Welcome to the March 2025 update from the RDS team
1.1 Stability issues - Tactuum implemented a fix on 24th March which we believe has finally addressed the stability issues experienced over recent weeks. The issue seems to have been related to the new “Tool export” function making repeated calls for content when new toolkit nodes were opened in Umbraco. No outages have been reported since then, and no performance issues in the logs, so fingers crossed this is now resolved.
1.2 Toolkit URL redirects failing– these were restored manually for the antimicrobial calculators on the 13th March when the issue occurred, and by 15th March for the remainder. The root cause was traced to adding a new hostname for an app migrated from another health board and made live that day. This led to the content management system automatically creating internal duplicate redirects, reaching the maximum number of permitted redirects and most redirects therefore ceasing to function.
This issue should not happen again because:
1.3 Gentamicin calculators – Incidents have been reported incidents of people accessing the wrong gentamicin calculator for their health board. This occurs when clinicians are searching for the gentamicin calculator via an online search engine - e.g. Google - rather than via the health board directed policy route. When accessed via an external search engine, the calculator results are not listed by health board, and the start page for the calculator does not make it clearly visible which health board calculator has been selected.
The Scottish Antimicrobial Prescribing Group has asked health boards to provide targeted communication and education to ensure that clinicians know how to access their health board antimicrobial calculators via the RDS, local Intranet or other local policy route. In terms of RDS amendments, it is not currently possible to change the internet search output, so the following changes are now in progress:
We would encourage all editors and users to use the Help and Support standard operating procedure and the Editors’ Teams channel to highlight issues, even if you think they may be temporary or already noted. This helps the RDS team to get a full picture of concerns and issues across the service.
A new presentation illustrating how RDS supports all partners in the patient journey – multiple disciplines across secondary, primary, community and social care settings – as well as patients and carers through self-management and shared decision-making tools – is now available. You will find it in the Promotion and presentation resources for editors section of the Learning and support toolkit.
A new user guide is now available in the Guidance and tips section of Resources for providers within the Learning and Support area, explaining how to embed content from Google Calendar, Google Maps, Daily Motion, Twitter feeds, Microsoft Stream and Jotforms into RDS pages. A webinar for editors on using this new functionality is scheduled for 1 May 3-4 pm (booking information below.)
A new checklist to support editors in making all the checks required before making a new toolkit live is now available at the foot of the “Request a new toolkit” standard operating procedure. Completing this checklist is not a mandatory part of the governance process, but we would encourage you to use it to make sure all the critical issues are covered at point of launch – including organisational tags, use of Alias URLs and editorial information.
Introductory webinars for RDS editors will take place on:
Special webinar for RDS editors – 1 May 3-4 pm
This webinar will cover:
Running usage statistics reports using Google analytics
To book a place on any of these webinars, please contact Olivia.graham@nhs.scot providing your name, role, organisation, title and date of the webinar you wish to attend.
The following toolkits were launched during March 2025:
SIGN guideline - Prevention and remission of type 2 diabetes
Valproate – easy read version for people with learning disabilities (Scottish Government Medicines Division)
Obstetrics and gynaecology induction toolkit (NHS Lothian) – password-protected, in pilot stage.
Oral care for care home and care at home services (Public Health Scotland)
Postural care in care homes (NHS Lothian)
Quit Your Way Pregnancy Service (NHS GGC)
Release of the redesign of RDS search and browse, archiving and version control functionality, and editing capability for shared content, is now provisionally scheduled for early June.
The Scottish Government Realistic Medicine Policy team is leading development of a national approach to implementation of Patient-Reported Outcome Measures (PROMs) as a key objective within the Value Based Health and Care Action Plan. The Right Decision Service has been commissioned to deliver an initial version of a platform for issuing PROMs questionnaires to patients, making the PROMs reports available from patient record systems, and providing an analytics dashboard to compare outcomes across services. This work is now underway and we will keep you updated on progress.
The RDS team has supported Scottish Government Effective Prescribing and Therapeutics Division, in partnership with Northern Ireland and Republic of Ireland, in a successful bid for EU funding to test develop, implement and assess new integrated care pathways for polypharmacy, including pharmacogenomics. As part of this project, the RDS will be working with NHS Tayside to test extending the current polypharmacy RDS decision support in the Vision primary care electronic health record system to include pharmacogenomics decision support.
