Name of Group / Meeting: Date: Time: Venue: Present: 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 England 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 Apologies: Alison Brown, Newcastle Dr Kalathil, South Tyneside Bryan Yates, Northumbria Sid Ahmed, Sunderland Jonathan Perry, Northumberland MINUTES 1. INTRODUCTION 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 record. 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 Enclosure 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. PD QIP: The CRG have discussed a potential dashboard for AKI patients having dialysis. No meeting date yet. 2. SPECIFIC ISSUES ARISING 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. AKI  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 website.  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. RT CKD  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. SK/AF RT/SK  Pregnancy advice The Renal Network will work with the Maternity Network to develop:  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. IM AF to liaise with LD, Network Manager, Maternity Network regarding drugs and pregnancy national and regional work. AF 2.2 Commissioning  Calcium V Non calcium WH informed the group that the NICE guidelines have not changed.  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 attached’. WH 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 IM 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. REGULATORY 3.1 Clinical Governance Issues None discussed. 3.2 Any Other Business  Website – The NESCN website will go live on the 16th June. www.nescn.nhs.uk  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 4. MEETING CLOSE SK