National Cancer Peer Review Urology Cancer Services Report 2012/2013

National Peer Review Programme National Cancer Peer Review Urology Cancer Services Report 2012/2013 www.nationalpeerreview.nhs.uk

UROLOGY Urology Local Teams Overall Performance Of the 88 reviewed against the 40 measures, 71 were on the self-assessment cycle, 10 were on the internal validation cycle and 7 had a peer review assessment. The table below shows the outcomes against the measures for 89 reviewed in 2012/2013; Teams Compliance SA IV PR 100% 1 1 0 90-99% 56 4 0 80-89% 14 3 2 70-79% 0 1 3 60-69% 0 1 1 50-59% 0 0 1 40-49% 0 0 0 0-39% 0 0 0 Median 93% Range 56-100% Interquartile Range 88-95% 100% Overall Compliance Ranges Urology (L) MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% L Urology 11 12 L Urology 12 13 Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 13 were selected for a cancer peer review visit in 2013/2014. 2

Immediate Risks and Serious Concerns (SA) (IV) (PR) Total no of IRs Percentage of (SA) (IV) (PR) Total no of SCs Percentage of services 3 0 3 6 7% 7 0 4 11 13% The main focus of these were: National shortage of BCG immunotherapy. Some patients are having treatment planning decisions made without the benefit of a full MDT discussion, which can potentially affect the treatment and outcome of these patients. Prostate patients are clinically diagnosed without pathological confirmation. Radical complex surgery continues to take place at a local service despite this being non IOG compliant. Nephron sparing surgery is undertaken on two sites at one service which is not compliant with the Improving Outcomes Guidance (IOG). No cover for radiologist. No cover for patient pathway co-ordinator. Other immediate risks and serious concerns related to: Unmanageable workloads in clinics which results in increased waiting times. Lack of referral for new patients to CNS s, which results in reduced patient support. Lack of clinical psychology support at level 3 and 4 reduces the quality of service that is available to patients with high levels of anxiety. Good Practice There are many examples of good practice, these particularly focused on The provision of Psychology and Psychosexual service is an excellent contribution to improving patient experience and meeting a significant gap / unmet need in this patient group. Nurse led clinics including; post treatment nurse led assessment / Nurse led intravesical Clinic for Bladder Cancer patients / Nurse led brachytherapy follow up clinic /Nurse-led TRUS results clinic / nurse led check flexible cystoscopy service. Enhanced recovery programme with protocol driven nurse led discharge. A percutaneous CT guided cryoablation of small renal mass service has been introduced. Patients with a high index of suspicion of prostate cancer who would in the future be suitable for radical treatment are having a pelvic MRI prior to a prostate biopsy to improve efficiency through the diagnostic part of the prostate pathway. A consultant carries out a ward every day on all acute and elective patients, and reviews all in-patient referrals within 24 hours. As a consequence, length of stay was reduced and overall readmission rate also fell. 3

Measures with below 50% compliance: Measure Number and Short Title SA (71 ) 11-2G-103 - Support for Level 2 Practitioners 44% 11-2G-119 - Attendance at National Advanced Communication Skills Training Programme 46% Measure Number and Short Title IV (10 ) 11-2G-103 - Support for Level 2 Practitioners 40% 11-2G-119 - Attendance at National Advanced Communication Skills Training Programme 40% 11-2G-120 - Extended Membership of MDT 40% Measure Number and Short Title PR (7 ) 11-2G-103 - Support for Level 2 Practitioners 29% 11-2G-107 - Core Member (or cover) Present for 2/3 of Meetings 29% 11-2G-117 - Core Nurse Member Completed Specialist Study 43% 11-2G-119 - Attendance at National Advanced Communication Skills Training Programme 14% 11-2G-124 - Provision of Written Patient Information 43% 11-2G-139 - Agreed List of Approved Trials 43% 11-2G-140 - Joint Treatment Planning for TYAs 40% 4

Urology Specialist Teams 5

Overall Performance Of the 49 reviewed against the 44 measures, 33 were on the self-assessment cycle, 9 were on the internal validation cycle and 7 had a peer review assessment. The table below shows the outcomes against the measures for 49 reviewed in 2012/2013; Teams Compliance SA IV PR 100% 0 0 0 90-99% 26 3 0 80-89% 7 4 4 70-79% 0 2 3 60-69% 0 0 0 50-59% 0 0 0 40-49% 0 0 0 0-39% 0 0 0 Median 91% Range 70-98% Interquartile Range 86-95% 100% Overall Compliance Ranges Urology (S) MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% S Urology 11 12 S Urology 12 13 Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 4 were selected for a cancer peer review visit in 2013/2014. 6

