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CANDOUR - ISSUE 12 - October 2000

The newsletter of the Joint ASA/ JRCALC Clinical Effectiveness Committee and the ASA Clinical Effectiveness Programme

In this issue:

JRCALC Conference 3rd November 2000

National Institute for Clinical Excellence Conference 29-30th November 2000

New JRCALC Website - http://www.jrcalc.org.uk

National Guidelines Update

Update from NICE on Collaboration

Issue 11 CANDOUR INDEX Issue 13

Joint Royal Colleges Ambulance Liaison Committee (JRCALC)
Conference - Royal College of Physicians of London, Friday 3rd November 2000

"Towards a Unified Approach" - Standards, strokes and thrombolysis.

This promises to be a timely and informative conference focusing on the key work of the ASA/JRCALC and highlighting the future role of JRCALC before concentrating on the important issues surrounding pre-hospital treatment of acute stroke and experiences of pre-hospital thrombolysis. The day will be introduced by Professor Douglas Chamberlain (Chair, JRCALC).

The morning session focuses on the main work of the ASA and JRCALC. Dr Iain McNeil (JRCALC) will present the New National Guidelines produced through the JRCALC Clinical Guidelines Sub-Committee before passing to another member of the ASA/JRCALC Clinical Effectiveness Committee, Graham Brown (Westcountry Ambulance Service), who will explore how guidelines are put into practice. Stuart Nicholls (ASA National Clinical Effectiveness Programme) will then talk about the role of clinical audit in the on-going evaluation of guidelines and the requirement for accurate and timely data.

Following a break for coffee Barry Johns (President, ASA) will ask what does the ambulance service need from JRCALC in the new millenium. There will then be an opportunity to discuss and question the morning's speakers before lunch.

The afternoon session concentrates on the treatment of stroke and thrombolysis. Gary Ford (Consultant Physician, Wolfson Unit, University of Newcastle upon Tyne) will present a rapid ambulance protocol for acute stroke. We will then hear about the Swedish experience of pre-hospital thrombolysis before Professor Richard Vincent looks ahead to pre-hospital thrombolysis in the UK. This will undoubtedly lead into an interesting discussion and summary of the main points to end the day.

Joint Royal Colleges Ambulance Liaison Committee (JRCALC) - Conference - Royal College of Physicians of London - Friday 3rd November 2000
"Towards a Unified Approach" - Standards, strokes and thrombolysis.

The following programme was correct at time of press. However, titles and speakers may change.
09:30 Registration and Coffee
10:00 Welcome and Introduction - Chair JRCALC, Professor Douglas Chamberlain
10:15 Drawing up the New National Guidelines - the process - Dr Iain McNeil, Chair JRCALC Clinical Guidelines Sub-Committee
10:45 Principles into practice - making guidelines work as protocols - Graham Brown, Westcountry Ambulance Service
11:15 Collecting the right data from the right forms at the right time - Stuart Nicholls, Manager ASA National Clinical Effectiveness Programme
11:45 Coffee
12:00 "What does the ambulance service need from JRCALC in the NEW Millennium?" - Barry Johns, President ASA
12:30 Forum Session 1
13:00 Lunch
13:45 A rapid ambulance protocol for acute stroke - Gary Ford, Consultant Physician, Wolfson Unit, University of Newcastle upon Tyne
14:15 Pre-hospital thrombolysis in Sweden - Swedish speaker to be confirmed
15:00 Tea
15:15 Pre-hospital thrombolysis in the UK- looking ahead - Professor Richard Vincent
15:45 Forum Session 2
16:15 Closing comments and summary

To book contact:
Peter Plume, Administrator, Joint Royal Colleges Ambulance Liaison Committee, (Royal College of Physicians), 11 St Andrews Place, Regents Park, London. NW1 4LE Tel: 020 7935 1174 Fax: 020 7487 5218 Email:
[email protected]

Update - visit the JRCALC website (see below) for a summary of the day and copies of the presentations

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National Institute for Clinical Excellence: Annual Conference

Staying with the theme of national conferences you will find below details of the National Institute for Clinical Excellence (NICE) Annual Conference and Exhibition - 29-30th November 2000, Harrogate International Conference Centre.

