NWSSP PROCUREMENT SERVICES
MINUTES OF ENFit ACCOUNT MANAGERS MEETING
11:00am, 9th May 2016.
COMPANIES HOUSE, CONFERENCE ROOM 1
In Attendance
Joanna Protheroe (JP)
Hayley Nash (HN)
Gill Bailey (GB)
Paula Edwards (PE)
Liz Foden-Shroff
(LFS)
Jenny Wykes (JW)
Cherry Pickery (CP)
Ruth Davies (RD)
Kim Helling (KH)
Claire Devine (CD)
Robert Matthews
(RM)
Anne LlewellynEdwards (ALE)
Helen Hughes (HH)
Victoria Prendiville
(VP)
Adrienne Tunna (AT)
Mark Mapstone (MM)
Judy Wright (JW)
James Rhodes (JR)
Liam Davies (LD)
Max Richards (MR)
Paula Mainwaring
(PM)
Jeff Nagy (JN)
Jo Hackney (JH)
Denise Everall (DE)
Function
Location
Category Manager
Category Officer
Category Manager
Nurse Specialist
Nutritional Support
NWSSP
NWSSP
NWSSP
Head of Dietitics
Nutritional Nurse
Associate Clinical Lead
Dietetics
CNS Nutritional Support
Medical Devices Training
Officer
Medical Devices Training
Officer
Betsi Cadwaladr
Betsi Cadwaladr
Medical Devices Trainer
Head & Neck & Nutritional
Support Nurse
Senior Dietitian
Service Lead Nutrition
Support
Advanced Enteral Feeding
Dietitian
Nutrition Nurse
Dietetics Nurse
Product Manager
Sales Manager
Business Development
Manager
Cwm Taf
Account Manager
Enteral Specialist
Enteral Specialist
Enteral Specialist
Nutricia LTD
GBUK Enteral LTD
GBUK Enteral LTD
GBUK Enteral LTD
Corpak
MedSystems
Fresenius Kabi
Fresenius Kabi
Covidien
(Medtronic)
Kirsty Bennett (KB)
Sue Humphrey (SH)
James Lorey (JL)
Account Manager
Scientific Affairs
Enteral Specialist
Shane Field (SF)
Product Manager
Betsi Cadwaladr
Betsi Cadwaladr
Betsi Cadwaladr
Abertawe Bro
Morgannwg
Abertawe Bro
Morgannwg
Velindre
Cwm Taf
Hywel Dda
Abertawe Bro
Morgannwg
Cardiff & Vale
Cardiff & Vale
Medicina
Medicina
Vygon (UK) LTD
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Andy Drake (AD)
Allen Watts (AW)
Barbara Bates (BB)
John Tharme (JT)
Liam Barrett (LB)
Account Manager
Contract Manager
Contract Manager
Sales Director
Sales Specialist
Covidien
(Medtronic)
Abbott
Abbott
InterVene
InterVene
Apologies
Pete Phillips
Matthew Alderman
Director - SMTL
Category Manager
SMTL
NWSSP
No
Minute
1
Welcome
Acti
on
JP asked everyone to introduce themselves and gave a brief overview on
the purpose of the meeting and the topics of discussion.
2
Low Dose Syringe
JP asked the suppliers around the table what they had prepared in terms of
communication and awareness training to support the launch of the new
syringes. She confirmed that this should include the recommended
technique of ‘Flicking & Tapping’ the Low Dose Syringe in order to remove
the fluid within the moat to avoid the risk of overdose.
JN (GBUK) confirmed there will be awareness and training sessions
available. Specialist areas such as NICU, SCBU and Paediatrics, who are the
main users of the LDS, will have specialist training as part of the roll out
programme for their syringes.
JP stated that communication and awareness should be made available
from June onwards within the community and Neonatal departments
regardless of when each Health Board plans to roll out. JN (GBUK)
confirmed this is feasible and further explained that the material such as
FAQ’s, booklets and pictures available on the LDS will be made available on
posters and leaflets for both the acute and community settings for Wales.
JN (GBUK) further explained that Enteral Specialist trainers are available
for both South & North areas.