Immediate Risks and Serious Concerns (SA) (IV) (PR) Total no of IRs Percentage of (SA) (IV) (PR) Total no of SCs Percentage of services 3 3 3 9 18% 6 4 5 15 31% The main focus of these were: Nepron sparing surgery should be undertaken by a specialist team, however in some this still being carried out by local, this is not IOG compliant practice. Surgeons undertaking less than the minimum requirement for radical prostatectomies which could compromise patient care. Worldwide shortage of BCG, this has an impact on service delivery and surgical capacity. Lack of CNS cover and staff. Lack of surgical pathology support, meaning that frozen section examination of tissue removed during surgery is not available. Surgical attendance at MDT s, in some cases this has been below 50%. It is reported that one of the consultant surgeons who performs pelvic surgery has attended no MDT meetings. Other immediate risks and serious concerns related to: Lack of funding for new innovations for example robotic surgery. Insufficient video conferencing facilities for MDT meetings. Difficulties achieving cancer waiting targets due to surgical theatre capacity. Good Practice There are many examples of good practice, these particularly focused on: Continued increase in number of patients treated using the De Vinci Robot system, this has included roll-out to include partial nephrectomy. Implementation of enhanced recovery pathway for laparoscopic nephrectomy, pyeloplasty and nephroureterectomy. Nurse led activity including; histology clinics for prostate, bladder and kidney patients, nurse led post operative clinic for prostate, bladder and kidney patients; telephone followup; erectile dysfunction clinics; flexible cystoscopy clinics, chemotherapy and Bacillus Calmette-Guérin (BCG) clinics. Continued establishment of high Dose Rate (HDR) brachytherapy. Implementation of holistic assessment tool for patients for all uro-oncology patients at key stages (Distress thermometer). Introduction of Dynamic Contrast Enhanced MRI pre template biopsies. 7

Measures with under 50% compliance: Measure Number and Short Title SA (33 ) 11-2G-203 - Support for Level 2 Practitioners 36% 11-2G-221 - Attendance at National Advanced Communication Skills Training Programme 33% Measure Number and Short Title IV (9 ) 11-2G-203 - Support for Level 2 Practitioners 33% 11-2G-215 - MDT Agreement to Policy for Patient Access to Joint Meeting to Discuss Treatment Options 11-2G-221 - Attendance at National Advanced Communication Skills Training Programme 33% 11% Measure Number and Short Title PR (7 ) 11-2G-219 - Core Nurse Member Completed Specialist Study 43% 11-2G-221 - Attendance at National Advanced Communication Skills Training Programme 0% 11-2G-242 - More Than 5 Procedures by Specified Topic 43% 8

Urology Supranetwork Testicular Teams 9

Overall Performance Of the 13 reviewed against the 32 measures. 9 were on the self-assessment cycle, 2 were on the internal validation cycle and 2 were subject to a full peer review assessment. The table below shows the outcomes against the measures for 13 reviewed in 2012/2013; Teams Compliance SA IV PR 100% 0 0 0 90-99% 3 2 0 80-89% 4 0 0 70-79% 2 0 1 60-69% 0 0 1 50-59% 0 0 0 40-49% 0 0 0 0-39% 0 0 0 Median 88% Range 61 97% Interquartile Range 76-91% 100% Overall Compliance Ranges Testicular MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Testicular 11 12 Testicular 12 13 Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 1 team was selected for a cancer peer review visit in 2013/2014. 10

Immediate Risks and Serious Concerns (SA) (IV) (PR) Total no of IRs Percentage of (SA) (IV) (PR) Total no of SCs Percentage of services 0 0 1 1 8% 0 0 1 1 8% The main focus of these were: An immediate risk was identified at one trust with regards to only two patients received first line BEP chemotherapy delivered in Carlisle in the last year, this does not represent sufficient clinical volume to maintain the expertise required to deliver a safe and effective service. A serious concern was identified at the same trust regarding patients who have a relapse of their testicular cancer are being treated by a member of the specialist team but not at a specialist centre; this falls outside of the Network s clinical guidelines. Good Practice There were many examples of good practice. These particularly focused on: Double reporting of histopathology and radiology as routine with governance and educational role for dealing with variance proforma for feedback. A patient triggered follow up system is now in place allowing patients to have their investigations performed at their convenience, within a predefined follow up schedule. Patients attend a workshop to develop skills in self-management. A web based monitoring system allows patients to access their results once screened by the treating physician, and collects data on quality of life and disease specific symptoms. Development of nurse led follow up for Germ Cell Tumour patients. Measures with under 50% compliance: Measure Number and Short Title SA (9 ) 11-2G-303 - Support for Level 2 Practitioners 33% 11-2G-311 - MDT Meeting With Referring Teams/Collaborative Audit 22% 11-2G-319 - Attendance at National Advanced Communications Skills Training Programme 22% Measure Number and Short Title 11-2G-319 - Attendance at National Advanced Communications Skills Training Programme IV (2 ) 0% Measure Number and Short Title PR (2 ) 11-2G-308 - Core Member (or cover) Present for 2/3 of Meetings 0% 11-2G-313 - Operational Policy for Named Key Worker 0% 11-2G-321 - Patient Permanent Consultation Record 0% 11-2G-322 - Patient Experience Exercise 0% 11-2G-323 - Provision of Written Patient Information 0% 11

