DRAFT SCAN Gynae Group Thursday 28 th February 2013 Edinburgh Breast Unit Seminar Room with videolinks to Royal Infirmary of Edinburgh and Victoria Hospital, Kirkcaldy MINUTES Present Awatif al-nafussi Lorna Bruce Camille Busby-Earle Nidal Ghaoui Kate Macdonald Melanie Mackean (Chair) Sheena Mackenzie Cameron Martin Fiona Nussey Tzyvia Rye Jacqueline Stevenson In attendance Kathryn Brechin Val Doherty Apologies Alison Allen Scott Fegan Maureen Gallanagh Jo McGinty Consultant Pathologist, NHS Lothian SCAN Gynae Audit Facilitator Consultant Gynaecologist, NHS Lothian Locum Consultant Gynaecologist, NHS Fife Network Manager, SCAN Consultant Oncologist, Edinburgh Cancer Centre SCAN Groups and Communications Co-ordinator Consultant Gynaecologist, NHS Lothian Consultant Medical Oncologist, Edinburgh Cancer Centre Clinical Trials Data Manager Cancer Audit Facilitator, NHS Fife Clinical Nurse Manager, NHS Lothian SCAN Clinical Lead SCAN Audit Manager Consultant Gynaecological Oncologist, NHS Lothian/NHS Fife Gynae Oncology Clinical Nurse Practitioner, NHS Lothian Gynae CNS, NHS Lothian A full membership list is available on www.scan.scot.nhs.uk Item Action 1 Introductions, apologies, minutes The Group approved the minutes of the meeting on 8 th November 2012. Matters Arising Reducing the number of cases discussed at MDM It was noted that there were informal pathways at the Royal Infirmary of Edinburgh and in Fife for getting radiology opinions for cases that might not need MDM review. Gynae surgery for Dumfries & Galloway patients It was noted that Graeme Walker had established that, for financial/practical reasons, it was not possible for gynae surgery to be offered in Dumfries. Lymphoedema leaflets It was noted that updated copies of the lymphoedema leaflets referred to by Allan Thomson-Filant at the November meeting were now available and would be circulated with the minutes (copies attached). SCAN Office, Pentland House, 47 Robb s Loan, Edinburgh EH14 1TY T: 0131 465 7682 W: www.scan.scot.nhs.uk sheena.mackenzie@nhslothian.scot.nhs.uk Page 1 of 6
2 Wider SCAN Issues The Group heard updates on regional and national developments, including: plans to strengthen interactions between SCAN tumour-specific groups, the Regional Cancer Planning Group and management. Transforming Care After Treatment a national initiative, supported by Macmillan, to enhance care after treatment. It was suggested that the Dumfries & Galloway model of nurse-led follow up and the Uterine Low- Risk Follow-Up Protocol should be highlighted as examples of good practice which might be adopted in other areas. Val Doherty advised the Group that 5m over 5 years would be available to support pilot projects. chemotherapy electronic prescribing it was noted that the Chemocare system had been implemented for Gynae in Lothian and Borders. CEL 30 (2012): [Revised] Guidance for the Safe Delivery of Systemic Anti-Cancer Therapy the tool for auditing practice against the CEL is due to be considered by the Scottish Cancer Taskforce (SCT) on 1st March. Once the audit tool is approved by SCT, boards will have 6 months to complete their audits. acute oncology a regional short-life working group has been established to agree standards and priorities, share good practice and provide peer support. There are plans to develop an education programme for primary care and front door staff before the end of the year. 3 Gynaecology Issues Gynae MDM A revised operating protocol and gynae referral form had been circulated with the meeting papers. Melanie Mackean advised the Group that the post of Gynae MDM Co-ordinator had been advertised and that Gill Wilkie would be providing administrative support in the interim. The Group discussed the following key issues: Recording minutes it was suggested that, as an immediate priority: - Pathologists and Radiologists should summarise their opinions (if possible in a single sentence) and that the Chair should dictate a summary of the outcome to allow the minutes to be typed by an administrator during the meeting. - options for projecting MDM forms during meetings should be explored (eg using a separate projector or switching between the form and radiology slides). This would allow the text being entered to be reviewed by clinicians during the meeting. Chair It was agreed that the role of chairing meetings should be shared across all members of the clinical team and that no-one should be expected to chair a meeting if they were the sole representative of a particular speciality in attendance. However, it was agreed that this change should not be implemented until the new MDM Co-ordinator was in post and more robust MDM systems were in place. Automatic referral back to MDM when Pathology available it was Page 2 of 6
