Pathway specification for urological cancers

Transcription

1 London Cancer: Pathway specification for urological cancers Originally published May 2012, updated December 2012 Version 2.0

2 Contents 1. Introduction London Cancer Pathway specifications Pelvic cancer pathway specification Renal cancer pathway specification Appendix: London Cancer Urology Technical Group Introduction 1.1. London Cancer The cancer care providers of North East London and North Central London and West Essex agreed in July 2011 to develop an integrated cancer system in response to the requirements of London s Strategic Health Authority and commissioners. Since April 2012 this integrated cancer system, London Cancer, has been commissioned to provide cancer services for a resident population of 3.2 million. Its mission is to drive superior outcomes and experience for our patients and local communities, and thereby position its staff as leaders in cancer care locally, nationally and globally. London Cancer will be underpinned by patient-empowerment, research, evidence and information sharing. It will radically refocus hospitals into working in partnership with each other, primary care and patients, to deliver coordinated, comprehensive pathways of excellent care for every patient irrespective of where they access our system or the type of cancer that they have. The agreed priorities of the integrated cancer system are: Being patient-focused through listening, communication, involvement, information, education, choice, and personalisation Optimising care along a co-ordinated pathway earlier diagnosis, exceptional treatment for all, local treatment where appropriate, compassionate aftercare and empowering/supporting patient self-management Embedding research for personalised care, equitable access to trials, the discovery of new treatments and evaluating new ways of working together with patients Increasing value superior outcomes for patients per pound invested. 2

3 In addition to these priorities, London Cancer has carried out extensive research on what matters to patients and has distilled this work into ten key themes that will be central to everything that we do: 1. Diagnosis patients are diagnosed at an earlier stage 2. Ethos patients are treated holistically as individuals, and with dignity, sensitivity and respect, so that they do not feel that they are treated as a set of cancer symptoms 3. Communication patients receive written and verbal information about diagnosis and all treatment options, including side effects and quality of life implications 4. Choice patients and carers are fully involved in the choice of hospital and treatment options 5. Support patients are given information on support groups, benefits entitlement and are offered emotional and psychosocial support 6. Carers carers are fully involved and supported throughout the pathway 7. Holistic assessment patients have holistic assessments at appropriate stages throughout the pathway, with action to meet their needs taken as a result 8. Seamless care all patients are assigned a CNS when diagnosed and a community keyworker on discharge 9. Transport patients should only travel when necessary and appropriate arrangements should be made for the immunosuppressed; patients should be provided with free parking or transport vouchers 10. Discharge patients and their GPs should be provided with discharge information and follow-up advice Pathway specifications London Cancer will deliver a step-change in cancer services in North East London and North Central London and West Essex. It will do this through empowering clinicians and placing patients at the heart of cancer care. Clinically led pathway boards will be constituted for each cancer pathway and these boards will, under the leadership of a pathway director, lead service improvement and change across the pathway. The focus of pathway boards will be the whole patient pathway, including: The diagnostic interface with the public Primary care and accident and care in emergency departments Initial assessment and appropriate rapid onward referral where necessary The provision of various aspects of patient treatment Follow-up or supporting end of life care. To instigate change pathway boards may constitute sub-groups, called technical groups, which are responsible for developing specifications for the future delivery of services along their pathways within the integrated cancer system. The organisations of London Cancer that contribute to the pathway will then be invited to demonstrate how they could meet the requirements of these specifications for the components of the pathway that they wish to provide. The London Cancer Urology Technical Group was the first to be constituted. It met during a four-month period between December 2011 and March 2012 to develop the specification for the future delivery of urological cancer services. A full list of those who sat on the group and the dates on which it met can be found in the appendix. 3

