1. health and fitness
2. disease
3. cancer

Skin NSSG Annual Report
2009/10
Agreement Cover Sheet
This Annual Report has been agreed by:
Position:
Chair of the NSSG
Name:
Peter Dziewulski
Organisation:
Mid Essex Hospitals Trust
Date Agreed:
April 2010
Position:
Chair of the Network Board
Name:
Pam Court
Organisation:
NHS South West
Date Agreed:
Planned 14th September 2010
NSSG members agreed the Annual Report on:
Date Agreed: 15th June 2010
1
Skin Cancer Network Site-Specific Group
Annual Report 2009/10
Category
Report
Introductions
This annual report from the Skin NSSG covers the period 1st April 2009 to 31st March 2010.
As a fairly new NSSG, established following merger of South Essex and Mid Anglia Cancer Networks
in 2007, key emphasis in 09/10 was of consolidation of the group, implementing the ECN agreed
plan for delivering IOG compliant Skin Cancer services and planning for comprehensive Peer Review
programme in June 2009.
The Group has matured into a cohesive strong group with cross network representation (acute and
primary) making significant progress towards delivering IOG compliance. There remain areas where
attendance from core members could be improved
Key achievements include: stronger NSSG, agreed clinical guidelines and constitution; completed
network-wide audit and progress to deliver IOG. Key challenges where progress made but
additional work required next year includes: strengthening role and functioning of the single SSMDT
and IOG compliant community skin cancer services across all localities
NSSG
Meetings
Schedule /
Attendance
There have been 5 x Skin NSSG meetings during 2009/10. (Appendix 3) This is a higher than average
number which was felt to be required to deliver the network IOG implementation plan. Appendix 1
presents the attendance summary for the meetings that have taken place during 2009/10.
The summary also demonstrates attendance from core members of each of the Skin MDTs within
the Network.
Network
The configuration of local and specialist MDTs year end has changed dramatically during 2009/10.
Configuration At the start of the year there were 3 x SSMDTs - South Essex SSMDT, Mid Essex SSMDT and North
East Essex SSMDT. However, summer 2009 saw the establishment of a single network SSMDT
hosted by Broomfield (linking all four ECN localities) receiving referrals from North East LSMDT and
South Essex LSMDT.
Consolidation and development of new SSMDT will be a priority for 2010/11 work plans.
2009/10 saw increased commitment across all 4 PCTs in ECN to deliver IOG compliant Skin Cancer
services in community. All PCTs have undertaken baseline assessment and have a clear
understanding who is excising what in primary care. They also are reasonably clear of the service
model they wish to support. However formalizing these arrangements has been compounded by
draft NICE guidelines on BCC management which has been out for consultation. All PCTs have now
established formal reporting arrangements with local pathology departments with appropriate
governance arrangements in place to take action if melanomas/SCCs are excised in community.
Further work required in 2009/10 to further define and formalize arrangements.
2
Activity
Overview
Skin Cancer Surgeries
Essex Acute Trusts
01/04/2009 - 31/03/2010
PCT
Procedure
(All)
(All)
Count of Episode_ID
Month
Provider_ID
200904
200905
200906
200907
200908
200909
200910
2
9
7
7
8
10
7
8
Chelmsford
150
121
133
142
136
171
169
191
Colchester
55
67
72
81
71
71
94
83
Basildon
Southend
Grand Total
Basildon
9
4
17
8
7
10
8
12
216
201
229
238
222
262
278
294
200912
201001
201002
201003
Grand
Total
4
7
9
9
87
Chelmsford
136
131
177
202
1859
Colchester
64
72
65
99
894
Southend
Grand Total
200911
7
3
10
6
101
211
213
261
316
2941
Waiting
Times
See Appendix 4 for 2009/10 Data
Annual
Review
Date: 4th March 2010
Conducted by: Mr. Tom Carr, Medical Director Appendix 5
Clinical
Guideline
During 2009/10 the NSSG formally developed and agreed the clinical guidelines for management of
skin cancer in ECN under the leadership of Dr Elizabeth Fraser-Andrews. These along with referral
guidelines and organisational arrangements have been incorporated into the Skin NSSG
Constitution document which was formally approved in April 2010.
The constitution is due for review March/April 2011.
Network
Audit
The NSSG completed one Skin Cancer Network Audit Project during 2009/10. This was an audit of
management of Cutaneous Lymphomas in ECN. The audit reviewed several years of lymphoma
management across all localities and the results were presented at the NSSG on 26th Jan 2010.
Key conclusion points for debate and action were:
•
•
•
•
•
•
Long natural history, discuss at diagnosis/progression
TSEB not required in Essex if available at tertiary centre
Increasing use of Bexarotene may have funding implications
Treatment of CTCL and CBCL in line with current guidelines
Need better pick up of cases for discussion at skin MDT
ECN Cutaneous lymphoma management guidelines and referral pathways require
clarification (see NSSG Guidelines)
The NSSG remain committed to network-wide audit and have agreed that the ‘Management of SCC
on Ear’ would be the topic for 2010/11.
Clinical Lead – Peter Dziewulski
3
Time Period – All cases diagnosed in calendar year 2008 and managed through both Skin and H&N
MDTs
Audit Presentation: Autumn 2010
Research
The current list and recruitment into each clinical trial for the 2009/10 (up to March 2010) is listed
in Appendix 2.
During 2009/10 the two cancer research networks serving ECN were merged to create a single
Essex Cancer Research Network co-terminous with service network. A lead manager (Ashley Solieri)
and Lead Clinician (Dr Madhavan) have been appointed.
The NSSG has not to date held and recorded details of a dedicated meeting to discuss clinical trial
activity (as required by measure 1C-151) and this will be actioned during 2010/11.
Service
Improvement
& Service
Delivery Plan
The NSSG identifies the Service Delivery Plan priorities for advice to the Network Board. The key
issues all relate to delivering IOG compliant services in ECN and will be subject to review as part of
2010/11 NSSG Work Plan. Priority areas include development of SNB at MEHT and consolidating
SSMDT.
Network-wide service improvement initiatives during 2009/10 have concentrated on strengthening
local MDTs and establishing the single SSMDT for ECN. Some examples include:
North east – local skin cancer database, improved MDT attendance, patient survey, communication
skills training, improved patient information circulation
South – Improved administration for MDT; new teleconference facilities, dedicated pathway coordinator
At the outset of 2009/10 there was only one Skin cancer CNS in ECN (Esther Kay – South Essex).
However since Peer Review in June 2009 all ECN localities have secured funding and appointed
dedicated Skin cancer CNSs . This is an excellent patient centered development for the network.
Patient &
Carer
Feedback
and
Involvement
Due to shortfalls in CNS provision the opportunity to complete network-wide patient survey
through the NSSG during 2009/10 was compromised however this will be addressed during
2010/11, ensuring that details of the outcome of this work impact changes to service delivery as a
result.
