Gynaecology Tumour Site Specific Group 21 st April 2016 9.00-12.00 Robert Hardwick Room, Academic Centre, Maidstone Hospital Final Meeting Notes v 1.0 Present Initials Title Organisation Andreas Papadopoulos (Chair) Consultant Gynae Oncologist Maidstone & Tunbridge Wells NHS Trust (MTW) Justin Waters JW Consultant Medical Oncologist East Kent Hospitals University Foundation Trust (EKHUFT) / M&TW Natalie Aluwalia NA Service Improvement Facilitator Kent & Medway Cancer Collaborative (KMCC) Katy Palmer (notes) KP Administrator KMCC Kannon Nathan KN Consultant Oncologist MTW Gaynor Reeve GR Gynae CNS MTW Karen Flannery KF Macmillan Gynae Oncology CNS Medway NHS Foundation Trust (MFT) Vickie Gadd VG Gynae Oncology CNS MTW Steve Montalto SM Consultant Gynae Oncologist MTW Heather Dias HD Macmillan Radiographer MTW Rema Jyothirmayi RJ Consultant Clinical Oncologist MTW Angela Dickerson AD Gynae Nurse Specialist EKHUFT Rema Iyer RI Consultant Gynae Oncologist EKHUFT Robert MacDermott RM Consultant O & G Lead Clinician Darent Valley Hospital(DVH) Rosie Baur RB Interim Manager KMCC / Cancer Services Manager KMCC / EKHUFT Terence Gage TG Cancer Data Analyst KMCC Michelle Jee MJ Commissioning Project Manager Medway CCG Linda Caine LC Cancer Compliance Manager MFT Debbie Pyart DP Commissioning Programme Manager Swale CCG Sue Whitehead SW Macmillan Project Manager KMCC Omer Devaja OD Consultant Gynae Oncologist MTW Barbara Mercier BM Research Delivery Manager - Cancer NIHR Kent, Surrey and Sussex Apologies Mike Coutts MC Consultant Histopathology/Cytopathology MTW Fani Kokka FK Consultant Gynae Oncologist MTW Jeff Summers JS Consultant Clinical Oncologist M&TW Andy Nordin AN Consultant Gynae Oncologist EKHUFT Hany Habeeb HH Consultant Gynaecologist MMH Julie Hopping JH Cancer Services Manager MFT 1 of 6
Sam Rose SR Partnership and Project Co-ordinator KMCC Description Discussion Agreed Action 1) Apologies As above 2) Notes from previous 3) Kent & Medway Cancer Collaborative Update & SCN Update 4)TSSG Documentation Previous Minutes & Actions -The previous s notes were signed off as a correct record from 15 th October 2015 and any further actions are included within this agenda. - 2WW is on hold due to NICE guidance and will be discussed today. - confirmed the issue with Medway pathology being reviewed has now been resolved. 3a) KMCC Team update provided by Natalie Aluwalia: - Katy Palmer has now joined the team as an Administrator. - We are currently advertising for Band 5 and Band 6 Infoflex Development roles, to assist with moving forward Infoflex changes as required. requested a team structure as well as a go to person for Citrix & Infoflex for West Kent. 3b) Peer Review Update provided by NA: - There is no external review for Gynae this year but we have comprehensive review of CUP across all of the trusts. NA has requested a timetable for 2017 but as of yet has not received one. 3c) SCN Update: - please see draft work plan attached - It has been a difficult time for the clinical networks staff as we have been in the consultation period of the national networks and senates review since November with significant ongoing debate on our future role and structure. Final structures have now been released and we are in the process of implementation with active recruitment of staff to try and negate our high vacancy factor between April-June. - The key delivery focus of the clinical networks will be on the national priority programmes of mental health (adult, children and young people and dementia), diabetes prevention, cancer, maternity and the urgent and emergency care component of cardiovascular disease (heart attack, stroke, vascular). - Despite the high vacancy factor we have a number of excellent interims and clinical leads supporting the work programmes and the outputs and achievements of the South East networks team has been considerable. 4a) Gynae TSSG Workplan, (Discussion led by A.Papadoplous): - discussed the main issues for the work plan which is updating the documents especially the operational policy, which Andreas will undertake. - The 4 pathways for Gynae are due for updates. The group discussed members to undertake these as follows: Endometrial Rema Jyothirmayi to action for the TSSG Ovarian BRCA testing insert to be added Rema Iyer to action for the TSSG Sentinel Node isis not mentioned in the pathway for Cervix. OD to undertake this Agreed NA to find out who is in charge of Infoflex for to update and circulate the HOP document NA to liaise with to NA Update to be provided at the next. NA 2 of 6
