London Cancer Breast Pathway Board Date: Monday 6 June, 15.00-17.00 Venue: Boardroom, UCLPartners, 3rd Floor, 170 Tottenham Court Road, London W1T 7HA (https://goo.gl/maps/wd0il ) Chair: Rebecca Roylance ( RR ), Pathway Director 1. Welcome, Apologies and Minutes of last meeting RR welcomed members of the board including new members, introductions were made and apologies heard. New GP members are still required for the board and all asked to consider any suitable candidates The minutes of the last meeting were accepted as an accurate record of proceedings. Actions from previous meeting discussed. VW has finalised the ECT guidance, board has agreed sign-off, but need to share with original authors of guidance prior to uploading on LC website ACTIONS: Board to help identify any new GP members RR to share the electrochemotherapy guidelines with the original authors of the guidance for final approval. Finalised guidelines to be uploaded onto the London Cancer website. RR to request that MA share mastectomy audit results 2. Cancer Vanguard Update (MR) SC provided update on UCLH Cancer Collaborative. Recruitment process underway to develop the cancer vanguard and clinical leadership team. Paper being developed to demonstrate how pathway boards/partners will be able to release capacity across the system via implementation of MDCs/STT initiatives, MDT improvement methods and stratified follow-up. 3. Board workplan (RR) Three elements of workplan already agreed and prioritised moving forward: 1. An updated gap analysis of the specification 2. Stratified Follow-up 3. Metastatic pathway Specification gap analysis - update Metastatic pathway and stratified follow-up key areas of focus of this work. Additional points made: Plastics equitable access required. Barts negotiating at trust exec level re. having designated plastics beds at Barts site Timed pathways TCST currently reviewing these. Involves obtaining a revised common timed pathway, identifying a baseline and progress against it. KK explained that these were generated a couple of years ago. NHSE (London) developed timed pathways - they were
attached to 13/14 commissioning intentions. ACTIONS: Trust reps to inform re. an updated gap analysis SC circulate pan-london timed pathway Stratified Follow-up progress across the trusts fed back to the board: BHRUT: Have begun to hold meetings to plan implementation. Now identifying patients on a trial basis in MDTs, waiting for admin support prior to starting Homerton: In process of recruiting a Recovery package project manager (0.5 WTE) who will have responsibility of implementing stratified follow-up PAH: Recovery package project manager began two weeks ago. Rolling out stratified follow-up is part of remit of post. Barts: Barts site is the only site currently delivering stratified follow-up. Whipps Cross and Newham have yet to do so. A business case has been developed for Whipps Cross, awaiting outcome, no plans yet for NUH Whittington: Pathway co-ordinator posts have been recruited to support remote monitoring in prostate, breast and colorectal cancers. EPR system (ICE) has been adapted to track patients for flagging up for annual mammograms. Will begin use of the electronic system in September to test if tracking/reporting is robust. RFL: Two phases of process. To discharge all the patients currently under long term follow up and RC developing a business case for admin and nursing posts to deliver. NMH: First stratified follow-up clinic beginning in July. Process of stratifying will be conducted in the MDT and open access follow-up model to be implemented. A data manager has been employed by the cancer team to track patients. UCLH: Ongoing pilot but awaiting IT system to track patients prior to full roll out Across all trusts, 2 common obstacles to successful roll-out were identified: 1. Funding sufficient resource for delivery and implementation of IT remote monitoring systems 2. Implementation of the recovery package and the need to ensure this is in place prior to roll out Discussion on how to best support trusts to implement recovery package and sharing of work took place. For example, supporting trusts with integrating treatment summaries (TS) into the pathway. A possible solution is to trial/share template of useful information to include within a TS. SC advised the group that a Living with and Beyond Cancer (LWBC) Implementation ERG has been established to support rollout of the recovery package and stratified follow-up. SC stated that would circulate membership of trust representatives to the board to enable board members to link with their representative as required. There was also a discussion around Infoflex as a number of trusts were looking to utilise an Infoflex module for stratified FU and have been liasing independently with CIMs (Infoflex developers) discussed possibility of joining together to speed up processes, potentially reduce costs costs and explore data sharing across trusts. ACTION: SC to circulate breast information template for treatment summary comment
