Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services. Skin Cancer Network Site Specific Group. Annual Report

Transcription

1 Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services Skin Cancer Network Site Specific Group Annual Report 2015 Version 1.0 1

2 This Annual Report was prepared by: Amrit Darvay, Chair of the SWAG Skin NSSG, Consultant Dermatologist, North Bristol NHS Foundation Trust Helen Dunderdale, SWAG Cancer Network NSSG Support Manager This Annual Report has been agreed by: Name Position Trust Date agreed Dr David de Berker Consultant Dermatologist University Hospitals Bristol NHS Foundation Trust (UH May 2016 Dr Inma Mauri-Sole Dr Rachel Wachsmuth Dr Jill Adams Dr William Porter Mr Antonio Orlando Associate in Consultant Dermatologist Consultant Dermatologist Consultant Dermatologist Consultant Plastic Surgeon Bristol) Royal United Hospitals Bath NHS Foundation Trust (RUH) Yeovil District Hospital NHS Foundation Trust Taunton and Somerset NHS Foundation Trust Gloucestershire Royal Hospitals NHS Foundation Trust North Bristol NHS Trust May 2016 May 2016 May 2016 May 2016 May 2016 Version 1.0 2

3 Skin Contents Section Contents Measures Page 1 Overview, achievements and challenges 1.1 Overview of report Overview of service Achievements and key service improvements over the past 4 12 months 1.4 Challenges for the NSSG 5 2 The Network Group Meeting and Membership 14-1C-104/5j 2.1 Chair of the NSSG Network Group Membership Attendance Spreadsheet Extended Members of the NSSG Network Group Quoracy Service Development Implementation of The National Cancer Survivorship Initiative The service development function of the NSSG meeting 14-1C-106j Chemotherapy Treatment Algorithms 5 Patient Experience and Feedback User Involvement Feedback from The National Cancer Patient Experience Survey 14-1C-110j 14-1C-115j Clinical Outcome 13 Indicators and Audits 14-1C-116j 6.1 The Network Audit for Version 1.0 3

4 6.2 The Network Audit for Clinical quality indicators 13 7 Clinical Trials and 14 Research Activity 14-1C-118j 7.1 Discussion of Clinical Trials Recruitment Action Plan Current Clinical Trials Activity Recruitment of Teenagers and Young Adults (TYA) Overview, achievements and challenges 1.1 Overview of report This report reflects the period of activity for the NSSG from 1 st January 2015 to 31 st December It contains a summary of the activity of the Skin NSSG for this period measured against several key performance indicators that have been outlined in the National Cancer Peer Review Programme. The report should be reviewed alongside three other key documents for the NSSG: the Constitution, Clinical Guidelines and the Work Programme. The Skin NSSG Constitution provides an overview of how the NSSG operates, outlining the general working processes of the NSSG, the patient referral pathways and the guidelines to which the NSSG adheres. The Clinical Guidelines outline the diagnostic and treatment processes agreed by the network group. The Work Programme summarises the key areas for growth, development and improvement of the NSSG over the next financial year (and beyond where appropriate). All four documents should be reviewed together to give a full overview of the NSSG, its performance and its future plans. 1.2 Overview of service The Skin site-specific group aims to oversee, support and bring together the viewpoints of all the multi-disciplinary teams working within Skin cancer services across the Network. The group also aims to ensure the same standard of care and treatment with this type of cancer across the Network. The NSSG works to ensure implementation of NICE guidelines for investigation and treatment of skin cancers and to provide guidelines for supportive care. It supports a programme of education on key developments in the field of skin cancer. It also aims to continue and expand the clinical trials programmes available within individual trusts. 1.3 Achievements and key service improvements over the past 12 months The following are noted as key achievements and service improvements of the Skin NSSG over the past 12 months (during 2015): The NSSG has undergone reconfiguration in line with the national cancer clinical networks, inviting Gloucester and Cheltenham NHS Trust to collaborate The NSSG has updated the previous network clinical guidelines The NSSG has updated the previous network constitution Version 1.0 4

