Gynae Regional Meeting 19 th January 2010, Belfast City Hospital

Transcription

1 Gynae Regional Meeting 19 th January 2010, Belfast City Hospital In attendance: Dr John Price Clinical ead Dr Jackie Clarke Ms Joan afferty Dr Bernie Corcoran Dr Julie Anne Forbes Ms Elish McColgan Ms Sarah Williamson Ms Wendy Cunningham Dr Eimear Murtagh Ms Helen Vennard Ms Joanne Ferguson Ms Gail Malmo Ms Pippa McCabe Ms isa Dr Sarah McKenna Dr Geoff McCracken Dr Gary Dorman Dr David Glenn Dr Stephen Dobbs Dr Sharon Fallows Dr Ray McClelland Apologies: Dr Ian Harley Dr Arthur Grey Dr Hans Nagar Dr Anne Carson Ms Joan Wells Summary of key points / outcomes/ action Clinical eads Business Dr John Price welcomed everyone to this meeting stating that a number of key pieces of regional work were being signed off at the meeting ahead of the peer review visits. Dr Price acknowledge everyone s commitment and effort over the last nine months and reminded members that the MDTs would need to hold a meeting in the next week to consider all of the regional guidance and identify any areas for action. Peer Review of Gynae Cancer MDTs Network Site Specific Group Attendance Record this record has been complied by the Network and will be amended to include today s attendance before being forwarded to the MDTs eads. A 67% attendance across the MDT and for MDT eads s required for compliance. Identified Party & date

2 Pre Visits Feedback from MDT eads Dr Price invited the MDT eads to provide feedback on their pre visits. BEFAST: Dr Stephen Dobbs indicated that the Belfast/ SE/Northern ocal MDT and the Specialist MDT are on track and thanked Ms Sarah Williamson and Ms Elish McGolgan for their hard work. Dr Dobbs highlighted that the Trust have a new directive that all mail is to be posted 2 nd class which will pose a problem for communicating to GPs within 48 hours. Other MDT eads indicated that this standard would be unachievable in their Trusts as well. Dr Dobbs questioned whether it would be possible to try encrypting information to a sample of GP practices. Ms stated that it was something which could be run past the Network Primary Care Director NORTHERN: Dr Gary Dorman stated that the pre visits had been very positive and that he was trying to secure a named deputy. SOUTH EASTERN: Dr David Glenn stated that a 0.5WTE CNS has been approved with Macmillan funding. It was also reported that a staff grade would be the named deputy for Dr Glenn. The peer reviewers queried one element of the SE Trust care pathway in that where a colposcopy for 1a cervix has been carried out at lagan valley and then required further cone biopsy patients aren t being transferred to Dr Glenn at the Ulster. The reviewers asked for regional agreement that this was acceptable. There followed much discussion on this point and on the practice in the other Trusts. It was subsequently agreed that an agreed number of clinicians need to do cone biopsies and that these clinicians must be core members of an MDT. Dr Price stated that he would ask Dr Hans Nagar to write a statement to this effect for inclusion in a future version of the cervical cancer CMG. Dr Price SOUTHERN: Dr Geoff McCracken stated that the visit had highlighted no surprises in that there was a discussion around the lack of oncology presence at the MDT and not having a dedicated cancer theatre list. There is currently no CNS to act as a key worker and it was reported that a Registrar would be Dr McCracken s deputy. WESTERN: Dr Sharon Fallows stated that the pre visit had not been all that helpful and felt that the reviewers were overly picky about low grade endometrial cancers. The issue of oncology attendance at the MDT was also raised. MDT Configuration In relation to Oncology input at the Southern and Western Trusts it was flagged by Drs Price and Dobbs that the reviewers questioned if these trust should be reviewed as diagnostic rather than local MDTs. From discussions with Trust it has been agreed that this would be inappropriate as all cases would come to the local Belfast Trust MDT or the Specialist MDT.