Urology Supranetwork Penile Teams 12

Overall Performance Of the 9 reviewed against the 32 measures. 6 were on the self-assessment cycle, 2 on the internal validation cycle and 1 team was selected for an external peer review assessment. The table below shows the outcomes against the measures for 9 reviewed in 2012/2013; Teams Compliance SA IV PR 100% 0 0 0 90-99% 3 1 0 80-89% 3 0 0 70-79% 0 0 0 60-69% 0 1 0 50-59% 0 0 0 40-49% 0 0 1 0-39% 0 0 0 Median 89% Range 45-95% Interquartile Range 84-95% 100% Overall Compliance Ranges Penile MDTs (11/12 and 12/13) 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Penile 11 12 Penile 12 13 Red vertical lines: complete range Blue box: inter-quartile range Orange horizontal line: median value Team below 50% (If more than one team, number in brackets) 1 team was selected for a cancer peer review visit in 2013/2014. 13

Immediate Risks and Serious Concerns (SA) (IV) (PR) Total no of IRs Percentage of (SA) (IV) (PR) Total no of SCs Percentage of services 0 0 0 0 0% 0 1 1 2 22% The main focus of these were: Major cancer surgery is being performed outside the designated specialist centre, meaning that the service is not IOG compliant. Lack of clarity regarding referral and clinical guidelines in a specialist centre. Lack of penile surgeon on the core team membership, this results in delays for patients as a result of the service being managed by a single handed surgeon. A serious concern was reported around the need to offer sentinel node biopsy s which will reduce the number of patients currently having prophylactic lymph node dissections. Good Practice There were many examples of good practice. These particularly focused on: Commencement of Fine needle aspiration of groin Lymph nodes. Development of Dynamic Sentinel Node Biopsy which now includes the training of Nuclear Medicine radiologists to administer the radioactive tracer. Measures with below 50% compliance: Measure Number and Short Title IV (2 ) 11-2G-403 - Support for Level 2 Practitioners 0% Measure Number and Short Title PR (1 team) 11-2G-402 - Level 2 Practitioners for Psychological Support 0% 11-2G-403 - Support for Level 2 Practitioners 0% 11-2G-404 - Team attendance at NSSG Meeting 0% 11-2G-406 - Attendance at National Advanced Communication Skills Training Programme 0% 11-2G-407 - MDT Meeting with Referring Teams/Collaborative Audit 0% 11-2G-408 - MDT Agreement to Network/Supranetwork Follow up Guidelines 0% 11-2G-409 - MDT Agreement to Penile Patient for Access to Meeting to Discuss Treatment Options 0% 11-2G-410 - Named Hospital for Penile Surgical Procedures 0% 11-2G-412 - Provision of Written Patient Information 0% 11-2G-414 - MDT Agreement to Network/Supranetwork for Referral Guidelines for Penile Cancer 11-2G-415 - MDT Agreement to Network/Supranetwork for Referral Guidelines to Another Team 0% 0% 14

NETWORK 100% Urology NSSGs 2012-2013 90% 80% 70% 60% 50% 40% 30% 20% SA IV PR 10% 0% There were many examples of good practice at network level. These particularly focused on: Participation in the National Awareness and Early Diagnosis Initiative (NAEDI) and Local Awareness and Early Diagnosis Initiative (LAEDI) project. Continued implementation of Enhanced Recovery. Improvements in the recruitment of patients to trials Introduction of Intensity- Modulated Radiation Therapy (IMRT). Involvement of Allied Healthcare Professional (AHP) representatives and development of rehabilitation pathway for patients with urological cancers. Progress with delivery of radiotherapy and information prescriptions. 15

Appendix 1 OVERALL PERCENTAGE COMPLIANCE AGAINST THE MDT PEER REVIEW MEASURES Urology Local Measure Number and Short Title SA (71 ) IV (10 ) PR (7 ) 11-2G-101 - Lead Clinician and Core Team Membership 94% 100% 86% 11-2G-102 - Level 2 Practitioners for Psychological Support 75% 50% 57% 11-2G-103 - Support for Level 2 Practitioners 44% 40% 29% 11-2G-104 - Team Attendance at NSSG Meetings 97% 90% 100% 11-2G-105 - MDT Meetings 99% 100% 100% 11-2G-106 - MDT Agreed Cover Arrangements for Core Member 11-2G-107 - Core Member (or cover) Present for 2/3 of Meetings 11-2G-108 - Annual Meeting to Discuss Operational Policy 11-2G-109 - Policy for All New Patients to be Reviewed by MDT 11-2G-110 - MDT Agreement to Guidelines for the Management of High Risk Superficial Bladder Tumours 11-2G-111 - MDT Agreement to Guidelines for the Management of Kidney Cancer 11-2G-112 - Policy for Communication of Diagnosis to GP 75% 70% 57% 89% 70% 29% 96% 100% 86% 100% 100% 86% 100% 100% 86% 93% 100% 57% 11-2G-113 - Operational Policy for Named Key Worker 97% 100% 86% 11-2G-114 - MDT Agreement to Network/Supranetwork Follow up Guidelines 11-2G-115 - Agreed Policy for Patient Access to MDT to Discuss Treatment Options 11-2G-116 - Core Histopathology Members Taking Part in Histopathology EQA 11-2G-117 - Core Nurse Member Completed Specialist Study 11-2G-118 - Agreed Responsibilities for Core Nurse Members 11-2G-119 - Attendance at National Advanced Communication Skills Training Programme 99% 100% 86% 82% 56% 71% 99% 100% 100% 89% 100% 43% 100% 100% 71% 46% 40% 14% 11-2G-120 - Extended Membership of MDT 96% 40% 71% 11-2G-121 - Oncology Core Members of a Specialist Urology Team 93% 70% 86% 11-2G-122 - Patient Permanent Consultation Record 87% 100% 57% 11-2G-123 - Patient Experience Exercise 100% 90% 57% 11-2G-124 - Provision of Written Patient Information 100% 100% 43% 11-2G-125 - Regular Prostate Clinic 90% 80% 71% 16

