London Cancer Urology Pathway Board

Transcription

1 London Cancer Urology Pathway Board Date: Thursday, 24 July 2014, 16:00 18:00 Venue: Guild room, 1st floor, St Bartholomew s Hospital, North Wing, EC1A 7BE Chair: John Hines, Pathway Director 1. Welcome, Introductions and Apologies (JH) JH welcomed members of the board, introductions were made and apologies heard. 2. Review of minutes of the last meeting and action log (JH) The minutes of the last meeting were accepted as an accurate record of proceedings. Alison Hill and Gillian Basnett at UCLH will help support with the patient information standardisation there is a nursing group meeting on 17 September which will identify a date to start this in October. JH has sent letter to each Trust as requested. Local and Specialist MDTs. Renal the meeting time has changed to better suit the timetables of those that need to attend. JH asked how all the Trusts link to the SMDT (could be up to 12 Trusts) and do they all need to? TP Trusts do not all need to link every week it is necessary to do so when there is a patient to present. However, the system for referral into the SMDT is paramount. JH asked that this process be written down so it is clear, understood and widely available for everyone to know. TP Pathology situation still requires further work and agreement. The pathway currently is that patients are biopsied locally and that work remains local and when a patient travels for their radical treatment the specimen will be and remain at the centre. JH suggested the uro-pathology group meet to address all the concerns that have arisen with the change of pathways and that Kidney Cancer be the first area to discuss. It was agreed that all pathologists within the London Cancer geography with an interest in kidney cancer be invited and the meeting be set up with at least 6 weeks notice. Prostate There is a requirement to have only 3 SMDTs to ensure that each MDT has a population of at least 1 million. These SMDTs will be at Queens, Barts and UCLH. It was agreed they need to work to the same set of rules and criteria and the process must be robust. SG asked how to ensure quality control of this and how best to ensure the link between the local MDTs and the SMDTs to ensure the best timing and patients are not repeatedly seen at MDT meetings. One answer is first to map the local MDTs and SMDTs understand if there is a timing issue and if required then consider how job plans need to change. NC asked if a patient had to be discussed at the SMDT at a Trust where a particular treatment was available. JH responded no and that a patient can be discussed at any one of the three SMDTs and receive a discussion of all the possible treatment options and then following the discussion 1

2 London Cancer be referred to the appropriate place. NC requested that this information be communicated clearly to patients. SG asked if we knew the numbers across each of the SMDTs numbers were suggested but this needs to be confirmed to ensure we know the SMDTs will work effectively. Research meeting. It is hoped that the next research meeting can be tagged onto a currently organised meeting at UCLH on th January. This is being led by Senthil Nathan. JH to speak to SN about adding on a poster presentation to this meeting. The meeting will be focused on pelvis. A save the date will need to be sent out. TP added there will be 2 research meetings a year (one for upper tract and one for lower tract) and therefore another renal meeting will take place in 2015 to take place at the Royal Free London. All other actions actioned. ACTION: MA to document the pathway for renal patients from local to SMDT (send to CL) ACTION: Uro-pathology to meet. LB and TP to confirm with CL who needs to attend and the invite will go out from London Cancer for a date with at least 6 weeks notice. ACTION: CL to send a save the date for the Research meeting in January at UCLH. 3. 2WW Form (All) Forms were updated 2.5 years ago. A new version has been sent to the PB to consider agreement that the form needs to be as simple as possible. JH asked if the GPs are happy with the form. Discussion around PSA results when should a patient be referred. 1 st raised PSA or 2 nd (after a GP has seen a patient again and re-tested the PSA). It was explained that this was to reduce patients referred with UTIs. The importance of guidance notes on the form was highlighted as especially helpful (especially to new GPs). SG agreed to look for any new evidence of National Guidance to make changes / IOGs and report back before the next meeting. All Trusts must ensure the contact numbers quoted are accurate and up to date. Importance that red flag systems are clear Penile cancer section ok; renal masses on Imaging / kidney section ok (further clarity required in the guidance notes). Not all pages have patient identification this needs to be noted. The form will not be signed off at this meeting until all feedback received. ACTION: SG to review National Guidelines to know if changes required to the current 2WW form and to agree on the words to be used for suspected prostate cancer ACTION: All to check contact numbers quoted for their Trust to ensure accuracy to Karen Molloy at London Cancer by August 29th 4. Prostate & Bladder Clinical Guidelines (JH / LR) Prostate Pathway Skeleton diagram was sent out as a guide. pre biopsy MRI if PSA over 10. 2