Clinical Excellence: Setting Standards and Spreading Good Practice

Clinical Excellence is now firmly established as the largest conference within the NHS today. With a responsibility to promote clinical and cost effectiveness through appraisal, guidance and clinical audit, the National Institute for Clinical Excellence is dedicated to providing an interactive, informative and multidisciplinary forum to meet these aims.

Wednesday 29 and Thursday 30 November
Setting Standards and Spreading Good Practice

A prestigious line up of plenary session speakers will focus on quality and spreading good practice in the NHS, including:
o Secretary of State, the Welsh Secretary and other government officials
o Senior members of the NICE team
o International speakers

There will also be over 70 parallel sessions, covering a range of topics, making Clinical Excellence 2000 an essential event for all those involved in HTA, Quality, Audit and Clinical Governance. Sessions include:

oClinical audit
o Dissemination and implementation of NICE guidance
o National Service Frameworks
o Clinical Governance
o Care Pathways
o Developments in Wales and Scotland
o Change management
o Multidisciplinary teamworking
o Quality standards in management
o Ethics
o Patient confidentiality
o Secondary, primary and community care
o PAMs o Industry
o Professional reporting systems
o Sentinel audits
o Personal and team development
o Appraisal
o Reducing risk
o Confidential Enquiries
o Excellence through errors
o Practically involving patients
o Commissioning quality services
o Health economics for non experts Plus satellite sessions and forums run by the Royal Colleges and other representative organisations for individual professional groups together with something 'alternative'.

Poster Displays and Presentations

An important element of the event will undoubtedly be the multitude of projects and posters presented during parallel sessions and on display throughout the exhibition. This year there are five categories, enabling delegates to learn from others' experiences across a variety of settings and disciplines, including:
o Implementation of NICE and other national guidance
o NHS priority areas, e.g. Cancer, CHD and Stroke, Accident Prevention, Mental Health, Smoking, Drugs, Teenage Pregnancy
o Multidisciplinary Team Working
o Patient Perspectives/Involving Patients
o Miscellaneous

Come and visit

Ambulance Service Association National Clinical Effectiveness Programme at Stand number 55 as part of the Clinical Excellence Exhibition.
An ideal opportunity to see at first hand the work of the ASA Programme and the Joint ASA/JRCALC Clinical Effectiveness Committee
including :
the new National Guidelines for ambulance services
the Coronary Heart Disease Database for ambulance services
results of the national Patient Report Form survey
results of the national Evidence for Change III survey
surf the websites of the ASA and JRCALC

And discuss developments in ambulance service clinical excellence with others from the wider NHS.
Click here for press release 20/11/00

Educational Excellence

The Event has fast become a major learning opportunity for both managers and clinicians alike. The programme is CME, PGEA, CPPE and SCPPE approved. organised on behalf of NICE by Sterling Events Ltd, 62 Hope Street, Liverpool L1 9BZ . Tel 0151 709 8979 Fax 0151 709 0384.
[email protected]
You can also visit the NICE website on
Conference Helpline 0151 709 8979

Copies of the conference booking form are available from Stuart Nicholls, Manager, National Clinical Effectiveness Programme, Ambulance Service Association, c/o Kent Ambulance NHS Trust, Heath Road, Coxheath, Maidstone, Kent. ME17 4BG. Tel/Fax: 01622 664929 Email:
[email protected]

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New JRCALC Website - http://www.jrcalc.org.uk

The new website of the Joint Royal Colleges Ambulance Liaison Committee was launched in September 2000. It gives a brief history and background to JRCALC and includes:

membership details of the main JRCALC committee
details of sub-committees
details of the JRCALC guidelines programme
JRCALC publications
Details of the JRCALC Conference
News and views from JRCALC
Synopses of JRCALC meetings
Links to individual Royal College websites

Check it out now at - http://www.jrcalc.org.uk

National Guidelines Update

Following the recent meeting of the JRCALC Clinical Guidelines Sub-Committee Dr Matthew Cooke was pleased to announce that the "Medical Directors" Guidelines, which will act as the basis for future national pre-hospital guideline development, are to be published in November.

The guidelines were ratified by the main JRCALC Committee and have been peer-reviewed by the relevant experts.

