Skin Clinical Network Group (CNG)

Skin Clinical Network Group (CNG) Annual Report 2013-2014 This Annual Report has been agreed by: Title Name Date Agreed Skin CNG Co-Chairs Andrea Howes & Philip Brackley 08.08.2014 CMSCN Cancer Clinical Lead Chris Warburton 12.08.2014 CWW Area Team Medical Director Kieran Murphy 12.08.2014 Agreed by the Skin CNG 12.08.2014 Colorectal CNG Annual Report (Approved 12.08.2014) Page 1 of 11

Contents 1.0 Structure and function of the CNG... 3 2.0 Coordination of care/patient pathways... 3 3.0 Patient experience... 4 4.0 Clinical outcomes/indicators... 4 5.0 Good Practice... 4 6.0 Concerns... 5 Appendix 1.0: Educational Meeting Agenda... 6 Appendix 2.0: CNG (Core Membership)... 7 2.1: CNG (Extended Membership)... 8 Appendix 3.0: CWT Data... 9 Appendix 4.0: Clinical Trials Data... 10 Colorectal CNG Annual Report (Approved 12.08.2014) Page 2 of 11

1.0 Structure and function of the CNG This annual report for Cheshire & Merseyside Strategic Clinical Network (CMSCN) Skin Clinical Network Group (CNG) relates to the operational period 1st April 2013 to 31st March 2014. This report describes the work carried out across the Network over the course of the year. The CNG supports the overall aims of the network by facilitating collaboration between providers and users of skin cancer services in order to provide seamless care based on best practice. The Group is the main source of clinical advice to the CMSCN Cancer Steering Group & Oversight Group. 14-1C-104j - The CNG is a busy, productive multi-professional group with strong engagement from participating Trusts and MDTs. Group membership is fully compliant with peer review requirements. The CNG s Constitution is reviewed & updated on an annual basis. Content includes: Terms of Reference Communication requirements Key Responsibilities 14-1C-105j The CNG meets triannually. Each MDT was represented at CNG meetings during this period. Appendix 1.0 contains a summary record of meeting dates & attendance. 14-1C-106j - The CNG has produced a detailed work programme, which reflects the strategic ambitions of CMSCN. This has been agreed with the Network Cancer Clinical Lead & Medical Director of Cheshire, Wirral & Warrington Area Team. 14-1C-107j The Network MOHS service hosted by St Helens & Knowsley Teaching Hospitals NHS Trust. The Designated Practitioner for Mohs Surgery is Mr Hamid Tehrani. A second surgeon is currently undergoing training to support the service. The SSMDT assures the CNG annually that each practitioner has completed a minimum of 50 cases per year. Service data will be presented in May 2014. 14-1C-108j - The CNG has a network agreed policy & list of assessors for Model 2 Community Practitioners with Named Trainers /Assessors. This will be updated during 2014. 2.0 Coordination of care/patient pathways 14-1C-109j - The network group has reviewed & updated its clinical guidelines during this reporting period. These reflect all relevant modalities, including: Imaging Pathology Surgical Management Chemotherapy Radiotherapy 14-1C-110j - The network group, in consultation with the relevant chemotherapy cross cutting has agree a list of acceptable chemotherapy treatment algorithms. This is updated bi-annually. Colorectal CNG Annual Report (Approved 12.08.2014) Page 3 of 11

