3. Cancer Vanguard. 4. Feedback from leads gap analysis, stratified follow up. London Cancer Gynaecological Cancer Pathway Board

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1 Lndn Cancer Gynaeclgical Cancer Pathway Bard Date: Tuesday, 17 th January 2017, 16:00 18:00 Venue: Bardrm, UCLH Westmreland Street Hspital, Westmreland St, Lndn W1G 8PH Chair: Tim Muld, Pathway Directr 1. Welcme, Intrductins and Aplgies TM welcmed members f the bard, intrductins were made and aplgies heard frm Chandrakala Sathish, Kate Farrw, Heather Evans and Jeremy Berger. 2. Minutes and matters arising The minutes f the previus meeting were accepted as an accurate recrd f prceedings. Matters arising are cvered in item 4 f the agenda. 3. Cancer Vanguard The UCLH Cancer Cllabrative, Ryal Marsden Partners and the Christie were successful in winning natinal vanguard funding fr cancer. The bjectives are still aligned with Lndn Cancer with sme specific bjectives fr early diagnsis initiatives Mre infrmatin can be fund here: There was a discussin abut the cnfiguratin f services and there were n plans t change this currently 4. Feedback frm leads gap analysis, stratified fllw up Gap analysis update against best practice pathways. TM gave backgrund t the best practice pathways. There is supprt frm CCGs, Lndn Cancer and Trusts t meet these. Hmertn ne f main challenges has been t get imaging dne in gd time. This has imprved. Histlgy was als a challenge but there have been imprvements and the Trust are nw hitting 7 day targets regularly. The Trust management are engaged and have implemented 7 day targets. UCLH - managers fund gap analysis helpful. There has been increased radilgy prvisin as a result and plans t increase pathlgist capacity. Increased access t hysterscpy lists is wrk in prgress. Staff are trying t phne patients t advise f appintment dates. Referring Trusts were supprtive f this apprach. Whittingtn there is an additinal hysterscpy clinic as a result but there are still waiting time challenges s there will be a need t re-audit. There was n CNS fr 6 mnths which has psed prblems. 1

2 Lndn Cancer Whipp s Crss a new cnsultant started tw mnths ag s still n ne stp clinic but there is an additinal utpatient hysterscpy clinic. There are persistent prblems with imaging and an ld MRI scanner. Tw week wait clinics were always n a Friday but nw there is an additinal clinic n a Thursday. Theatre capacity is a challenge. PAH tw week wait perfrmance is gd. There is a shrtage f staff in pathlgy. Patient engagement is a challenge e.g. peple ging n hliday. This may relate t cmmunicatin and messages frm the GP. There was a discussin abut what is best fr patients and what relates t patient waiting times and targets. There are als prblems with transprt and mre cmplex patients (e.g. bariatric r claustrphbic patients) which Trusts aren t always aware f which can cause delays. TM suggested that this links int wrk f Lndn Cancer and links with Primary Care which will be fed back t the grup. Queen s tw week waits are nw ging thrugh gynae-nclgy which shuld lead t imprvements. Barts there are increased numbers f tw week wait and direct access clinics. The Trust are wrking twards reducing tw week wait times t 10 days. NMUH pathways have helped engagement with managers and radilgy and estimating capacity requirements. Outpatient hysterscpy clinic capacity nw gd. General anaesthetic hysterscpy still a challenge. Tw week wait perfrmance is sme way ff the 7 day aspiratin. Stratified fllw up PAH There is a Macmillan prject manager in place but fcusing n ther tumur pathways currently. Trust fcusing n treatment summaries. UCLH the fcus is currently trying t frmat final end f treatment summaries and streamline the prcess fr cmpletin thrugh autmatin. The bard were still supprtive f this apprach and will cntinue t wrk twards it , 2017 audit results TM presented the audit results. Results were received frm all hspitals except the Whittingtn. Cytlgy review There is variability in implementing this prcess. Pathway bard agreed t ensure that this prcess is fllwed. The Ryal Lndn crdinate this prcess n behalf f sme ther Trusts s it was nt clear whether sme f these reviews have been cmpleted have been missed in the figures. Where treatment is carried ut at a centre (Barts r UCLH) it was nt clear whether the cytlgy review is als carried ut at the centre and whse respnsibility it is t infrm the patient. It was agreed that a trigger is required when the reprt is generated t ensure that the review is ffered with the patient. This culd be part f the end f treatment summary prcess. HIV testing 2

