SCAN Gynae Group Thursday 8 th November 2012

Transcription

1 SCAN Gynae Group Thursday 8 th November 2012 Edinburgh Breast Unit Seminar Room with videolink to Royal Infirmary of Edinburgh MINUTES Present Alison Allen Colin Barrie Lorna Bruce Camille Busby-Earle Scott Fegan Maureen Gallangah Nidal Ghaoui Kate Macdonald Melanie Mackean (Chair) Cameron Martin Jane McCafferty Jo McGinty Fiona Nussey Tzyvia Rye Jacqueline Stevenson Alison Stillie Stefan Symonides Graeme Walker Alistair Williams Mark Zahra Ishtiaq Zubairi In attendance Barbara Lyle Allan Thomson-Filant Apologies Adrian McCullough Alistair Meikle Gail Thomson SCAN Audit Manager Oncology Registrar, ECC SCAN Gynae Audit Facilitator CNS, NHS Lothian Locum Consultant Gynaecologist, NHS Fife Network Manager, SCAN Consultant Oncologist, Edinburgh Cancer Centre SCAN Groups and Communications Co-ordinator CNS, NHS Fife CNS, NHS Lothian Consultant Medical Oncologist, Edinburgh Cancer Centre Clinical Trials Data Manager Cancer Audit Facilitator, NHS Fife Consultant Clinical Oncologist, Edinburgh Cancer Centre Medical Oncology STF, ECC Reader / Hon. Consultant in Pathology NHS Lothian/University of Edinburgh Consultant Clinical Oncologist, ECC Oncology Registrar, ECC Superintendent Physiotherapist, NHS Lothian Lymphoedema Services Medical Director, Acute Services, NHS D&G Audit Facilitator, NHS Borders Oncology Nurse Specialist, NHS D&G A full membership list is available on Item Action 1 Introductions, apologies, minutes Melanie Mackean welcomed new members and visitors to the meeting. The Group approved the minutes of the meeting on 8 th March SCAN Office, Pentland House, 47 Robb s Loan, Edinburgh EH14 1TY T: W: sheena.mackenzie@nhslothian.scot.nhs.uk Page 1 of 6

2 Matters Arising Audit of PET protocol Mark Zahra said that the audit had shown that PET scans were being requested in accordance with the protocol. Additional CNS post for Lothian There was no news on the outcome of the application for NRAC funding for an additional CNS post. Joint operating with colorectal surgeons Scott Fegan reported that there were plans to appoint two new colorectal surgeons from April 2013 and that the colorectal service had suggested Friday as a possible day for joint operating. Gynae clinicians commented that Friday was not a suitable day for them, particularly as it is the day that gynae brachytherapy is undertaken in theatre at the WGH and it was agreed that Scott Fegan should feed this back to David Anderson. Action: Scott Fegan to feed back to David Anderson that Friday would not suit Gynae clinicians as the day for joint operating. Scott Fegan Mandatory op. note in Lothian The surgeons said they were still discussing the introduction of a mandatory op. note. It was noted that this was an action point from a previous audit report and that Fife had a good template. Top up of drug funding It was noted that top-up drug funding was operating relatively smoothly for patients who were entirely self-funded but that there could be problems for patients relying on health insurance. 2 Wider SCAN Issues Kate Macdonald gave an update on regional and national developments: Chemotherapy electronic prescribing and administration system (CEPAS) go live for electronic prescribing in Lothian has been provisionally scheduled for 19 th November. Tzyvia Rye said that CEPAS would not allow trials staff to access data in CEPAS which they needed and this was causing extra work for health professionals. Kate Macdonald said she would ask David Clifford and Lucy Wall whether arrangements could be put in place to address this problem. Action: Kate Macdonald to liaise with David Clifford and Lucy Wall about how to resolve the issue of providing trials staff with access to the data they require from CEPAS. Kate Macdonald Regional Cancer Planning Group (RCPG) The RCPG has agreed a workplan and revised terms of reference. Action: to circulate RCPG workplan and revised terms of reference when ratified by the RCAG. Cancer Modernisation Funding SCAN will feed back to the Scottish Government in early January on the outcomes of projects which received national cancer modernisation funding. Chemotherapy CEL SCAN is awaiting details from Health Page 2 of 6