Minimum
Data Sets
The NSSG have agreed a minimum dataset for all patients discussed in MDT and this is set out in
two MDT proformas (a) melanoma and Non-melanoma. These documents can be found as an
appendix of the respective MDT Operational Policy
4
Appendix 1
Skin NSSG Attendance (2008/09)
Name
Title
ORG
Plastic Surgeon
Lead Cancer Clinician
Consultant Dermatologist
Medical Oncologist
Histopathologist
Histopathologist
CNS
MDT Coordinator
Lead Manager
Manager
PCT Lead
GP lead
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
MEHT
NHSME
NHSME
Consultant Dermatologist
Clinical Oncologist
CNS
Derm manager
Lead manager
PCT lead
GP lead
CHUFT
CHUFT
CHUFT
CHUFT
CHUFT
NHSNEE
NHSNEE
Consultant Dermatologist
Consultant Dermatologist
Consultant Dermatologist
Lead Cancer Manager
Histopathologist
Clinical Oncologist
Skin Cancer CNS
Derm Nurse
BTUHFT
BTUHFT
BTUHFT
BTUHFT
SHUFT
SHUFT
SHUFT
BTUHFT
16/04/09
30/06/09
24/11/09
20/01/10
23/03/10
%
√
√
60%
40%
20%
40%
20%
40%
60%
40%
40%
100%
60%
Mid Essex
Peter Dziewulski (Chair)
Professor Neville Davidson
Hilary Dodd
M Arum
Mahir Petkar
Dia kamel
Elizabeth Ann Dust
Sheryl Jones
Belinda Grant
Karen Cook/Elizabeth Podd
Tracy Porter/Lyn Smith
Donald McGeachy
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
√
North East Essex
Elizabeth Fraser-Andrews
Alan Lamont
Michelle Marshall
Mel Crouch
Michelle Bath
Tracy Beastall
Linda Mahon-Daly
√
√
√
√
√
√
√
√
√
√
√
√
√
80%
60%
40%
20%
20%
20%
20%
South Essex
Mohsen Khorshid
Rohaj Metha
Stephanie Lateo (from 25.1.2010)
Jackie Gibson
Maryse Sundarsen
Krishnaswamy Madhavan
Esther Kay
Janice Armitt
√
√
40%
√
√
√
√
√
√
√
√
20%
60%
20%
20%
0%
20%
5
Julie Hopping
Linda Brett
Dave Fazey
Maryse Sundaresan
PCT Lead
NHSSWE
√
PCT Lead
Histopathologist
SEEPCT
SHUFT
√
√
√
Kevin McKenny
Tom Carr
Ashley Solieri (joined 1.3.2010)
Network Director
Lead Clinician
Research Manager
ECN
ECN
ERCN
√
√
Michael Scances
User Facilitator
ECN
20%
60%
100%
20%
√
√
√
√
√
√
√
√
√
100%
0%
√
20%
60%
Cancer Network
Total in Attendance
12
12
√
√
√
14
15
14
Entries in Blue are also Core Skin MDT members
6
Appendix 2
Essex Cancer Research Network – Melanoma Studies and Recruitment 2009/10
Trial Name and
Short Description
Southend
09/10
Total
Basildon
09/10
Total
AVAST-M / A randomised trial evaluating bevacizumab (Avastin®),as
adjuvant therapy following resection of AJCC stage IIB , IIC and III
cutaneous melanoma
Melanoma Cohort Study
*NCRN062 / A Clinical Trial to Evaluate the Efficacy and Safety of
Treatment with OncoVEXGM-CSF Compared to Subcutaneously
Administered GM-CSF in Previously Treated Melanoma Patients with
Unresectable Stage IIIb, IIIc and IV Disease
*NCRN063 – Study 6 / A randomised study to assess the efficacy of
AZD6244 (Hyd-Sulfate) in combination with dacarbazine compared
with dacarbazine and placebo to AZD6244 in first line patients with
BRAF positive advanced cutaneous melanoma (Closed)
0
Studies of Familial Melanoma
0
2
0
Chelmsford
09/10
Total
14
49
Colchester
09/10
Total
0
In set
up
9
9
9
Non-NCRN Studies
*Commercial study
7
Appendix 3
Essex Cancer Network Skin Cancer Network Site Specific Group
Tuesday 16th April 2009
09.30am – 12.30pm
Swift House
MINUTES
1.
Present:
Mr Peter Dziewulski (Chair)
Mr. Kevin McKenny
Jackie Gibson
David Fazey
Krishnaswamy Madhavan
Dr. Elizabeth Fraser-Andrews
Dr. Hilary Dodd
Tracey Beastall
Tracey Porter
Julie Hopping
Karen Cook
PD
KMK
JG
DF
KM
EFA
HD
TB
TP
JH
KC
Dr. M. Arun
MA
Plastic Surgeon, MEHT
ECN Network Director
Lead Cancer Manager, BTUHFT
Commissioning Lead, SEE PCT
Consultant Oncologist, SUHFT
Consultant Dermatologist, CHUFT
Consultant Dermatologist, MEHT
Commissioning Lead, NEE PCT
Commissioning Lead, Mid Essex PCT
Commissioning Lead SW Essex PCT
General Manager Burn Unit
and Head and Neck
and General Manager Plastic Surgery,
MEHT
Medical Oncologist, MEHT
Apologies
Maryse Sundaresen, Alison Shaw, Esther Kay, Ian Seddon, Mel Crouch, Alan Lamont
2.
Previous Minutes – 24th March 2009
These were agreed as a true record of proceedings
3.
Matters Arising
3.1 Single SSMDT for ECN
Every effort had been made to deliver SSMDT on 27th April as planned. However, there
remain significant concerns about the ability of both Chelmsford and Colchester to have
functioning teleconferencing facilities available, despite local efforts. Colchester are
highly unlikely to have additional kit but Elizabeth Fraser-Andrews stated she would be
happy to consider travelling to Chelmsford to join in a link-up with South Essex if required.
Chelmsford are in advanced negotiations with BT to secure the appropriate lines in
advance of 27th April. South Essex arrangements are already in place and ready to link up.
Action:
MEHT to communicate with all MDT members next week confirming if
facilities available for 27th April and that SSMDT will go ahead.
SSMDT Operational Policy
This is now complete and available for up-load to CQUINS to inform Peer Review
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assessment.
NOTE POST-MEETING - MEHT, as host of the SSMDT, do not need to also Peer Review
assess for LSMDT.
3.2 Peer Review Planning
All MDTs are clear about self-assessment and evidence up-load requirements for their
respective MDTS and the cut-off timetable of 21st April.
Community Leads also aware of their responsibilities in respect of self-assessment and
up-load to CQUINs by 21st April. The Leads are:
•
•
•
•
North East Essex Tracey Beastall
Mid Essex
Tracey Porter
South West Essex Julie Hopping
South East Essex David Fazey
PCT have five measures to self-assess against. KMK will be circulating Skin NSSG
constitution for Peer Review upload which includes reference to the organisational
arrangements for Skin Cancer services in the Community for each locality.
