ESSEX CANCER NETWORK UROLOGY NSSG MEETING. Monday 13 th February 2012 at hrs Swift House, Middle & Annexe Chelmsford CM2 5PF

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1 ESSEX CANCER NETWORK UROLOGY NSSG MEETING Present: Monday 13 th February 2012 at hrs Swift House, Middle & Annexe Chelmsford CM2 5PF Tom Carr (Chair) TC Medical Director, ECN R Ravi RR Consultant Urologist, BTUHFT Ann Tull AT CNS, SUHFT David Tsang DT Clinical Oncologist, SUHFT Maggie Braithwaite MB CNS, CHUFT Claire Turner CT CNS, MEHT Chris Stubbings CS CNS, MEHT Mo Dooldeniya MD Consultant Urologist, SUHFT Roger Bassett RB User Representative Ashley Solieri AS Research Manager, ECRN Anil Vohra AV Consultant Urologist, BTUHFT Priscilla Leone PL Consultant Urologist, MEHT Ranjan Thilagarajah RT Consultant Urologist, MEHT Sue Maughn SM Network Director, ECN F M McQueen FM Clinical Services Manager, BTUHFT 1. Apologies Helen Hegarty, Lucy Powell, Jo Cook, Martin Nuttall, Kiran Kancherla, Kate Patience, Sampi Metha, Alan Lamont, Brian Liversage, Dr Kumar, Olivia Chan, Petra Orebanwo, Bruce Sizer, Andrew Tanqueray, Rachael West, and John Corr. It was agreed that it would be useful to avoid dates that fell in the school holiday if at all possible. Reconstruction Audit- Deferred until next time. Miss Hegarty unable to present. 2. Previous Minutes 15 th December 2011 The minutes required 2 corrections before they could be considered to be a true reflection of the meeting: Rebecca Dale was the SpR who had attended the meeting from MEHT Section 4.2, the CNS s had not been able to meet due to sickness. 3. Matters Arising 3.1 IOG Compliant Arrangements Letter from NCAT The letter from NCAT had been discussed at the ECNB. The board had asked that the NSSG give it further consideration and report back. TC produced a discussion document. There was a general discussion. The consensus was 1 of 6

2 that a working party be established outside of the NSSG to consider this and report back. The discussion document will be distributed with the minutes. SM to establish a work group. Robotic Pathways The work to include the pathways within the Constitution is outstanding. A small group to meet to review the Clinical Guidelines. SM to facilitate. RT queried if the patients need to go through both the ECN SMDT and the Chase Farm SMDT. Currently these patients are only going through the ECN SMDT. RT to confirm with Chase Farm. 3.2 Peer Review Programme 2011 and 2012 There had been 2 serious concerns noted. The first had been dealt with in Section 3.1 With regard to Histopathology, a letter had gone out to all trusts informing them of the requirement for all slides to be reviewed by the SMDT pathologist. This applies to all specialties. Also, where specimens are removed at a centre they need to remain again for the interpretation of the local pathologist. SUHFT suggested that this may cause them some short term operational issues but should have them resolved soon. The processes to be established between pathology services and not add extra burden to clinical staff, especially CNS s There will be no visits to the Urology teams or NSSG this year. All teams, with the exception of MEHT, need to do the Self-assessment process who also need to do an IV. SM suggested that although there is no requirement to upload and link documents, uploading them so that they are publically available is good practice. The deadline for completing the process is the 30 th September, but all teams to check with their local management as some set their own internal targets. 3.3 Audit Update on 2011 Audit actions Acute Oncology Presentation: Agreed All teams to ensure that they put in place the fast track appointments required to accommodate the AOS. All teams to ensure that local processes are reflected in revised Ops policies. Patient experience of being referred to a Cancer Centre Audit: Agreed Actions: CNS group to review the information given to patients on discharge. 2 of 6