SC to circulate membership of LWBC Implementation ERG RR to discuss joined-up approach to Infoflex development/data sharing with JG Metastatic pathway Commissioning intentions being worked up at present so it is recommended that proposals be put forward now. RR asked the Board if it felt that this would be useful with regards to the metastatic pathway. KK advised that Cancer waiting times a priority for commissioning intentions, but any other proposals such as implementation of the metastatic pathway could be inserted as service developments and this was agreed. Metastatic pathway updates from trusts NMUH have begun a metastatic MDT has been running for two months. CNS provide crosscover for the whole pathway Whittington CNS provide cross cover for whole pathway BHRUT have recruited a metastatic CNS RFL: Metastatic nurse in post at Barnet site. Metastatic discussion has been implemented into existing MDTs UCLH: Pfizer project has yielded baseline information Homerton: Metastatic patients referred to Barts Some larger sites identified need for recruiting metastatic nurses. However, CG provided opinion that smaller trusts would best benefit from having nurses skilled in provision of care across the whole pathway (includes early integration of palliative care). Thus advised upskilling of current breast CNS workforce. ACTION: RR to liaise with LCA re metastatic standards to be included in commissioning intentions 2017/18 Other ideas for areas of focus for the Board Audit: Board asked to consider ideas for an audit Patient experience. Discussed whether there were specific areas the board needed to concentrate on over and above the ongoing work PD discussed consequences of treatment: Are late effects of treatment discussed adequately and how is this done? Is this information provided when patients consented? VW suggested that oncologists review last adjuvant 20 patients and review what the individual has consented for? Surgical/radiology consents could also be reviewed for auditing purposes. There was general agreement to action this. ACTIONS: Board members to consider options for audit Each site to review previous 20 consents in radiology/surgery/chemo for consequences of treatment audit 4. Psychological support pathway for Risk Reduction Mastectomy LS, AP, EH/MB to edit draft guidelines ACTION: Finalised guidelines to be sent to the board for comment and ratification in September
5. Nursing update (CG written report) Vacancies in the area are stable well staffed across our geography at present Recovery Package data not reflecting practice due to issues with reporting robust figures to London Cancer The audit report, the checklist for service specification of prosthetic fitting and the patient questionnaire has been circulated to the board, and will be circulated to trusts ACTION: CM to circulate final versions of prosthetic fitting documents to all trusts 6. Guidelines ECT: Done Radiotherapy: A pause on these at present as there is a national draft due out end of July. This will be the first national guidelines for breast radiotherapy ever developed. VW advised that the Board adopt these national guidelines a few slight changes will be recommended for consideration. Clips: VW and Lead Radiographer at UCLH have looked at best methods to boost patients. VW stated that further discussions require surgical input to determine what/where to clip. The question was posed to the board: Do we want to write our own guidelines? It was suggested that once surgical guidelines are updated, section on therapeutic mammoplasties could be reviewed, but that given the current state of surgical opinion, at present no further work on these guidelines would be done. Oncology: RS stated that Systemic guidelines were still being updated, ES kindly agreed to help with this. Denosumab: Update on current proposal to move administration of denosumab into the community. This has proven more complex than anticipated therefore plan is now to look at patient self-administration. UCLH to conduct a pilot looking at this. ACTION: VW to circulate national radiotherapy guidelines ahead of September meeting RS/ES to update systemic therapy guidelines by Sept 7. Mini MD Project (RR) Successfully ran again in March with very positive feedback. RR extended congratulations and thanks to the board. 8. Breast Study Day (RR) Faye Gishen has led and co-ordinated the planning of the study day. To take place 11 th July at the Royal College of Physicians. 133 attendees have signed up thus far.