4 The resulting pathway specification was published internally to London Cancer in May In August trusts were invited to express their interest in hosting a local unit or specialist centre that met the specification. Following these expressions of interest, trusts were given further time to strengthen the clinical consensus on the proposed model and to try and achieve consensus on the location of the specialist centres. Consensus on the clinical model was achieved during these discussions in autumn It has been possible therefore to clarify the pathway specification in light of this consensus. This update has been carried out by the Urology Pathway Co-Directors and Pathway Manager. The update also provided opportunity to add further detail on key areas such as leadership and partnership working across the system as well as specialist MDT clinic, on-call and readmission arrangements. 4

5 2. Pelvic cancer pathway specification Where a provider serves both as a local unit and specialist centre then it must meet both local unit and specialist centre specification. POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Leadership Partnership working Primary care Diagnosis of cancer All providers work together in an integrated team Demonstrates commitment to partnership when developing plans against the specification Makes specialist urological advice available to GPs by telephone and GPs use NICE 2-week urology referral criteria and London Cancer agreed forms and criteria GPs use national guidelines for monitoring minor PSA rises Adheres to agreed London Cancer diagnostic guidelines Clinical nurse specialist present at all cancer diagnoses Clinical workforce trained in advanced communication Provides full written information about tumour type and treatment options through designated specialised staff skilled in counselling patients on treatment options Rapid onward referral to specialist centre Written confirmation of diagnosis and responsible consultant sent to GPs within 24 hours of patients being informed of new cancer diagnosis Named leader who takes responsibility for system-wide collaborative working to ensure availability of relevant specialist expertise at local units and equitable access to best practice and research Implements the pathway across all providers Demonstrates leadership in clinical and non-clinical innovations across the system Maintains and develops the multidisciplinary team All providers work together in an integrated team Demonstrates commitment to partnership when developing plans against the specification 5

6 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE MDT Composition Local MDT with membership as per Peer Review measures Weekly pelvic cancer-specific specialist MDT with professional constitution including: Specialist surgeons Specialist oncologists Interventional radiologist Organ-specific histopathologist Clinical nurse specialist Clinical trials nurses Palliative care professional MDT co-ordinator Clinical nurse specialist Holistic care Information Provides access to a key worker for all patients (usually a clinical nurse specialist) who shares information freely with specialist centre Clinical nurse specialists work as collective network across system Carries out holistic assessment, including palliative care and travel needs Refers to appropriate cancer rehabilitation specialists Capacity for reliable videoconferencing with specialist centre and other local units Capacity for real-time electronic recording of discussions and decisions Sends all MDT letters detailing decision and tests requested to GPs electronically (e.g. via systems such as Path Links) Provides access to a key worker for all patients (usually a clinical nurse specialist) who shares information freely and gives support and advice to referring unit Clinical nurse specialists work as collective network across system Carries out holistic assessment at key points in treatment pathway Refers to appropriate cancer rehabilitation specialists Capacity for reliable videoconferencing with local units Capacity for real-time electronic recording of discussions and decisions Sends all MDT letters detailing decision and tests requested to GPs electronically (e.g. via systems such as Path Links) Specialist MDT clinic Develops a network of multi-professional specialist MDT clinics across the system Treatment decision Prostate cancer Trained unbiased professional to use specialist MDT guidance to discuss treatment options with patients between diagnosis and multi-professional specialist MDT Trained unbiased professional uses specialist MDT guidance to discuss treatment options with patients between diagnosis and multi-professional specialist MDT 6