3 NSSG to agree for a target time for follow up post surgery. There were discussion amongst the group and the following post surgical follow up was suggested. Bladder - Prostate - Renal weeks 6 weeks 4-6 weeks. Target times for follow up to be included in the next version of the clinical guidelines. TWOC clinics: Action complete Network-wide BCG Audit: Agreed MEHT only unit now not getting written consent. Southend to share their proforma. AT to share Southend documentation with MEHT CNS s All Cancer Managers to ensure that this is put in place. Audit of RT late Toxicity effects: Agreed Audit to be extended to cover both RT centres in PL to lead on the audit. Daily use of Cialis- see section 3.4 ERP Audit: Agreed The roll out of standard ERP pathways across the Network to be added to the Service Delivery Plan. Still outstanding. Audit 2012: Topics Agreed: Repeat of late toxicity audit- Lead PL Repeat Patient experience of being referred to a Cancer Centre-CNS group to lead Rehabilitation services Gap analysis- Kate Patience Research presentation- AS to confirm lead Neoadjuvant chemo for cystectomy- Lead MD and MB Update on MRI audit- Lead IM and MD 3 of 6

4 3.4 Penile Rehabilitation Programme TC and SM had met with Commissioning Pharmacists in respect of the daily use of Cialis. They had also discussed the Penile Rehabilitation paper produced by Mr Garaffa. They suggested that this protocol was not acceptable as they would not commission the use of Cialis outside of its licensed dosage. They have asked the NSSG to produce a pathway against which they can commission. SM reported that the Chemo Board, subject to ECNB approval, will have a wider remit to include commissioning decisions on other Cancer Pathway related drugs to be renamed the ECN Medicines Management Board. Once a protocol for the use of cialis is agreed it will need to be presented to this Board. Working group to be established to develop a Penile Rehabilitation Protocol SM 3.5 Sarcoma Guidelines SM, at the request of the CNS s, had asked for the contact details of the CNS at the centre. This was discussed at the Sarcoma NSSG at the centre who fed back that they will not provide this information and that all contact should be through the MDT Co-ordinator. All felt that this was unacceptable. DT suggested that this could be overcome with a CNS in the Network taking responsibility for Sarcoma. Southend had made attempts in the past to do this but with no luck. RL to write to the Chair of the Sarcoma Advisory Group. 3.6 MRI AUDIT: MD provided feedback to the group. At the outset there had been concerns about the impact on Radiology. They have found that 80% of the MRI scans were proven to have cancer on biopsy. They have since revised their protocol further. Those that have the following have MRI prior to TRUS Bx:- PSA > 10 Abnormal DRE Suitable for radical treatment. MD said that in their experience you cannot judge suitability from the referral letter so all are seen in clinic prior to the MRI. In some cases the MRI where suspicious had encouraged early re-biopsy in the face of a normal/negative first biopsy. Several cancers have been diagnosed in this way indicating that the MRI and TRUS/Bx may become complimentaruy. All agreed that a Network-wide policy would be advantageous. MD to prepare a protocol for discussion at the next meeting. 3.7 Feedback from Zonal Team meeting See Section 3.1 above. 4 of 6

5 4. Standing Agenda Items 4.1 User Involvement RB reported that there had many changes in the Network User Partnership. He also reported that Brian Liversidge will be taking a back seat for a while. AT asked of the chair could write to Brian with well wishes and thanks for his help to date. RL The Southend Group had now secured funding from Macmillan for an Information Centre, which should be completed by December Support has been offered to MEHT who are looking to do something similar. 4.2 CNS update The CNS s had not been available to meet as a group, it had been hoped that this would have been earlier today. 4.3 Service Developments: Potential IOG arrangements Penile Rehab Protocol MRI prior to TRUS Bx All discussed earlier. 4.4 Agree Action points from Audit: Please see Section 3.3 above. 4.5 Research RT would like to open the Hymn commercial study at MEHT. Will require support from all Trusts if this is to be pursued given the numbers that would need to be recruited to justify the additional equipment requirements. The group was not sure that there would be the numbers. However, all agreed to retrieve potential numbers from their trusts and feedback. All 5. Any other Business 5.1 NSSG Vice Chair SM described how the default position had been that if the chair is not available then she had been asked to chair. Today it had been necessary for TC to chair as she was taking minutes. Other NSSG s have a Vice chair from the membership entirely for this purpose. SM to out to the whole membership for nominations, and subsequently for a ballot if required. SM 5 of 6

6 6. Date of Meetings for 2012 All 2.00pm 4.00pm, Middle and Annexe, Swift House Wednesday 9 th May Wednesday 11 th July Swift Middle & Annexe Please note extra date Wednesday 24 th October Audit and NSSG pm venue tbc 6 of 6