Visit Schedule
All localities aware of the visit programme and the respective day that the Peer Review
Team will be visiting each locality. Lead Managers in each locality should already be
arranging appropriate meeting rooms for visiting teams.
Skin NSSG visit
NSSG members were reminded that the Peer Review visits in respect of Skin NSSG would
be taking place on 10th June at the South Lodge Hotel, Chelmsford. KMK will be asking for
confirmation from group members on who would be attending, representing their
locality. It would be important to have representation from each locality at this NSSG
assessment event.
3.3 Community Skin Cancer Services
The current organisational arrangements in each locality have now been clarified by each
PCT and are reflected in the Skin Constitution document. All PCTs acknowledged that
they have work to do to deliver the clinical governance IOG requirements, in particular
SLA agreements with GPsWSI/Community Practitioners and their interface with local Skin
Cancer MDT. Delivery of IOG compliant Skin Cancer services for the community will be a
key NSSG work programme objective for this group in 09/10.
3.4 ECN Clinical Guidelines
Now incorporated into the Skin NSSG Constitution document, which KMK will circulate to
all making it available for up-load to CQUINS as required to inform local assessment.
3.5 Network Audit
NSSG were asked to consider Network Audit topics for 09/10. Following discussions it
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was agreed that the following topics would be subject to a Network-wide Audit:
•
•
•
Review of the management of Skin Lymphomas over 12 months – Clincial Lead –
Elizabeth Fraser-Andrews
Management of high risk SCC thicker than 4mm wider than 2mm (on the ear)
reviewing six months data – Clinical Lead – Peter Dziewulski
Network-wide Patient Survey – Clinical Lead – CNSs (to be confirmed)
It was agreed that the Skin NSSG would hold a half-day Audit event in the Autumn to
present these audits, inviting a wider audience.
3.6 Clinical Trial Recruitment.
It was acknowledged that the 09/10 Work Programme would need to put stronger
emphasis on assessing levels of clinical trial recruitment across all Network MDTs and
regular Network-wide reports coming to the NSSG on performance and appropriate
action as required. Also the group needs to formalise their Clinical Research Lead.
Interim – Dr. K. Madhavan.
3.7 Sentinel Node Biopsy
Aspirations remain in MEHT to develop this service. Business Case currently under
development. PD will keep group informed of progress. In the meantime patients are
referred into Barts and the London. PD also stated that they have a new plastic surgeon
starting in May who will also provide sessional time at BTUHFT and is keen to offer SNB to
the Network.
3.8 Skin Cancer Nurses
An appointment at MEHT is imminent. CHUFT are still progressing the Macmillan Cancer
sponsorship route, however, progress is slow. Also support is looking favourable in South
Essex for expansion of CNS provision.
4.
Any Other Business
Nil to note.
5.
Date of Next Meeting
Tuesday 30th June 2009
-
4.00pm – 6.00pm Swift House, Middle and
Annexe
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Essex Cancer Network Skin Cancer Network Site Specific Group
Tuesday 30th June 2009
4.00pm – 6.00pm
Swift House, Chelmsford, CM2 5PF
Middle and Annexe
MINUTES
Present:
Mr. Kevin McKenny
David Fazey
Dr. Linda Mahon-Daly
Lynn Smith
Karen Cook
KMK
DF
LMD
LS
KC
Dr. M. Arun
Dr. M. Khorshid
Mel Crouch
Dr. Alan Lamont
Dr. Donald McGeachy
Linda Brett
Elizabeth Ann Dust
MA
MK
MC
AL
DMG
LB
EAD
1.
ECN Network Director
Commissioning Lead, SEE PCT
Primary Care Cancer Lead, NEE PCT
Dermatology Lead, Mid Essex PCT
General Manager Burn Unit
and Head and Neck
and General Manager Plastic Surgery,
MEHT
Medical Oncologist, MEHT
Consultant Dermatologist, BTUHFT
General Manager, CHUFT
Consultant Oncologist, CHUFT
GP, Mid Essex PCT
Dermatology Manager, BTUHFT
Skin Cancer CNS, MEHT
Apologies
Maryse Sundaresen, Esther Kay, Dr. K. Madhavan, Tom Carr, Jackie Gibson, Neville
Davidson, Tracy Porter
In view of Peter Dziewulski’s absence KMK agreed to Chair. At the next meeting it
will be important to clarify Deputy Chair arrangements for this group.
2.
Previous Minutes – 16th April 2009
These were agreed as a true record of proceedings
3.
Matters Arising
3.1
Single SSMDT for ECN
SSMDT was now up and running and had met twice. It remains embryonic with still
some gaps in core membership which it is envisaged will improve over time. The
administrative support arrangements at MEHT were good with strong MDT coordination.
Teleconferencing appears to work and they are able to discuss all cases. It is
important that the level 5 cases that need to be submitted and discussed are clearly
defined pre-SSMDT. A clear shortfall for the SSMDT is access to Sentinel Node
Biopsy. It appears that the business case for SNB at MEHT is progressing; however,
this is getting increasingly urgent if we are to offer an equitable service across
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localities. Currently South Essex cases are going into Barts.
Colchester have now secured teleconferencing access which should be available for
the next meeting.
3.2 LSMDT
MK reported oncologist shortfalls for their LMDT; however, a locum is now
providing cover. It is vital that there is South Essex medical oncologist input to the
new SSMDT. Peter Szlosarek’s job plan does not currently enable this. Hopefully
this will be addressed in the near future.
3.3 Community Skin Cancer Services
KMK reminded all of the verbal feedback from Peer Review demonstrated that no
PCT has got an IOG compliant skin cancer service in the community. All PCTs need
to go through the four phases of development.
1.
Baseline assessment to get a clear indication of who is excising skin cancers
in primary care.
Identifying GPsWSIs
Train and accredit GPsWSIs
Issue SLA/establish Governance Arrangements
2.
3.
4.
5.
It is vital that all localities have governance arrangements in place so that there is a
“flag” when a cancer is excised by a non-accredited clinician in primary care so that
action can be taken.
North East Essex
LMD reported that they had already put in place monitoring arrangements on
primary care excisions using MDT co-ordinator. LMD is also writing to all GPs
regarding establishment of IOG compliant arrangements asking them for
nominations for individuals who would be interested in doing this work and also
clarifying the financial reimbursement for individual procedures. It is hoped that
the letter will generate potentially three GPsWSIs for North East Essex.
Mid Essex
LS gave up-date. PCT still needs to complete the audit to have a clear
understanding of who is excising skin cancers. They already have a dedicated
GPsWSI dermatologist developed through the intermediate dermatology service
with local consultant dermatologist providing support.
There is concern from GPs about the level of commitment required to fulfil
accreditation requirements.
South Essex
South Essex localities also need to complete the baseline and identify which GPs are
excising skin cancers. In South East Essex no GPs are stepping forward to take on
this work. It is also important to clarify who is excising and separate this work from
enhanced minor surgery. Currently they have 120 GPs who are providing minor
surgery of one sort or another.