7 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Timeliness of treatment Bladder cancer clinic Patients informed of all treatment options Clear protocol for watch and wait decision, including access to psychosocial support Gives patients a treatment plan, including responsible consultant and hospital site of any therapy, and copies it electronically to GP Trained unbiased professional to use specialist MDT guidance to discuss treatment options with patients between diagnosis and multi-professional clinic Patients informed of all treatment options Gives patients a treatment plan, including responsible consultant and hospital site of any therapy, and copies it electronically to GP Capacity to assess and treat patients with minimum delay and at least within 62 days of urgent referral and 31 days of diagnosis clinic Patients informed of all treatment options Clear protocol for watch and wait decision, including access to psychosocial support Gives patients a treatment plan, including responsible consultant and hospital site of any therapy, and copies it electronically to GP Trained unbiased professional to use specialist MDT guidance to discuss treatment options with patients between diagnosis and multi-professional clinic Patients informed of all treatment options Gives patients a treatment plan, including responsible consultant and hospital site of any therapy, and copies it electronically to GP Capacity to assess and treat patients with minimum delay and at least within 62 days of urgent referral and 31 days of diagnosis Surgery Population Single centre serves whole population of London Cancer Assessment Admission Treatment for prostate cancer Treatment for bladder cancer Theatre capacity Carries out pre-operative assessment Enhanced recovery protocol in place covering whole admission Carries out trans-urethral resection Does not carry out radical prostatectomies Trans-urethral resection carried out by nominated surgeons only Does not carry out radical cystectomies Capacity to carry out diagnostic and therapeutic procedures as day cases 7 Centre carries out a cumulative total of ca. 350 radical prostate and bladder procedures a year Enhanced recovery protocol in place covering whole admission Carries out radical prostatectomies Capacity for robotic surgery Carries out radical cystectomies Carries out bladder reconstruction Capacity for robotic surgery Capacity to carry out a total of ca. 350 pelvic cancer procedures a year at 7/8 a week

8 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Inpatient care Skills and workforce Co-locations Capacity to carry out diagnostic and therapeutic procedures as day cases A minimum of 2 nominated surgeons to carry out transurethral resection of bladder Median lengths of stay of 2.5 days for radical prostatectomy and 12 days for radical cystectomy Sufficient dedicated ring-fenced beds (estimated at 5 to 8 beds) Capacity to deal with surgical readmissions efficiently and effectively within 24 hours of admission to local unit Ward nursing capacity for level 1 patients Intensive care capacity for median stay of 1 night for radical cystectomy Provides access to specialist rehabilitation service adhering to NCAT rehab pathway Dedicated team to carry out ca. 350 procedures a year across the system Sufficient specialist pelvic surgeons Consultant specialist pelvic surgical on-call rota (with no duties elsewhere) Sufficient anaesthetists and skilled theatre teams Enhanced recovery nurse Access to pelvic emergency surgeon 24-hour interventional radiology Mandatory co-dependency with specialist gynaecological cancer surgery Ablative therapies Provides ablative therapies or has a referral pathway to a site that does Specialist surgeon not required and delivery on specialist site not necessary Provides ablative therapies or has a referral pathway to a site that does System-wide capacity for ca. 250 procedures a year on sites seeing sufficient volume to provide a critical mass Systemic therapy Treatment for prostate cancer Delivers chemotherapy and hormone therapy where deemed appropriate by the specialist MDT Protocols to allow specialist management of patients with safe local delivery where appropriate Issues patient-held records Delivers targeted therapy and hormone targeted therapy Refers new cases of castrate-resistant prostate cancer for Reviews all new cases of castrate-resistant prostate cancer 8

9 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Treatment for bladder cancer Skills and workforce Infrastructure review at specialist centre Refers new cases of Gleason sum 8,9&10 for review at specialist centre Delivers systemic therapy for only metastatic/advanced disease where deemed appropriate by the specialist multidisciplinary team Delivers intravesical agents as deemed appropriate by the specialist MDT Issues patient-held records Dedicated oncology clinical nurse specialist Chemotherapy pharmacist Capacity to deliver ambulatory chemotherapy Capacity to recruit into national trials investigating systemic therapy and delivers targeted hormone therapy (CYP-17 inhibitors) for castrate-resistant prostate patients Reviews all new cases of Gleason sum 8,9&10 Issues patient-held records Makes clinical trials available for patients with advanced and metastatic prostate cancer Protocols to allow specialist management of patients with safe local delivery where appropriate Delivers neo-adjuvant chemotherapy within the context of multidisciplinary team Delivers systemic therapy for advanced/metastatic disease Delivers intravesical agents as appropriate Makes clinical trials available Issues patient-held records Expertise in targeted therapy and hormone targeted therapy for prostate cancer Expertise in neo-adjuvant chemotherapy for bladder cancer Dedicated oncology clinical nurse specialist with expertise in hormone therapy, targeted therapy and chemotherapy Chemotherapy pharmacist Specialist histopathology and dedicated genito-urinary radiology Capacity to deliver ambulatory chemotherapy Capacity for multidisciplinary clinics Facilities for tissue banking Links with clinical trials unit External beam radiotherapy Treatment for prostate cancer Not necessary on site IMRT available on all radiotherapy sites 9