3 London Cancer TP asked if there are any guidelines which should be followed legally. NC stated that as a board there should be agreement to which guidelines will be followed and this is stated. An MRI meeting is being set up on 25 Sept from (pre next PB meeting) with the help of Caroline Moore at UCLH. JH asked that a surgeon and radiologist be invited from each Trust. All names to be sent to either JH or CL LB expressed concern that the pathology cannot meet the 10 days as stated it the pathway across London Cancer Trusts. It was agreed that the CWT are nationally agreed standards (14, 31 and 62) are not negotiable. It was noted that Trusts could obviously meet the suggested timeframe faster than is stated in the pathway, however it was noted that if a Trust cannot deliver within the recommended/stated days this needs to be addressed by a Trust. It was discussed how the pathway should and will be viewed ie as an aspiration (noted that some of the pathway is not in national guidance) JK stated that the MRI needs to be reported and used for the biopsy. SG agreed but said this was not taking place at BHRUT and this absolutely must be addressed at BHRUT. JS asked that a decision is clearly noted following MDTs (shows exit of patient from the pathway clearly). Patients remain on a clock until treatment commences. ACTION: Send JH and/or CL the names to attend working group on 25 September ACTION: JH to make agreed amendments to the pathway in order that the agreed document be circulated with the minutes. 5. Reducing delays workshop (21 st ) (JH/All) (Feedback and actions going forward) Summary will be circulated to attendees and members of the pathway board. A further developed pathway will come out of that workshop. Part of the meeting will address which patients should have MRI, real definition of a multi MRI, and understand which Trusts do not have the right machinery. Feedback from the PB is that the invitation to the meeting was not 6 weeks in advance and this should be noted as an issue. It was noted that the push came from commissioners who want pathways that are clinically effective and discourage breaches. It was also noted the importance of the meeting as the prostate pathway and the issues in London (patients breaching 100 days) Pathway Board agreed another working party in Feb (not half term) to discuss the pathway further following MRI sub group and uro-pathology group meetings. ACTION: Pathway Board to agree date around Feb 2015 for a further working party. 6. GP engagement how to process (All) As per Directors meeting yesterday GP engagement and education is of prime importance. CM said that there was an appetite for education but how this can be achieved would have to be carefully considered. There is a meeting in August between LC, GP leads and NHS England to discuss areas of finance (where GPs might be taking on more work of the pathway). 3

4 London Cancer SC confirmed that self-managed pathway meeting will be August 28 at London Cancer and this links with GPs education around the cancer pathway. JH noted that at the Pathway Directors there was a discussion around how best to develop the engagement and education and one suggestion was to mix common and rare cancers to attract more GPs to attend. CM suggested different meetings in London and in Essex with the board agreeing the material and messages and then the meetings take place across the London Cancer geography. Any different approach for GP Trainees? CM said it would be easier as trainees as they have set times for training. Noted that case studies always helpful. Other requirements for GPs access to advice, telephone consults, building relationships. ACTION: JH/ Pathway Directors to establish a programme of education TIMEFRAME? 7. AOB (All) Peer Review on next agenda. Bladder and Prostate guidelines will be circulated before 25 September. ACTION: Peer Review to be put on the next meeting agenda (CL) ACTION: Bladder and Prostate guidelines will be circulated before 25 September meeting ACTION: KM to recirculate Guidelines (Agenda Item 4) as not received by some members 8. Next Meeting The next (additional) meeting focused on stratified follow-up and supported self-managed pathways is scheduled to take place on the 28 th August in Meeting Room 1 at London Cancer offices, 3 rd Floor, 170 Tottenham Court Road, W1T 7HA (with Matthew Perry and Janice Minter attending from St George s Hospital) Prostate not Renal. The next Pathway Board meeting will be held on 25 September, at 16:30 in Meeting Room 1 at London Cancer offices, 3 rd Floor, 170 Tottenham Court Road, W1T 7HA. The MRI sub group will meet before the pathway board from at a location TBD. 4

