Nican Upper GI/HBP Regional Group Meeting

Approved Minutes of Regional Gynaecological Network

Wednesday 18th June, 2008NICaN

NICaN Regional Gynaecological Network

Wednesday 18th June

10.30am – 12.30pm

Ennis Room, BelfastCityHospital

Record of Attendees

Apologies:Ms Alison Love, Mr David Lowry, Ms Karin Jackson, Ms Sharon Fallows, Ms Anne Hamilton, Ms Eileen Deery, Dr Arthur Grey, Dr Gary Dorman, Ms Maureen Clarke, Ms Janis McCulla and Ms Jill Shaw-O’Doherty.

Welcome and Introductions

Dr Price welcomed everyone to the meeting, introductions were made and apologies noted as recorded above.

Ms Tourish was introduced to the group and it was noted that she will be the Clinical Network co-ordinator within NICaN who will be providing support to the Gynaecological group.

GG-0806-29Minutes and Matters Arising from Meeting – 9th April, 2008

The minutes of the meeting held on 9th April were agreed as accurate without amendment.

GG-0806-30Relevant updates from last meeting

Cancer Access Standards

Dr Price informed the group that the 62 day targets are being met within the service; however there is evident difficulty in meeting the 31 day targets due to annual leave cover etc.

Dr Price noted that until data becomes available from the Service Delivery Unit, it is difficult to judge where the service sits regionally within the targets.

‘Red Flag’ referrals

Dr Price advised that an audit had been carried out in relation to ‘red flag’ referrals which found that overall there is not an issue with inappropriate referrals. Generally, the referrals received were appropriate and some were upgraded to ‘red flag’ status once triaged.

The group suggested that there was still a need for GP education in relation to what is viewed as a ‘red flag’ for referral. Ms Henderson highlighted that a Primary Care Director is currently being recruited within the Cancer Network and that the issue of GP referral will form a large sector of this role and will be a key priority within the work plan for the newly appointed Director.

Action: Dr Price urged group members to carry out similar audits within their service and report back.

Cancer Services Framework

Ms Tourish provided update in relation to the Cancer Services Framework highlighting to the group that three standards were included in relation to gynaecological cancers and that implementation of these standards will form a large part of the groups work plan.

Ms Henderson advised that feedback from external quality assurance in relation to the framework was positive and the standards for Gynaecological cancers were endorsed as key standards for improving patient care.

Ms Tourish highlighted that there is a number of generic standards within the framework that apply across all cancers and thus will be relevant within Gynaecological cancers and drew specific attention to the standard fro Lymphoedema, a copy of which was shared with the group.

Standard for Effective Multi-Disciplinary TeamWorking

Ms Henderson highlighted the importance of the standard on multi-disciplinary team working highlighting that this will be a key standard as peer review is being introduced.

The group highlighted a number of issues in relation to the functionality of the Gynaecological MDT and in particular the time constraints to discuss patients effectively.

Ms Henderson advised that the Urology group recently participated in a session dedicated to the effective functioning of MDTs which proved very useful and sought comments from the group as to whether they felt that they could benefit from a similar session.

Action: It was agreed that a dedicated session would be worthwhile. Ms Henderson and Ms Tourish to arrange session and inform group of date and venue.

GG-0806-31Clinical Minimum Dataset

Ms Tourish advised the group that Dr Ranaghan (NI Cancer Registry) is currently collating comments received and also wishes to liaise with one further Consultant to gain feedback prior to circulating an amended dataset.

It was noted that Dr Ranaghan is to issue an amended dataset to Ms Tourish week commencing 23rd June, 2008 and Ms Tourish will then circulate to regional group for final comment.

Action: Group members to review amended dataset and provide any comment to Ms Tourish. Sign off to be achieved off line.

GG-0806-32Patient Transfer Form

Dr Price drew the group’s attention to a patient transfer form which had been developed by Dr Nagar. Copies of the form were circulated and comments sought as to whether this would be useful for roll out across the service.