11-2G-126 - Regular Haematuria Clinic 93% 100% 71% 11-2G-127 - Agree and Record Individual Patient Treatment Plans 11-2G-128 - MDT Agreement to Network Clinical and Referral Guidelines for Kidney Cancer 11-2G-129 - MDT Agreement to Network Clinical and Referral Guidelines for Bladder Cancer 11-2G-130 - MDT Agreement to Network Clinical and Referral Guidelines for Prostate Cancer 11-2G-131 - MDT Agreement to Network Clinical and Referral Guidelines for T2 Muscle Invasive Bladder Cancer and Organ-Confined Prostate Cancer 11-2G-132 - MDT Agreement to Network Clinical and Referral Guidelines for Testicular Cancer - Diagnosis & Assessment 11-2G-133 - MDT Agreement to Specialist Team Referral Guidelines for Testicular Cancer 11-2G-134 - MDT Agreement to Network Wide Guidelines on Testicular Cancer - Defining Specialist Care for the Network 11-2G-135 - MDT Agreement to Clinical and Referral Guidelines for Penile Cancer - Diagnosis, Assessment & MDT Discussion 11-2G-136 - MDT Agreement to Network/Supranetwork Defined Specialist and Supranetwork MDTs 99% 100% 86% 100% 100% 86% 99% 100% 86% 99% 100% 86% 100% 100% 86% 11-2G-137 - Agreed Collection of Minimum Dataset 99% 90% 86% 11-2G-138 - Network Audit 76% 50% 86% 11-2G-139 - Agreed List of Approved Trials 93% 70% 43% 11-2G-140 - Joint Treatment Planning for TYAs 91% 80% 40% 17

Urology Specialist Measure Number and Short Title SA (33 ) IV (9 ) PR (7 ) 11-2G-201 - Lead Clinician and Core Team Membership 11-2G-202 - Level 2 Practitioners for Psychological Support 73% 89% 71% 11-2G-203 - Support for Level 2 Practitioners 36% 33% 71% 11-2G-204 - Team Attendence at NSSG Meetings 94% 100% 100% 11-2G-205 - MDT Meeting 100% 89% 100% 11-2G-206 - MDT Agreed Cover Arrangements for Core Member 11-2G-207 - Core Member (or Cover) Present for 2/3 of Meetings 11-2G-208 - Annual Meeting to Discuss Operational Policy 11-2G-209 - Policy for all New Patients to be Reviewed by MDT 11-2G-210 - MDT Agreement to Network Guidelines for the Management of High Risk Superficial Bladder Cancer 11-2G-211 - MDT Agreement to Network Guidelines for the Management of Kidney Cancer 11-2G-212 - Policy for Communication of Diagnosis to GP 100% 89% 57% 85% 56% 57% 94% 100% 100% 100% 89% 71% 100% 100% 71% 100% 100% 71% 97% 89% 86% 11-2G-213 - Operational Policy for Named Key Worker 97% 100% 86% 11-2G-214 - MDT Agreement to Follow up Guidelines 97% 100% 57% 11-2G-215 - MDT Agreement to Policy for Patient Access to Joint Meeting to Discuss Treatment Options 61% 33% 57% 11-2G-216 - Single Site Surgery and Post Operative Care 94% 78% 71% 11-2G-217 - Surgical Cross Cover Arrangements 100% 78% 100% 11-2G-218 - Core Histopathology Members Taking Part in Histopathology EQA 11-2G-219 - Core Nurse Member Completed Specialist Study 11-2G-220 - Agreed Responsibilities for Core Nurse Members 11-2G-221 - Attendance at National Advanced Communication Skills Training Programme 100% 100% 71% 94% 56% 43% 100% 100% 86% 33% 11% 0% 11-2G-222 - Extended Membership of MDT 94% 89% 86% 11-2G-223 - Patient Permanent Consultation Record 88% 67% 100% 11-2G-224 - Patient Experience Exercise 97% 89% 71% 11-2G-225 - Provision of Written Patient Information 97% 89% 71% 11-2G-226 - Regular Prostate Clinic 97% 89% 100% 11-2G-227 - Regular Haematuria Clinic 97% 89% 86% 11-2G-228 - Record of Treatment Planning Decision 97% 100% 100% 11-2G-229 - MDT Agreement to Network Clinical and Referral Guidelines for Kidney Cancer 100% 100% 86% 18

