Cancer Clinical Reference Group Notes of meeting: 9 th September :00 14:30pm Wandsworth Town Hall (Extension) - Conference Room 3a 2nd floor

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1 In attendance: Cancer Clinical Reference Group Notes of meeting: 9 th September :00 14:30pm Wandsworth Town Hall (Extension) - Conference Room 3a 2nd floor Anthony Cunliffe (AC) Alexandra Ames (AA) Raj Bhattacharjee (RB) Fiona Lofts (FL) June Allen (JA) Maria Wallace (MW) Sarah Deedat (SD) Beverley Van Der Molen (BVM) Sarah Gigg (SG) Petra Griffiths (PG) Jan O Brien (JOB) Cancer Clinical Commissioning Lead (Chair), WCCG/Public Health Wandsworth GP, Wandle Locality Lead Macmillan Involvement Coordinator Medical Oncologist, St Georges NHS Trust St Georges NHS Trust GP, West Wandsworth Locality Lead Public Health Wandsworth Information and Education Officer Paul s Cancer Support Centre Senior Development Manager Macmillan Director, Paul s Cancer Support Centre Commissioning Redesign Support, WCCG (notes) Agenda Item 1. Welcome and Apologies Apologies: David Seychell (DS), Nick Beavon (NB), Amanda Cranston (ACr), Jatinder Bhuhi (JB), Imogen Locke (IL), Justine Hofland (JH) 2. Minutes of last meeting Spelling correction page 1 - Raj Bhattacharjee otherwise minutes agreed 3. Matters arising: 4.1 AC has made changes to TOR as suggested by ACr final version to be sent out to CRG members 4. Self-Management Project Paul s Cancer Centre AC introduced Petra Griffiths, Centre Director and Self-Management Programme Coordinator for Paul s Cancer Centre. The CRG need to consider how best to disseminate the services on offer across Wandsworth. PG gave an overview of her presentation and the services offered by Paul s and explained the aims of the courses and coursework. 1) Structured courses help develop self-care and build resilience 2) Tailored physical activity classes Action JOB

2 3) One-one approaches to build skills The self-management course is in conjunction with St Georges. The next course will be held at Paul s Centre at the beginning of February. It was noted there will be a free talk in Central London at the end of February and a 2 day work shop for health professionals for which there will be a small charge details to be circulated. Looking to get 1-1 approaches funded through other sources next year; would like to offer courses more frequently. Group discussion and questions: Could Paul s ask to be invited into GP practices to raise awareness? Cancer care review PACT LES template could a little box be added? Wandsworth Carers Centre are aware There is promotion of Paul s Cancer Centre at St Georges e.g. speciality nurses tell patients about services Need to be multi-site, geographically suitable, possible sites to be discussed; to happen 2 or 3 times a year; dependent on funding PG - the centre has trained volunteers who offer massage/befrienders and a home visiting service There are a range of other therapies such as counseling They accept GP and self-referral AC although the CCG website is still being developed the information there could be highlighted to Practice Managers so that GPs can easily access itsd there will be a Public Health pop up shop in January where Paul s services could be promoted 5. Best Practice Commissioning Pathway Ovarian basic change suggested CA125/ultrasound when both done togethernumber of missed cancers are reduced, Noted that this is only small numbers AC reported that the message from GPs is they do that anyway TVUSS requests would rise, but the estent of the rise is difficult to predict AC has drafted a bid to go to the CCG potentially per year, difficult to put into a bid but has to be in this form, cancer is special in this area as it is not always about savings but best practice. The group discussed the pathway does not suggest how quickly the ultrasound should be but could request as urgent previously radiologists have said not possible because of higher demand pick up will still be low because ovarian cancer is not common most GPs seeing patient s multi times with the same symptoms would investigate and are doing this anyway. The pathway will make it more formalised. Secondary care would welcome seeing patients earlier

