Download file - Northern England Strategic Clinical Networks

Name of Group / Meeting:
Renal Advisory Group
10 June 2014
2:30 pm
Academic Centre, James Cook University Hospital
Fiona Dallas, Clinical Director for Renal, North Cumbria
Peter Dixon, Senior Local Service Specialist, NHS
Will Horsley, Pharmacist, NHS England
Steven Kardasz (Chair), Lead Clinician, South
Tees/Northern England Strategic Clinical Networks
John Main, Clinical Director for Renal, South Tees
Ian Moore, Consultant, Sunderland
John Murray, Renal Consultant, South Tees
Linda Pickering, NKF Advocacy, NKF/BKPA
Rachel Tomlin, Network Delivery Lead, Northern England
Strategic Clinical Networks
Alison Brown, Newcastle
Dr Kalathil, South Tyneside
Bryan Yates, Northumbria
Sid Ahmed, Sunderland
Jonathan Perry, Northumberland
1.1 Welcome & Apologies
SK welcomed all to the meeting and apologies were noted.
1.2 Previous Minutes
The minutes of the previous meeting were accepted as a true
1.3 Action Points from Previous Minutes
 Terms of Reference
The Terms of Reference were agreed by the group. They will be
available on the NESCN website.
 CRG Update
SK gave an update; the service specification is to remain largely
unchanged however, there will be changes to the specification
regarding fistula targets. The group discussed the possibility of
using CQUIN in the future to incentivise their use. There are
likely to be some changes to the commissioning for holiday
dialysis the transplant wait is suspended for patients who are
away. The group would like data demonstrating those patients let
down by the service, excluding those that choose not to have
dialysis as there is no data at present. The CRG will meet again
in six months SK will keep the group updated.
 CQUINs & QIP – shared care
CQUINs: There was some discussion as to the nature and
purpose of CQUINs. PD to liaise directly with FD.
QIP: The CRG have discussed a potential dashboard for AKI
patients having dialysis. No meeting date yet.
2.1 Project Plan:
 Time to transplant listing
CW and KJ will lead on this project and will report back to the
group. They will focus initially on pathways and will be asked to
take account of numbers of live donors.
 ACEi advice to GPs
The guidance was distributed to GPs and was generally well
received. Amendments have been made following this feedback
and version 2 will be sent out and available on the NESCN
 Advice to MDs
The AKI guidance has been well received. There has been a
slight change to some of the wording within the guidance and
version 2 will be sent out and put on to the NESCN website.
 Guidance and e-alerts
JM reported that some work is being carried out nationally
regarding the barriers to an e-alert system. There is to be a
meeting shortly and JM will update the group as necessary.
 RRT in Critical Care
Isabel Gonzales from the Critical Care Network is initially
conducting this analysis.
 Network guidance
The group discussed the current Network guidance. SK will
review and update this and would like input from primary care.
SK and AF to prepare a letter from the Renal Advisory Group to
go to each CCG to ask for their involvement in this piece of work.
 CKD proposal
Alan Green, Academic Pharmacist Practitioner from Sunderland
has sent over a proposal for a project to determine where
pharmacists can intervene to improve the quality of care and
knowledge of patients at risk or with CKD. SK has sent a letter of
support and asked Alan to attend our meeting in the future once
he has some data to present.
 Pregnancy advice
The Renal Network will work with the Maternity Network to
 A letter for patients regarding the importance of not
becoming pregnant when on certain drugs.
 Contraceptive advice for those on these drugs.
 Pre- conceptual information for women wanting to have a
baby who are on these drugs.
IM volunteered to be involved with this project.
AF to liaise with LD, Network Manager, Maternity Network
regarding drugs and pregnancy national and regional work.
2.2 Commissioning
 Calcium V Non calcium
WH informed the group that the NICE guidelines have not
 EPOs
WH informed the group that there is some variation in the use of
these nationally and this is reflected in the Network with some
units using different products. It would be preferable if there was
consistency of use across the Network. WH asked for data and
volumes as this is for review in July 2015.
 Transplant Immunosuppressants
These will be prescribed in acute trusts from April 2015.
The group discussed this, in particular the time taken by
Pharmacy and the potential implications for patients.
 Phosphate binders
WH noted that in some areas the CCGs are not prescribing
phosphate binders in primary care. This is not a major issue in
the Network area as the CNTW Area Team has asked CCGs to
continue to deliver these drugs as per shared care agreements.
A letter has been send to all CCGs regarding the repatriation of
prescribing of post-transplant immunosuppressants. Copy
Enc 1
 Nocturnal dialysis – Stockton
This is a nurse-led service where patients attend for 7 ½ hours for
three nights. Early indications are that patients like the service
but it will be formally evaluated.
Newcastle is investigating the possibility of a satellite service in
Alnwick. This would be for one year initially.
2.3 Dialysis and Governance: blood borne viruses
Advice has been sought from the Liver Network regarding
patients with Hepatitis C. Patients do not need to be isolated but
should be treated by a trained and experienced nurse.
The group discussed travelling; It was noted that some patients in
the Leicestershire area are travelling with lines and infection rates
have been cut. SK informed the group that he has the list of high
risk countries.
2.4 Patient and Public Involvement
The group discussed whether transplant patients are reviewed for
skin cancer. In Sunderland patients are reviewed every year. In
South Tees patients are seen when a lesion is identified. IM
agreed to share the pathway with members.
2.5 Gelatine containing products
Fortium D3 and Renavit contain gelatine whilst HUX D3 does not.
It is important to ensure patients receive the correct information
so they can make an informed choice of product to use. SK to
share a letter with the group.
2.6 Feedback
 Renal Units
Not discussed – to be discussed at the next meeting.
 Commissioning
All items discussed previously.
 Network
Not discussed – to be discussed at the next meeting.
3.1 Clinical Governance Issues
None discussed.
3.2 Any Other Business
Website – The NESCN website will go live on the 16th
CCG TITO – letter to go to each CCG asking for a slot at
their TITO sessions.
NCRIN – not discussed.
Work Programme – RT to work with SK to complete this.
3.3 Date of next meeting
9 September 2014, 2:30 pm
Waterfront 4, Goldcrest Way, Newcastle upon Tyne, NE15 8NY