Approved Minutes of Gynaecology Regional Group MeetingNICaN
NICaN Gynaecology Regional Group Meeting
Thursday 29thNovember 2007
Linenmill Room, Dunadry Hotel
Record of Attendees
Ms Maureen Clarke, Angels of Hope / Mrs Janis McCulla, NICaN TeamDr Ann Hamilton, Ulster / Dr. Sally Magee, Western Trust
Mrs Liz Henderson, NICaN Team / Dr John Price, Belfast Trust
Mrs Eileen Deery, Northern Trust / Orla Conlon, Western Trust
Ms Gwen Thompson, Belfast trust / Ms Jill Shaw–O’Doherty, Belfast Trust
Dr. Brian Bond, SE Trust /
Ms Gail Allen, Belfast Trust
Dr. David Glenn, SE Trust /Dr. Robin Wallace, Southern Trust
Ms Eilis McColgan, Belfast Trust /Dr Paul Weir, Mater
Ms Cara McCay, NICaN Team /Mrs Gail Allen, Belfast Trust
Apologies:Dr Alison Love, Dr Gary Dorman,Dr Stephen Dobbs,Dr R Lyness, Dr. Glenn McCluggage, Dr. A Mairs
Welcome and Introductions
Dr John Price welcomed everyone to the meeting.
GG-0708-14Minutes and Matters Arising
The Minutes of previous meeting were agreed. Matters arising were covered by the Agenda items.
GG-0708-15Relevant Updates from last meeting
Dr. Price indicated that the Trusts had been working closely with SDU over the last six months to establish the cancer access standards. He indicated that tracking of patients had commenced during August/September but that there was a resource issue in terms of the number of trackers available.
GG-0708-16Gynaecology Care Pathway: Update
Dr Price informed the group that he had been asked to develop timed care pathways to support implementation of the access standards. Dr. Price presented the pathways and diagnostic protocols to the group, emphasising that they were best practice pathways and were intended to be aspirational.
Cervical pathway - Some discussion took place around the cervical pathway and the availability of MRI within units. The Ulster and Antrim currently send patients directly to Arthur Grey due to lack of local expertise. Dr. Price suggested that units might be able to undertake the work according to protocols developed within the Cancer Centre. Discussion took place around the Unit’s ability to develop that expertise and whether or not that would be an appropriate way forward in light of the patient volumes. Dr. Wallace indicated that the radiologist in Craigavon had received supervision from Dr. Grey and was, after a year of cross reading, reading and reporting scans independently and that the process worked well.
Endometrial pathway – Discussion took place around the tight turnaround time for hysteroscopy and the need to aspire to one stop / see and treat clinics to ensure that the pathway can be delivered within the access standards.
Ovarian pathway–Dr. Price identified the need to add RMI to the pathway. Discussion took place around the availability of core biopsy. Again, the discussion highlighted inequities in provision. Resource is a significant issue for the Ulster while in Craigavon biopsies are taken when required, as they are picked up on MRI. Dr. Price indicated that this related to a general issue in relation to the number of trained intervention radiologists.
Concern was raised regarding the large volume of red flags referrals to PMB clinics. The group discussed the need to raise GP awareness of the early signs and symptoms of gynaecological cancers. It was agreed that patient and public awareness of symptoms might be considered for inclusion in the service framework.
Liz Henderson suggested that it might be useful to arrange a meeting of the radiologists to consider the impact of implementing the pathways on capacity, training and workforce planning within units and to agree a way forward.
Actions
Dr Price / Liz Henderson - to arrange regional radiology meeting.
All -As soon as a diagnosis of cervical or endometrial cancer is confirmed by biopsy the tracker at the Cancer Centre should be notified, referral should not wait for the MRI to be reported. However, MDT discussion will not until the MRI results are available.
GG-0708-17Cancer Access Standards
(i) Red flag referrals
Discussion took place around the quality of GP red flag referrals. Cara McCay reported the group that the initial guidance issued in May had not been received by all GPs. NICaNService Improvement Lead has recently worked with Boards and Trusts to try and improve awareness. The following measures have taken place:
- all GPs on the performers list have received a laminated copy of the guidance
- information sessions have been held across the region targeting GP clinical and social care governance leads and practice managers.