MR (Vygon) confirmed that Vygon will not be involved in the low dose
syringe solution for neonatal as they have their own design “Nutrisafe”
which they have a company view of it being the safest option for patients.
Therefore, Vygon will continue to promote their “Nutrisafe” range.
JT (InterVene) & JR (Medicina) confirmed that they did not have an
‘’own’’ version, and would be producing the new design of the low dose
syringe.
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SF (Covidien) stated his concerns in regards to the guidance on use of the
LDS re the unscientific advice of ’flicking’/tapping the syringe as he said
that it was impossible to know if ’flicking and tapping’ had been undertaken
correctly. Consensus of opinion was that it was still necessary however;
syringe suppliers have agreed to provide posters/leaflets to visually show
this action. The group agreed to supply training and communication
material centrally to procurement in order for this information to be
cascaded down to local Health Board Groups and tailor the information from
each supplier to suit the individual HB.
Action: Suppliers to send communication and training material to HN.
ALL
Sup
plier
s
GB expressed the need for a generic description on LDS in order to avoid
the risk of confusion within the wards and community especially for the
critical care units (NICU, Peads). EPSG will agree on a standard description
however, may be bespoke to the individual supplier. (Further discussions at
the EPSG meeting 10th May).
The syringe suppliers all confirmed that Syringes will be made available
from the 1st June.
3
Availability of Adapters
JP explained that the samples of adapters that NWSSP had seen showed
that Suppliers were providing these in different sizes of packs, and with
different approaches to the manufacturing.( some with caps, some without)
It was also clear that packaging descriptions were not standard.
GB expressed concerns around the descriptions needed on the packaging
for each adapter in order to avoid confusion for clinical use, e.g. reverse
Luer to EnFit and vice versa.
SF (Covidien) expressed the terminology of adapters will vary from
supplier to supplier. It will be down to the individual supplier to provide the
training necessary. SF also stated that a number of suppliers use the same
manufacturer and will have the required CE marking and legal
requirements.
JT (Intervene) & KB (Corpak) confirmed that they are making their own
adapters while the rest of suppliers have one manufacturer for their
adapters.
JR (Medicina) confirmed adapters are available and ready within the
packaging.
JT (InterVene) expressed the issue of defining whether the adapters are
sterile/ single use, or sterile/ multi use from supplier to supplier. InterVene
expressed that their adapters will be sterile, single patient (multi) use and
down to the end user how long the adapters will be used for on the patient.
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KB (Corpak) confirmed their adapters are sterile, single patient use with
caps available on the end to cap the tube. KB also confirmed that Corpak
are now going to produce another adapter; ENFit to current luer syringe.
ALL
–
Action: All suppliers to confirm sterile, single use or sterile, single patient Sup
(multi) use.
plier
s
GB expressed concerns around the availability of adapters due to the
uncertainty around demand. JT (InterVene) reassured that between the
numbers of suppliers it was more likely that they would have an oversupply
of adapters.
JP raised concerns around the availability of adapters post December. JR
(Medicina) confirmed adapters will be available after the transition period.
MR (Vygon) also confirmed adapters of the funnel/ Christmas tree adapter
will remain available post transition. JT (InterVene) assured that their
production moulds will be available if demand for adapters remains post
transition period. GB confirmed that there would be a minority of patients
for whom it may not be possible to change their long-term tubes, requiring
the use of adapters in the long term.
MR (Vygon) stated their box sizes for the funnel adapter; Box 300. MR
further confirmed that 60,000 will be made available as a starting point and
comfortably stating that these will be made available from the beginning of
July (devices and tubes will remain available from June).
JR (Medicina) confirmed adapters from current to ENFit and vice versa are
available and ready now, however, the funnel adapter will be available
around the middle of June.
JN (GBUK) confirmed 4 adapters are currently in stock and will be made
available from June.
JT (InterVene) confirmed that both adapters will be available by June.
JP asked the question of whether as well as the adapters being made
available on the catalogue for the Health Boards to order, if any suppliers
would be sending boxes out in advance ahead of their roll out date. JN
(GBUK) confirmed that all of their tubes converting to ENFit will have an
adapter available in the pack in order to be able to connect to current luer
syringes. As discussed earlier, suppliers are taking different approaches to
this, with some putting adapters in the packs with their tubes, others
providing them separately.