5 London Cancer ACTION LOG Action Owner Date Status SM to send details of NHS campaigns to CL for accessible funding, along with details for minority and traditionally hard to reach groups PB members to send any ideas on Early Diagnosis & how to raise awareness to CL JH to update on his communications with Arsenal, West Ham and other football clubs Set up a research group to lead with the identity of Trials across the network and to set up a knowledge base for sites to work out which trials best to conduct. Prioritise and design by resources available and geographical SM 12 Jun asap ALL 12 Jun asap JH 12 Jun 24 July TP 12 Jun asap Document the renal pathway from local to SMDT MA 24 July 25 Sept Uro-pathology to meet. LB and TP to confirm with CL who needs to attend and the invite will go out from London Cancer for a date with at least 6 weeks notice. Save the date for the Research meeting in January at UCLH to be circulated Review National Guidelines to know if changes required to the current 2WW form and to agree on the words to be used for suspected prostate cancer All to check contact numbers quoted for their Trust to ensure accuracy to Karen Molloy at London Cancer by August 29th Send JH and/or CL the names to attend MRI working group on 25 September JH to make agreed amendments to the pathway in order that the agreed document be circulated with the minutes. Pathway Board to agree date around Feb 2015 for a further working party. LB & TP 24 July asap CL 24 July asap SG 24 July 25 Sept All 24 July 29 Aug All 24 July asap JH 24 July To be circulated with minutes All 24 July 25 Sept JH/ Pathway Directors to establish a programme of education JH 24 July TBD Peer Review to be put on the next meeting agenda CL 24 July 25 Sept Bladder and Prostate guidelines will be circulated before 25 September meeting CL / KM 24 July 25 Sept 5

6 London Cancer Attendees Name Role Trust/Organisation John Hines Urologist Barts Health Christine Moss General Practitioner GP - West Essex CCG Cid O Sullivan Clinical Nurse Specialist Royal Free Hampstead Clare Stevenson Clinical Psychologist Homerton University Hospital Jeevan Kumaradevan Consultant Radiologist The Whittington Hospital John Sandell Patient Representative Patient Representative Michael Aitchison Consultant Urologist, Director renal Royal Free Hospital cancer services Neil Cameron Patient Representative Patient Representative Sacha Ali Clinical Nurse Specialist Homerton University Hospital Sandeep Gujral Urologist Barking, Havering and Redbridge University Hospitals Sharon Cavanagh Survivorship Lead London Cancer Thomas Powles Medical Oncologist Barts Health Also Present Name Role Trust/Organisation John Kelly Attending for Lois Roberts UCLH Karen Molloy London Cancer minutes London Cancer Apologies Name Role Trust/Organisation Claire Levermore Pathway Manager London Cancer Frank Chinegwundoh Urologist Barts Health Guy Webster Urologist Barnet and Chase Farm Hospitals Jane Smith Patient Representative Patient Representative Jolanta McKenzie Medical Director Princess Alexandra Hospital Lois Roberts Manager University College London Hospitals Sue Maughn Clinical Adviser, Transforming Cancer Services Team - NEL Commissioning Support Unit Cancer Commissioning Team Representative Veronica Brinton Patient Representative Patient Representative 6