11-2G-230 - MDT Agreement to Network Clinical and Referral Guidelines for Bladder Cancer 11-2G-231 - MDT Agreement to Network Clinical and Referral Guidelines for Prostate Cancer 11-2G-232 - MDT Agreement to Network Clinical and Referral Guidelines for T2 Muscle Invasive Bladder Cancer and Organ-Confined Prostate Cancer 11-2G-233 - MDT Agreement to Network Clinical and Referral Guidelines for Testicular Cancer - Diagnosis & Assessment 11-2G-234 - MDT Agreement to Network Specialist Team Referral Guidelines for Testicular Cancer 11-2G-235 - MDT Agreement to Network wide Guidelines on Testicular Cancer-Defining Specialist Versus Supranetwork Care for the Network. 11-2G-236 - MDT Agreement to Network Clinical and Referral Guidelines for Penile Cancer - Diagnosis, Assessment and MDT discussion 11-2G-237 - MDT Agreement to Network/Supranetwork Defined Specialist and Supranetwork MDTs 100% 89% 100% 100% 89% 100% 11-2G-238 - Agreed Collection of Minimum Dataset 97% 100% 86% 11-2G-239 - Network Audit. 82% 67% 86% 11-2G-240 - Agreed List of Approved Trials 85% 89% 57% 11-2G-241 - Number of Radical Prostatectomies/Total Cystectomies, Performed by Individual Surgical Member of the MDT 100% 89% 100% 11-2G-242 - More Than 5 Procedures by Specified Topic 91% 78% 43% 11-2G-243 - Combined More Than Total of Specified Radical Procedures 100% 89% 100% 11-2G-244 - Joint Treatment Planning for TYAs 84% 78% 67% 19

Urology Supranetwork Testicular Measure Number and Short Title 11-2G-301 - Single Named Lead Clinician and Named Core Team Members 11-2G-302 - Level 2 Practitioners for Psychological Support SA (9 ) IV (2 ) PR (2 ) 78% 100% 50% 89% 50% 50% 11-2G-303 - Support for Level 2 Practitioners 33% 100% 50% 11-2G-304 - Team Attendance at NSSG meetings. 11-2G-305 - All Consultants Core Member of Testicular MDT 11-2G-306 - MDT Meetings 11-2G-307 - MDT Agreed Cover Arrangements for Core Members 11-2G-308 - Core Member (or cover) Present for 2/3 of Meetings 11-2G-309 - Annual Meeting to Discuss Operational Policy 11-2G-310 - Policy for all New Patients to be Reviewed by MDT 11-2G-311 - MDT Meeting With Referring Teams/ Collaborative Audit 11-2G-312 - Policy for Communication of Diagnosis to GP 89% 100% 50% 78% 100% 0% 22% 50% 50% 75% - 100% 11-2G-313 - Operational Policy for Named Key Worker 89% 100% 0% 11-2G-314 - Network/Supranetwork Agreed Testicular Cancer Follow Up Guidelines 11-2G-315 - Named Hospital for Resect Team of Residual Mass Post-Chemotherapy 100% 100% 50% 11-2G-316 - Patients Offered Sperm Storage 11-2G-317 - Core Nurse Member Completed Specialist Study 11-2G-318 - Agreed Responsibilities for Core Nurse Members 11-2G-319 - Attendance at National Advanced Communications Skills Training Programme 100% 50% 50% 100% 100% 50% 22% 0% 50% 11-2G-320 - Extended Membership of MDT 89% 100% 50% 11-2G-321 - Patient Permanent Consultation Record 78% 100% 0% 11-2G-322 - Patient Experience Exercise 67% 100% 0% 11-2G-323 - Provision of Written Patient Information 89% 100% 0% 11-2G-324 - Agree and Record Individual Patient Treatment Plans 11-2G-325 - MDT Agreement to Network/Supranetwork Referral Guidelines for Testicular Cancer 11-2G-326 - MDT Agreement to Network Specialist Team Referral Guidelines for Testicular Cancer 100% 100% 50% 20

11-2G-327 - MDT Agreement to Network/Supranetwork Guidelines for Testicular Cancer - Defining Specialist Versus Supranetwork Care for the Network. 11-2G-328 - Agreed Collection of Minimum Dataset 100% 100% 50% 11-2G-329 - Network Audit 89% 50% 100% 11-2G-330 - Agreed List of Approved Trials 78% 100% 100% 11-2G-331 - Number of Annual Testicular Cancer Referrals 11-2G-332 - Total Annual Number of Post Chemotherapy Surgical Resections 89% 100% 100% 89% 100% 100% 11-2G-333 - Joint Treatment Planning for TYAs 78% 100% 50% 21

