Head and Neck Cancer MCN Work Plan /18 Objective Deliverables / Outcomes Lead 1. Manage the development/review of Head and Neck Cancer Management Guidelines and Clinical Guidance Documents. 1.1 Identify lead author/reviewer and communicate requirements of the development/review process in accordance with WoSCAN Standard Operating Procedures. Regional or national MCN Clinical Management Guidelines / Clinical Guidance Documents circulated for implementation. Timely and consistent development/ review of Clinical Management Guidelines and Clinical Guidance Documents in accordance with WoSCAN Standard Operating Procedures. MCN MCN / Lead Documentation used to inform clinical practice will be developed and reviewed to ensure safe, equitable management of patients across the region and optimise effectiveness of treatment and care. Clinical Management Guidelines: Nasopharyngeal c/f Sinonasal c/f Anterior Tongue/Oral Cavity c/f Laryngeal c/f Oropharyngeal c/f Clinical Guidance Documents: Enhanced Recovery after Surgery (ERAS) Programme for Head & Neck Cancer Patients c/f Oral Screening Pathway Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 1
2. Participation in the West of Scotland rolling programme of regional and national education events; utilising the opportunity for learning and sharing of current best practice and innovation. Established Managed Clinical Network educational events maximised to promote best practice and drive improvement in care delivery. Lead MCN Sharing our best practice across the region should optimise the effectiveness of treatment and care and ensure equity of service provision. 2.1 Host regional Head and Neck Cancer Education Event which facilitates review of clinical audit data and shared learning of current best practice and innovation. Successful education event which delivered a wide range of topics and achieved engagement with multi-professional groups. Lead MCN Nov 3. Support delivery of the National Cancer Quality Programme for /18, ensuring the regional/national governance process is adhered to. 3.1 Support the data verification process as defined by regional/local governance framework. Programme delivered in line with agreed download schedule, Quality Performance Indicators (QPIs) and governance processes. Clinical and service issues are escalated and actioned appropriately. Audit data reports verified by NHS Boards. Board comments returned for inclusion in annual Audit Reports. Information MDT Leads/Clinical Effectiveness Leads Nov QPI performance monitoring will ensure that quality improvement activity is focussed on those areas that are most important in terms of improving survival and patient experience whilst reducing variance and ensuring safe, effective and person centred cancer care. 3.2 Input to the production of Annual Audit Report. Audit reports issued in line with agreed schedule. Report contains clearly defined regional/local actions to address areas where performance requires to be improved and status of unresolved actions highlighted and escalated as appropriate. Information /MCN Clinical Lead/ MCN Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 2
3.3 Identify requirements for further data analysis to aid understanding of variance, and inform improvement work. Improved understanding of reasons for variance, enabling more targeted improvement work to be undertaken, ensuring service issues are addressed. 3.4 Monitor progress against agreed local/regional action/improvement plans, ensuring regional actions identified are progressed and outcomes documented and reported. 3.5 Contribute to the national Head and Neck Cancer QPI formal review process, ensuring appropriate engagement and feedback across all specialities in the MCN, throughout Formal Review. Progress reported to the MCN Advisory Board. Review/refinement of indicators following year three analysis to ensure measures are fit for purpose, and proposal of new QPIs where appropriate. / Board Clinical Effectiveness Leads National Cancer Quality Programme Coordinator/MCN Clinical Lead/ MCN Nov 4. Update and further develop the regional service map for head and neck cancer service provision, detailing the points of service delivery and the connections between them. Head and neck cancer service map updated to maintain a baseline position in support of use as an internal planning resource. Leads / MCN s To ensure equity of care for cancer patients in the West of Scotland by using information to improve quality and outcomes. 4.1 Review the current high level service map for Head and Neck Cancer MCN. Service map reviewed for Head and Neck Cancer MCN. Leads / MCN s / MDT Chairs 4.2 Agree and source additional information to populate new service map template. Regionally agreed high level service map for head and neck cancer which will be used to inform any detailed service planning work undertaken. Leads / MCN s / MDT Chairs Feb Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 3