3 Colorectal over 55 with criteria that does not fit 2 week rule should be investigated by endosopy AC has met with Mr Leicester, discussed activity and current service which is not being used Does not appear that GPs know about the service Some GPs acknowledged knowingabout rapid access flexible sigmoidoscopy but thought it was a pilot AC explained this pathway will be dealt with like any other 2WR referral with a step less, and is less costly to the CCG AC to meet with Mr Hagger about a triage service as suggested in best practice commissioning pathway There is a need to promote the flexi-sig service and use service more - people who do not meet 2WR criteria Flexi sig screening NHS England responsibility not CCG Thoughts on pathway AC thinks it is a good service but needs to be utilised more Forms are too clumsy as SWL Cancer Network no longer exists the forms need to change anyway To be discussed at next meeting: Change to forms need Mr Leicester s agreement Triage service 6. Practice Nurse Training project AC reported that the AHSN bid had been turned down CRG needs to consider what it s current funding should be used for - the money does not have to be used for this or exercise bid The previous bid was discussed and where costs could be brought down so the money can be used in the best possible way Discussion: Need people to facilitate/talk on course and evaluation would be work for all, may need to pay for their facilitation time/preparation time It was felt theer was no need to pay for travel expenses for nurses taking part Chance GPs could do as their Macmillan Day, Macmillan would need to agree this Practices have an obligation to train nurses People living beyond cancer and things they come across could change the course, could use previous resources hope to get venue for free Costs would hopefully come down Follow on mentoring specialist nurses as a point of contact AC would be supportive of this

4 Group agreed to look at planning 7. Exercise on prescription AC explained there is some funding which could be used for this if agreed. Funding is non recurrent which needs to be allocated by March 2014 Money is specifically for cancer services. Could be innovative There is an allotment project in Hillingdon - SD to talk to them about outcomes Discussion/ideas: - Argument for this is not prevention but trying to prevent relapse/long term effects and treat side effects of treatment. - Not sure what uptake will be but referral process would be the same as for exercise on prescription with an extra box for Cancer - Will require a robust evaluation with agreed clear outcomes - Quality evaluation at beginning/end with measurables e.g. BP, number of visits to GP, weight - Exercise needs to be ongoing to be beneficial motivation part of a group - Set on a course - could be fed into groups like Paul s, reduced gym membership - Follow up phone call up to a year after (extra motivation) - How to get short term evidence to give to CCG - Social companionship helps find evidence of where this works (not necessarily those with cancer) - unsure about using allotments, gardening, DIY as evidence is for more intense exercie, group to think about and bring ideas to next meeting - Public Health service is already up and running - People are interested but something stops them following through GP signs consent form, shows people s desire but then something is blocking them from getting to a group AC will have further discussion with Public Health to pin down specifics 6 week course for trainers will bring figures to next meeting 8. 2 Week Rule Patient information Leaflet AC reported good feedback from practice visits General consensus is that it is clear and has everything GPs need to know Action: Minor changes - Font change - PDF - Send to all GP practices 9. Patient Representation recruitment As discussed at the last CRG the intention is to recruit to a parallel group which would meet just before each CRG meeting. *There has been a lot of interest but no applications to date. RB noted that the advert did not appear on the Healthwatch newsletter JOB to ask Jatinder to check with Ambra from Healthwatch AC JOB JOB/JB

5 CRG members asked to mention the recruitment opportunity to patients It was generally agreed that the commitment may put people off from applying and that the application form needs some change and to reflect flexibility. It was agreed that there does need to be some formality and other CRGs have advised the need for formal selection and interview. Action: AC to have another look at the advert; as it stands it appears too professional RB has other adverts which he can share *Note: three applications have been received since the CRG meeting 10. AOB Public Health/CCG - joint vision key challenges AC has briefly looked at strategic awareness raising awareness early detection knowledge screening Will be published on council website next year 11. Date of next meeting: 9 th December 2013, Watershed House, MR2 Future meetings: 13 th January pm Watershed House, MR2 24 th February pm Watershed House, Committee meeting room 7 th April pm Watershed House, MR2 19 th May pm Watershed House, MR2 30 th June pm Watershed House, MR2 11 th August pm Watershed House, MR2 22 nd September pm Watershed House, MR2