Skin Cancer Clinical Network Group (CNG)

Transcription

1 Skin Cancer Clinical Network Group (CNG) Constitution Version 1.0 This Constitution has been agreed by: Title Name Date Agreed Skin Cancer CNG Co-Chair Skin Cancer CNG Co-Chair Andrea Howes Philip Brackley CMSCN Cancer Clinical Lead Chris Warburton CWW Area Team Medical Director Kieran Murphy Agreed by the Skin Cancer CNG Skin Cancer CNG Constitution 2014 Page 1 of 18

2 Version Control This is a controlled document please destroy all previous versions on receipt of a new version. Date Approved: August 2014 Review Date: April 2015 Version Date Issued Review Date Brief Summary of Change 1.0 Aug 2014 April 2014 Approved Skin Cancer CNG Constitution 2014 Page 2 of 18

3 Table of Contents Section 1.0: Structure and Function Structure & Function Network Configuration of MDT s C-101j Network Configuration of Skin Cancer Services in the Community- 14-1C-102j Agreed Network Distribution of Clinics for Immunocompromised Patients with... 6 Skin Cancer C-103j Membership C-104j CNG Chair Terms of Reference Communication Key Responsibilities Strategic Development Meeting Frequency C-105j Work Programme & Annual Report C-106j Designated Hospital Practitioners for Mohs Surgery C-107j Training Policy for Model 2 Community Practitioners with Named Trainers /Assessors C-108j... 9 Section 2.0: Co-ordination of Care/Patient Pathways Clinical Guidelines C-109j Chemotherapy Treatment Algorithms- 14-1C-110j Patient Pathways for Primary Care/ Community Services and MDTs C-111j Patient Pathways between MDTs C-112j Patient Pathways for Supranetwork MDTs/Services C-113j Patient Pathways Shared with Other MDTs C-114j Section 3.0: Patient Experience C-115j Section 4.0: Clinical Outcomes/Indicators C-116j Performance Indicators CNG Audits Clinical Governance Arrangements for Community Practitioners C-117j Clinical Trials C-118j Appendix 1.0: Skin Cancer CNG Membership Appendix 2.0: Skin Cancer CNG Guideline Summary Skin Cancer CNG Constitution 2014 Page 3 of 18

4 Section 1.0: Structure and Function 1.1 Structure & Function Cheshire & Merseyside Strategic Clinical Networks (CMSCN) are based in the North West of England & cover a population in excess of 2.4 million. The healthcare system covers a mix of rural and urban populations with high levels of deprivation and poor physical and mental health. The work of the SCN is facilitated by a support team hosted by Cheshire, Warrington and Wirral Area Team. The network comprises a number of stakeholders including: Patients, carers/families and members of the public 12 Clinical Commissioning Groups 2 NHS England Local Area Teams 9 Acute Hospital Providers (8 with A&E provision) 5 Specialist Hospital Providers 2 Mental Health Trusts 4 Vertically Integrated Community Trusts 3 Community Trusts 10 Hospices 9 Local Authorities 9 Health and Wellbeing Boards 9 Local Healthwatch organisations 2 Academic Health Science Networks 1 Ambulance Trust This document outlines the Constitution and Terms of Reference for the Skin Clinical Network Group (CNG) and will be reviewed on an annual basis. 1.2 Network Configuration of MDT s C-101j Within CMSCN there is a Skin Cancer Network Group (CNG) which has membership from each LSMDT and SSMDT. The implementation milestones to meet the requirements of the NICE IOG for Haemato-oncology have been met. The identity and location of the local skin MDT s (LSMDT) and specialist skin MDT (SSMDT) with the identified referring CCG are included in the tables below. LSMDT s Hospital Trust Bridgewater Community Healthcare NHS Trust Countess of Chester NHS Foundation Trust Royal Liverpool & Broadgreen University Hospital NHS Trust Referring CCG s Warrington CCG West Cheshire CCG Knowsley CCG Liverpool CCG Skin Cancer CNG Constitution 2014 Page 4 of 18