4.3 Finalise and publish service map for head and neck cancer. Annual update of the service map completed to maintain a baseline position and published on intranet site. Feb 5. Utilise learning from the TCAT programme to determine the current use and future applicability of Holistic Needs Assessment (HNA) and treatment summaries to patients with head and neck cancer, defining requirements for specific patient groups. In collaboration with key stakeholders, develop an implementation plan to support regional rollout. Lead/Clinical Lead for TCAT/ MCN (TCAT)/MCN Develop person-centred models of care that focus on recovery and health and well being. 5.1 Undertake baseline analysis of current practice in relation to HNA across the region. Understanding of current practices across the region and identification of areas where learning can be shared. /CNSs July 5.2 Assess the learning and outcomes from all relevant TCAT projects and define the application of suitable components to patients with head and neck cancer. 5.3 Develop regional rollout and local implementation plans. Potential identification and implementation of suitable models of care utilising HNA and treatment summaries in practice in the region. Facilitation of regional rollout of any suitable model identified, through local NHS Board implementation. Lead/Clinical Lead for TCAT/ MCN (TCAT)/MCN Lead/Clinical Lead for TCAT/ MCN (TCAT)/MCN 6. Regional Robotic Service for Trans Oral Resection: support service development and implementation. Access, for those patients with a head and neck malignancy who will benefit from access to a specialist robotic surgical service. Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 Lead/ MCN / MCN Advisory Board Tbc Tbc Consistently improved surgical and patient reported outcomes. 4
6.1 Subject to the review and approval by national and regional planning groups, determine pathways for access to the robotic service. 7. Conduct a pilot study to provide patients with head and neck cancer access to smoking cessation services immediately after diagnosis, with the aim of improving the percentage of patients who successfully stop smoking. Regionally agreed clinical criteria and patient pathways ensuring equitable access to this specialist service for those patients who will benefit. Defined and agreed smoking cessation referral pathway for implementation across the WoS. Lead/ MCN / MCN Advisory Board /MCN members 2016 Dependant on decision of national/regional planning groups to progress service development To ensure equity of access to smoking cessation interventions and improve recovery and health and wellbeing. 7.1 Configure working group to agree study strategy and detail. 7.2 Map current access to smoking cessation services across the WoS and identify areas of good practice. 7.3 Conduct pilot study over agreed timescale and report findings. 7.4 Using outcomes from pilot study, identify optimal process to make smoking cessation interventions more accessible to all patients with head and neck cancer throughout the region. 8. Support clinical pathway work currently ongoing within NHSGGC for patients with occult primary head and neck cancer with a view to reaching consensus on optimal pathway for regional implementation; identify other areas where development of regional diagnostic pathways would be appropriate. Short Life Working Group established and pilot study proposal agreed with clearly defined protocol. Smoking cessation activities mapped for all WoS Boards. Pilot study completed and final report with recommendations presented to Advisory Board. Regionally agreed pathway for access to smoking cessation services endorsed for local implementation. Defined and agreed diagnostic testing pathway for occult primary head and neck cancer suitable for implementation across WoS. Jul Develop an efficient and effective diagnostic pathway to improve referral to treatment times across the region. Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 5
8.1 Liaise with NHSGGC Head & Neck Cancer Patient Pathway Development Group to obtain output from meetings and review proposed diagnostic pathway. 8.2 Map current diagnostic pathway for patients with occult primary head and neck cancer in other WoS Boards and identify any variations in practice. Agreement from NHSGGC Head & Neck Cancer Patient Pathway Development Group to review optimal diagnostic pathway and assess feasibility of wider implementation across WoS. Mapping completed for all WoS Boards with any variations in practice highlighted. Jun 8.3 Identify any changes in practice necessary for regional implementation of proposed NHSGGC pathway and assess resource implications. Individual Board pathways compared with NHSGGC pathway and any resource implications identified. 8.4 Agree optimal regional diagnostic pathway with key stakeholders and support implementation. 8.5 Identify areas where regional diagnostic pathways would be appropriate for other head and neck cancer subgroups and produce a phased plan for development. 9. Support the development and implementation of a guideline on the management of terminal haemorrhage in head and neck cancer within NHSGGC with a view to agreeing regional consensus for roll-out across WoS. Regionally agreed diagnostic pathway for patients with occult primary head and neck cancer produced and endorsed for local implementation. Phased plan for developing sitespecific diagnostic pathways for other head and neck cancers. Standardised management of terminal haemorrhage in patients with head and neck cancer. Lead/ MCN / Palliative Care Clinicians Guideline development will ensure safe, equitable management of patients across the region and optimise effectiveness of care. 9.1 Co-ordinate the development of Terminal Haemorrhage Guideline for initial use within NHSGGC. Agreed optimal management guideline for terminal haemorrhage. Jul Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 6
9.2 Map current practice for the management of terminal haemorrhage in Boards out with NHSGGC and identify any variations in practice. Mapping completed for all WoS Boards with any variations in practice highlighted. Jul 9.3 Identify any changes in practice necessary for regional implementation of proposed NHSGGC guideline and assess resource implications. Individual Board practice compared with NHSGGC guideline and any resource implications identified. 9.4 Agree optimal regional guideline with key stakeholders and support implementation. Regionally agreed guideline for the management of terminal haemorrhage produced and endorsed for local implementation. Nov Final Published Head and Neck Cancer MCN Work Plan /18 v1.0 26/04/17 7