We have just completed a series of three workshops consulting on proposed improvements to the Being a partner in my care: Realistic Medicine together app, following piloting on 10 sites in late 2024. This app has been commissioned by Scottish Government Realistic Medicine to support patients and citizens to become active partners in shared decision-making and encouraging personalised care based on outcomes that matter to the person. We are keen to gather more feedback on this app. Please forward any feedback to ann.wales3@nhs.scot
The GGC Maternity services are committed to providing safe, effective and efficient, person centred care for all accessing the service, in keeping with Quality Everyone Everywhere NHSGGC’s Quality Strategy 2024-2029.
The purpose of this document is to provide a framework to support the planning of person centred, individualised care for women who are considering antenatal, intrapartum and/or postnatal care choices that are outwith NHSGGC recommended guidance, but is applicable to all women accessing maternity care.
This guide is informed by
There should be consideration of whether there are safeguarding concerns for every woman accessing NHSGGC Maternity services. Declining care does not, in itself, warrant any referrals to Blossom Team, Maternity and Neonatal Psychological Interventions (MNPI) Team or Public Protection.
However, it may be appropriate to exclude safeguarding concerns. These can be discussed with the Blossom Team and the Public Protection Team, and referrals made if indicated. Blossom Team referral criteria
All women should be able to access and discuss current reliable evidence based information with their midwife and obstetrician. Midwives should signpost women to reliable sources of information including:
Staff should ensure that they access reliable sources of information to support them in providing care to women asking for care outside guidance, including:
To support a woman requesting care or making choices outwith recommended GGC guidance, maternity staff should work in partnership with the woman to develop an individualised plan of care and to provide assurance through documentation of the discussions that choices and decisions are informed.
Building a trusting relationship is a key element of supporting women who are choosing care outside guidance and contributes to minimising risk. Advocating for a woman’s informed choices is an essential element of building a trusting relationship. Continuity of carer should be maximised for all appointments. If there are difficulties in continuing this development of a trusting relationship, women should be advised that they are able to request a different primary midwife.
Aspects of care may include:
It should be recognised that discussions to explore birth options and to develop an individualised plan of care require adequate time. Facilitating these conversations from early in pregnancy is best practice for all women, but particularly so for women considering choices outwith NHSGGC recommended guidance. Consideration should be given to additional or double appointments. Documentation of consultations and co-produced care plans should be shared to BadgerNet to allow visibility to all involved in the woman’s care, including the woman.
Birth choice discussions are the within the remit and responsibility of the primary midwife as part of the universal midwifery care pathway. Where the GGC recommended plan of care includes the wider maternity multidisciplinary team, that collaborative discussion should involve escalation or referral to the appropriate professional.
It is important that the primary midwife is confident to discuss the evidence around the particular choice being made. This should include sharing robust, clear evidence about potential risks and benefits of different choices in a format that is comprehensible for the woman and her family. The primary midwife should seek any support needed in accessing this evidence from their senior charge midwife, the service librarian for literature searches and obstetric and other specialist colleagues.
Common examples of requests for care out with recommended GGC guidance
These are examples, not a comprehensive list.
Midwives are encouraged to seek support from a senior/experienced midwife, usually the relevant Senior Charge Midwife, for case review/supervision. With a woman's agreement a group meeting with both the primary and senior charge midwife can be facilitated.
If a woman has already been counselled, and this is clearly and comprehensively documented, respect and honour her choices.
Women may choose to decline some aspects of maternity care offered to them, such as consultant obstetrician appointments, or choose not to engage with maternity services. In this situation the Lead Midwife for Community and Outpatients (Glasgow) or the Lead Midwife (Clyde) should be informed.
In the absence of safeguarding concerns, the next step is to communicate to the woman, both verbally and in writing, that maternity care remains accessible, and can recommence at any time during the antenatal, intrapartum or postnatal period. Advice should be shared around birth notification, the legality around acting as a midwife, and safety/what to do in an emergency (see appendix for suggested draft letter).
Supporting women who choose to make choices out with NHSGGC guidance may be emotionally and professionally challenging for maternity staff. Staff have access to:
Woman expresses desire to choose care outside NHSGGC guidance
Conversation facilitated by Primary midwife to discuss any concerns associated with choices, using evidence based information.
Care should be taken to ensure an unbiased approach is taken.
Documentation of conversation, including detail of topics discussed, with an outcome or plan included
[Management Plan, with use of critical alerts for appropriate dissemination of pertinent information]
Liaise with the MDT and action referrals if criteria are met.
Consider MNPI, Blossom Team, Public Protection helpline, named obstetrician.
Update/escalate to Senior Charge Midwife for support and case review/supervision