5 The NSSG has appointed patient representatives The NSSG has agreed a clinical audit The NSSG continues to provide a well-attended annual education day. 1.4 Challenges for the NSSG The key challenges for the Skin NSSG moving forward are highlighted below: Ensuring that all Trusts in the Network regularly contribute to the educational and audit programmes Continuing to expand and support the clinical trials programme Improving diagnostic capacity Streamlining patient pathways to improve the patient experience Streamlining data collection for National mandatory audits Re-stratification of patient follow up. 2. The NSSG Meeting and Membership (measure 14-1C-104/105j) 2.1 Chair of the NSSG Dr Amrit Darvay has been the Chair of the Skin NSSG since A list of responsibilities for the NSSG, for the Chair, and for other members of the NSSG, plus the NSSG terms of reference, can be found in the paper Recurrent Arrangements for Cancer Network Clinical Groups and Responsibilities for Peer Review, as proposed by the (SWSCN) Cancer Network Manager, Jonathan Miller (14 th July 2014): Recurrent-Arrangements-v5-Final.pdf The NSSG meetings are also conducted in line with the Manual for Cancer Services, Skin Measures, Version Network Group Membership The Skin NSSG is held approximately every six months. In 2015, meetings were held on the 20 th January 2015 and the 24 th September Attendance Spreadsheet The table below shows the core members of the NSSG and their attendance in January, plus the combined attendance for the Skin Cancer Business and Education Day in September. All participants at MDTs are welcome to attend the NSSG meetings. Version 1.0 5

6 Table 1.0 Skin NSSG core members and attendance 2015 Trust Name Title 20th January th September 2015 Adam Bray Consultant Dermatologist Amrit Darvay Consultant Dermatologist GLOS Anita Takwale Consultant Dermatologist and Skin Cancer Lead Cameron Kennedy Consultant Dermatologist David DeBerker Consultant Dermatologist Debbie Shipley Consultant Dermatologist YDH Felicity Edwards Consultant Dermatologist Giles Dunnill Consultant Dermatologist, Regional Lead for Skin Lymphoma Jane Sansom Consultant Dermatologist TST Jill Adams Consultant Dermatologist TST Joseph Boyle Consultant Dermatologist YDH Martyn Richards Consultant Dermatologist TST Rachel Wachsmuth Consultant Dermatologist GP Shalini Narayan Consultant Dermatologist YDH Susan Adams Consultant Dermatologist GLOS Tom Millard Consultant Dermatologist TST Victoria Lewis Consultant Dermatologist RUH William Phillips Consultant Dermatologist RD&E Andrew Wilson Consultant Plastic Surgeon Grammahti Mitsala Consultant Plastic Surgeon Version 1.0 6

7 TST TST Antonio Orlando Ceri Hughes Dominic Ayers Graham Merrick Mike Davidson Consultant Plastic /Maxillofacial Surgeon Consultant Plastic /Maxillofacial Surgeon Consultant Plastic /Maxillofacial Surgeon Consultant Oral & Maxillofacial Surgeon Consultant Oral & Maxillofacial Surgeon Ewan Wilson Consultant Plastic Surgeon Robb Warr Consultant Plastic Surgeon Rebecca Ford Consultant Ophthalmologist Specialising in Oculoplastics Richard Harrad Consultant Ophthalmologist Amar Challapalli Consultant Clinical Oncologist Amit Bahl Consultant Clinical Oncologist TST Mili (Urmila) Barthakur Consultant Clinical Oncologist Chris Price Consultant Medical Oncologist TST Clare Barlow Consultant Medical Oncologist Tania Tillett Consultant Medical Oncologist RUH Paola De Mozzi Consultant Dermatologist Keith Miller Consultant Histopathologist RUH Leigh Biddlestone Consultant Histopathologist Glos WESTON Paul Craig Richard Daly Consultant Histopathologist & Dermatopathologist Consultant Histopathology, Cytopathology & Morbid Anatomy YDH Robert Blahut Consultant Histopathologist TST Stephen Holwill Consultant Histopathologist Version 1.0 7

8 RUH John Mitchard Consultant Pathologist Jon Oxley Consultant Pathologist Joya Pawade Consultant Pathologist Nicholas Rooney Cellular Pathologist Graham Collin Consultant Radiologist Beth Wright Daniel Keith Katherine Finucane Katherine Nightingale Speciality Registrar Speciality Registrar in Associate Associate in GLOS Sarah Hughes Speciality Doctor Fiona Tasker Clinical Teaching Fellow Joanna Fawcett Clinical Teaching Fellow TST RDE GP RUH Martin Sanderson Suchitra Rajan Alison Hepplewhite Ben Hawthorne Caroline Furze Christina Wlodek Penny Williams Nahla Ali Elizabeth Metcalfe Gemma Gregory General Practitioner Speciality of Speciality Registrar in Therapy Speciality Registrar in Speciality Registrar in Speciality Registrar in Version 1.0 8