5 Southport and Ormskirk Hospital NHS Trust St Helens & Knowsley Teaching Hospitals NHS Trust Wirral University Teaching Hospital NHS Foundation Trust West Lancs CCG Southport & Formby CCG South Sefton CCG Halton CCG St Helens CCG Knowsley CCG Wirral CCG West Cheshire CCG Wrightington, Wigan and Leigh NHS Foundation Trust 1 Wigan Borough CCG 1 Wrightington, Wigan and Leigh NHS Foundation Trusts falls within the geography of the GMLSCSCN but is part of CMSCN skin cancer network as patients are referred from their LSMDT to the SSMDT at St Helens and Knowsley Teaching Hospitals NHS Trust. All relevant patients will be discussed at the SSMDT. Wrightington, Wigan and Leigh patients will be able to access radiotherapy and Mohs through the GMLSCSCN, i.e. under the care of The Christie and Salford Royal respectively. Within Merseyside and Cheshire Cancer Network there is an SSMDT hosted by St Helens & Knowsley Teaching Hospitals NHS Trust. The MDT deals with all cases of taking all referrals of malignant melanoma for level 5 care from their catchment population; and all referrals of malignant melanoma for level 4 care from their local (secondary) catchment population. The MDT serves a network population of 2.4 million. The Supranetwork Cutaneous T-cell Lymphoma MDT is hosted by The Royal Liverpool & Broadgreen University Hospitals NHS Trust 1.3 Network Configuration of Skin Cancer Services in the Community- 14-1C-102j The CNG has agreed with the CCGs a policy for provision of skin cancer services in the community which includes that the provision of treatment for skin cancer over the network, if carried out for NHS patients in the community setting, should be drawn only from the following 4 service models as specified in the introduction to these skin cancer measures: i. The service provided under the DES/LES contracting system. ii. Service Model 1 iii. Service Model 2 iv. Service Model 3 CCG s Care Level Supporting Information Halton CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care Knowsley CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care Liverpool Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care Skin Cancer CNG Constitution 2014 Page 5 of 18

6 South Sefton and Southport & Formby CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care St Helens CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care Warrington CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care West Lancs CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care Western Cheshire Care Level 2/Model 1 3 GPwSIs connected with Chester LSMDT Wigan Borough CCG Care Level 1 Precancerous / benign lesions only; all low risk BCCs and above into secondary care Wirral CCG Care Level 2/Model 1 Peninsula LLP (1 GPSI and 1 consultant) connected to Wirral LMDT Precancerous / low risk BCC (not on T zone of face)/ benign lesions; all high risk BCCs (on T zone of face) and above into secondary care. 1.4 Agreed Network Distribution of Clinics for Immunocompromised Patients with Skin Cancer C-103j Immunocompromised patients with skin cancer will be managed via one of the designated LMDTs (The Royal Liverpool & Broadgreen University Hospitals NHS Trust, Wirral University Teaching Hospitals NHS Foundation Trust, Countess of Chester NHS Foundation Trust, St Helen s & Knowsley Teaching Hospitals NHS Trust). 1.5 Membership C-104j Within CMSCN there is a single Skin Cancer Clinical Network Group (CNG). Core membership consists of: a core member from each of Skin Cancer MDTs a dermatologist surgical representation including plastic and reconstructive surgery a clinical oncologist a medical oncologist a histopathologist a radiologist Skin Cancer CNG Constitution 2014 Page 6 of 18