Each ambulance service will receive a copy of the guidelines on CD-ROM.

They will appear on the website's of the ASA National Clinical Effectiveness Committee (http://www.asancep.org.uk) and JRCALC (http://www.jrcalc.org.uk).

They will also appear on the website of the National Electronic Library for Health (http:/www.nelh.nhs.uk). Dr Matthew Cooke, a member of JRCALC and the ASA/JRCALC Clinical Effectiveness Committee, has been seconded to develop the Emergency Care Virtual Branch Library of the NeLH.

NeLH: Emergency Care Virtual Branch Library

The aims of the work to be completed in 2000/2001:
To have a preliminary site for NELH-EC by Nov 2000, to launch at NELH meeting in Newcastle
To obtain opinion of users on the format and content of an emergency care branch.

The scope of the work that will be completed:
Consultation with potential users on their needs, expectations and desired content
The site to include search facility for emergency care guidelines, links to appropriate texts and sites, search tools to medical literature. It will also include access to databases such as the national poisons information and drug information databases.
Database of guidelines will be started with three levels of information - rapid view guidelines for clinical support, full guidelines for background information and referencing/search for latest information.

Further details of NeLH developments can be obtained by writing to:
Dr Matthew Cooke, Senior Lecturer in Emergency Care, Centre for Primary Health Care Studies, University of Warwick, Coventry. CV4 7AL.

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Update from NICE on Collaboration

Back in Issue 9 of CANDOUR (Ambulance UK - April 2000) we reported on the close collaboration between NICE and the ASA National Clinical Effectiveness Programme.

There have been several developments in between time which will impact upon the national co-ordination of clinical effectiveness issues across the UK's ambulance services.

In June 2000 NICE decided at their Board meeting that they would review and restructure the funding arrangements for all NHS Effective Clinical Practice Programmes including the ASA Clinical Effectiveness Programme. Following a brief consultation period it was decided that the future arrangements for funding the development of guidelines and clinical audit tools which serve the priorities of the NHS and NICE would change radically.

Rather than funding around twenty three individual college/professional bodies to develop and promote effective clinical practice, NICE will now fund six 'Core Collaborating Centres'. The role of theses centres will be to produce evidence based guidelines complete with audit tools as commissioned by NICE through their work programme. The centres will house expertise in guideline development, health economics, audit methodology, patient liaison and many other facets NICE have stipulated as best practice for developing guidelines.

NICE will then commission individual centres to develop specific guidelines according to the relevant clinical expertise of the centre. The centre will then 'sub-contract' to other clinical experts to ensure the comprehensive development of the guideline by all stakeholders.

What this means to the ASA National Clinical Effectiveness Programme is that funding from NICE will be withdrawn at the end of March 2001. Also, given that pre-hospital issues do not currently, nor for the foreseeable future, appear on NICE's work programme it is very unlikely that NICE will fund guideline development within the ambulance service. At best the ASA will receive a 'consultancy' fee from one of the centres whenever pre-hospital expert opinion is required.

The ASA are currently looking for other sources of funding to ensure the Clinical Effectiveness Programme continues beyond March 2001. Meanwhile, in order to secure a pre-hospital voice among the NICE Collaborating Centres, the ASA National Clinical Effectiveness Programme has already agreed to enter into partnerships with, initially, the Royal College of Surgeons and the Royal College of Physicians and will also look to secure similar agreements with the Royal College of General Practitioners.

Hopefully by the next issue of CANDOUR a future will have been secured for the ASA National Clinical Effectiveness Programme.


NICE recently issued a Guideline Stakeholders Interest Form to ensure that all relevant stakeholders were consulted during the development of NICE commissioned guidelines. The ASA expressed stakeholder interest in the following guidelines:

Secondary prevention of acute myocardial infarction
Pressure ulcer - treatment and prevention
Management of hypertension
Management of type II diabetes
Management of depression in the community
Induction of labour

Although pre-hospital input into these guidelines may at present be minimal it is important the ASA are 'at the table' for future NICE work programmes, and also looking to the future development of Practitioners in Emergency Care (PEC's) to provide a primary care type of role accompanied by more extended skills.

Details of the NICE work programme can be found on their website at http://www.nice.org.uk

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