3 Improvement Scotland (HIS) about the audit of protocols which is expected to be undertaken in late 2012/early Chemotherapy QPIs Quality Improvement Indicators (QPIs) will be developed for chemotherapy in addition to tumour-specific standards. Transforming Care After Treatment (TCAT) Val Doherty and Kate Macdonald are members of the Programme Board for the national TCAT initiative which aims to ensure that Scots diagnosed with cancer are prepared for and supported to live with the consequences of their diagnosis and its treatment. The Programme Board has identified the following key workstreams: follow-up protocols, risk stratification, preventing recurrence and social care integration. Pilot of chemotherapy helpline for patients - The Edinburgh Cancer Centre is one of three sites in Scotland which will be involved in piloting a 24-hour helpline for chemotherapy patients. 3 Gynaecology Issues Lymphoedema Risk Reduction Information Provision Allan Thomson-Filant gave a presentation on the findings of his study on the provision of lymphoedema risk-reduction information (LRRI) by hospitalbased health care professionals in Lothian to women undergoing treatment for gynaecological malignancies. He said that the study had highlighted the need to improve LRRI provision to gynae cancer patients in Lothian and made the following recommendations: Standardised lymphoedema risk reduction information (LRRI) should be provided routinely to all gynae cancer patients with treatment-related risk factors LRRI should be provided by key health professionals at identified points in the patient pathway Other health professionals should provide LRRI to patients on request. Allan said that the lymphoedema service could provide training for colleagues in Lothian and drew Group members attention to the patient information leaflet which the lymphoedema service had developed. It was agreed that the lymphoedema leaflet should be circulated to Group members and published on the SCAN website and suggested that other boards might adapt the information for use in their areas. Action: Allan Thomson-Filant to send lymphoedema leaflet to Sheena Mackenzie for circulation to Group members and publication on the SCAN website. Allan Thomson- Filant Menopause and Cancer: Lothian Consensus Document Group members endorsed the Lothian consensus document on the menopause and cancer and agreed that it and a link to the Menopause Matters website ( should be added to the SCAN website. Action: to add the Lothian Consensus Document on Menopause and Cancer and a link to the Menopause Matters website to the SCAN website. Page 3 of 6

4 Trials Update Melanie Mackean reported that SCAN was the top recruiter in the UK for the PETROC trial and was also recruiting well to the trial on Parp Inhibitors. It was agreed that Charlie Gourley should be asked for a trials update to circulate to the Group. Action: to ask Charlie Gourley for a trials update to circulate to the Group. Surgery for Dumfries & Galloway Patients Graeme Walker suggested that, in view of the limited surgical capacity in Lothian, consideration should be given to sending Dumfries & Galloway patients to Glasgow for surgery or Lothian surgeons performing operations in Dumfries. He said that Adrian McCullough could make a Dumfries operating theatre available all day on a Tuesday and noted that a Dumfries gynae surgical rota would require two Lothian surgeons, to allow for holiday cover. It was agreed that Graeme Walker should go ahead and explore the options and report back to the Gynae Group. Kate Macdonald suggested that NHS Lothian s Healthcare Planner for Cancer, Peter McLoughlin, should be kept in the loop. Action: Graeme Walker to explore alternative options for providing gynae surgery for Dumfries & Galloway patients, keep Peter McLoughlin informed and report progress to the Gynae Group. Graeme Walker Audit Draft ovarian QPIs It was noted that the draft QPIs would require documentation of the Risk of Malignancy Index (RMI) and suggested that the MDM form might be updated to facilitate this. Lorna Bruce advised the Group that the draft standard on BRCA1 and BRCA2 sequencing of high grade serous tumours had been dropped from the latest version of the draft ovarian QPIs. Group members suggested that a revised standard, referring to patients offered sequencing, should be included and it was agreed that Lorna Bruce and Charlie Gourley should feed this back to the Ovarian QPI Development Group. Action: Lorna Bruce and Charlie Gourley to feed back to the Ovarian QPI Development Group the suggestion that a revised standard, referring to patients offered sequencing, should be included in the final list of ovarian QPIs. Lorna Bruce Charlie Gourley National QPI clinical governance process Alison Allen advised the Group that the National Cancer Quality Sub Group (NCQSG) had proposed a governance process for QPIs which would involve annual comparative audit reporting on a regional basis and national reporting every three years. An expert review group, hosted by Healthcare Improvement Scotland (HIS), would review both the three-yearly national reports and regional action plans for addressing any non compliance with QPIs. Alison said that HIS had proposed piloting the reporting process using lung cancer data. It was agreed that details of the proposed QPI clinical governance process should be circulated (see CEL2012_06 attached). Page 4 of 6

