patients Forum

PD presented a survey that was carried out with patients from the Frontline which looked at, amongst others, patients concerns about using GPs and what model of care they prefer.

102 patients completed the survey [download report].

Main areas of concern were:
Confidence – patient’s lack of confidence in GPs ability to treat their HIV
Convenience – patients not happy with the forced fractionalisation of services
Cost -
Communication – information flow between clinic and GP not always smooth. Also how safe is information being moved about. Will Electronic Patients information be accessible to other people not involved in patients care?
Training - Important for GPs to be updated. This includes attending relevant conferences and getting access to upto date information on HIV, [which would be easily accessible to them if based at the HIV clinic]. However, attendance has dropped from Chelsea and Westminster HIV awareness training courses, how then will GPs be kept updated? There is also the cost to consider as when a GP attends a day’s training then a locum has to be brought in to cover. Ongoing support needed included: refresher courses; workshops; conference feedback etc –which would be naturally available at the clinic.
E-support websites, email lists and internet chat rooms.

64% of the patients preferred the GP in the clinic model. Main reasons being convenience –easy mechanism to guide patients to best care givers; central point of care; confidence in level and quality of support available in the clinic.

Recommendations
E-support
Electronic patient records- who would have access? Local, national, individual treatment areas.
Cost – investigate the potential for one GP to cover two hospitals – reduced overheads, sharing costs between NHS Chelsea and Westminster – if GP were to be shared between St Mary’s[Imperial College NHS Trust] and Chelsea and Westminster NHS Trust.
Benefit to continuing research – specific data sets could be easily collected and analysed; GP and HIV consultant could effectively support each other with complex cases
Recognition that for many patients the HIV clinic is the centre of their world; it will be hard for them to build that level of long tem relationship with GPs

Patients do recognise the need for cost effective services.

Other discussion

HIV and aging
ST – need to ensure that any models the project explores are future proof. Also consider that conditions such as Cardiovascular disease and diabetes are not always going to be treated in acute care.

Commissioners need to explore seamless care pathways round shared care. They also need to be creative and flexible based on patient needs.

Other points raised
Shared care already happens in other areas and they aren’t always perfect. Example given of a patient with respiratory condition who needed be referred to an expert and who had experienced fragmentation, so HIV not exclusive.

Communication between HIV clinics is also not always easy – so not just the case between hospitals and GPs.

Shared care already happens and it’s important that issues raised by patients are recognised in order for the right decisions to be made.

ST – we cannot predict the future however it is generally accepted that acute services are more experienced in dealing with HIV than those in the community.

Presentation

Dr Steeden presented on:
The changing place of primary care and the person living with HIV.[download presentation]

He then led the group in a discussion around the pros and cons of two of the main care models.

Results:
Hospital Service with Resident GP

Pros

• Holistic
• Quicker Access
• Removing duplication
• Time/finance
• Confidence assured,
• Good communication
• Responsibility for location of care
• Expertise of GP
• Effective care

Cons

• Lack of integrated services and other agencies
• Home visits

Polysystems/New SP services

Pros

• [Same as Hospital & GP service but in a different setting]
• Holistic Quicker
• Access
• Removing duplication
• Time/finance
• Confidence assured, communication
• Responsibility for location of care
• Expertise of GP
• Cost effective
• Effective care
• Home visits

Cons

• ?Home visits
• Possible variance

[AS suggested that results be put up on the project website in order for the Steering Group to continue the discussion].

Discussion

After the presentation, a discussion followed which included:

A need to look at what incentives GP need in order for them to be interested in joining LES
Also raised was the issue of how sustainable the model of having a GP in HIV clinic would be.
Models proposed could include aspects of the two models.
The group acknowledged that there is a general awareness that community services do lag behind the HIV services, and as such there was a general consensus that there was a need to re-skill some GPs as some had been de-skilled in particular where most of the care for the patient was provided at acute services.
We also need to acknowledge that the DH [Department of health] is working on improving the quality of health care.

Commissioning HIV services
CF confirmed that Commissioners are looking at services review with the scope around how to address the primary care news/issue. CF also confirmed that the direction of travel is very much towards polysystems.

AOB
Project timeline
ST reiterated that the project report needs to be ready in time to fit in with commissioning intentions in March. [Please see PP presentation on PCA project on project website, also circulated to Steering Group with August meeting notes].

Steering Group suggested that any models proposed be piloted first.
ST commented that the original Project Initiation Document [PID] did not include a pilot; however, if that is what the Steering Group wants, then it should be made clear in the project proposal report in order for the PCT to consider the best way forward.

Other discussion
PD asked ST re: the possibility of the PCT funding pilot research projects. ST clarified that the PCT is not able commission such projects.

PD – suggested the group invite someone from Diabetes patient group to present to Steering Group – re: how shared care works with diabetes patients.

Donm
Thursday 26 November 2009

Speakers:
Dr John Walsh - Imperial College NHS Trust
Dr Laura Waters – Chelsea & Westminster NHS Trust