Urology Supranetwork Penile Measure Number and Short Title SA (6 ) IV (2 ) PR (1 team) 11-2G-401 - Named Core Team Members 100% 50% 100% 11-2G-402 - Level 2 Practitioners for Psychological Support 83% 50% 0% 11-2G-403 - Support for Level 2 Practitioners 50% 0% 0% 11-2G-404 - Team attendance at NSSG Meeting 83% 50% 0% 11-2G-405 - All Consultants Core Member of Supranetwork Penile Team 11-2G-406 - Attendance at National Advanced Communication Skills Training Programme 11-2G-407 - MDT Meeting with Referring Teams/Collaborative Audit 11-2G-408 - MDT Agreement to Network/Supranetwork Follow up Guidelines 11-2G-409 - MDT Agreement to Penile Patient for Access to Meeting to Discuss Treatment Options 11-2G-410 - Named Hospital for Penile Surgical Procedures 50% 50% 0% 67% 50% 0% 100% 100% 0% 100% 100% 0% 100% 100% 0% 11-2G-411 - Extended Membership of MDT 83% 100% 100% 11-2G-412 - Provision of Written Patient Information 100% 50% 0% 11-2G-413 - Agree and Record Individual Treatment Plans 11-2G-414 - MDT Agreement to Network/Supranetwork for Referral Guidelines for Penile Cancer 11-2G-415 - MDT Agreement to Network/Supranetwork for Referral Guidelines to Another Team 11-2G-416 - MDT Agreement to Network for Collection of Minimum Dataset 100% 100% 0% 100% 100% 0% 11-2G-417 - Network Audit 100% 50% 100% 11-2G-418 - Agreed List of Approved Trials 75% 100% 100% 11-2G-419 - Number of Annual Penile Cancer Referrals 11-2G-420 - Total Annual Number of Penile Surgical Procedures by Individual Surgeon 22

Appendix 2 UROLOGY LOCAL TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - Barnsley NTCN - North Trent 100 IV MDT - George Eliot ArCN - Arden 100 SA MDT - Dorset County Hospitals DCN - Dorset 98 SA MDT - East Lancashire Hospitals LSCCN - Lancashire & South Cumbria 98 SA MDT - Heatherwood & Wexham TVCN - Thames Valley 98 SA MDT - Kettering EMCN - East Midlands 98 SA MDT - Mid Staffordshire NHS Foundation Trust GMCN - Greater Midlands 98 SA MDT - South Devon PCN - Peninsula 98 SA MDT - St Helens & Knowsley MCCN - Merseyside & Cheshire 98 SA MDT - West Suffolk AngCN - Anglia 98 SA MDT - St George's SWLCN - South West London 97 SA MDT - Airedale YCN - Yorkshire 95 SA MDT - Bolton GMCCN - Greater Manchester & Cheshire 95 IV MDT - Buckinghamshire Healthcare NHS Trust TVCN - Thames Valley 95 SA MDT - Chelsea & Westminster NWLCN - North West London 95 SA MDT - Chesterfield NTCN - North Trent 95 SA MDT - Frimley Park SWSHCN - Surrey, West Sussex & Hampshire 95 IV MDT - Hinchingbrooke AngCN - Anglia 95 SA MDT - Kings College SELCN - South East London 95 SA MDT - Kings Lynn AngCN - Anglia 95 SA IR SC MDT - PRUH SELCN - South East London 95 SA MDT - Royal Berkshire TVCN - Thames Valley 95 SA MDT - RUH ASWCN - Avon, Somerset & Wiltshire 95 SA MDT - Sandwell & West Birmingham PBCN - Pan-Birmingham 95 SA MDT - Southport & Ormskirk MCCN - Merseyside & Cheshire 95 SA MDT - The Royal Wolverhampton Hospitals Trust GMCN - Greater Midlands 95 SA MDT - UHB ASWCN - Avon, Somerset & Wiltshire 95 SA MDT - University Hospital North Staffordshire NHS Trust GMCN - Greater Midlands 95 SA MDT - Worthing & Southlands SCN - Sussex 95 SA SC MDT - York YCN - Yorkshire 95 SA MDT - Aintree MCCN - Merseyside & Cheshire 93 SA 23

