In April 2019, the Panel met and discussed:
- Gluten free prescribing
- Urgent and Emergency Care Programme 999 Ambulance Calls - Diversionary Pathways
- Hyper Acute Stroke Patient Leaflet for Review
In relation to gluten free prescribing
Rob Wise, Head of Medicines Management for Bassetlaw CCG and lead for ‘over the counter’ (OTC) workstream gave a short presentation providing background for the project and led a discussion with panel members.
Nationally the Department of Health undertook a consultation in 2017 and then agreed to recommend a limit to the prescribing of gluten free products to just bread & mixes (and no other gluten free foods).
In South Yorkshire and Bassetlaw, four areas (Barnsley, Bassetlaw, Doncaster and Rotherham) currently all have similar recommendations regarding prescribing of gluten free products, i.e. to follow the outcome of the national consultation and only prescribe bread and mixes.
- Barnsley has gone a little further in that it restricts the recommended amount of bread and mixes prescribed to 8 units per month.
- Bassetlaw, Doncaster and Rotherham are following the Coeliac Society recommendations for the number of units of bread and mixes prescribed (an example is that this can be up to 18 units per month for a male aged 19-59. 18 units is equivalent to 8 x 400g loaves of bread).
- Sheffield consulted in 2017 and restricted the prescribing of ALL gluten free products to adults, including bread and mixes.
Conversations are now taking place in South Yorkshire and Bassetlaw about whether it is fair to local patients that where they live dictates what they can get on prescription.
It is recommended that the CCGs for Barnsley, Bassetlaw, Doncaster, Rotherham and Sheffield undertake public engagement to gather public perceptions on potentially changing the prescribing of gluten free products in some parts of the region so that it is all inline and ensures equity of access to products
The CP members felt it was important that all local areas prescribed the same and it not being a postcode lottery. They felt it should be about equity rather than cost saving.
Equity of accesses (making things equal) is a fundamental principle of the NHS, particularly if going down to the lowest option without a safety net. Further consideration should be given to rural areas where they would struggle to get products from their local store. There needs to be more signposting to online websites and companies that deliver.
Members asked questions on:
- Level of need for gluten free
- The national position
- Differences between gluten intolerance and coeliac disease
- Reaction to newly introduced changes in Sheffield and reaction of local people
- Consideration of social care aspects that can potentially offer support if items are withdrawn
In relation to Urgent and Emergency Care Programme 999 Ambulance Calls - Diversionary Pathways
The Yorkshire Ambulance Service (Yorkshire and Humber) receives 1 million 999 calls per year. In
South Yorkshire approx. 320,000 999 calls per year circa 62,000 (19.4%) don’t go to hospital.
Benchmarking in terms of national policy requirements and expectations:
•Urgent and Emergency Care National Strategy – “up to 50% of 999 calls can be managed at the scene”
•NHS Operational Plan for 19/20 – “increase rate of ‘non-conveyance’”
•NHS Long Term Plan – boosting out of hospital care, improving clinical advice out of hours and to care homes, increase number of 999 callers that don’t get to hospital (appropriately)
Some key areas were highlighted to the panel in terms of respiratory (particularly during winter demand), care homes and mental health. This work is being undertaken in association with the Academic Health Science Network.
Members asked questions on:
- Elements that need to be considered to provide more support to patients and paramedics to avoid hospital attendance
- Experiences of calling 999 and being taken to hospital
In relation to Hyper Acute Stroke Patient Leaflet for Review
This year (2019) anyone who has a stroke in Barnsley, Bassetlaw, Doncaster, Rotherham or Sheffield will be taken directly to: Doncaster Royal Infirmary in Doncaster, The Royal Hallamshire Hospital in Sheffield or Pinderfields Hospital in Wakefield for this first part of their care. All of these places provide 24/7 specialist care and clot-busting treatments for people who have had a stroke and have highly skilled, specialist staff available.
Members were presented with a patient leaflet for the regional Hyper Acute Stroke Service. The leaflet has been prepared with feedback from the Stroke Association and has had input from many partners and groups. The group provided constructive feedback in terms of the language used and the flow of information.
The group were informed that the leaflet would only be received by those who are taken for this specific treatment and when not taken to their nearest Hospital (e.g. Patients from Barnsley, Rotherham and Bassetlaw). They were advised that their comments would be taken into consideration as it continues to be developed and assured it will be ‘reviewed’ by future patients alongside a Stroke Nurse.
In term of the design it will be considered by the stroke aphasia group (a stroke can affect one’s ability to find the right words, to understand what others are saying and/or reading and writing) who will advise on the visual layout and design. A comprehensive communications plan will support general awareness rising around the hyper acute stroke service in SYB.
It was agreed that the Panel would not meet in May.