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KMK stated that he is meeting with Pathologists later this week and will be asking
for baseline data across all four PCTs. Clearly we now have PCT representation and
support so it is imperative that action plans are developed for each locality to
establish IOG compliant arrangements. This in turn will also be required as part of
the Peer Review response.
3.4 ECN Constitution
Peer Review feedback indicates that there may be elements within our clinical
guidelines that need to be reviewed, in particular, the need to discuss all new
melanomas in the SSMDT and also the guideline arrangements for SCC do not meet
some of the national standards. Lead EFA
3.5 Peer Review
KMK shared the verbal feedback received from Peer Review. The letters concerning
any immediate risks and serious concerns are likely to be circulated shortly. The
two immediate risks identified are relevant to South Essex and these include:
•
•
that melanomas are being excised in Primary Care and also that these had
not been discussed at the MDT prior to such a procedure being carried out
substantial proportion of more complex surgical procedures were being
carried out by a plastic surgeon who is not a designated core MDT member
and did not attend MDT meetings.
These immediate risks will need to be addressed and responded to within two
weeks; the serious concerns will need a response within four weeks.
Action:
KMK to circulate peer review letter as soon as this becomes
available
3.6 Network Audit
As agreed at last meeting, management of T-Cell Lymphoma is a key Audit topic for
2009/10 which EFA has kindly agreed to lead. EFA has already circulated the
proforma and supporting information for this Audit. EFA will be keen to get
feedback and that the document circulated was deemed to be acceptable and that
we can get on with this Audit over the summer months. EFA would be keen to
receive data from all localities by mid-September so that she can present at NSSG in
Autumn.
Pending discussions with Pathologists, Audit meeting should also include
presentation of the PCT baseline assessments in respect of the GPs excising skin
cancer. Key questions within this audit are:
Who is carrying it out? What is being excised? Where is it being carried out? When
and what action was taken post-positive diagnosis?
3.7 Clinical Trial Recruitment
KMK up-dated group on advanced plans to merge the South Essex and Mid Anglia
Cancer Research Network to create a new Essex Cancer Research Network
coterminous with the service network. It is hoped that the new network will be up
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and running by October following appointment of a Lead Clinician and Research
Manager. With the new network it is envisaged that NSSG will receive networkwide reports comparing clinical trial recruitment across localities.
3.8 Sentinel Node Biopsy
NSSG urged MEHT to progress this business case and develop their service as soon
as possible, so that new SSMDT would have immediate access to this vital
component of skin cancer care.
3.9 Skin Cancer Nurses
New appointment at MEHT now at place, Elizabeth Ann Dust?? At CHUFT
Macmillan have approved funding for a CNS and they hope to make the
appointment in the very near future.
4.
Any Other Business
Nil to note.
5.
Date of Next Meeting
NSSG Business Meeting – 22nd September 2009 4.00pm – 6.00pm, Kestrel House,
CM2 5PF (adjacent to Swift House)
Audit Event and Business Meeting – 24th November 2009 2.00pm – 4.30pm,
Venue to be confirmed
Essex Cancer Network Skin Cancer Network Site Specific Group
Tuesday 24th November 2009
2.00pm – 4.30pm
Courtyard Suite Regiment Way Golf Club CM3 3PR
MINUTES
Present:
Mr. Kevin McKenny
Mohammad Ghazavi
KMK
MG
Sheryl Jones
Michelle Bath
SJ
MB
Michael Scanes
Belinda Grant
Neville Davidson
Lynne Smith
MS
BG
ND
LS
Elizabeth Podd
Mohsen Khorshid
Janice Armitt
Linda Brett
EP
MK
JA
LB
ECN Network Director
Dermatology SpR, Leicester Royal
Infirmary (in attendance)
MDT Co-ordinator, Melanoma, MEHT
Assistant Service Manager, Cancer,
CHUFT
User Facilitator, ECN
General Manager for Cancer, MEHT
Oncologist, MEHT
Service Redesign (Commissioner) NHS
Mid Essex
General manager, Plastic Surgery, MEHT
Consultant Dermatologist, BTUHFT
Senior Dermatology Sister, BTUHFT
Service Manager, Dermatology, BTUHFT
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David Fazey
Dia Kamel
Mahir Petkar
Maryse Sundaresan
1.
DF
DK
MP
MS
Programme Manager, NHS SEE
Consultant Pathologist, MEHT
Consultant Histopathologist, MEHT
Consultant Histopathologist, SUHFT
Apologies
Dr. Donald McGeachy, Tracey Porter, Jackie Gibson, Elizabeth Dust, Peter Dziewulski, Charlot
Grech, Tom Carr, Esther Kay.
Audit Presentations
1.
Management of Cutaneous Lymphoma in ECN
Lead: Dr. E. Fraser-Andrews
At the outset, EFA confirmed that she had not received any information from South
Essex or Mid Essex localities to inform the Audit, hence the Audit could only be
presented from a Colchester Hospital perspective.
Post Audit Presentation KMK confirmed that despite agreeing Audit topic back in the
Spring 2009, it is extremely disappointing that 3 x ECN localities had not submitted
data to enable a single network-wide Audit Presentation. This is a key requirement
for Peer review.
In order to complete Audit, it was suggested that outstanding data for Mid Essex and
South Essex localities is submitted to EFA by the end of the year and that the Skin
NSSG meeting in January will include a presentation of the Audit, incorporating data
from all localities.
In respect of generic clinical guidelines, EFA also circulated draft guidelines for the
management of cutaneous lymphoma for inclusion in the ECN Constitution
Document. Comments to be returned to EFA by the end of the year.
2.
Lead Dr Ghazavi
Dr Ghazavi kindly presented an audit of skin cancer surgery in South West Essex.
Audit presentation to be circulated to group members for their information.
Key point of note is requirement of GP training of ‘diagnostic skills’
2.
Previous Minutes – 30th June 2009
These were agreed as a true record of proceedings
3.
Matters Arising
3.1 Peer Review Report and Action Plan
The spreadsheet of results and Peer Review Report and subsequent Network Action Plan had
been circulated with papers for information. KMK reminded the group that the network was
required to report formally to Peer Review by the end of the year on progress made against
Skin NSSG and SSMDT/LSMDT Peer Review concerns. This would also be submitted to Essex
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Cancer Network Board on 12th January 2010. Key areas requiring action were discussed in
detail under the remaining agenda items.
3.2 SSMDT for ECN clearly acknowledged that the network had been unable to deliver an IOG
compliant SSMDT hosted by Mid Essex Hospitals serving all 4 localities despite confirmation
back in May that this would be established. Clearly there are a range of operational issues
that have not been put in place to make SSMDT successful. The following key points were
noted:
•
MEHT as host organisation has a responsibility to ensure smooth operation and coordination of meetings. A dedicated MDT co-ordinator should be receiving proformas
from all localities, collating agenda and circulating it in advance of SSMDT. Each
patient discussed should have agreed action recorded.