MDT - Basingstoke and North Hampshire Hospital CSCCN - Central South Coast 93 SA MDT - Bedford AngCN - Anglia 93 SA MDT - Broomfield (Chelmsford) ECN - Essex 93 IV MDT - Doncaster & Bassetlaw NTCN - North Trent 93 SA MDT - Ipswich AngCN - Anglia 93 SA SC MDT - James Paget AngCN - Anglia 93 SA MDT - Luton & Dunstable MVCN - Mount Vernon 93 SA IR SC MDT - Milton Keynes General TVCN - Thames Valley 93 SA MDT - North Middlesex University Hospital MDT - Pennine Acute NCLWECCN - North Central London and West Essex CCN GMCCN - Greater Manchester & Cheshire 93 SA 93 SA MDT - Rotherham NTCN - North Trent 93 SA MDT - Sherwood Forest Hospitals EMCN - East Midlands 93 SA MDT - Surrey & Sussex SWSHCN - Surrey, West Sussex & Hampshire 93 IV MDT - Taunton ASWCN - Avon, Somerset & Wiltshire 93 SA MDT - The Dudley Group NHS Foundation Trust GMCN - Greater Midlands 93 SA MDT - Warrington & Halton MCCN - Merseyside & Cheshire 93 SA MDT - Watford General Hospital MVCN - Mount Vernon 93 SA SC MDT - West Middlesex NWLCN - North West London 93 SA MDT - Weston ASWCN - Avon, Somerset & Wiltshire 93 SA MDT - Worcestershire Acute Hospitals NHS Trust 3CCN - 3 Counties 93 SA MDT - Hillingdon NWLCN - North West London 92 SA MDT - Blackpool Teaching Hospitals Trust LSCCN - Lancashire & South Cumbria 90 SA MDT - Burton Hospital EMCN - East Midlands 90 SA MDT - Colchester Hospital University NHS Foundation Trust ECN - Essex 90 SA MDT - Hereford Hospital 3CCN - 3 Counties 90 SA MDT - IoW CSCCN - Central South Coast 90 SA MDT - North Cumbria NECN - North of England 90 SA MDT - Northern Lincolnshire And Goole Hospital MDT - Royal Free Hampstead NHS Trust NEYHCA - North East Yorkshire and Humber Clinical Alliance NCLWECCN - North Central London and West Essex CCN 90 SA 90 SA MDT - Salisbury NHS Foundation Trust CSCCN - Central South Coast 90 SA MDT - Whittington Hospital NCLWECCN - North Central London and West Essex CCN 90 SA MDT - Countess of Chester MCCN - Merseyside & Cheshire 88 SA MDT - Croydon SWLCN - South West London 88 IV MDT - Great Western Hospitals TVCN - Thames Valley 88 SA 24

MDT - Hastings SCN - Sussex 88 SA MDT - Maidstone Hospital KMCN - Kent & Medway 88 SA IR MDT - North Devon PCN - Peninsula 88 SA MDT - North Tees And Hartlepool NECN - North of England 88 IV MDT - Northwick Park Hospital NWLCN - North West London 88 PR IR MDT - Royal Cornwall PCN - Peninsula 88 SA MDT - Royal Hampshire County Hospital CSCCN - Central South Coast 88 PR SC MDT - RWST CSCCN - Central South Coast 88 SA MDT - Wrightington, Wigan And Leigh GMCCN - Greater Manchester & Cheshire 88 SA SC MDT - Epsom & St Helier SWLCN - South West London 85 SA MDT - S Warwickshire General ArCN - Arden 85 SA MDT - The Princess Alexandra Hospital NCLWECCN - North Central London and West Essex CCN 85 SA MDT - Peterborough AngCN - Anglia 83 SA MDT - Royal Marsden - Chelsea SWLCN - South West London 83 SA MDT - Calderdale & Huddersfield YCN - Yorkshire 80 SA SC MDT - Yeovil ASWCN - Avon, Somerset & Wiltshire 80 IV MDT - Kingston SWLCN - South West London 77 PR IR MDT - Barts & London NELCN - North East London 75 PR SC* MDT - Harrogate YCN - Yorkshire 75 IV MDT - DMH/BAGH NECN - North of England 73 PR MDT - Scarborough And North East Yorkshire Health Care NEYHCA - North East Yorkshire and Humber Clinical Alliance 68 IV MDT - Walsall Healthcare PBCN - Pan-Birmingham 68 PR SC MDT - Morecambe Bay Hospitals LSCCN - Lancashire & South Cumbria 56 PR IR SC * = Resolved 25