PE suggested updating the current list HN previously circulated in order to
include a column indicating when the adapters and product devices will
become available.
Sup
Action: Suppliers to contact HN to confirm and update on the adapter and plier
product availability.
s
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Minute
Action
Action: HN to update supplier information spreadsheet and circulate to HN
LHB’s.
RM stated the concerns on the adapters and the variance of style/ colour
from supplier to supplier where this may cause confusion for the clinicians.
JP and ALE also stressed the risk of clinicians needing the adapters there
and then in critical situations.
GB suggested further descriptions and images needed on the adapters to
include on the current spreadsheet in order to aid the clinicians further and
understand the differences from supplier to supplier. The group agreed.
Sup
Action: Suppliers to provide narrative/ descriptions and pictures on their plier
adapters.
s
Action: HN to update the spreadsheet to include description and images of HN
adapters and circulate to LHB’s.
MR (Vygon) confirmed they currently have a spreadsheet that provides
what will be available from June and where the more complex products will
be available from a later date.
JP suggested all of the suppliers should update central procurement on any
products that will not be available from June.
Sup
plier
s
Action: Suppliers to contact HN to highlight ENFit product availability.
Action: HN to circulate information to LBH’s.
4
HN
Product Availability (Current & ENFit)
JP asked the suppliers if they were in a position to let us know (based on
the usage figures sent by HN) when they may run out of the standard
reverse luer, and if it was possible for them to ‘ringfence’ enough standard
stock for Health Board’s to transition at different deployment dates.
JR (Medicina) confirmed that their high usage items i.e. infant tubes and
syringes, are estimated to run out of stock by October/ November. Slow
moving items are perceived to continue over Jan/ Feb of 2017.
SF (Covidien) confirmed that ‘ringfencing’ stock is unlikely to happen. SF
and JR (Medicina) continued to state that the 6 months transitional period
is for when old stock will deplete as new ENFit stock gets introduced and will
not intentionally have a full range of current luer in stock by the end of
December.
KB (Corpak) confirmed that they are planning their current stock around
Wales. However, will need the roll out plan confirmed in order to plan
around stock.
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JN (GBUK) stated that from a syringe perspective, they are aware of the
stock needed and have not stopped the production on their syringes. Again,
an organised roll out plan will be needed to organise their demand of
current stock.
Action: All LHB groups to confirm their roll out dates and plans going LHB
forward - Send to HN.
Action: HN to circulate roll out dates to suppliers.
HN
JP explained that NHS Wales planned to adopt a roll out strategy to the
Phase 2 OF Enfit to allow time for comprehensive supplier supported
training too take place at each Health Board and to ensure that we
maintain a continuity of supply of all products. With regards to the roll out
plan for each Health Board. September/ October is the preferred
deployment period for most LHB’s:
Betsi/ Pow - June onwards over a 3 stage phased approach to cover each
area.
Hywel Dda – October
ABMU - TBC
Cardiff & Vale - October
Cwm Taf – September
Aneurin Bevan – TBC
Velindre - same time as first HB roll out (retrieving patients).
5
JP asked whether the production of reverse luer had stopped? JR
(Medicina) stated most items being producing was ENFit only, and only a
few lines of current luer are still being produced. KB (Corpak) confirmed
that both lines will be running alongside while current luer will discontinue
slowly within the transition period.
All Wales Transition Plan
KH stressed around the problems and risks associated with the neonatal
departments and the retrieval system in Wales. There are also risks
involved around the requirement to use multiple adapters in the situation
where extension sets are also being used by some neonatal departments
during the process of feeding. The All Wales Enteral group are waiting for a
response from the Neonatal Network in Wales on the final decision, but
anticipate that they will advise we roll out to Enfit for Neonatal Units at the
same time, and that we employ a “swap out “ strategy so there will be
minimal need for adapters.
LHB
/JP
Action: update needed from Neonatal Network.