•
Core members should attend as many meetings as possible. It is imperative that
individuals do not simply attend the MDT link and then leave when they have
presented their cases. This undermines the true nature of what MDT meetings are
about.
•
Tele-conferencing links with Colchester need to be organised as a matter of urgency. It
was reported that CHUFT are no longer committed to buying additional teleconferencing facilities.
Action:
KMK to liaise directly with Senior Management at CHUFT in this regard
•
The MDT operational policy needs to be updated to reflect new SSMDT arrangements
and key points of contact proforma, etc.
•
It was agreed that the SSMDT will take place weekly, starting on Monday 30th
November 1pm. Initially every third week, there will be a business meeting to address
any operational short-falls and difficulties.
•
Communication across all skin cancer CNS’s within the network will be key to
delivering a successful SSMDT. The CNS must work closely with the MDT co-ordinator
to ensure they receive the appropriate clinical support.
•
Somerset Information System will be available within the next 12 months in all Trusts
to support better data collection at MDT’s.
•
Peter Dziewulski to ensure that Plastic Surgeons attend all LSMDT’s and SSMDT’s as
required by IOG and Clinical Governance. PD will be formally writing to all respective
Plastic Surgeons in the this regard.
3.3 Community Skin Cancer Services
KMK confirmed that it appears that all PCT’s are formally committed to delivering IOG
Compliant Skin arrangements. All PCT’s appear to be at a similar level of development.
Development includes: (a) Baseline assessment and mapping was currently happening in
each locality (b) Identifying preferred service model, including named individuals (GPSwSI)
(c) Providing appropriate education and training arrangements for GPSwSI’s supported by
Service Level Agreements and strong clinical governance arrangements with GPSwSI’s
actively involved with SMDT’s as required.
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North East Essex appeared to be at an advanced stage, having developed a draft Service
Level Agreement, which has been circulated to other localities for information.
Mid Essex have completed their audit and have a good understanding of the level of activity
across GP’s. Negotiations are ongoing in an effort to secure a optimum IOG compliant
arrangement.
South East Essex. The key requirement for them was to separate skin cancer from those GP’s
undertaking enhanced skin surgery practice. Dedication to skin cancer is a key with training
support from consultants.
In respect of education training, it was suggested that Peter Dziewulski and Liz FraserAndrews develop a training package jointly for use within the network.
South West Essex. Unfortunately no PCT representation so unable to report on updates.
Action: KMK to confirm South West Essex PCT representative.
3.4 ECN Constitution
EFA kindly agreed to update guidelines in respect of shortfalls identified at Peer Review
including BCC’s, SCC’s and cutaneous lymphoma. Final draft document to be formally
approved early next year.
3.5 Network Audit
Actions are as discussed earlier. All localities to submit cutaneous audit data to EFA by the
end of the year for presentation at the next NSSG.
3.6 Clinical Trial Recruitment
KMK updated group on the progress regarding establishment of the new merged Essex
Cancer Research Network. Dr Madhavan has been appointed as Lead Clinician and Ashley
Solieri is the Lead Research Manager. It is hoped in the near future that all Site Specific
Groups will receive a regular report on trial recruitment across localities for NSSG to action
accordingly.
Dr Neville Davidson was indentified as Research Lead for the NSSG.
3.7 Sentinel Node Biopsy
It was confirmed that the business case to establish SNB at MEHT was now at an advanced
stage. The skin NSSG and Essex Cancer Network will fully support this development and the
ability of SNB’s to be accessed directly from SSMDT hosted by MEHT.
3.8 Skin Cancer Nurses
It was confirmed that all localities have now appointed or are in the process of appointing
dedicated skin cancer CNS’s and thereby delivering IOG compliance.
4.
Any Other Business
None.
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5.
Date of Next Meeting
Tuesday 26th January 2010 2pm-4pm at Swift House Board Room
Essex Cancer Network Skin Cancer Network Site Specific Group
Tuesday 26th January 2010
2.00pm – 4.30pm
Board Room, Swift House
MINUTES
Present:
Peter Dziewulski (Chair)
Mr. Kevin McKenny
Dr E. Fraser-Andrews
Sheryl Jones
Dr. Donald McGeachy
Michael Scanes
Jackie Gibson
Neville Davidson
Elizabeth Podd
Rohan Mehta
Linda Brett
David Fazey
Michelle Marshall
Elizabeth Dust
Alan Lamont
1.
PD
KMK
EFA
SJ
DM
MS
JG
ND
EP
MK
LB
DF
MM
ED
AL
Plastic Surgeon, MEHT
ECN Network Director
Consultant Dermatologist, CHUFT
MDT Co-ordinator, MEHT
GP Representative, NHSME
User Facilitator, ECN
Lead Manager, BTHUFT
Consultant Oncologist, MEHT
General Manager, Plastic Surgery, MEHT
Consultant Dermatologist, BTUHFT
Service Manager, Dermatology, BTUHFT
Programme Manager, NHS SEE
Skin Cancer CNS, CHUFT
Skin Cancer CNS, MEHT
Consultant Oncologist, CHUFT
Apologies
Mohsen Khorshid, Tom Carr, Audrey Loos, Hillary Dodd, Vivienne Loo, Stephanie Lateo,
Michelle Bath, Esther Kay, Lynne Smith
Audit Presentation 2009/10
Management of Cutaneous Lymphoma in ECN
Lead: Dr. E. Fraser-Andrews
EFA presented completed audit which included information from all ECN localities including
South and Mid Essex (network-wide). Key conclusion points for debate and action were:
•
•
•
•
•
•
Long natural history, discuss at diagnosis/progression
TSEB not required in Essex if available at 3° centre
Increasing use of Bexarotene may have funding implications
Treatment of CTCL and CBCL in line with current guidelines
Need better pick up of cases for discussion at skin MDT
ECN cutaneous lymphoma management guidelines and referral pathways require
clarification (see draft NSSG Guidelines)
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Action:
2.
Audit to be circulated to group members for information alongside updated
draft NSSG Guidelines. Dr Ghazavi’s audit of skin cancer surgery in South
West Essex presented at last NSSG to be circulated.
Skin NSSG
24th November 2009
These were agreed as a true record of proceedings
3.
Matters Arising
3.1 Peer Review Report and Action Plan
The spreadsheet of results and Peer Review Report and subsequent Network Action Plan had
been circulated with papers for information. KMK shared with the group, the paper
presented to network board on 12th January 2010 detailing progress made against the
concerns reported for Skin NSSG and SSMDT /LSMDTs. Key areas requiring action were
discussed in detail.
This report will also inform discussions with Peer Review Zonal leads on 4th March 2010. A
meeting specifically convened to discuss and report progress (or lack of).