9 TST GLOS GLOS TST YDH Glos RUH GLOS GLOS CRN Jaye Kissane Joanne Watson Karen Curtis Louisa Hancox Louise Pound Jo MacDonald Mihaela Savu Nicola Congdon Sarah Lewis Alison O'Connor Kerry Sant Kim Wilcox Daisy Morgan Lynda Knowles Maxine Taylor Lymphodema Clinical Nurse Lymphodema Clinical Nurse Lymphodema Clinical Nurse Macmillan Skin Cancer Clinical Nurse Macmillan Skin Cancer Nurse Senior Research Delivery Manager / Organisational Development Lead RUH Doreen Quibell MDT Co-ordinator Julia Griffith MDT Co-ordinator GLOS Sandra Collins MDT Co-ordinator Sharon Keenan User Representative Sharon Scrivens User Representative Administration Lauren Waldron User Representative Helen Dunderdale Cancer Network SSG Support Manager Version 1.0 9

10 Administration Samantha Larsen Cancer Network SSG Support Administrator 2.4 Extended Members of the NSSG The table below notes the extended membership of the NSSG during 2015 and their attendance at the meetings. Table 1.1 Extended NSSG members and guests attendance 2015 Name Role 20 th January th September 2015 Catherine Carpenter- Clawson Cancer Manager Macmillan Survivorship Catherine Neck Lead MDT and Cancer Gail Kemp Performance Manager Veronique Poirier Principle Analyst - NCIN Carlos Rocha NCIN Senior Research Delivery Maxine Taylor Manager 2.5 NSSG Quoracy The NSSG meetings held on the 20 th January 2015 and the 24 th September 2015 were considered quorate. The information from each meeting was distributed and the opportunity to participate in the discussion after the meeting was given to all of the core members. TRUSTS/OTHER 20/01/ /09/ GLOS RUH 1 2 TST 3 3 YDH 1 1 Administration 2 2 User Representatives 0 2 RD&E 1 GUESTS 3 5 Total Attendance Version

11 Skin NSSG Attendance 20/01/2015 GLOS RUH TST WAHT YDH Administration User Representatives RD&E GUESTS Skin Cancer Education and Business Attendance 24/09/2015 GLOS RUH TST WAHT YDH Administration User Representatives RD&E PHE GUESTS Version

12 3. Service Development (measure 14-1C-106j) 3.1 Implementation of the National Cancer Survivorship Initiative The Skin NSSG has agreed to conduct a review of patient follow up systems in line with the practices recommended by the National Cancer Survivorship Initiative. Due to the ever increasing population of patients living with and beyond cancer, the current follow up systems are not sustainable, therefore new follow up methods need to be established to provide the support that patients require to lead as healthy and active a life as possible, for as long as possible 1. The Skin NSSG will work to ensure that all patients have access to the recommended Recovery Package. The Recovery Package consists of holistic needs assessments, treatment summaries and patient education and support events. The Skin NSSG will also develop risk stratified pathways of post treatment management, promote physical activity and seek to improve management of the consequences of treatment. 3.2 The service development function of the NSSG meeting The NSSG meeting will have an educational function, review major service developments on a regular basis, and escalate operational issues to the Cancer Operational Group and funding issues to the Clinical Commissioning Groups. 4. Chemotherapy Treatment Algorithms (measure 14-1C-110j) An agreed list of acceptable chemotherapy treatment algorithms is reviewed bi-annually and is available to view on the SWSCN website here. Any treatment algorithms that require updating are to be listed in the NSSG work programme. 5. Patient Experience and Feedback (measure 14-1C-115j) 5.1 User involvement The NSSG has user representative members who are invited to contribute opinions about the Skin service at the NSSG meetings. The NHS employed member of the NSSG nominated as having specific responsibility for users issues, and information for patients and carers, is the Cancer Network NSSG Support Manager. The NSSG actively seeks to recruit further user representatives. 5.2 Feedback from the National Cancer Patient Experience Survey The results from the National Cancer Patient Experience Survey are included as a recurring agenda item at the NSSG meetings. The results are examined by looking at Trust level best practice to be shared, Trust / network level priorities identified for pathway improvements, and the actions 1 Version