10 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Brachytherapy for prostate cancer Treatment for bladder cancer Referral Population Assessment Treatment Theatre capacity Inpatient care low dose rate Inpatient care high dose rate Skills and workforce Co-locations Not necessary on site Assesses suitability for brachytherapy Written protocols for referral to brachytherapy centre(s) 10 Assesses suitability for brachytherapy Written protocols for referral to brachytherapy centre(s ) Brachytherapy takes place in dedicated centre(s) with a minimum throughput of 50 patients per year Brachytherapy centres do not need to be located with specialist prostate surgery centre(s) Pre-operative assessment takes place at brachytherapy centre(s) Takes place at brachytherapy centre(s) System-wide capacity to carry out ca. 100 cases a year in dedicated brachytherapy theatre lists Capacity to grow service as demand increases Median length of stay for low dose rate brachytherapy of 24 hours Carries out morning lists to allow discharge on same day where possible Dedicated radiation protection rooms for patients Ward staff (including junior doctors) trained in radiation protection and radiation protection supervisor in place Median length of stay of 3 days for temporary high dose rate brachytherapy boost administered as a single fraction under spinal anaesthetic No requirement for radiation protection on ward as applicators removed in theatre Dedicated team(s) to carry out ca. 100 procedures a year system-wide Brachytherapy centres have: A minimum of 2 trained radiation oncologists A training specialist registrar in clinical oncology A minimum of 2 trained radiologists or urologists A urologist specialised in dealing with urological complications following brachytherapy A clinical nurse specialist A minimum of 3 trained physicists or dosimetrists (one of whom should be a trained radiation supervisor) Trained theatre staff Access to radiation physics and urology High dose rate brachytherapy for prostate co-located with brachytherapy procedures for other tumour types due to equipment

11 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Acute oncology Full acute oncology service that meets Peer Review standards Full acute oncology service that meets Peer Review standards Posttreatment Discharge Clear procedures for receipt of patients discharged from care of the centre Provides electronic end of treatment summaries with accessible record of treatment for GPs and patients Discharge carried out by skilled professionals Provides electronic end of treatment summaries with accessible record of treatment for local units, GPs and patients Ability to readmit any patient with a complication within 24 hours of presentation to a local provider Follow-up for prostate cancer Capacity to host specialist outreach clinics Not necessary for patients to return to specialist centre after treatment Follow-up for bladder cancer Care for patients once discharged from specialist centres Follows up patients who have undergone radical cystectomy for up to 2 years before transferring care to local units Follows up patients who have undergone neo-bladder reconstruction for up to 3 years Primary care Follows NICE guidance on transferring prostate follow-up to primary care Follows NICE guidance on transferring prostate follow-up to primary care Provides GP with clear details of primary care follow-up required for prostate patients Provides GP with clear details of primary care follow-up required for prostate patients Provides primary care with clear details of how to reaccess secondary care Provides primary care with clear details of how to reaccess secondary care Palliative care Clear referral pathways for patients with palliative and specialist palliative care needs Clear referral pathways for patients with palliative and specialist palliative care needs Clear referral guidance for management of: End of life care Complex symptom control GP and palliative care team to manage patient as appropriate Clear referral guidance for management of: End of life care Complex symptom control GP and palliative care team to manage patient as appropriate 11

