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Q&A minutes
Sarah Poole Will the tier 2 have ability to initiate antifibrotics or will that still come form the hub?
LS Tier 2 can prescribe through blueteq only allowed when standards have been m,et. LS has had commissioning meetings recently NW have forms to complete to make sure that criteria for prescribing have been met and specialist centre satisfied standards have been met.
Tier 2 sites that want to prescribe should discuss through tier 3 virtual MDT when they want to prescribe important that tier 3 sites certainly for the first year
The 3 ICBs going live with tier 2 prescribing as of april NW, East of England and midlands. Unlikley to be live for another year in other areas. The forms will need to be developed
Sophie Ryder
Has come for a tier 3 to probably tier 1 or 2 resp centre in terms of competency for nursing and AHPs how will we support staff to come up to a tier 2 standard. Ill we have a scheme for education or a competency standard?
MN Yes, we are looking at developing this starting with CNS and then other health professionals. An email has been sent out requesting job plans and business cases. Host a quarterly meeting with charity, commericial and charity partners to make sure we are representing everyone’s requirements.
LS There may be no competency framework but the care is already going on and being delivered in other areas of the country very well and these have been established by nursing teams supporting tier 2 centres. LS nursing team have a monthly MDT with tier 2 sites
Nurses run network meetings several times a year with nurses and AHPs from tier 2 centres for teaching and trouble shooting. Interested staff should work towards gaining competency.
Tier 1b sites could become tier 2 sites with the right infrastructure and support.
MN concerns about tier 1 and tier 2 getting in loer banded HCPs to increase tier status and competency frameowrks would support developement.
LS you need a band 7 nurse for at least a signifcant part of the week there is a role for a band 8 nurse in spec comm centres and at least band 8a pharmacist in spec comm centres. Tier 2 centres need at least band 7 for clinical seniority and leadership.
Ahmed
Can you email slides?
Is there any support from NHSE for tier 1b who would like to become tier 2? Minimum number of nursing and pharmacist from NHSE would help centres applying for business cases given financial climate?
LS has asked lots of people about financial situation there is no money to support any of these services or pathways. Cancer pathways and acute medicine pressures do have some funding but there is none for ILD. LS has met merseyside commissioners who have confirmed no money. There has been no money and centres became established because interested clinicians lobbyed locally and within trusts for financial support to run these services. ICBs told to look at whole pathway and not ust isolated parts of it. Environmental impact of people not having to travel should be included in any business case. You need to look at one voice slides.
Sharla
Good afternoon, thank you for the update. what competencies/standards are required? we are very close to being a tier 2 site.
LS there are forms that you have to fill in and you are assessed against certain criteria –do you have an MDT? Have you got an experienced radiologist? Have you got specific ILD training? Do you have a dedicated clinic? Do you have dedicated nursing staff?
Any centre that prescribes will have to provide dashboard data to NHSE to demonstrate you are meeting quality standards and delivering similar standards of care to commissioned centres.
One of the sticking points for smaller hospitals might be getting pharmacy infrastructure and support for homecare and blueteq. Some centres have found it easier to get nursing support.
One of the hospitals will be prescribing and request will come through Aintree hospital but they will need pharmacy time to support immunosuppression
Sandra Olive
Do you have any new tips on the right metrics that tick the right boxes. We are so focussed on the drugs but there are a huge cohort of patients who require nursing care but don’t actually need antifibrotics.
LS There is no set of standard data, nobody has written down that there should be so many nursing hours to support a set of patients. In terms of data – Can we look at rheumatology as a model? New referrals? Ne antifibrotics? New immunosuppression? Numbers of patients who you retain monitoring. Nurse phone call contacts
If we can get X number of patients looked after closer to home that will save X CO2, what is the environmental impact of patients travelling? Patient time saved? Patient money saved in fuel and car parking? You can’t put a price on the satisfaction that patients get from good care delivered close to home.
Anon
In COPD and Asthma, there are high value protected treatments and interventions that are promoted via a disease management bundle; this is interrelated with relevant commissioning structure.
Have high value treatments been considered in the ILD commissioning pathway?
LS has tried since 2015 to get tariff or bundle for ILD but there has never been appetite to support this. Looking forward if pathway is in place and it is accepted and implemented, we will need to assess whether people are meeting the targets. ILD is a small part of respiratory and the NHS and it can be difficult to garner support.
Stef Cormack
Thanks Lisa, I wonder if you could speak to the appetite from NHS England on driving/supporting these changes in England, and also how insight from patients has driven or benefitted this work?
LS Hasn’t spoken to NHSE since pathway published but sure the commissioning team who have been involved and engaged in the process. It is a fantastic piece of work and great that APF and OV ILD have published this
Patient engagement and APF will be able to outline the patient engagement with the pathway.