14-1C-111j The CNG is currently reviewing its primary care pathways. These address the named services, hospitals and MDTs which a patient should be referred to according to named indications, during their investigation, treatment, psychological and social support, rehabilitation and follow up). The pathways include the relevant contact points for hospitals and MDTs. Separately, Trust Lead Cancer Nurses and Macmillan Cancer Information & Support Centre Managers are developing local service directories to enable MDT members to signpost patients on to appropriate sources psychological support, social support and rehabilitation. 14-1C-112j -14-1C-114j The CNG is currently reviewing its primary care pathways/mdt pathways/supranetwork MDT s and shared MDT pathways. The intention is to merge these into one document for ease of reference. These will be ratified in September 2014. 3.0 Patient experience 14-1C-115j - Results of the 2013 National Cancer Patient Experience Survey were released at the end of August 2013. Nationally 1854 skin patients responded to the survey of which CMSCN accounted for 2.7%. Nationally, 88% of patients reporting their care was either excellent or very good, with CMSCN skin cancer patients reporting more positively network average 94%. The results demonstrate a number of information giving issues which will be discussed at the May 2014 meeting along with the SSMDT action plan. 4.0 Clinical outcomes/indicators 14-1C-116j - Cancer Waiting Times data is reported at each meeting & issues relating to pathway breaches investigated. Cancer Outcomes and Services Dataset (COSD) conformance is reported at each meeting to support 100% data compliance by January 2015 & resulting improved skin cancer outcomes using high quality data and intelligence 14-1C-118j - The network group discussed MDT's clinical trial reports at its meeting in December. The region is the top performing networks in the UK for trials for melanoma. Figures show 55 patients were screened and 40 were recruited. The network will be one of the biggest contributing centres to the Melmark study. There were two LSMDT/SSMDT issues raised; within the R& D department at St Helens and Knowsley the administrators are not processing trial plans fast enough, so patients are being missed and this is going to be addressed. Also the attribution of recruitment remains contentious & subject to senior level discussions to address. Each Unit agreed to be more proactive in ensuring equity for patients wishing to go into trials. 14-1C-117j - Clinical Governance Arrangements for Community Practitioners were reviewed in year and will be subject to further update during 2014. 5.0 Good Practice The skin CNG hosted an education day in June 2013. The event was well received by 58 delegates. Dr Richard Azurdia began and presented MDT working in cutaneous T-Cell lymphoma. Mr. Hamid Colorectal CNG Annual Report (Approved 12.08.2014) Page 4 of 11

Tehrani presented Mohs surgery and demonstrated how effective this technique was in accurately managing disease and morbidity for patients. A key point from the session was that photograph would provide enhanced assessment. This was echoed by the audience who felt that all MDTs should have photographs available. Dr Khizar Hayat provided insight as to radiotherapy and treatment of skin cancer and suggested that this treatment option should be presented to patients. Sister Wheelhouse talked about holistic needs assessment and reiterated that this is not necessarily additional work. It is something that is always done but teams need to ensure that the whole person is considered and should not avoid difficult subjects. Dr John Lear presented an update on nonmelanoma skin cancer and the use of vismodegib, a new hedgehog signaling pathway inhibitor, in the treatment of inoperable BCCs and Gorlins s syndrome. Key worker pathway developed to improve care coordination & communication between LSMDT s and SSMDT. Electronic HNA pilot commenced at St Helens & Knowsley Teaching Hospitals NHS Trust with SSMDT participating. Additional nursing support secured for SSMDT. Improved communications with Wirral Assura Service Proactive approach to clinical trials demonstrated by trials portfolio and recruitment figures. 6.0 Concerns Access to timely data intelligence to support the CNG in benchmarking clinical outcomes and monitoring patient experience of care Colorectal CNG Annual Report (Approved 12.08.2014) Page 5 of 11

Appendix 1.0: Educational Meeting Agenda Skin CNG Annual Report (Approved xx.xx.2014) Page 6 of 11

Skin Cancer CNG - Core Membership Appendix 2.0: CNG (Core Membership) Name Organisation Role 26.06.13 25.09.13 11.12.13 Dr. John Ashworth Bridgewater Community Healthcare NHS Trust LSDMT Lead, Consultant Dermatologist AT AP AP Dr Asad Salim Countess of Chester NHS Foundation Trust LSDMT Lead, Consultant Dermatologist AT AP AT Dr Neil Wilson Royal Liverpool & Broadgreen University Hospital NHS Trust LSDMT Lead, Consultant Dermatologist D D D Dr Aamir Memon Southport & Ormskirk Hospital NHS Trust LSDMT Lead, Consultant Dermatologist AT AP AT Dr Elaine Hindle St Helens & Knowsley Teaching Hospitals NHS Trust LSDMT Lead, Consultant Dermatologist AT AT AP Dr Andrea Howes St Helens & Knowsley Teaching Hospital NHS Trust CNG Co-Chair, Consultant Radiologist AT AT AT Mr Philip Brackley St Helens & Knowsley Teaching Hospitals NHS Trust CNG Co-Chair, Consultant Plastic Surgeon AP AT AT Dr Naveen Sharma St Helens & Knowsley Teaching Hospitals NHS Trust Consultant Histopathologist AT AT AP Rachel Duncan 1 St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Nurse Specialist AT AT AP Dr Ernie Marshall 2 The Clatterbridge Cancer Centre NHS Foundation Trust Medical Oncologist AP AP AP Dr Mohamed Saipillia The Clatterbridge Cancer Centre NHS Foundation Trust Clinical oncologist AP AP AT Dr William Dunne Wirral CCG GPwSI (Assura) AP AP AP Dr Boon Tan Wirral University Teaching Hospital NHS Trust LSDMT Lead, Consultant Dermatologist AT AT AP Dr Elizabeth Stewart Wrightington, Wigan and Leigh NHS Foundation Trust LSDMT Lead, Consultant Dermatologist AT AP AT TBC N/A User Representative TBC N/A User Representative Debbie McEllenborough Cheshire and Merseyside Strategic Clinical Networks Network Assistant D D AT 1 CNG Lead for users issues and information for patients and carers 2 CNG Lead for ensuring recruitment into clinical trials and other well designed studies KEY: AT = Attended AP = Apologies sent D = Deputy sent R = Remote Attendance (TC/VC) Skin CNG Annual Report (Approved xx.xx.2014) Page 7 of 11