In summary, the following concerns were deemed to be addressed (RAG Assessed as Green)
•
•
•
•
•
•
•
Fully constituted NSSG in place which includes PCT representation (however SWE and
NEE representation could be criticised)
Oncologist attending all ECN Skin MDTs (outstanding issue for SE LSMDT)
Constitution/Clinical Guidelines reviewed agreed and reflects national policy where
applicable (recently updated)
Information systems (linked to local Histopath Depts) in place in all localities reporting
excisions in community
Access to Immuno-compromised clinics in all localities
Operational Policy for SSMDT formally agreed (needs review)
Skin Cancer CNS in all four localities
The following concerns were deemed to be incomplete but progressing (RAG Assessed as
Amber)
•
•
•
•
Plastic surgeon attending 66% of all LSMDT and SSMDTs (ongoing)
Development of Sentinel Node Biopsy in ECN at MEHT (draft BC available)
IOG compliant community Skin cancer arrangements in all 4 localities
SSMDT serving ECN (hosted by MEHT) in place but not yet fully compliant due to
operational difficulties (improving)
Peer Review Programme 2010
Group were reminded that all skin services will experience Peer Review (internal validation
process) this year with self assessment and evidence to be submitted by end of June 2010.
The SSMDT hosted by MEHT will receive a formal visit early June with a April/May timetable
for self assessment and evidence submission.
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3.2 SSMDT for ECN (hosted by MEHT)
It was reported that the SSMDT for ECN had made significant progress since the
reported dysfunctional non-IOG compliant SSMDT at last NSSG. It was confirmed that
many of the operational issues hampering the smooth running of the SSMDT are being
addressed. The following key points were deemed crucial:
•
MEHT as host organisation has a responsibility to ensure smooth operation and
co-ordination of meetings. A dedicated MDT co-ordinator should be receiving
proformas from all localities, collating agenda and circulating it in advance of
SSMDT. Each patient discussed should have agreed action recorded. Now in
place.
•
Core members should attend as many meetings as possible. It is imperative that
individuals do not simply attend the MDT link and then leave when they have
presented their cases. This undermines the true nature of what MDT meetings
are about. To a lesser degree but still an issue
•
Tele-conferencing links with Colchester need to be organised as a matter of
urgency. Now been addressed.
•
The MDT operational policy needs to be updated to reflect new SSMDT
arrangements and key points of contact proforma, etc.
Action:
EP agree to lead this review of Operational Policy – KMK to forward
current draft
•
SSMDT taking place weekly, starting on Monday 30th November 1pm. Every
third week, there is a business meeting to address any operational short-falls
and difficulties. In place
•
Communication across all skin cancer CNS’s within the network will be key to
delivering a successful SSMDT. The CNS must work closely with the MDT coordinator to ensure they receive the appropriate clinical support. Ongoing.
•
Somerset Information System will be available within the next 12 months in all
Trusts to support better data collection at MDT’s. Roll out underway
•
Peter Dziewulski to ensure that Plastic Surgeons attend all LSMDT’s and SSMDT’s
as required by IOG and Clinical Governance. PD will be formally writing to all
respective Plastic Surgeons in this regard.
•
Separately, BTUHFT management attempting to secure dedicated oncologist
input to the South Essex LSMDT. Lead LB
•
SSMDT will need to begin formulating their 2009/10 annual report to inform
2010 Peer Review.
3.3 Community Skin Cancer Services
It appears that all PCT’s remain committed to delivering IOG Compliant Skin
arrangements. All PCT’s currently appear to be at a similar level of development.
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Development includes: (a) Baseline assessment and mapping was currently happening
in each locality (b) Identifying preferred service model, including named individuals
(GPSwSI) (c) Providing appropriate education and training arrangements for GPSwSI’s
supported by Service Level Agreements and strong clinical governance arrangements
with GPSwSI’s actively involved with SMDT’s as required.
It was noted that NICE are currently out to consultation on specific guidance related to
management of BCC in community. In view of this, formal establishment of IOG
compliant service models across 4 x PCTs may be delayed pending outcome and
recommendations in this guidance once published.
Link: http://www.nice.org.uk/guidance/index.jsp?action=folder&o=46334
North East Essex representation not present but appear to be at an advanced stage,
having developed a draft Service Level Agreement, plus plans to go to advert for
GPsWI.
Mid Essex have completed their audit and have a good understanding of the level of
activity across GP’s. Negotiations are ongoing in an effort to secure an optimum IOG
compliant arrangement.
South East Essex. The key requirement remains to separate skin cancer from those
GP’s undertaking enhanced skin surgery practice. Dedication to skin cancer is key with
training support from hospital consultants.
In respect of education training, it was suggested that Peter Dziewulski and Liz FraserAndrews develop a training package jointly for use within the network.
South West Essex. Unfortunately no PCT representation so unable to report on
updates.
Action: KMK to confirm South West Essex PCT representative.
3.4 ECN Constitution/Guidelines
EFA kindly agreed to update guidelines in respect of shortfalls identified at Peer Review
including BCC’s, SCC’s and cutaneous lymphoma. Final draft document to be recirculated and formally approved at next meeting. Community section may need to
read ‘pending outcome of NICE consultation’.
Lead dermatologists with interest in lymphomas were named as: Dr Fraser-Andrews,
Dr Khorshid and Dr Dodds.
RM reported that Photodynamic therapy was up and running at BTUHFT and the
service was happy to accept referrals from other localities.
It was acknowledged that there is a national review of guidelines for management of
MM underway (draft circulated for information). The outcome of which may see
requirement to review local guidelines accordingly.
Action:
Draft MM guidelines for consultation to be circulated to NSSG for
information.
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3.5 Network Audit 2010
It was agreed that the ‘Management of SCC on Ear’ would be the network-wide topic
for 2010.
Clinical Lead – Peter Dziewulski
Time Period – All cases diagnosed in calendar year 2008 and managed through both
Skin and H&N MDTs
Audit Presentation: Autumn 2010
Action:
PD to draft proforma and circulate to local clinical leads for
completion.
3.6 Clinical Trial Recruitment
KMK informed group that the merged Essex Cancer Research Network was now
operational. Dr Madhavan has been appointed as Lead Clinician and Ashley Solieri is
the Lead Research Manager (taking up post early Feb 2010). It is hoped that, in the
near future, all Site Specific Groups will receive a regular report on trial recruitment
across localities for NSSG to action accordingly.
3.7 Sentinel Node Biopsy
Draft business case to establish SNB at MEHT was shared with group. The skin NSSG
and Essex Cancer Network will fully support this development and the ability of SSMDT
to access SNBs directly from MEHT. SSMDT need to be clear on cases to be referred for
SNB and confirm this in Operational Policy. Ideally used as a prognostic index in
patients entering clinical trials.
The NSSG await with interest MEHT’s progress in establishing local service
3.8 Skin Cancer Nurses / Service Improvement
It was confirmed that all localities have now appointed or are in the process of
appointing dedicated skin cancer CNS’s and thereby delivering IOG compliance. NSSG
recommends that the CNSs meet collectively as a group and lead on service
improvement/improving patient experience initiative on behalf of NSSG.
CNSs already confirmed that they have agreed standardised approach to patient
information and use of patient diary.
4.
Any Other Business
None.
5.