/GB
/HN
PE raised concerns around the new ENFit tubes being places within the
Health Boards without staff awareness and stressed that communications
will need to be in place around June, followed up by training sessions prior
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Minute
Action
to each Health Board’s roll out. PE continued to suggest that it should be
down to the HB’s to contact the individual suppliers they use. It was agreed
that a ‘joined up’ universal approach to training and communication
transition from standard to Enfit, does not appear to be the strategy that
they wish to pursue and should be based locally. The group favoured this.
Sup
Action: All suppliers to send HN contact details on the ‘go to’ person for plier
LHB’s.
s
Action: HN to re-send usage figures to Health Boards.
6
HN
All Wales Communication & Training Strategy
JP suggested that there should be generic material/ descriptions from
GEDA. SF (Conidian) confirmed generic descriptions should be produced
from industry/ EPSG, and also bespoke material from each supplier. JP also
stated that awareness and training sessions should only be based around
the ENFit connector, and not to promote the brand itself.
JP suggested we adopt a ‘road show/ hands on approach’ with suppliers
joining forces to cover the training requirements of all Health Boards. JT
(InterVene) had concerns around getting clinicians to attend based on
previous experience. SF (Covidien) suggested training a ‘champion’ within
the LHB wards in order to facilitate the training with the clinicians at ward,
department level in each hospital. JP asked if suppliers would therefore
commit to hold ‘Train the Trainer’ sessions.
The group agreed that the publicity needs to be layered due to different roll
out dates for each LHB. Initially, for June, suppliers should start with
posters, leaflets & ‘Train the Trainer’ sessions, as well as continuing to
broadcast Welsh Alerts and generic GEDSA awareness/ alerts.
Action: All suppliers to send over training and communication material
Action: Health Boards and suppliers to organise ‘Train a Trainer’.
PE suggested that there will be a 3 phased approach for North Wales and
will take longer than other Health Boards.
Sup
plier
s
/LH
B
JP asked the suppliers if the roll out phased approach is reasonable. The
suppliers agreed. Some Health Boards may require a ‘swap out approach’
while others will want to run down current stock with the use of adapters.
SF (Covidien) confirmed they will not be taking back stock as it will not be
any use to them or cost effective. JP & DE (GBUK) suggested moving high
usage items across different Health Boards.
GB suggested whether it would be an idea to introduce a ‘take back’
scheme for recycling products which are deemed to be ‘written off’ or to
give to a 3rd world country. The suppliers agreed that there will be
commitment to liaise with NHS Wales on the basis of organising/ shifting
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Action
left over stock.
The LHB representatives agreed that it is down to local implementation to
organise and tailor their individual HB needs for a smooth transition. ALE
stated that Velindre will need to roll out the same time as when the first
health board deploys due to patients being retrieved to Velindre across
Wales.
GB asked Abbot and Nutricia if there was a communication strategy with
regards to rolling out EnFit with community patients. PM (Nutricia) stated
that they will be running down old stock and liaising with the local groups
for implementation for when the Health Board decided to change. PM
continued to explain however that when they would receive the Enfit stock
is dependent on the delivery dates from their suppliers, which she said they
were not in control of. JW stressed around the aim to prioritise new
patients in hospital who are discharged home to be placed with ENFit. It
was suggested that established patients should work around current stock
to avoid confusion if they are shown ENFit in Hospital. BB (Abbott)
continued to elaborate that ENFit should be managed on an individual
patient bases and to work with the Health Care professional for control,
stock and to answer clinical questions around ENFit. JP asked whether the
home care suppliers would be able to mirror the acute roll out plan. BB
(Abbott) confirmed this would not be possible due to delivery orders on a
patient basis. However, there will be commitment in terms of training and
support services from the home care suppliers.
GB raised concerns around the home care patients who are discharged from
hospital on ENFit, and admitted back into a ‘non-ENFit’ hospital which will
cause cross boarder issues around HB’s. The clinicians present confirmed
that communication would be crucial, and as with patients moving from one
hospital to another, it would be vital that the Transfer Team take
responsibility to contact the ‘’outgoing’’ LHB to determine whether they are
using ENFit or current luer.
JN (GBUK) confirmed that the mini button extension sets will come with an
adapter in situations where patients in the community are admitted back
into hospital.
7
AOB
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