agreed that, following changes to minute-taking and chairing arrangements, consideration should be given to Pathologists referring patients back to the MDM following their surgery when pathology results were available. Review of MDM decisions Melanie Mackean advised the Group that it was good practice to review MDM decisions (decision made at MDM versus actual treatment) on an annual basis. Cameron Martin suggested that this would be a good project for one of his SE4 students. Actions: Cameron Martin to approach his SS4 medical student about undertaking an audit of gynae MDM decisions. Melanie Mackean to ask Gill Wilkie to explore the possibility of using a separate projector at gynae MDMs to display the MDM forms. Cameron Martin Melanie Mackean Gynae Workforce Group members highlighted the critical role played by clinical nurse specialists (CNSs) and current shortfalls in CNS cover. Nidal Ghaoui reported that he had had no CNS support for 5 weeks and that he had been working long hours to compensate. He said that he had reservations about accepting a 6-month extension to his locum post in view of the lack of action to address both the current lack of support and succession planning for the CNS post. It was agreed that, in the short-term, Nidal Ghaoui and Scott Fegan should continue to work with Murdina Macdonald, Lead Cancer Nurse in Fife, to resolve the immediate situation and that longer-term action might include exploring the possibility of training link nurses to provide CNS cover and applying to Macmillan for support for a second CNS. Lothian - Kathryn Brechin reported that a decision on a bid for funding for a second gynae CNS for Lothian was imminent and that she had been given some grounds to believe that the outcome would be positive. It was noted that a separate bid had been made for surgical CNS support. Joint Colorectal/Gynae Surgery in Lothian Group members expressed frustration that issues first highlighted 3-4 years ago had not yet resulted in a robust referral system for patients requiring joint colorectal/gynae surgery. Melanie Mackean said that Dr Tracey Gillies, Divisional Medical Director for NHS Lothian, had agreed that patients could be referred for joint gynae/colorectal surgery in both Lothian and Fife on a case by case basis, pending the development of a robust referral system in Lothian. Cameron Martin reported that he had had discussions with Paul Dewart, Clinical Director for Gynaecology, and that it had been suggested that one session per week might be included in the job plan for one gynaecologist, allowing a joint colorectal/gynae surgical slot to be provided once per month. Group members had reservations about this approach, arguing that colorectal surgical support needed to be available on an ongoing basis. Melanie Mackean wondered whether any of the gynae surgeons would be interested in undertaking training in colorectal surgery. Page 3 of 6
CA125 Referrals Melanie Mackean drew the Group s attention to the guidance notes and flow chart on CA125 referrals which Graeme Walker had produced for primary care. She encouraged colleagues to cut and paste relevant sections into their letters for GPs. It was noted this advice may change depending upon publication of the upcoming SIGN guidelines. It was agreed that the documents should be shared with the Chair of the SCAN Primary Care Group and published on the SCAN website and the Edinburgh Cancer Centre s Online Oncology Quality System (OOQS). It was also agreed that Sheena Mackenzie should approach John Donald, Referrals Adviser for NHS Lothian, about incorporating them into Ref Help. Tzyvia Rye warned Group members that comparisons should not be made between CA125 results from different labs. Camille Busby-Earle suggested that the advice on repeating the CA125 test at 4 weeks should be amended to 3 or 5 weeks to avoid the possibility of both first and repeat tests coinciding with menstruation. Actions: Sheena Mackenzie to: Sheena Mackenzie Liaise with Graeme Walker about the amendment suggested by Camille Busby-Earle and about adding a review name and date to the documents forward the CA125 guidance notes and flow chart to the Chair of the SCAN Primary Care Group for dissemination and information arrange for the CA125 guidance notes and flow chart to be published on the SCAN website and OOQS approach John Donald about incorporating the CA125 guidance notes and flow chart into Ref Help. Clinical Quality Monitoring and Improvement 2011 comparative report on ovarian cancer Lorna Bruce reported that the report would be published on the SCAN website, following checks for disclosive information. Quality Improvement Indicators (QPIs) Group members were encouraged to submit comments on the draft ovarian QPIs before the deadline of 29 th March. In view of the discussions at the previous meeting, Melanie Mackean offered to speak to Charlie Gourley about making a comment about the exclusion of the BRCA testing standard from the final draft list. Action: Melanie Mackean to speak to Charlie Gourley about making a comment about the exclusion of the BRCA testing standard from the final draft list of ovarian QPIs. Ovarian Cancer Networks Meeting: 14 th May 2013: Crosshouse Hospital Melanie Mackean said that national comparative audit data would be compared at the ovarian cancer networks meeting in May and encouraged colleagues to note the date in their diaries. Page 4 of 6
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4 Any Other Business Group Chair Melanie Mackean announced that she had chaired the Group since 2007 and would be stepping down at the end of 2013. She invited colleagues to consider whether they would be interested in taking on the role. Patient Representation Melanie Mackean asked colleagues for their help in identifying possible patient representatives to join the Gynae Group. 5 For Information The Group noted the following documents, which had been circulated for information: Regional Cancer Planning Group workplan and terms of reference Update on gynae clinical trials 6 Dates of Future Meetings 23 rd May 2013 5 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