12 POINT IN THE PATHWAY LOCAL PROSTATE/BLADDER UNIT SPECIALIST PROSTATE/BLADDER CENTRE Research and innovation Education and training Patient travel Access to multidisciplinary oncology service including: Clinical trial research Research nursing Carries out prospective audit of service and publishes transparent outcomes data Informs patients of support available for travel to specialist centre and radiotherapy units Access to multidisciplinary oncology service including: Tissue banking Clinical trial research Research nursing Carries out prospective audit of service and publishes transparent outcomes data Offers simulation training in new surgical techniques Conducts training in delivery of systemic therapy Robust patient travel plan in place 12

13 3. Renal cancer pathway specification Where a provider serves both as a local unit and specialist centre then it must meet both local unit and specialist centre specification. POINT IN THE PATHWAY LOCAL RENAL UNIT SPECIALIST RENAL SURGERY CENTRE Leadership Partnership working Primary care Diagnosis of cancer All providers work together in an integrated team Demonstrates commitment to partnership when developing plans against the specification Makes specialist urological advice available to GPs by telephone and GPs use NICE 2-week urology referral criteria and London Cancer agreed forms and criteria Adheres to agreed London Cancer diagnostic guidelines One-stop haematuria service for all patients within two weeks of receipt of referral Clinical nurse specialist present at all cancer diagnoses Clinical workforce trained in advanced communication skills Provides full written information about tumour type and treatment options through designated specialised staff skilled in counselling patients on treatment options Written confirmation of diagnosis and responsible consultant sent to GPs within 24 hours of patients being informed of new cancer diagnosis 13 Named leader who takes responsibility for system-wide collaborative working to ensure availability of relevant specialist expertise at local units and equitable access to best practice and research Implements the pathway across all providers Demonstrates leadership in clinical and non-clinical innovations across the system Maintains and develops the multidisciplinary team All providers work together in an integrated team Demonstrates commitment to partnership when developing plans against the specification

14 POINT IN THE PATHWAY LOCAL RENAL UNIT SPECIALIST RENAL SURGERY CENTRE Rapid onward referral to specialist centre, including for patients with ultrasound with incidental findings MDT Composition Local MDT with membership as per Peer Review measures Weekly renal specific specialist multidisciplinary team with professional constitution including: Specialist upper tract surgeons Specialist upper tract oncologists Specialist clinical oncologists Interventional radiologist Organ specific histopathologist Clinical nurse specialist Nephrologists/renal physicians Clinical trials nurses Palliative care professional MDT co-ordinator Clinical nurse specialist Holistic care Information Provides access to a key worker for all patients (usually a clinical nurse specialist) who shares information freely with specialist centre Clinical nurse specialists work as collective network across system Carries out holistic assessment, including palliative care and travel needs Refers to appropriate cancer rehabilitation specialists Capacity for reliable videoconferencing with specialist centre and other local units Capacity for real-time electronic recording of discussions and decisions Sends all MDT letters detailing decision and tests requested to GPs electronically (e.g. via systems such as Path Links) Provides access to a key worker for all patients (usually a clinical nurse specialist) who shares information freely and gives support and advice to referring unit Clinical nurse specialists work as collective network across system Carries out holistic assessment at key points in treatment pathway Refers to appropriate cancer rehabilitation specialists Capacity for reliable videoconferencing with local units Capacity for real-time electronic recording of discussions and decisions Sends all MDT letters detailing decision and tests requested to GPs electronically (e.g. via systems such as Path Links) 14