5) InfoFlex Data Completeness Update update. Vaginal & Vulval is to be updated by SM adding sentinel node to this pathway - NA to send word versions so that can distribute these for updates 4b) 2WW SCN Template discussion led by A.Papadopoulos: - The group discussed the 2WW template HRT / PMD are areas of contention. - raised his concerns about the HRT guidelines. suggested stopping HRT for 4 weeks and if the bleeding continues then they will need to be referred. If the patient wants to continue on HRT they will need to be assessed again but this may create confusion and 2ww clinics will get too full. - R McDermott has been in touch with NICE around the bleeding HRT Guidance; BGCS Guidance does not follow NICE. to contact A Nordin to gain his views. - to circulate 2WW proforma for comments and then this will need to be approved via CCGs. We will then provide comments to the SCN via N.Aluwalia. Presentation by Terence Gage (TG) attached. The figures were not correct and the following actions were discussed and agreed: - The group discussed regarding DVH having the better figures on staging RM will look into and feed back to regarding good practise at MDT s. - Terence to complete monthly dashboard to do for all tumour sites. TG to provide both Infoflex as well as NCRS data as this is what Clinicians have previously requested at the s and as part of his dashboard - Between MDT, InfoFlex input, to the data upload on NCRS, analysis/clarification is required from day 1 to day 62 to see where they are falling down with this, whether this is the data input or if what is being sent up is not captured with NCRS and why. - A Key piece of work is required around analysis of which Trusts are doing this well and feeding this into other Trusts - Terence to clarify whether the referring Trust and the treating trust shares the figures or if it is only with the referring trust - Terence to clarify which field within InfoFlex correlates with the upload i.e Pre-Op/Post- Op staging fields - In depth training with MDT Coordinators is required, by individual tumour site. - Terence to confirm the figures around new Gynae cancers i.e. the WHO performance which was presented as this appeared to be all new cancers and Terence was not able distribute these as agreed. All Updates to be ratified at the next to contact AN to circulate for comments TG to complete actions and feed back TG 3 of 6
to clarify - Rosie/Terence to speak with Vickie Gadd to find out the issues they have and try and resolve these long standing problems which have been discussed previously at the TOSG on 9th May. VG liaise with TG/RB/TG re issues VG/TG/RB 6) Patience Engagement Review Sue Whitehead discussed with the group: - Exciting time for the Partnership. Radical change. Everything is up for grabs! - Thank you to those who completed the questionnaire - The questionnaire was one element of the on-going process of the Review. Had over 100 responses - Prior to the Review the LG s were the Partnership and these were publicised for the majority of time only within the hospitals they were being held and in the TSSG s. The stakeholder list developed for the Review has broadened this and we are now advertising in libraries, Healthy Living and community centres across Kent & Medway. - asked how clinicians can feed into these groups as he had not heard of them, this would be through CNS who are members of the groups. - Website being improved 2 months deadline and Facebook for KMCC being created, this will be promoted within each Trust when live. Update to be provided at the next 7) ESMO-ESGO- ESTRO Consensus Guidelines for Endometrial Cancer Presentation from Rema Jyothirmayi copy available upon request Guidelines are based on 2016 new guidance - The group discussed G1 LVSI + depth and what needs to be done next around an options discussion with the patient. EK are having discussions about nodes. The group agreed to keep current practise but audit to see if a change in practise is required this is to be the Kent Wide Audit and East / West Kent MDTs agreed to present this at one of the future TSSG. - KN/RJ/JS to work on audit proforma and distribute to the MDTs so that the data can be collected. 8) Follow Up Update - Document updates now given to NA. Updates to be done and circulated to the group for comments. 9) General Updates 9a) Research: - Barbara Mercier discussed with the group about the changes, they are now a 3 region research group (Kent Surrey and Sussex) not just Kent & Medway. This now covers 12 KN/RJ/JS to action /NA to liaise around updates and circulate BM to liaise with Mark Hill KN/RJ/JS /NA BM/MH 4 of 6
acute trusts. - Reports are being done from the national databases but she is aware that the data is not always correct but this will improve. - The Sub Specialty Lead for Gynae is now Rebecca Herbertson but is only part time so they agreed that they needed a Cluster Lead, she confirmed that they are not allowed to go back to the old structure but would welcome pressure from the TSSGs to put a structure in place. agreed to approach JS re cluster lead role for Gynae. 9b) NOG update by Heather Dias: - The group met in January and main conversations are around new ESMO guidance. - MRI Imaging cervix patients - The recommendations have been discussed around Peer Review 9c) CNS Update from Vickie Gadd: - The only update is the new CNS starting on the 11 th May at MTW 9d) Gynae Sub Specialist Training update from Omer Devaja: - Raz joined the team 1 month ago in Surrey before rotating to MTW next year. - We have a clinical fellow that will be working with OD, hoping he will step up to sub spec after 1 year. 9e) NCIN update by Andreas Papadopoulos: - No formal minutes from last 2015 - There was a trial presented from the UCH group looking at lymph node dissection need to try to get hold of the protocol. as the Lead for KSS and feedback. to approach JS re cluster lead role /JS Update required next 10) AOB N/A 11) Dates of next Thursday 29 th September 2016 2pm-5pm Lecture Hall William Harvey Hospital/Lord Meeting North Room Maidstone Hospital 5 of 6