7 a GPwSI in skin cancer practising in the community two user representatives a named chair who should be a core MDT member an NHS employed member of the CNG nominated as having specific responsibility for users' issues and information for patients and carers a member of the CNG nominated as responsible for ensuring that recruitment into clinical trials and other well designed studies is integrated into the function of the CNG named secretarial/administrative support Please see Appendix 1 for full membership list. 1.6 CNG Chair The Skin Cancer CNG has two co-chairs: Dr Andrea Howes, Consultant Radiologist, St Helens & Knowsley Teaching Hospitals NHS Trust and Mr Phil Brackley, Consultant Plastic Surgeon St Helens & Knowsley Teaching Hospitals NHS Trust. The term of the Chair s role should be reviewed after three years. The Chair will have an annual review with the Network Cancer Clinical Lead. Members of the skin cancer community who express interest in chairing the CNG will be invited to a meeting with the Cancer Clinical Lead who will decide the Chair based on agreed skills and competencies. A key part of the role will be to ensure effective engagement of constituent members and communication with stakeholders. 1.7 Terms of Reference The Skin Cancer CNG is the main source of clinical advice to the CMCSN Cancer Steering Group & Oversight Group on all matters relating to its area of expertise. The role of the CNG is to ensure coordination of the cancer pathway, consistency of clinical practice and to achieve the best possible outcomes and experience for patients, irrespective of where their treatment and care is provided. The role of the CNG includes: Service planning Service improvement Service monitoring including clinical performance and outcomes Workforce development Research and development The CNG has a key role in the development of plans to implement national guidance and to monitor implementation. These will subsequently form part of the Network s Service Delivery Plan. It will ensure that concerns and areas of risk are raised with the Taskforce via agreed governance agreements. The NCG should have active engagement of all chemotherapy teams in the network. 1.8 Communication The Chair will provide feedback to the Cancer Steering Group including presenting key areas of work e.g. service priorities. The Chair will represent the Network appropriately, including at a regional and national level. Members should ensure that all decisions are fed back and become integrated into constituent organisational structures and processes. Skin Cancer CNG Constitution 2014 Page 7 of 18

8 The Chair will ensure that all CNG peer review evidence is updated annually. 1.9 Key Responsibilities The responsibilities of the CNG are to: Review latest national guidelines/standards published by NICE, Department of Health, Royal Colleges and other professional bodies/committees agreeing best practice recommendations. Coordinate the consistent implementation of national guidance/recommendations across the network. To work closely with other network groups to develop clinical and referral guidelines that reflect best practice Identify local population needs and gaps in service and advise on approaches to address these. To provide expert advice to commissioners on the commissioning of cost effective anticancer therapies, best service models, pathways of care and emerging technologies Develop workforce recommendations in response to service developments, recruitment difficulties and emergent technologies. Annually monitor progress regarding compliance against cancer measures, participating fully in the peer review process and ensuring any remedial action plans following peer review are implemented. Stimulate and lead areas for service improvement and innovation within the network. Analysis of national minimum data sets for variations in clinical practice/patient outcomes Review approved clinical trials, other research and development initiatives and encourage patient entry Undertake network wide audit and provide a forum for the wider discussion of local audits as part of its role in education and development. Ensure there is a process for obtaining patient and carer advice and involvement in service issues and in the development of plans related to the CNG Strategic Development The CNG will ensure engagement and communication with stakeholders with regard to service plans and developments. This will include triennial identification of investment requirements necessary to meet quality standards and outcomes which will serve to influence strategic commissioning plans. This will be agreed and monitored as part of the CNG work programme. In line with its terms of reference the NCG will ensure that service planning; considers the whole patient pathway promotes high quality care and equal access to services takes account of the views of patients and carers considers opportunities for workforce and service redesign 1.11 Meeting Frequency C-105j CNG meetings will be held triannually with additional meetings as required for short term task and finish projects. The meeting will be quorate when 50% of the units are represented at the meeting. Meeting attendance will be recoded and reported annually. Skin Cancer CNG Constitution 2014 Page 8 of 18