5 Ovarian national networks meeting Alison Allen said that SCAN had been asked to co-ordinate the national ovarian cancer networks meeting in 2013 and that it had been suggested that this meeting might be held in April or May. She said that the meeting would include reporting of ovarian audit data and presentations on developments in ovarian cancer. Group members agreed that early May (after Easter and before half term) would be the best time and Melanie Mackean offered to liaise with her counterparts in WOSCAN and NOSCAN about which day of the week to choose and ideas for presentations. Action: Melanie Mackean to liaise with the Gynae Clinical Leads in WOSCAN and NOSCAN about the timing of the national ovarian cancer networks meeting and ideas for presentations. Melanie Mackean Update on 2010 actions points A summary of progress in implementing the actions from the 2010 comparative audit report for ovarian cancer had been circulated with the meeting papers. It was agreed that the action relating to chest imaging was no longer relevant and should be removed. Scott Fegan reminded the Group that, although he had been appointed as an additional Consultant Gynaecologist, the service was operating with one Consultant short, due to the ongoing absence of one member of the team. Education Programme for Relapsed Ovarian Cancer Information about a draft education programme for patients with relapsed advanced stage ovarian cancer had been circulated with the meeting papers. Melanie Mackean said that the intention was to pilot the five-week programme with a maximum of eight Lothian patients and that the first session would be held at the end of Jan She said that she would update the Group on the outcome of the programme and suggested that, if it was successful, the programme might be rolled out to other parts of the region. Brachytherapy Measuring Patient Experience Kate Macdonald said that the national Radiotherapy Programme Board had asked the cancer networks to review patient experiences of brachytherapy and that Sandra Bagnall, SCAN s Patient Involvement Manager, had offered to support this. The Group agreed that the proposal was laudable but there was insufficient capacity within the service to implement it. Workforce Issues Group members reported workload pressures across the board, including: Loss of junior medical staff Lack of CNS cover (and delays in arranging maternity leave cover) MDM issues recurrent IT problems and excessive numbers of patients to discuss in the available time In response to a query from Kate Macdonald, the Gynae Group confirmed that they would be interested in developing an IT MDM solution. Alistair Williams raised the issue of cases being brought to the MDM before pathology reports were available. It was agreed that, except for cases of clinical urgency, patients should not be scheduled for discussion at the MDM within two weeks of their surgery. Melanie Mackean offered to circulate an about this. It was noted that patients would need to be made aware of the timescales. Page 5 of 6

6 Surgeons on the Group highlighted cases where operations had been cancelled at the last minute because patients (from other health boards whom they had not seen) were found to be unfit to have anaesthetic. It was suggested that the MDM form should include information about whether a pre-op anaesthetic assessment was required. Martin Keith offered to raise with colleagues locally the possibility of arranging pre-op anaesthetic assessments for Dumfries & Galloway patients. It was agreed that there was no scope in Consultants job plans to change the timing of the gynae combined clinic but it was suggested that Scott Fegan might explore the idea of having a separate Radiology meeting at the RIE. Melanie Mackean said that there was an Excel spreadsheet in the shared MDM folder which summarised Consultant Oncologist availability and suggested that it would be helpful to have a similar spreadsheet for the Surgeons for the MDM and Thursday clinic availability. It was agreed that Melanie Mackean should feed back the MDM issues to Clare Gorman and invite Kathryn Brechin to speak at the next Gynae Group meeting regarding CNS for gynae in Lothian. Actions: Kate Macdonald to feed into the SCAN ehealth Strategy that Gynae would be keen to develop an MDM IT solution. Martin Keith to raise with colleagues locally the possibility of arranging pre-op anaesthetic assessments for Dumfries & Galloway patients. Scott Fegan to 1) explore the idea of having a separate Radiology meeting at the RIE 2) create an Excel spreadsheet in the shared MDM folder to show Surgeon availability. Melanie Mackean to - 1) feed back Gynae MDM issues to Clare Gorman 2) invite Kathryn Brechin to speak at the next Gynae Group meeting regarding gynae CNS 3) send out an about not scheduling patients for discussion at MDM within two weeks of surgery, except for clinical emergencies 4) Give Scott Fegan access to the shared MDM folder. Kate Macdonald Martin Keith Scott Fegan Melanie Mackean 4 Any Other Business There was no other business. 5 Dates of future meetings 28 th Feb rd May th Sept 2013 All meetings at 10.00am in the Edinburgh Breast Unit Seminar Room with videolinks available from RIE, D&G and VHK. Page 6 of 6