Glasgow update December 2010

Rosemarie Davidson

Staffing levels

• Posts filled: 3.4+ Consultants, plus share of NM post.6 A&C (2 band 3s, 3 band 4s, 1 data

analyst/manager) – 1 has left!5 Band 7 genetic counsellors (2 cancer, Hb,

cardiac, community)1 staff grade (neuromuscular)0.6 Band 6 research nurse1 Band 5 Genetics clinic nurse

Impact of freeze on posts

• Frozen1 Band 4/5 A&C – delayed awaiting outcome of appeal2 8A counsellors – delayed pending results of appeals Unable to provide community genetics service for half the

region.1 Consultant (staged, intended to be 2010/11)

Gaps in service. HD / Marfan / Metabolic / Forth Valley.1 Band 7 genetic counsellor (staged, intended to be

2010/2011)No dedicated neuromuscular genetic counsellor – input from one of the experienced cancer counsellors.

Key Priorities• Cut waiting times, especially cancer (2 additional

counsellors, 8A post frozen) and at satellite clinics (new consultants setting up new clinics)

• Rationalise appointments / records system, to enable more efficient and safer working – requires dedicated database, as well as access to records electronically and additional A&C staff already appointed.

• Develop new services (and respond to increasing referrals) – additional consultant and counsellor funding has allowed increased input to cardiac genetics, haematology and community genetics, and freeing up senior genetic counsellor to develop further areas of community genetics (but only for part of the region with second community post frozen). Prenatal clinics about to start.

Key Priorities• Cut waiting times, especially cancer and at

satellite clinics. Much improved but need to maintain improvement and continue to reduce waiting times at some clinics.

• Rationalise appointments / records system, to enable more efficient and safer working. Hoping to have new system by end of year.

• Develop new services). Prenatal clinics have started. New clinics in Lanark, Newmains, additional Ayrshire clinic, more CDC clinics, new cancer clinics at Wishaw and Ayr. Skeletal dysplasia clinic expanded, links with ophthalmology.

Challenges• Waiting times – further improvements; few now

waiting 6 months but not yet achieving 12 week target in all clinics.

• Negotiating local management processes to attempt to purchase / implement electronic developments eg scanning software, European tending process for database. Laptops now available for peripheral clinic, but still need access to network.

• Communication / integration and training of new staff – harder to keep everyone informed in larger department; new staff needing training / mentors. Move to new building.

Challenges

• Other – Agenda for change appeals almost complete!

– counselling supervision now in place.

Electronic working• Majority of casenotes now scanned, small number

outstanding. • Invu software has been installed and is working fairly well. • Additional scanners / photocopier allow better access to

this. • Now stopped filing in attempt to avoid duplication in

digitising and paper increasing workload. Problems being up to date if see patients with casenotes at satellite clinics.

• Need access to network from satellite clinics etc before this will be achieved.

• Lack of proper appointments system / database is main difficulty, so still much double / treble entering of data and few controls over accuracy and very timeconsuming getting data out!

Progress with waiting times

Total numbers

Clinic attendance

• 2009: 6578 appts in total.64% new first appt, 8% returns61% attended, 19% cancelled, 19% not

attended (24% of appts which were not cancelled.)

• 2010: 7296 appts in total.60% new first appt, 26% returns65% attended, 19% cancelled, 16% not

attended (20% of appts which were not cancelled).[Cancer – 58% attended, 24% cancelled, 18% fta (23%)]

Diagnoses

• 2009: all appts 6578cancer 3297

(50%)neuromusc. 220+cardiac 711+learning 83+

• 2010: all appts 7296cancer 2696 (38%)neuromusc 372cardiac 814 (75% in cardiac clinic)learning 300 (30%

in CDC)

Overall waiting times (% within target times)

Median 7Median 11

Glasgow clinics(% within target times)

Median 12 / 9

Median 8 / 5

All satellite

Community genetics(% within target times)

Median 9Median 8

Cancer totals

Average waits – cancer [weeks]

Median 14 Median 7Median 24 Median 20

Cancer clinics – waiting times[% within target times]

0102030405060708090

100

2007 2008 2009 2010

Average wait% <=12w

% <= 18w% <= 26w

Glasgow cancer [% within target times]

Satellite cancer

Glasgow clinics(% within target times)

Median 12 / 9

Median 8 / 5

All satellite

Paisley [% within target times]

Greenock

Stirling [% within target times]

Falkirk

Wishaw [% within target times]

Cumbernauld

Dumfries [% within target times]

Ayr