15 POINT IN THE PATHWAY LOCAL RENAL UNIT SPECIALIST RENAL SURGERY CENTRE Specialist MDT clinic Treatment decision Timeliness of treatment Trained unbiased professional to use specialist MDT guidance to discuss treatment options with patients between diagnosis and multi-professional specialist MDT clinic Patients informed of all treatment options Gives patients a treatment plan, including responsible consultant and hospital site of any therapy, and copies it electronically to GP Capacity to assess and treat patients with minimum delay and at least within 62 days of urgent referral and 31 days of diagnosis Develops a network of multi-professional specialist MDT clinics across the system Trained unbiased professional to use specialist MDT guidance to discuss treatment options with patients between diagnosis and multi-professional specialist MDT clinic Patients informed of all treatment options Gives patients a treatment plan, including responsible consultant and hospital site of any therapy, and copies it electronically to GP Capacity to assess and treat patients with minimum delay and at least within 62 days of urgent referral and 31 days of diagnosis Surgery Assessment Carries out pre-operative assessment Admission Enhanced recovery protocol covers whole admission Enhanced recovery protocol covers whole admission Treatment of T1 and T2 disease Treatment of T3 and T4 disease Benign disease Theatre capacity Inpatient care Does not carry out partial nephrectomies (nephron-sparing surgery) or nephro-ureterectomies May carry out radical nephrectomies as agreed by specialist MDT and performed by specialist surgeons (i.e. those treating T3 and T4 disease at specialist centre) Carries out palliative treatments only Capacity to carry out local radical nephrectomy, where appropriate Capacity to care for patients following local radical nephrectomy, where appropriate 15 Carries out appropriate surgery, including all nephronsparing surgery and nephro-ureterectomies, with specialist team Capacity for robotic surgery Carries out appropriate surgery with specialist team Capacity for robotic surgery Capacity to carry out surgery on complex benign renal disease (up to 100 cases per year) Capacity to carry out a total of ca. 400 procedures a year at 10 a week (includes up to 100 benign cases) Median length of stay of 3.5 days for nephrectomy Sufficient dedicated ring-fenced beds (estimated at 8 to 10 beds) Capacity to deal with surgical readmissions efficiently and

16 POINT IN THE PATHWAY LOCAL RENAL UNIT SPECIALIST RENAL SURGERY CENTRE Ablative therapies Skills and workforce Surgical colocations Support for other services effectively within 24 hours of admission to local unit HDU capacity for a third of surgical patients Provides access to specialist rehabilitation service adhering to NCAT rehab pathway Sufficient specialist renal surgeons (urology and/or transplant) Consultant specialist renal surgical on-call rota (with no duties elsewhere) Renal medicine all aspects of renal replacement therapy 24-hour interventional radiology Vascular surgery centre Hepato-pancreato-biliary Cardiac surgery Pelvic cancer surgery co-location desirable but not mandatory Provides support to centres performing complex procedures in other specialities, such as: Urothelial (upper tract) Retroperitoneal lymph node dissection Sarcoma Vascular Hepato-pancreato-biliary Pelvic cancer Delivers radiofrequency and cryotherapy ablation for eligible T1 patients Systemic therapy Targeted therapy Delivers targeted therapy and immune therapy for renal cancer patients Issues patient held records Makes available clinical trials 16

17 POINT IN THE PATHWAY LOCAL RENAL UNIT SPECIALIST RENAL SURGERY CENTRE Skills and workforce Two medical oncologists with recognised expertise in in targeted therapy and immune therapy in renal cancer Dedicated oncology clinical nurse specialist with expertise in targeted therapy Dedicated genito-urinary histopathology and radiology Systemic therapy pharmacist Infrastructure Capacity to deliver supportive measures Capacity for multidisciplinary clinics Facilities for tissue banking Links with a clinical trials unit Radiotherapy Not necessary on site Not necessary on site Acute oncology Full acute oncology service Full acute oncology service Posttreatment Discharge Clear procedures for receipt of patients discharged from care of the centre Provides electronic end of treatment summaries with accessible record of treatment for GPs and patients Discharge carried out by skilled professionals Provides electronic end of treatment summaries with accessible record of treatment for local units, GPs and patients Ability to readmit any patient with a complication within 24 hours of presentation to a local provider Follow-up Capacity to host specialist outreach clinics Follows up patients who have undergone treatment once, before transferring care to local units Primary care Transfers care of low risk patients to primary care 5 years post-treatment and after 10 years for medium risk patients Does not transfer follow-up of high risk patients to primary care Provides primary care with clear details of how to reaccess secondary care Provides primary care with clear details of how to reaccess secondary care 17