9 1.12 Work Programme & Annual Report C-106j The CNG will review and update its constitution annually. An annual report and work programme will be complied by the group. The three key documents will be ratified by the CNG at the first meeting following 1 st April each year Designated Hospital Practitioners for Mohs Surgery C-107j Patients requiring Mohs surgery will be referred to the SSMDT St Helen s & Knowsley Teaching Hospitals NHS Trust. The Designated Practitioner for Mohs Surgery is Mr Hamid Tehrani. A second surgeon is currently undergoing training to support the service. The SSMDT assures the CNG annually that each practitioner has completed a minimum of 50 cases per year Training Policy for Model 2 Community Practitioners with Named Trainers /Assessors C-108j The CNG, in consultation with the MDTs, has agreed a training policy for the network for Model 2 Community Practitioners. This includes the requirement that unless they fulfil the exemption conditions, practitioners should be trained and assessed in an agreed selection of the skin surgery curriculum and competencies as set out in 'Guidance for the accreditation of General Practitioners with a special interest in dermatology (GPwSIs) and General Practitioners performing skin surgery 2011'. Exemptions may only be conferred by the practitioner having had 2 years of practice in skin cancer surgery, as verified by the lead clinician of the MDT. The CNG has an agreed list of named trainers / assessors of competence for the network for the Model 2 practitioners', which is reviewed annually. In addition, the CNG has agreed, the following policy for community practitioners: GPwSIs and model 2 practitioners practicing in the community should each be associated with one LSMDT or SSMDT The practitioners associated with a specified MDT should undertake the following: - undergo 15 hours CPD in skin cancer each year - have one session each year with a Consultant Dermatologist who is a core member of that MDT - have their community skin cancer practice included in the MDT s contribution to the Network audit - attend 4 MDTs each year including 2 teaching / audit meetings The lead clinician of the MDT will monitor adherence to requirements of the model 2 practitioners associated with the MDT Section 2.0: Co-ordination of Care/Patient Pathways 2.1 Clinical Guidelines C-109j The CNG is responsible for ensuring coordination and consistency across the network. This is supported by a number of CNG agreed guidelines. These detail how a given patient should be clinically managed i.e. the level of which modalities of imaging and pathology investigation and which modalities of treatment are indicated. Skin Cancer CNG Constitution 2014 Page 9 of 18

10 Designated CNG members will be identified by the CNG to lead on specific guidelines. The CNG will ratify the guidelines and individual MDTs will agree to abide by them. The CNG will subsequently review, agree and update these guidelines on a regular basis and will audit the implementation of these guidelines, making sure they are kept up to date implementation is required, a network guideline will be developed. See Appendix 2 for full list of NCG agreed polices/guidelines. The guidelines include: the pathology requesting and reporting protocol with failsafe mechanisms, applicable to community and hospital practice there is a named histopathologist for the network, to whom all new presumed cases of cutaneous lymphoma, should be referred for a second histology opinion (Geetha Menon, Royal Liverpool & Broadgreen University Hospital NHS Trust) that cases referred to an SSMDT from another MDT are subject to a review of their histology by a core Histopathologist member of the SSMDT. 2.2 Chemotherapy Treatment Algorithms- 14-1C-110j The network group, in consultation with the Acute Oncology & Chemotherapy CNG has agreed a list of acceptable chemotherapy treatment algorithms. The list will be updated bi-annually. 2.3 Patient Pathways for Primary Care/ Community Services and MDTs C-111j The CNG has produced patient pathways (i.e. the named services, hospitals and MDTs which a patient should be referred to according to named indications, during their investigation, treatment, psychological and social support, rehabilitation and follow up). The pathways include the relevant contact points for the community services, hospitals and MDTs and cover the following: that actinic keratoses and precancerous lesions may be dealt with by any GP (level 1 care) that GPs should refer suspected cases of skin cancer requiring treatment, including BCCs, to the contact point of the relevant named MDTs in the network configurations, or for cases of low risk BCC, there is the option of referral to the contact point of a relevant GP based service the guidance for GPs on clinically identifying low risk BCCs incorporating the lists of clinically low risk BCCs. the named individual practices which will refer patients to which named MDT, one practice referring to one team. The pathways have been distributed to the hospital core members of the LSMDTs and the SSMDTs in the network. 2.5 Patient Pathways between MDTs C-112j The network group has produced patient pathways between MDTs (i.e. the named services, hospitals and MDTs which a patient should be referred to according to named indications, during their investigation, treatment, psychological and social support, rehabilitation and follow up). The pathways include the relevant contact points for the hospitals and MDTs and cover the following: that LSMDTs should refer cases of the types of skin cancer needing care level 5, to the SSMDT for discussion and management. In addition the following cases will be referred to the relevant site specialty MDT as per agreed referral parameters: o cutaneous lymphoma o kaposi's sarcoma Skin Cancer CNG Constitution 2014 Page 10 of 18