- Boards have agreed to dedicated a practice based learning session to facilitate cascade of the information to the wider practice team – a powerpoint presentation has been made available to practices to support this.
Cara indicated that she hoped clinicians would start to see improved use of the red flag system and that she was liaising with Dr. Hubert Curran at SDU with a view to developing the Minimum Data Set to facilitate electronic referral of suspect cancer. In the meantime she indicated that GPs had stated that they would welcome feedback from clinicians on inappropriate referrals as they come in. She also informed that group that she hoped that further GP sessions would be run next year and that if anyone wanted to provide specific feedback to NICaN on patterns of poor referring that information could be fed into the education process. Dr Price highlighted that this will be an ongoing process of education and requires clinician engagement.
The group agreed the need for triage of red flags to be undertaken daily by a consultant, senior registrar or staff grade. Clarification was given that GP red flags cannot be down graded. The group agreed that a partnership approach to triage was required in order to ensure cover for annual leave.
Dr. Price highlighted the need for clinicians to develop relationships with their patient navigators / trackers and to ensure that the latterare notified of GP red flags, consultant upgrades and patients referred through A&E or through incidental findings. Cara McCay reiterated this stating that access data indicates that only a small proportion of suspect cancers are currently being tracked.
Some discussion took place around models for ensuring rapid access for red flag referrals. Dr. Price indicated that red flags would be seen at the weekly PMB clinics and that 6 “red flag” slots were held over during regular clinics. Dr. Bond indicated that the Ulster now holds two red flag clinics each week (Tuesdays and Thursdays) and that there was a nurse dedicated to the management of those clinics and to liaison with the tracker. The group agreed that all units should aspire to holding dedicated clinics.
Action
All - To ensure patient navigators /trackers receive information on GP red flags, consultant upgradesand patients referred through A&E or through incidental findings.
GG-0708-18Framework Standards for Gynaecology Cancer Services
Liz Henderson informed the group that the comprehensive spending review means there is likely to be very little new money coming into cancer over the next three years or so. She emphasised that the CSF would probably be the services only lever to attract new funding. Hence, it was important that any service development priorities are included in the CSF. She informed the group that the standards should not include issues already being addressed by other means (e.g. access; HPV vaccination). Rather, the standards should reflect wider quality and equity issues within the service.
Dr. Price provided the group with an outline of the draft standards developed by Stephen Dobbs and others at the CSF workshop held by NICaN on the 12th October. Some discussion took place around what the service priorities would be. Gail Allen indicated that sexual dysfunction was a major issue for this patient group and that there was currently no dedicated service. The group agreed that this would be a worthwhile service development.
The group agreed to establish a sub-group to look at the standards in more details. Subgroup membership agreed as follows:
Dr. J PriceEilish McColgan
Dr. S DobbsLiz Henderson
Dr P WeirCara McCay
Gail Allen
Actions
Sub group members: To attend meeting on 14th December, 2pm, Tutorial Room, 4 North BCH.
Cara McCay: To circulate drafts of the generic standards and a more developed tumour group standard to the sub group in advance of the meeting.
GG-0708-19Gynaecology Cancer Dataset
Mrs Jill Shaw-O’Doherty informed the group that audit team no longer had access to the gynae clinical data set and that no audit data had been available since August 2007. The group agreed that this needed to be addressed as a matter of urgency.
Action
Dr. Price to follow up with Trust Executive Team and Cancer Registry
GG-0708-20Patient and Public Involvement
The group was informed about an upcoming conference being developed in partnership with Mrs. Maureen Clarke which aims to raise GP awareness of the early signs and symptoms of ovarian cancer. The conference is to take place on 7th March at Edenmore Golf Club, Moira. Drs Price and Dobbs have kindly agreed to be keynote speakers. Mrs Janis McCulla informed the group that the conference will be evaluated and if successful could potentially be replicated or further developed to provide GP awareness on other aspects of ovarian cancer treatment and care.
Date of next meeting - TBC
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