18 POINT IN THE PATHWAY LOCAL RENAL UNIT SPECIALIST RENAL SURGERY CENTRE Palliative care Research and innovation Education and training Patient travel Clear referral pathways for patients with palliative and specialist palliative care needs Clear referral guidance for management of: End of life care Complex symptom control GP and palliative care team to manage patient as appropriate Access to multidisciplinary oncology service including: Clinical trial research Research nursing Carries out prospective audit of service and publishes transparent outcomes data Informs patients of support available for travel to specialist centre and radiotherapy units Clear referral pathways for patients with palliative and specialist palliative care needs Clear referral guidance for management of: End of life care Complex symptom control GP and palliative care team to manage patient as appropriate Access to multidisciplinary oncology service including: Tissue banking Clinical trial research and research nursing Carries out prospective audit of service and publishes transparent outcomes data Offers simulation training in new surgical techniques Conducts training in delivery of ablative therapies Conducts training in delivery of systemic therapies Robust patient travel plan in place 18

19 Appendix: London Cancer Urology Technical Group London Cancer Urology Technical Group attendees John Hines (Co-chair), Consultant Urologist, Whipps Cross University Hospital NHS Trust and London Cancer Urology Pathway Co-Director Mark Emberton (Co-chair), Consultant Urological Surgeon, University College London Hospitals NHS Foundation Trust and London Cancer Urology Pathway Co-Director Anand Kelkar, Consultant Urological Surgeon, Barking Havering and Redbridge Hospitals NHS Trust Angela Lee, Clinical Nurse Specialist, Barking Havering and Redbridge Hospitals NHS Trust Bruce Turner, Uro-oncology Nurse Practitioner, Homerton University Hospital NHS Foundation Trust Colin Bunce, Consultant Urological Surgeon, Barnet and Chase Farm Hospitals NHS Trust David Nicol, Consultant Urologist, The Royal Free Hampstead NHS Trust and University College London Hospitals NHS Foundation Trust Faiz Mumtaz, Consultant Urologist, Barnet and Chase Farm Hospitals NHS Trust Frank Chinegwundoh, Consultant Urological Surgeon, Newham University Hospital NHS Trust Gillian Smith, Consultant Urological Surgeon, The Royal Free Hampstead NHS Trust Guy Webster, Consultant Urologist, Barnet and Chase Farm Hospitals NHS Trust Jaspal Virdi, Consultant Urological Surgeon, The Princess Alexandra Hospital NHS Trust Jhumur Pati, Consultant Urological Surgeon, Homerton University Hospital NHS Foundation Trust John Peters, Consultant Urologist, Whipps Cross University Hospital NHS Trust Katharine Pigott, Consultant Clinical Oncologist, The Royal Free Hampstead NHS Trust Maneesh Ghei, Consultant Urologist, The Whittington Hospital NHS Trust Rateb Samman, Consultant Urologist, The Princess Alexandra Hospital NHS Trust Sandeep Gujral, Consultant Urological Surgeon, Barking Havering and Redbridge Hospitals NHS Trust Tim Briggs, Consultant Urologist, Barnet and Chase Farm Hospitals NHS Trust Tom Powles, Consultant Medical Oncologist, Barts and the London NHS Trust Patient representative input from: Christopher Kennedy, Patient Steve Johnson, Patient Primary care input from: Karen Sennet, General Practitioner, Islington Mike Gocman, General Practitioner, Enfield Palliative care input from: Adrian Tookman, Consultant Physician in Palliative Medicine, The Royal Free Hampstead NHS Trust Clare Phillips, Consultant in Palliative Medicine, Barts and the London NHS Trust and Newham University Hospital NHS Trust London Cancer Urology Technical Group meeting dates 2 nd December th January th February th March