Date of Next Meeting
Tuesday 23rd March 2010 2pm-4pm – Kestrel House, Board Room (please note
change of date to that agreed at the meeting)
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Essex Cancer Network Skin Cancer Network Site Specific Group
Tuesday 23rd March 2010
2.00pm – 4.00pm
Board Room, Swift House
MINUTES
Present:
Peter Dziewulski (Chair)
Mr. Kevin McKenny
Dr E. Fraser-Andrews
Michael Scanes
Jackie Gibson
Elizabeth Podd
David Fazey
Michelle Marshall
Elizabeth Dust
Alan Lamont
Belinda Grant
Ashley Solieri
Dia Kamel
Dr Stephanie Lateo
1.
PD
KMK
EFA
MS
JG
EP
DF
MM
ED
AL
BG
AS
DK
SL
Plastic Surgeon, MEHT
ECN Network Director
Consultant Dermatologist, CHUFT
User Facilitator, ECN
Lead Manager, BTHUFT
General Manager, Plastic Surgery, MEHT
Programme Manager, NHS SEE
Skin Cancer CNS, CHUFT
Skin Cancer CNS, MEHT
Consultant Oncologist, CHUFT
Head Of Cancer Services, MEHT
Cancer Research Manager, ECRN
Consultant Histopathologist, MEHT
Consultant Dermatologist, BTUHFT
Apologies
Lynne Smith, Maryse Sundaresan, Tom Carr, Linda Brett, Neville Davidson
2.
Previous Minutes - 26th January 2010
These were agreed as a true record of proceedings
3.
Matters Arising
3.1 Peer Review Action Plan to address concerns
Follow Up Meeting – 4th March 2010 to assess progress against 2009 concerns
KMK provided feedback on outputs from meeting that took place on 4th March 2010
with the Peer Review Zonal Leads to review progress against 2009 concerns. A full
formal report will be available shortly and circulated. KMK provided a verbal summary.
Background
At the time of the review in June 2009, the NSSG although well established, did not
have regular involvement from all local MDT’s. The Network Clinical Guidelines
(Constitution document) did not clarify the limits of the local MDT’s and the range of
skin tumours that the SSMDT would manage. The Guidelines needed updating for
BCCs and SCCs.
The Colchester local MDT did not meet sufficiently or frequently and did not fulfil the
requirement that skin cancers other than BCCs should be treated by core members in
MDT. Also lacked a CNS.
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South Essex local MDT relied on a surgeon who did not attend the MDT at the time
their participation in the SSMDT was inadequate due to job plan clashes.
The Network designated SSMDT hosted by MEHT had not yet started to meet and
complex skin cancers were still being managed by local MDT’s and referrals made to
specialist teams outside the Network.
The 4 PCT’s had not established a compliant Community Skin Cancer Service.
Progress made since June 2009 Review
NSSG meets regularly and attendance has improved. A dedicated CNS Group has been
established with CNS’s in post in all localities. Clinical Guidelines have been amended
accordingly. Network wide Audit took place for the management of Cutaneous
Lymphoma and changes reflected in referral pathway. Guidelines for BCC’s and SCC’s
have been updated and those for Melanoma revised in light of recent guidance.
Colchester MDT now meets more frequently with dedicated CNS, higher level of
histopathology attendance and made progress in concentrating surgery to core team
members who regularly attend. There is still an issue with plastic surgery attendance.
The South Essex local MDT has taken appropriate action regarding the Melanomas
being excised at Primary Care. BTUHFT have taken action to resolve problem of plastic
surgeon attendance at MDT. The inadequate oncology and plastic surgery input at
specialist MDT has not been addressed.
Membership for the SSMDT has improved following appropriate changes to job plans
and video links. The team meets weekly since November 2009.
The 4 PCT’s have made some progress in creating community services, however, yet to
be IOG compliant. All 4 have carried out base line assessments to identify the volume
of excisions taking place in the community. All PCTs in the process of identifying model
1 practitioners, however, progress has been hampered by recent draft NICE guidance
on management of BCCs currently out for consultation.
It was stated that all localities have established reporting arrangements with local
pathology departments, with appropriate alert systems, when Skin Cancer is excised in
the community. PCTs were urged to ensure appropriate local clinical governance
arrangements are in place to manage this scenario.
Action: KMK to circulate the full report when available
3.2 Single SSMDT for ECN (hosted by MEHT)
Co-ordination – Continues to improve and working well. Co-ordination issues are
discussed at monthly business meeting. Transfer of imaging and viewing imaging still
appears to be a problem.
Core Membership – Good attendance with all localities appropriately represented.
Teleconferencing – Have encountered some practical difficulties, but hopefully these
will improve with time. Also important that the teleconferencing arrangements are
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clearly documented in the Operational Policy.
Operational Arrangements/Review Operational Policy – It is vital that the Operational
Policy is up-dated to reflect current arrangements. Lead: MEHT leads.
Annual Report/Work Programme – It is vital that the SMDT agrees Work Programme
for 10/11 and completes the Annual Report for the six months or so that the SMDT has
been in existence. Lead: MEHT
3.3 Review 2009/10 Work Programme
KMK reminded NSSG of the Work Programme commitments for 09/10, progress for
which will need to be noted in the 09/10 Annual Report. The objectives include:
•
•
•
•
•
•
•
•
•
•
•
Action:
Consolidate NSSG – completed
Establish SSMDT – completed with on-going operational difficulties to be
addressed through monthly business meeting
Establish Community Skin Cancer Services – progress made but still significant
work to be done to deliver IOG compliance, therefore will continue as a work
objective for 10/11
Support local development of Sentinel Node Biopsy – not completed
Review and up-date NSSG Constitution/Clinical Guidelines document –
completed by Dr. Fraser-Andrews
Prepare for 2009 Peer Review Programme – completed
Appoint to Skin Cancer CNSs in all localities – completed
Identify key service developments for Skin Cancer - clearly incorporated in
NSSG business throughout 09/10
Agree Minimum Dataset and ensure data collection - incomplete but likely to
progress with roll out of Somerset System
Commit to Network-wide Skin Cancer Audit - completed and topic identified
for 2010
Contribute to the recruitment of clinical trials – group needs to formalise the
clinical trials list for Network to be actioned in 10/11
KMK in partnership with PD to draft Annual Report for 09/10 and
Work Programme for 10/11.
Possible 10/11 Work Programme objectives were summarised. These include:
•
•
•
•
•
•
•
Continue to strengthen SMDT
Formalise IOG compliant Community Skin Cancer arrangements
Commitment to Network-wide Audit and Service Monitoring.
Addressing any inequities in service provision for Skin Cancer across localities
Establish dedicated Skin Cancer CNS group to lead on service improvement for
Skin SSMDT
In partnership with Audit, present annual stats on Skin Cancer performance
and outcomes, addressing any inequities which may present
Support roll out of Somerset Information system and collecting data on all Skin
Cancer cases
3.4 Community Skin Cancer Services
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Unfortunately only SEE in attendance. Situation remains as reported previously.
Baseline assessments and report arrangements with histology departments in place.