UROLOGY SPECIALIST TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - Heart of England NHS Foundation Trust PBCN - Pan-Birmingham 98 SA SC MDT - Hull And East Yorkshire Hospitals NEYHCA - North East Yorkshire and Humber Clinical Alliance 98 SA MDT - Lancashire Teaching Hospitals LSCCN - Lancashire & South Cumbria 98 SA MDT - Newcastle NECN - North of England 98 IV MDT - Wirral MCCN - Merseyside & Cheshire 98 SA MDT - BSUH SCN - Sussex 95 SA IR SC MDT - Central Manchester & Manchester Childrens GMCCN - Greater Manchester & Cheshire 95 SA MDT - Derby Hospital EMCN - East Midlands 95 SA MDT - Leicester General Hospital EMCN - East Midlands 95 SA MDT - Lister MVCN - Mount Vernon 95 SA MDT - Royal Devon & Exeter PCN - Peninsula 95 SA MDT - University College London Hospitals NCLWECCN - North Central London and West Essex CCN 95 SA SC MDT - University Hospital Coventry and Warwickshire NHS Trust MDT - University Hospitals Southampton NHS Foundation Trust ArCN - Arden 95 SA CSCCN - Central South Coast 95 SA MDT - Kent & Canterbury KMCN - Kent & Medway 93 SA MDT - Leeds Teaching YCN - Yorkshire 93 IV IR SC MDT - Mid Yorks YCN - Yorkshire 93 SA MDT - North Bristol ASWCN - Avon, Somerset & Wiltshire 93 SA MDT - Northampton General Hospital NHS Trust EMCN - East Midlands 93 SA MDT - Addenbrookes AngCN - Anglia 91 SA MDT - Gloucestershire Hospitals NHS Foundation Trust 3CCN - 3 Counties 91 SA MDT - Lincoln County Hospital EMCN - East Midlands 91 SA IR SC MDT - Nottingham University Hospitals NHS Trust EMCN - East Midlands 91 SA MDT - Royal Liverpool & Broadgreen MCCN - Merseyside & Cheshire 91 SA IR SC MDT - Sheffield NTCN - North Trent 91 SA MDT - South Tees NECN - North of England 91 SA MDT - Southend ECN - Essex 91 SA MDT - Stockport MDT - University Hospital of South Manchester NHS Foundation Trust GMCCN - Greater Manchester & Cheshire GMCCN - Greater Manchester & Cheshire 91 SA 91 IV 26

MDT - Guy's & St Thomas' SELCN - South East London 89 SA MDT - Medway NHS Foundation Trust KMCN - Kent & Medway 89 PR IR MDT - Plymouth PCN - Peninsula 89 IV IR MDT - Salford GMCCN - Greater Manchester & Cheshire 89 IV MDT - University Hospitals Birmingham Foundation Trust PBCN - Pan-Birmingham 89 PR SC MDT - Royal Marsden - Chelsea SWLCN - South West London 88 SA MDT - Norfolk & Norwich AngCN - Anglia 86 SA MDT - Portsmouth CSCCN - Central South Coast 86 SA MDT - RSCH SWSHCN - Surrey, West Sussex & Hampshire 86 IV MDT - Sunderland NECN - North of England 86 SA MDT - Barnet And Chase Farm Hospitals NCLWECCN - North Central London and West Essex CCN 84 SA SC MDT - King George NELCN - North East London 84 PR SC* MDT - Oxford University TVCN - Thames Valley 84 IV SC MDT - Royal Bournemouth and Christchurch Hospitals DCN - Dorset 84 SA MDT - Shrewsbury & Telford Hospitals GMCN - Greater Midlands 84 PR SC MDT - Bradford YCN - Yorkshire 77 PR MDT - Whipps Cross NELCN - North East London 75 PR IR* SC MDT - Charing Cross NWLCN - North West London 70 PR IR SC MDT - Heatherwood & Wexham TVCN - Thames Valley 70 IV SC MDT - St Peters SWSHCN - Surrey, West Sussex & Hampshire 70 IV IR SC 27

UROLOGY SUPRANETWORK TESTICULAR TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - Sheffield NTCN - North Trent 97 SA MDT - Charing Cross NWLCN - North West London 94 SA MDT - Christie Hospital GMCCN - Greater Manchester & Cheshire 91 IV MDT - Oxford University TVCN - Thames Valley 91 SA MDT - Leeds Teaching YCN - Yorkshire 90 IV MDT - Royal Marsden - Chelsea SWLCN - South West London 88 SA MDT - University Hospitals Birmingham Foundation Trust PBCN - Pan-Birmingham 88 SA MDT - Barts & London NELCN - North East London 82 SA MDT - UHB ASWCN - Avon, Somerset & Wiltshire 82 SA MDT - University Hospitals Southampton NHS Foundation Trust MDT - Nottingham University Hospitals NHS Trust CSCCN - Central South Coast 76 SA EMCN - East Midlands 73 SA MDT - Newcastle NECN - North of England 70 PR IR SC MDT - Royal Liverpool & Broadgreen MCCN - Merseyside & Cheshire 61 PR * = Resolved 28

UROLOGY SUPRANETWORK PENILE TEAMS: IMMEDIATE RISKS, SERIOUS CONCERNS AND OVERALL COMPLIANCE Team Network % Stage IR SC MDT - Christie Hospital GMCCN - Greater Manchester & Cheshire 95 SA MDT - Leicester General Hospital EMCN - East Midlands 95 SA MDT - North Bristol ASWCN - Avon, Somerset & Wiltshire 95 IV MDT - Good Hope Hospital PBCN - Pan-Birmingham 90 SA MDT - St George's SWLCN - South West London 89 SA MDT - Norfolk & Norwich AngCN - Anglia 85 SA MDT - University College London Hospitals NCLWECCN - North Central London and West Essex CCN 84 SA MDT - Leeds Teaching YCN - Yorkshire 63 IV SC MDT - Sunderland NECN - North of England 45 PR SC * = Resolved 29

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