11 o o cutaneous sarcoma above superficial fascia other rare skin cancers e.g. Merkel cell tumours, atypical fibroxanthomas 2.6 Patient Pathways for Supranetwork MDTs/Services C-113j The CNG has produced patient pathways for supranetwork MDTs/services. The pathways include the relevant contact points for the hospitals and MDTs and cover the following: that cases of nodular mycosis fungoides (stage 2B or over) should be referred for discussion and consideration of TSEB to the supranetworkt-cell lymphoma MDT at Royal Liverpool & Broadgreen University Hospital NHS Trust that cases of erythrodermic cutaneous T-cell lymphoma, stages 3 and 4, having both skin involvement and circulating T-cell clonal cells, should be discussed with the clinician in charge of a named photopheresis facility for potential referral and treatment by photopheresis. 2.6 Patient Pathways Shared with Other MDTs C-114j The CNG has agreed patient pathways with the relevant CNG s specifying which out of the site specific MDT or skin cancer MDT should deal with which cases in which clinical situations and which parts of the patient pathway for the following: head and neck skin cancer anal and perianal skin cancer skin cancer of external female genitalia skin cancer of external male genitalia lymphoma involving skin sarcoma involving skin teenage and young adult (TYA) skin cancer patient pathways for initial management, follow up on completion of first line treatment and cases involving NHS specialised services CUP MDT Section 3.0: Patient Experience C-115j The CNG will annually review patient feedback of their associated MDT s and any actions implemented. The CNG will agree any actions required on a network foot print & allocate responsibility for delivery to an appropriate group. CMSCN is committed to user involvement in, and representation on, all Clinical Network Groups. Within the CNG, there are two appointed user representatives who are invited to participate in all discussions at the group and associated events with a standing opportunity for user issues to be raised at every CNG meeting for user feedback and input into the group s work programme. In addition, CMSCN use a range of different methods and mechanisms to maximise patient and public involvement in order to allow people to be involved as much or as little as they choose. Fundamental to this approach is the development of the People s Voice. This largely virtual assembly will consist of patient, carer, public and community representatives; its purpose is to support the participation and engagement of patients, carers and members of the public on changes and improvements to health and wellbeing services, policies or strategies. In addition, Rachael Duncan has been nominated as having specific responsibility for users issues and information for patients and carers. Skin Cancer CNG Constitution 2014 Page 11 of 18

12 Section 4.0: Clinical Outcomes/Indicators C-116j 4.1 Performance Indicators The CNG has agreed that the following network minimum datasets: National Cancer Waiting Times Dataset (NCWTMDS) Cancer Outcomes and Services Dataset (COSD) Cancer Waiting Times data is reported at each meeting & issues relating to pathway breaches investigated. Cancer Outcomes and Services Dataset (COSD) conformance is reported at each meeting to support 100% data compliance by January 2015 & resulting improved skin cancer outcomes using high quality data and intelligence. The CNG has agreed that collection of the MDS and associated checks on quality, quantity and validity is the responsibility of Trust Cancer Teams and ultimately is the responsibility of the named Executive Lead for Cancer in each Trust. All teams should collect the data relevant to the care they have provided. Where a patient is referred between teams for specialist investigations or treatment, then it is the responsibility of the specialist MDT to transfer the relevant dataset that they collect during the care of their patients back to the referring MDT. The Somerset Cancer Register (SCR) is accepted as the primary data collection system used to collect cancer data across CMSCN. Each Trust will ensure that data capture systems are organised to ensure that data is collected in a timely manner and in accordance with Caldicott and data protection policies. 4.2 CNG Audits In line with the agreed terms of reference, the CNG will agree a network audit project and review progress/completion on an annual basis. 4.3 Clinical Governance Arrangements for Community Practitioners C-117j The CNG, in consultation with MDTs, agree a policy for arrangements for community practitioners which includes the following: that Group 3 and skin lesion GPwSIs and 'Model 2' practitioners, practising in the network, should each be associated with a named LSMDT or SSMDT; that community skin cancer practitioners should have their practice included in the network audit; that MDT lead clinicians should monitor the attendance of any GPwSIs associated with their MDT, at four MDT meetings a year and an annual community practitioners educational network group meeting. The network group will hold at least one educational meeting per year to which community skin cancer practitioners are invited (2), and which includes: A presentation of network skin cancer audit results. The audit and the presentation should include a topic involving BCCs, of relevance to practitioners treating them in the community and a breakdown of individual practitioner performance; Skin Cancer CNG Constitution 2014 Page 12 of 18

