Hepatology Working Group

Membership of Group

To be completed

 

Protocols

Recommendations for management of 6-thioguanine related persistent splenomegaly/portal hypertension: click here

Investigation of Neonatal Conjugated Hyperbilirubinaemia: click here

 

ManagedClinical Network

Managed Clinical Networks (MCNs) are 'inked groups of health professionals and organisations from primary, secondary and tertiary care working in a co-ordinated manner unconstrained by existing professional and organisational boundaries to ensure equitable provision of high quality clinically effective services'. They are seen as one way of ensuring that organisations can work together to improve access to the service, the quality of the service and seamless care across the primary, secondary and tertiary interfaces despite the need to sustain appropriate levels of clinical skills and expertise particularly with increasing sub-specialisations amongst medical staff. 'The concept of managed clinical networks hopes to address the dilemma of centralisation of skills but decentralisation of care by concentrating specialist activity while dispersing expertise through the medical community'. In practice the term is seen as permitting a variety of arrangements operating at different possible scales for example, within a Primary Care Trust, across Primary Community and Acute Care within a health district across a number of health districts or a larger geographical area. The exact the nature of a network depends on its rationale and purpose

Network Meeting Report (18th January 2005)

Actions

(a) Participants would like correspondence to be sent by email. The only secure email service possible is NHS Net. This service is in the early process of development but all NHS employees should be able to obtain an NHS Net email address. Alastair Baker undertook to explore sending all correspondence by NHS Net if recipients will obtain NHS Net email addresses. (This is, in fact, possible)

(b) Audit of correspondence - the clerical service at King's College Hospital , which is currently managed by Ms Julie Dawkins is very much cognisant of the importance of sending correspondence within the target timescale of less than one week. Alastair Baker will ask her to provide data from ongoing audits of turnover time for correspondence from out-patient clinics and in-patient admissions including day cases.

(c) Attendees described the value of simple pro-forma communications based on changes in clinical plans and instructions for changes in care. We have developed pro-forma communications for biliary atresia, liver transplantation and auto-immune hepatitis. Alastair Baker will contact Dr Marianne Samyn who has led in these areas to ask whether further pro-formas for example, in portal hypertension, Wilson disease, alpha-1-antitrypsine deficiency and follow up surgical care are imminent.

(d) Joint Clinics have been extremely well received throughout England , Wales and Scotland . There is already a joint clinic in Redhill, which works very well. Attendees expressed enthusiasm for rotating joint clinics in the London area with the aim of improving interpersonal, interaction and communication, clarifying procedures and protocols, planning individual patient's care, demonstrating to patients and families the quality of interaction between different professionals and reducing patient's travelling time. Alastair Baker undertook to explore the possibility of joint clinics rotating throughout the Greater London area to enhance the function of the Managed Clinical Network.

(e) Managed Clinical Networks have rapidly progressed in a variety of specialties throughout the United Kingdom . In paediatric gastroenterology those leading the way appear to be based in Wales and Scotland . Alastair Baker undertook to obtain targets and standards for Managed Clinical Networks in those two locations to discuss on the next occasion this MCN meets. (contacts made)

(f) Attendees asked for correspondence to specify a point of communication for individual patients. Alastair Baker undertook to discuss this with his Consultant colleagues and Clinical Nurse Specialists at King's College Hospital .

(g) Attendees were in general agreement that a Managed Clinical Network for London in paediatric liver disease would be extremely beneficial to patients and to themselves in providing care. Six monthly meetings were opted. It was proposed that, in the first instance these would be held at King's College Hospital with a view to moving around London if there was a consensus as to how this could be achieved. The format was found broadly acceptable with a combination of educational and planning components associated with 2 CME points from the Royal College of Paediatrics and Child Health.

(h) Alastair Baker to arrange further Managed Clinical Network Meeting in early July at King's College Hospital .

The full report of this meeting can downloaded word

 

The Development of a Managed Clinical Network for Children's Liver Disease by Appreciative Inquiry

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