13 required to address identified priorities. The results from the 2015 analysis are within the notes on the SWSCN website here. 6. Clinical Outcome Indicators and Audits (measure 14-1C-116j) The NSSG aims to regularly review the data from each MDT s clinical outcomes, quality indicators and audits. At least one network audit will be performed each year. The results of this are presented at the NSSG meetings and distributed electronically to the group. 6.1 The network audit for 2015 Audit and quality control study of squamous cell carcinoma excised from scalp, nose, dorsum of hand with narrow deep margin (<1mm), and SCC with perineural or lymphovascular involvement with <1mm any margin clearance at all body sites. Results: The MDTs perform well at creating management plans. Follow up plans vary across Trusts, as detailed in the presentation. It was noted that the follow up guidelines were documented within the SWAG clinical guidelines. Patients should be provided with information for self-management of follow up where appropriate. A full analysis of the results is documented in the presentation. Conclusions: There is approximately an 11% recurrence rate with all recurrences occurring on the scalp or head and neck. The depth of the excision would be interesting to establish in the next audit. Actions: To ensure that follow up plans are discussed and recorded in the MDT outcomes, share best practice between Trusts, and potentially look at redesigning follow up once further data has been gathered, as recommended in the National Survivorship Initiative. The audit will be repeated on the 2014 cohort of patients. 6.2 The network audit for 2016 An Audit will be conducted on non-melanoma skin cancer (NMSC) excision, and completeness of histopathological reporting. 6.3 Clinical quality indicators Representatives from the National Cancer Intelligence Network (NCIN) were invited to attend the September 2015 meeting to explain how the registration of non-melanoma skin cancers could be improved, for the purpose of clinical quality indicator analysis. The cancer registry software system was centralised in 2013 to improve efficiency, with all information now being entered onto the Encore software database, rather than on 8 separate regional databases used previously. A project is currently being undertaken to address the long standing issues relating to incomplete registration of Version

14 non-melanoma skin cancers. This could be resolved if pathology was reported in standardised profomas that could automatically populate the registry, rather than in free text. The project aims are firstly to answer the following: Identify how many BCC + SCC reports we are receiving from each Trust Liaise with Trusts to determine whether we are receiving all reports, if not, how can we resolve this Which histopathologists are/are not using proforma reporting Why some histopathologists are not using proforma reporting and how do we encourage them to do so How many BCC + SCC records are submitted in COSD submissions How does the NCRS then identify proforma reports, provide initial feedback on pathology + COSD and then process them more efficiently in ENCORE. Objectives: Complete and consistent SNOMED coding on all Pathology reports Trust Pathology extract criteria identifies all non-melanoma skins. Proforma reporting on all non-melanoma skin cancers (COSD xml pathology extracts will help with this) NCRS record each and every occurrence of BCC + SCC by processing the majority of pathology reports and COSD data automatically Use the COSD reporting process to provide feedback on the completeness of the data (both submitted and processed) Detailed reports purely for NMSC. The target date for Trusts to start reporting pathology data in this format is January Clinical Trials and Research Activity (measure 14-1C-118j) 7.1 Discussion of clinical trials Members of the NSSG discuss each MDT s report on clinical research trials within every NSSG meeting. A list of open trials on the Skin NIHR portfolio, and any potential new trials, is supplied for each NSSG meeting by the West of England Clinical Research Network (CRN) Cancer Research Delivery Manager. Due to the CRN s mapping with the Academic Health Science Networks, Taunton and Yeovil are in South West Peninsula CRN. The Cancer Research Delivery Manager from the Peninsula CRN will provide the NSSG with the data for these Trusts. Potential new trials to open and actions to improve recruitment will be documented in the NSSG work programme. The NHS staff member nominated as the research lead for the NSSG is Dr Christopher Herbert. Version

15 7.2 Recruitment Action Plan The trials available in each Trust will be updated on the website at regular intervals so that the NSSG members can ensure, wherever possible, that clinical research trials are accessible to all eligible Skin cancer patients. NSSG members can view potential clinical trials to set up via the following link: Current Clinical Trials Activity A summary of the clinical trial recruitment into National Institute of Health Research trials during 2015 can be found on the SWSCN website here. 7.4 Recruitment of Teenagers and Young Adults (TYA) There were no TYA patients recruited to Skin studies in END- Version