13 A four hour CPD session, with an emphasis on skin lesion recognition and the up to date management of skin cancer (including BCCs) for community practitioners. 4.4 Clinical Trials C-118j The CNG will: Support local equity of access for all patients across CMSCN Support the development of the North West Coast Clinical Research Network (NWC CRN) portfolio of cancer studies Identify service configuration requirements to deliver local and national trials portfolio and develop plans for implementation Receive annual recruitment report from each MDT and agree any remedial actions. Skin Cancer CNG Constitution 2014 Page 13 of 18

14 Core Skin Cancer CNG Membership Appendix 1.0: Skin Cancer CNG Membership Name Organisation Role Dr John Ashworth Bridgewater Community Healthcare NHS Trust LSMDT Lead, Consultant Dermatologist Dr Asad Salim Countess of Chester NHS Foundation Trust LSMDT Lead, Consultant Dermatologist Dr Niall Wilson Royal Liverpool & Broadgreen University Hospital NHS Trust LSMDT Rep, Consultant Dermatologist Dr Aamir Memon Southport and Ormskirk Hospital NHS Trust LSMDT Lead, Consultant Dermatologist Dr Elaine Hindle St Helens & Knowsley Teaching Hospitals NHS Trust LSMDT/SSMDT Lead, Consultant Dermatologist Dr Andrea Howes St Helens & Knowsley Teaching Hospitals NHS Trust CNG Co-Chair, Consultant Radiologist Mr Philip Brackley St Helens & Knowsley Teaching Hospitals NHS Trust CNG Co-Chair, Consultant Plastic Surgeon Dr Naveen Sharma St Helens & Knowsley Teaching Hospitals NHS Trust Consultant Histopathologist Rachel Duncan 1 St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Nurse Specialist Dr Ernie Marshall 2 The Clatterbridge Cancer Centre NHS Foundation Trust Medical Oncologist Dr Mohamed Saipillia The Clatterbridge Cancer Centre NHS Foundation Trust Clinical Oncologist Dr William Dunne Wirral CCG GPwSI (Assura) Dr Boon Tan Wirral University Teaching Hospital NHS Foundation Trust LSMDT Lead, Consultant Dermatologist Dr Elizabeth Stewart Wrightington, Wigan and Leigh NHS Foundation Trust 1 LSMDT Lead, Consultant Dermatologist TBC N/A User Representative TBC N/A User Representative Debbie McEllenborough Cheshire & Merseyside Strategic Clinical Networks Network Assistant 1 CNG Lead for users issues and information for patients and carers 2 CNG Lead for ensuring recruitment into clinical trials and other well designed studies Skin Cancer CNG Constitution 2014 Page 14 of 18