9. Update lymphoedema audit (SC) Breast lymphoedema audit conducted between 1 st Jan 2016 and 31 st March 2016. All CNSs participated and data were submitted from all Trusts on the number of patients presenting with lymphoedema symptoms. Preliminary results verbally provided at the board. Full results to be presented at the next meeting ACTIONS: SC to feedback lymphoedema audit results at the September 2016 board 10. AOB (All) Breast and thoracic surgeons at UCLH together with plastic surgical input from the Free are looking to establish a chest wall service for London cancer. RR to invite team to present to board at next meeting. ACTION: RR to invite potential new chest wall service team to present to Sept meeting 11. Next Meeting(s) Mon 19-Sept-16 15:00-17:00 Breast Pathway Board Boardroom, 3rd Floor, 170 Tottenham Court Road, London W1T 7HA Tue 6-Dec-16 15:00-17:00 Breast Pathway Board Boardroom, 3rd Floor, 170 Tottenham Court Road, London W1T 7HA
ACTION LOG Action Owner Date Agreed Status Board to help identify any new GP members All 06-June 2016 Share the electrochemotherapy guidelines with the original authors of the guidance for final approval RR 06-June 2016 Done Finalised electrochemotherapy guidelines to be uploaded onto the London Cancer website SC 06-June 2016 Website migration in progress - ongoing Mastectomy audit results to be shared RR 06-June 2016 On Sept Agenda Trust reps to inform re an updated gap analysis All 06-June-2016 Needs admin support SC to circulate pan-london timed pathway SC 06-June 2016 Done Circulate breast information template for treatment summary content for Board to comment SC 06-June 2016 Circulated with Sept papers Circulate membership of LWBC Implementation ERG SC 06-June 2016 Done RR to discuss Infoflex/data sharing with JG RR 06-June 2016 Done Liaise with LCA re. metastatic standards to be included in commissioning intentions for 2017/18 RR 06-June 2016 Done Board members to consider options for audit ALL 06-June 2016 On Sept Agenda Each site to review previous 20 consents in radiology/surgery/chemo for consequences of treatment audit Psychological support pathway for risk reduction mastectomy guidelines to be sent to the board for comment and ratification in September Circulate final versions of prosthetic fitting documents to all trusts Circulate national radiotherapy guidelines ahead of September meeting ALL 06-June 2016 On Sept Agenda EH/MB 06-June 2016 On Sept Agenda CM 06-June 2016 VW 06-June 2016 Circulated with Sept papers Update systemic therapy guidelines by Sept. meeting RS/ES 06-June 2016 Lymphedema audit results to be presented at the September 2016 board RR to invite potential new chest wall service team to present to Sept. meeting SC 11-Feb-2016 On Sept Agenda RR 06-June 2016 Done
ACTION LOG Action Owner Date Agreed Status SC to take forward surgical treatment for lymphoedema for inclusion in London commissioning guidelines for lymphoedema Nursing: try and provide a breakdown of CNS workload and with the nursing sub group, produce best practice guidelines which can then be used by London Cancer to try and obtain support for CNSs Audit: Presentation of final data analysis of Mastectomy audit SC 11-Feb-2016 Done CM 14 Apr 2015 On Sept Agenda MA-D 16-Nov-2015 Partially done carried over Sept. Attendees Name Rebecca Roylance Antony Pittathankal Ash (Afshin) Mosahebi Claire Grainger Faye Gishen Kate Kavanagh Lucy Side Mary Falzon Rob Stein Ros Crooks Sharon Cavanagh Patricia Dean Esther Hansen Emma Spurrell Virginia Wolstenholme Isabelle Pallix Jasdeep Gahir In attendance (observer) Asraf Patel Apologies Name Claire Mabena Jonathan Gardner Muhamed Al-Dubaisi Mary Burgess Lesley Forrester Trust/Organisation University College London Hospitals Barking, Havering and Redbridge University Hospitals Royal Free London - Hampstead Princess Alexandra Hospital Trust Royal Free London - Hampstead NELCSU Great Ormond Street Hospital University College London Hospitals University College London Hospitals Royal Free London London Cancer Patient Representative Royal Free London - Hampstead Whittington Hospital Barts Health Homerton University Hospital North Middlesex University Hospital Trust/Organisation Princess Alexandra Hospital Trust Trust/Organisation Royal Free London - Barnet and Chase Farm UCLH Cancer Collaborative Royal Free London - Barnet and Chase Farm University College London Hospitals Patient Representative No apologies Name Tina Dah Trust/Organisation GP
Emma Staples Barking, Havering and Redbridge University Hospitals