3 In the MDT Configuration paper there was a request to amend population data to only show female population. Ms undertook to action this. Next Steps Ms Gail Malmo, who attended all of the pre visits, highlighted that MDTs could refer to achievements within the last 3 years before outlining the next steps as follows o Revisions are currently being made to key documents o Cancer Managers have draft template for MDT eaflet o MDTs need to minute discussion on all regionally agreed products o 31 st March 2010 deadline for submissions to CQUINS o Visits Timetable details of timings have been forwarded to cancer managers and they will liaise with MDTs on attendance etc. 20 th April Southern Trust 21 st April Belfast Trust 22 nd April SE Trust 27 th April Western Trust 28 th April Northern Trust Group Work Plan Updates Clinical Management Guidelines Main CMG Sign Off Dr Price reported that final versions of the Ovarian, Cervical, Endometrial and Vulva CMGs had been circulated on 5 th January incorporating all of the requested changes from earlier discussions and consultations. Small changes can be made after the meeting but members were asked to sign of this version of the CMGs there was an acknowledgement that these are not static documents and will need updated with evidence. The guidelines were signed off with the following agreed changes Ovarian RMI in Appendix 2 needs amended in example and marked as Jacobs Revised Dr Bernie Corcoran is to forward palliative care details for inclusion in all 4 guidelines. Trophoblastic Guidelines These had been forwarded by Dr Nagar on 23 rd November It was clarified that these are guidelines for management at supraregional level and that treatment would follow Charing Cross protocols. Dr Price stated that they were necessary to raise awareness of the disease with colleagues and to ensure patient registration. Dr Nagar will be asked to include a statement to this effect. Dr Harley Dr Corcoran Dr Nagar Other Guidelines 1. Rarer Tumours It was indicated that Glasgow were developing a database for rarer tumours and it was agreed that once their

4 fields had been defined that they would be replicated here and supra regional referral guidelines could then be developed. 2. Sarcomas It was agreed that Dr Price ask Dr Ian Harley to look at this as some would be included in the Ovarian CMGs. Dr Price Regional Patient Information Pathway An update prepared by Ms Danny Sinclair was tabled at the meeting. It was reported that a subgroup has been convened who have identified a comprehensive lsit of ovarian specific topics for mapping onto the pathway for this cancer. Members were invited to forward any additional items to Ms Sinclair e: patientinformation@cancerni.net. Clinical Trials A list of current clinical trials which had been quality assured by Dr Sarah McKenna and Dr Dobbs was tabled at the meeting. It was agreed to sign this list off and to include PORTEC3 for uterus stages 1-3 which is to open imminently. Dr Jackie Clarke agreed to forward details of this and for the EMBRACE study for inclusion. Dr Clarke Regional Audit Dr isa Ranaghan had provided an extract of workload data from CaPPS which had been circulated ahead of today s meeting. There followed some discussion around red flag v s routine referrals and the pick up of cancers. Dr Price reported that an audit was to commence in Belfast Trust using patient notes to determine differences in content/ language used in the red flag and routine referrals. Dr Price also indicated that he had determined from the other UK Gynae leads the ratio of cancers picked up from red flag referrals was in line with the rest of the UK. Dr Sharon Fallows queried why the numbers of cancer by type and at trust 1 st seen did not match total cancer numbers. Ms isa agreed to seek clarification from Dr Ranaghan. A list of regional audits scheduled and already tabled at the regional group were tabled and agreed. Referral Guidelines It was reported that at the last Network Primary Care Group that it had been agreed that the new DoH key signs and symptoms of ovarian cancer would be communicated to Primary Care along with a recommendation that CA125 testing is only done following an abdominal examination. Enhanced Recovery Programme (ERP) The principles behind enhanced recovery were forwarded ahead of today s meeting and there followed a discussion on current practice across the region and whether there was scope to pilot elements of or a full enhanced recovery programme. Dr Price indicated that most clinicians were using laparoscopic surgery and asked about other practice. Dr McCracken stated that Craigavon was using enhanced recovery for gynaecology and that Dr Sidhu has prepared a

5 presentation which could be shared. It was acknowledged that there are barriers to ERP and there is a requirement for initial investment in order for it to work. Emerging Issues Robotic Surgery It was reported that Belfast Trust have a joint Urology Gynaecology bid for robotic surgery with a strong business case prepared that shows it is cost neutral. Dr Dobbs sought and achieved support from this group for this business case. Evolving Role of PET It was reported that Dr Samir Gangoli was unable to attend today s meeting so this agenda item will be picked up at a later meeting. Dr Eimear Murtagh indicated that in future Belfast Trust radiologists might need be permitted to attend these regional meetings due to job planning. Dr Price agreed to contact the clinical director of radiology. Cancer Service Framework Consultation Dr Dobbs highlighted that the target for cervical screening within the CSF was set too low and that he was prepared to forward a response on behalf of this group highlighting this and querying the rates for incontinence. Date of Next Meeting: The next meeting will take place after the peer review visits. Date to be confirmed.