15 Extended Skin Cancer CNG Membership Name Organisation Role Dr Andrew Beare-Winter Bridgewater Community Healthcare NHS Trust Locum Consultant Dermatologist Jayne Corcoran Bridgewater Community Healthcare NHS Trust Clinical Nurse Specialist Mr Ali Juma Countess of Chester NHS Foundation Trust Senior Consultant Plastic Surgeon Dr Asad Salim Countess of Chester NHS Foundation Trust Consultant Dermatologist Joanna Martin Countess of Chester Hospital Skin Cancer Nurse Specialist Dr Richard Azurdia Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Dermatologist Dr Graham Sharpe Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Paediatric Dermatologist Dr Nitkin Khirwadker Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Histopathologist Dr Arti Bakshi Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Histopathologist Teresa Wood Royal Liverpool & Broadgreen University Hospital NHS Trust Clinical Nurse Specialist Sue Wood Southport & Ormskirk Hospital NHS Trust Clinical Nurse Specialist Alison Mahon Southport & Ormskirk Hospital NHS Trust Staff Nurse Ann Marr St Helens & Knowsley Teaching Hospitals NHS Trust Chief Executive Dr Elaine Hindle St Helens & Knowsley Teaching Hospitals NHS Trust Consultant Dermatologist and Skin MDT Lead Dr Naveen Sharma St Helens & Knowsley Teaching Hospitals NHS Trust Consultant Histopathologist Mr Hamid Tehrani St Helens & Knowsley Teaching Hospitals NHS Trust Consultant Plastic & Reconstruction Surgeon Mr Rowan Pritchard Jones St Helens & Knowsley Teaching Hospitals NHS Trust Consultant Plastic & Reconstruction Surgeon Karen Pocock St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Nurse Specialist Helen Martin St Helens & Knowsley Teaching Hospitals NHS Trust Physiotherapist Claire Anderson St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Psychologist Hannah Anstey St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Psychologist Jo Upton The Clatterbridge Cancer Centre NHS Foundation Trust Clinical Nurse Specialist Sue Taylor Wrightington, Wigan and Leigh NHS Foundation Trust Clinical Nurse Specialist Pat Gillis North West Coast Clinical Research Network Research Delivery Manager Skin Cancer CNG Constitution 2014 Page 15 of 18

16 Anna Bass Cheshire & Merseyside Strategic Clinical Networks Quality Improvement Lead Skin Cancer CNG Constitution 2014 Page 16 of 18

17 Appendix 2.0: Skin Cancer CNG Guideline Summary GUIDELINE CNG Lead REVIEW DATE Anal SCC pathway Philip Brackley July 2014 Peri-anal pathway Philip Brackley July 2014 BAD Guidelines for the Management of Basal Cell Carcinoma BAD Current BAD Multiprofessional Guidelines for the Management of the Patient with Primary Cutaneous Squamous Cell Carcinoma BAD Current CTCL pathway review Richard Azurdia July 2014 Referral to specialist cutaneous lymphoma clinic Richard Azurdia July 2014 Follow Up guidelines for SCC's Philip Brackley July 2014 Gynae Melanoma Pathway Philip Brackley July 2014 Training Policy for Community Practitioners 9including clinical governance arrangements) Philip Brackley July 2014 Head + neck (others) skin cancer pathway Philip Brackley July 2014 Head + neck skin cancer pathway Philip Brackley July 2014 Nasal mucosal melanoma pathway Philip Brackley July 2014 Ocular mucosal melanoma pathway Philip Brackley July 2014 Peri-occular melanoma pathway Philip Brackley July 2014 Network referral guidelines between team Philip Brackley July 2014 Guidelines for Imaging in Malignant Melanoma Andrea Howes September 2014 Pathology reporting guidelines Naveen Sharma July 2014 Mohs Referral Pathway Hamid Tehrani July 2014 Referral to Mohs Surgeon Hamid Tehrani July 2014 Sarcoma Pathway Philip Brackley July 2014 Skin Cancer CNG Constitution 2014 Page 17 of 18

18 Photophoresis guidelines Richard Azurdia July 2014 Skin MDS Philip Brackley July 2014 SSMDT Referral Proforma Elaine Hindle July 2014 CMSCN TYA pathways for initial management and for follow up on completion of first line Laura Elder August 2015 treatment CMSCN CUP Pathway Richard Griffiths July 2015 CMSCN Skin Cancer Rehabilitation Pathway Helen Martin July 2014 Primary Care Pathways Philip Brackley July 2014 Chemotherapy Algorithms Ernie Marshall July 2015 Radiotherapy Protocols Brian Haylock July 2015 Supportive Care pathway Rachael Duncan November 2014 Skin Cancer CNG Constitution 2014 Page 18 of 18