3 Lndn Cancer There is a lack f awareness f the bard plicy fr HIV testing. There is a need t incrprate this int the guidelines. The Whittingtn fed back that HIV tests have nt been being cmpleted but this has been raised at the MDT. The current recmmendatin is HIV testing fr cervical cancer. TM prpsed that HIV testing culd be carried ut fr all gynaeclgical cancer patients. There are a number f reasns fr this including that cancer treatments have a large impact n HIV psitive patients. The bard were supprtive f this apprach. Patient cnsent was discussed and the pint in the patient pathway where an HIV test shuld be ffered. The bard agreed that the cnsent prcess wuld be implemented lcally e.g. in preassessment leaflet. Actins: ALL t ensure that the prcess fr cytlgy review is fllwed. ALL t implement a lcal prcess fr rutine HIV testing fr all patients. 6. Annual research day Michelle Lckley is leading n this and utlined the agenda. There is an emphasis n varian cancer. ML utlined the prgramme and agreed t circulate it. Actin: Michelle Lckley t circulate prgram HS t crdinate venue fr this and educatin day 7. Early Diagnsis quality f ultrasund There may be pprtunities t standardise ultrasund reprting t drive imprvements. See belw fr mre detail. 8. AOB Sentinal nde surgery in vulval cancer This trial has nw stpped. Currently patients are still ffered this where apprpriate. The bard were happy with this. Endmetrial thickness investigatin Currently asymptmatic patients are being referred with less than 6.7mm endmetrial thickness. There is a trial f 11,000 patients which suggests that this shuld be the cut ff fr GP referral. Other reviews have suggested 10mm cut ff. The bard discussed what the guidance shuld be and whether the bard shuld recmmend that the pan-lndn tw week wait frm shuld be changed. A lt f referrals cme frm radilgy departments internally. It was agreed that the frms wuld nt be changed but that the bard guidelines will be that asymptmatic patients with thickness f 7mm r mre shuld be investigated. Wrk plan 3

4 Lndn Cancer TM presented the wrk plan which had been circulated. There was a discussin abut the need t capture clinical utcmes data and patient experience data The utcmes that the bard felt wuld be helpful t capture t drive imprvements were: Cmplicatins Readmissins relates t enhanced recvery prgrammes and wrking acrss the sectr as patients may be readmitted elsewhere in the sectr Laprscpic surgery rates fr endmetrial cancer Quality f ultrasund HS raised the data available thrugh the Vanguard which wuld be helpful t review. The bard raised the need t understand hw the data is cllected. Pathlgy at UCLH New lead t start in February. There is anther new member f staff wh is in pst. Patient transprt is an nging issue. Thur 06-Apr :00-17:00 Gynaeclgy Pathway Bard - Research 52 Club, Bnham Carter Huse, 52 Gwer St, Lndn WC1E 6EB ACTION LOG TM t send guidelines t trusts re self - management fr patients with lw-risk endmetrial cancer Actin Owner Date Agreed Status TM Cmplete TM t send ut timed pathways TM Cmplete ALL t ensure that the prcess fr cytlgy review is fllwed. ALL t implement a lcal prcess fr rutine HIV testing fr all patients Michelle Lckley t circulate research day prgram HS t crdinate venue fr this and educatin day All All ML Cmplete HS Cmplete fr research day 4

5 Lndn Cancer Name Trust/Organisatin Tim Muld University Cllege Lndn Hspitals Frances Evans Nrth Middlesex University Hspital Alexandra Lawrence Barts Health (The Ryal Lndn) Lisa Reid Princess Alexandra Hspital Nicla MacDnald University Cllege Lndn Hspitals Narendra Pisal The Whittingtn Hspital Stris Vimplit Barts Health (Whipp s Crss) Janaki Putran PAH Sue Gessler University Cllege Lndn Hspitals Eric Nyark Hmertn Elaine Burtn Hmertn Tania Adib BHRUT (Queen s) K. Rasheed PAH Helen Saunders minutes Lndn Cancer 5