However, progress hampered by NICE Guidelines on BCC out for consultation. SEE are
gearing up to implementing NICE Guidelines once published including GPs undertaking
minor surgery being clearly instructed not to remove any known Skin Cancers. There
are no current plans in SEE to have GPsWIs.
NSSG discussions re-emphasised the importance of appropriate clinical governance
arrangements within PCTs with pathology reports going to named leads and taking
appropriate action as required if Skin Cancer removed in the community.
Consultant-led Training Scheme – PD/EFA keen to develop a package similar to that
used in South Essex to enable standardisation across the Network.
3.5 Network Constitution
As acknowledged at last meeting, the Guidelines are now up-to-date thanks to Dr.
Fraser-Andrews.
3.6 Network-wide Audit 2010
Single topic for Network-wide Audit has already been agreed, this is “The Management
of Squamous Cell Carcinoma on Ear” – Lead Dr. Peter Dziewulski. Peter will be
circulating proforma in Excel asking local MDTs to complete and return data. It was
suggested that this includes all cases, not just those surgically managed, including
those cases where radiotherapy was a primary treatment. Date for presentation to be
agreed in Autumn 2010.
KMK asked that the group consider wider topics or presenting pre-agreed performance
metrics at Audit event. KMK reminded group members that key role of this group is to
demonstrate to Commissioners and the public that high-quality Skin Cancer service
exist in Essex and this should be demonstrated through half-day Audit and
performance presentation event.
3.7 Clinical Trial Recruitment
Ashley Solieri, ECRN Lead Manager, presented the NCRN-approved list of Skin Cancer
trials, and it was suggested that Ashley circulate this list to all the Lead Skin Cancer
Oncologists within the Network to secure standardised agreement and commitment to
trials list. This list in turn will be incorporated into NSSG Constitution document.
3.8 Sentinel Node Biopsy
Draft Business Case had been circulated widely within MEHT collating a range of
comments. Development is particularly pertinent to discussions around access to
clinical trials. It is primarily a staging tool with no survival benefit. All cases requiring
SNB should be agreed through the SSMDT and increasingly trials will require SNB and
should be developed through the Network. The NSSG, in conclusion, fully supported
develop of SNB at MEHT.
MOHS Surgery
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Unlikely to be developed within the Network within the short term, but again the NSSG
would fully support local access. Appropriate cases are currently referred to St. John’s.
Aspirational to establish service within the Network but ideally this should also be
placed at MEHT linked to plastic centre.
3.9 Skin Cancer Nurses Service Improvement Up-date
CNSs confirmed that they are now meeting regularly and discussing Service
Improvement initiatives, including nurse-led clinics, delivering keyworker,
standardising patient information, improving patient-focussed care, undertaking
Network-wide Patient Survey.
4.
New Business
4.1 National Patient Survey
NSSG reminded that all Acute Trusts were asked to sign up to the National Patient
Survey which will take place later this year.
4.2 Raising Awareness in Community Pharmacies Project – Skin Cancer CNSs were
approached and invited onto this project group looking at raising awareness within
community pharmacies. The CNSs were reminded that under no circumstances should
they be used to assess skin lesions in the community setting.
4.3 Head and Neck Skin Cancers – It was acknowledged and included in the Constitution
that patients with cancers above the clavicle will be discussed in both the Head and
Neck Cancer MDT and the Skin Cancer MDT, however, it was clear that the Skin MDT is
the best place to discuss the management of Melanoma cases. As both Essex MDTs
are hosted by MEHT this cross-communication/sharing of cases should be easily
managed. Clearly defined pathways need to be included in MDT Operational Policy.
5.
Date of Next Meeting
Tuesday 15th June 2010 – 2.00pm-4.00pm Kestrel House, Board Room
(Please note change of date to that agreed at meeting)
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Appendix 4
Skin Cancer Waiting Times
Performance against 3 cancer waiting times targets for each of the 4 Essex Cancer Network Trusts
PCT
South East
North East
Mid
South West
Total
Provider
Southend
Colchester
Chelmsford
Basildon
Total
2WW
No.
854/917
1745/1749
1091/1161
629/677
4319/4504
%
93.1%
99.8%
94.0%
92.9%
95.9%
2WW
No.
%
1/1
100.0%
2020/2024
99.8%
963/1046
92.1%
1342/1450
92.6%
4326/4521
95.7%
31 Day
No.
%
138/138
100.0%
60/62
96.8%
62/63
98.4%
153/153
100.0%
413/416
99.3%
31 Day
No.
%
19/19
100.0%
51/53
96.2%
116/117
99.1%
225/225
100.0%
411/414
99.3%
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62 Day
No.
55/56
40/42
53/55
62/62
%
98.2%
95.2%
96.4%
100.0%
210/215
97.7%
62 Day
No.
3/3.5
45/47
68/70
93/93.5
%
85.7%
95.7%
97.1%
99.5%
209/214
97.7%
Appendix 5
NSSG Chair Annual Review
Name: Peter Dziewulski
Date of Review:
Essex Cancer Network
NSSG Site: Skin
4th March 2010
Structure:
Peter Dziewulski has been chair of the Skin NSSG since its inception 18months ago and has
indicated his willingness to continue. His deputy is Elizabeth Fraser-Andrews a dermatologist
from Colchester.
Initially there was reluctance on the part of the Plastic Surgeons to attend the NSSG,
however they now attend regularly. The NSSG meets regularly and is properly constituted.
While the NSSG is well developed it did relied too heavily on the support of the previous
Network Director.
The NSSG recently held a good and well attended audit meeting.
The group is reviewing the management guidelines of Squamous cell carcinoma of the skin.
Strengths:
Peter Dziewulski felt that the NSSG was now coming together well and with a good spirit.
The organisation of individual case management such as staging and oncology treatments
has been better integrated with improved quality of care.
Areas for Improvement:
Video conferencing and SMDT organisation are still a challenge. Getting regular attendance
from busy plastic surgeons is still a problem but improving. A meeting to tackle node
dissections was planned to help plug the gap in service provision.
Develop plans for Mohs Surgery and Sentinel Lymph Node Biopsies
Documentation: The NSSG has produced the following documents:
•
•
•
•
Constitution including treatment guidelines
Annual Report
Work Programme
The strategic plan has still not been completed and needs to address the plans for
the development of Mohs surgery and Sentinel Lymph Node biopsies.
Peer review outcomes and concerns:
The Peer Review report was favorable and recognized good progress.
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Data and audit:
There are no issues around data collection with MDS proforma established.
Personal development needs and plans:
Peter Dziewulski requires more managerial support. Time is an issue for many members of
the group. He did point out that he was not paid for this role. (Traditionally this type of duty
is eligible for consideration for a Clinical Excellence Award, so mechanism for reward does
exist)
He was also reluctant to attend the mandatory Advanced Communication Skills course as it
would take 3 days; however he has now agreed to attend.
Signed
Mr T W Carr
Medical Director
Essex Cancer Network
4th March 2010
Next Review Due by 4th March 2011
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