Skin Cancer CNG - Extended Membership 2.1: CNG (Extended Membership) Name Organisation Role 26.06.13 25.09.13 11.12.13 Dr Andrew Beare-Winter Bridgewater Community Healthcare NHS Trust Locum Consultant Dermatologist AT AT AT Jayne Corcoran Bridgewater Community Healthcare NHS Trust Skin Cancer Clinical Nurse Specialist AP AP AT Mr Ali Juma Countess of Chester NHS Foundation Trust Senior Consultant Plastic Surgeon AP AT AP Joanna Martin Countess of Chester Hospital NHS Foundation Trust Clinical Nurse Specialist AT AT AP Dr Graham Sharpe Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Paediatric Dermatology AP AP AP Dr Richard Azurdia Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Dermatologist AT AT AP Dr Nitkin Khirwadker Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Histopathologist AT AP AP Dr Arti Bakshi Royal Liverpool & Broadgreen University Hospital NHS Trust Consultant Histopathologist AP AT AT Sue Wood Southport & Ormskirk Hospital NHS Trust Clinical Nurse Specialist AP AP AP Alison Mahon Southport & Ormskirk Hospital NHS Trus Staff Nurse AP AT AP Mr Hamid Tehrani St Helens & Knowlsey Teaching Hospitals NHS Trust Consultant Plastic Surgeon AT AP AP Mr Rowan Pritchard Jones St Helens & Knowlsey Teaching Hospitals NHS Trust Consultant Plastic Surgeon AT AP AT Karen Pocock St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Nurse Specialist AT AT AP Helen Martin St Helens & Knowsley Teaching Hospitals NHS Trust Physiotherapist AT AT AP Claire Anderson St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Psychologist AP AP AT Hannah Anstey St Helens & Knowsley Teaching Hospitals NHS Trust Clinical Psychologist AP AT AT Sue Taylor Wrightington, Wigan and Leigh NHS Foundation Trust Skin Cancer Clinical Nurse Specialist AP AT AP Pat Gillis North West Coast Clinical Research Network Research Delivery Manager AP AP AP Anna Bass Cheshire and Merseyside Strategic Clinical Network Quality Improvement Lead AP AT AT Skin CNG Annual Report (Approved xx.xx.2014) Page 8 of 11

Appendix 3.0: CWT Data Skin 2 Week Waits Q1 Q2 Q3 Q4 All Trusts Suspected Skin Cancer 94.2% 92.7% 96.0% 96.9% Skin 31 Day First Definitive Treatment Q1 Q2 Q3 Q4 All Trusts Skin All Care 99.2% 99.3% 99.2% 95.7% Skin 31 Day Subsequent Treatment Q1 Q2 Q3 Q4 All Trusts Skin All Care 100.0% 100.0% 100.0% 100.0% Skin 62 Day Treatment Q1 Q2 Q3 Q4 All Trusts Skin All Care 99.0% 100.0% 100.0% 99.1% Skin 62 Day Consultant Upgrades Q1 Q2 Q3 Q4 All Trusts Skin All Care 100.0% 100.0% 100.0% 100.0% Skin CNG Annual Report (Approved xx.xx.2014) Page 9 of 11

Appendix 4.0: Clinical Trials Data NB: Headline data only full report available via CMSCN or NWC CRN. Skin CNG Annual Report (Approved xx.xx.2014) Page 10 of 11

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