Dr Price highlighted that use of this form will provide necessary information in relation to the status of the patient.

Ms Tourish advised that as the group already has a diagnostic protocol developed and agreed via the Inter-trust transfer (ITT) group that this patient transfer form would need to sit along side the protocol and thus would need to follow correct procedures via the ITT group for implementation.

Action: Agreed that form would prove useful and some amendments were noted.

Ms Tourish to liaise with Dr Nagar in progressing submission of form to ITT and further roll out.

GG-0806-33Roll out of Angel of Hope Events

Ms Tourish advised that Ms Maureen Clarke had hoped to be in attendance at the meeting to discuss the roll out of these events, however had to give her apologies unexpectedly.

Ms Tourish sought comment from the group in relation to the structure for hosting a number of these events and the trust areas which should be covered.

Ms Henderson highlighted that the key purpose of the events was to raise awareness of ovarian cancers and that the last event was very positively evaluated.

Action: The group were very supportive of the roll out of the events and it was felt that another event should be held within the Southern area.

Ms Elish McColgan to liaise with Ms Clarke on behalf of the group in relation to organising future events.

GG-0806-34Formal review of management guidelines for Gynaecological Malignancy

Dr Price drew the group’s attention to the documents which had been circulated being the Clinical Management Guidelines developed in 2002 and the Improving Outcomes Guidance (IOG) for the management of Gynaecological Cancers.

It was noted that a review of the guidance was now necessary in light of the Cancer Services Framework and general progression within the service over the years.

Ms Tourish presented a number of slides which detailed the key recommendations taken from the Clinical Management Guidelines developed in 2002 and from the IOG. It was highlighted to the group that the aim was to review the guidance developed in 2002 in line with IOG and agree a new set of Clinical Management Guidelines.

Dr Price asked the group to note that there is new Gynaecological Measures being published for 2008 by the NHS National Cancer Peer Review Programme, this document had not been circulated to the group as it is being discussed at a NSSG meeting on 4th July, 2008.

Ms Henderson highlighted that this document follows a different structure to that of Clinical Management guidelines and these measures will prove useful in self assessment and identifying key priorities once the Clinical Management guidelines for Northern Ireland have been reviewed.

Action: Ms Tourish to circulate copy of new gynaecological measures to group once formally published. Document to be used in identification of key priorities within work plan for the group.

Ms Tourish to circulate copies of the slides detailing the key recommendations to the group to assist in the review of the evidence.

Sub-groups to review guidance

The following sub-groups were agreed to review the various sections within the Clinical Management Guidelines:

Ovarian

Ms Joanne Millar; Dr Ian Harley; Mr Geoff McCracken; Ms Wendy Cunningham and unit lead to be identified

Cervical

Dr Hans Nagar; Dr Anne Drake; Dr Jackie Clarke; Ms Sharon Fallows and Ms Gwen Thompson

Endometrium

Dr Stephen Dobbs; Dr Gary Dorman (Unit Lead) and Dr Drake (Deputy)

Vulva

Dr John Price; Dr Hans Nagar and Ms Helen Vennard

Psychosexual

Ms Elish McColgan and other members to be confirmed

Diagnostics

Dr Grey; Dr Murtagh and Dr Symir ??

Lymphoedema

Ms Gail Allen and other members to be confirmed

Pathology

Dr Lyness and Professor McCluggage

Radiotherapy

Dr Price to advise sub-group members

Action: All sub-groups to review identified sections within guidance using Improving Outcomes Guidance as a minimum standard.

Amended sections to be completed by end of September 2008 in preparation for a workshop to be held on the morning of Friday 24th October, 2008.

GG-0806-36Gynaecological work plan

The template for populating the Gynaecological work plan was not discussed, however the group identified a number of key priorities within the work of the regional group as follows:

• Functioning of MDT
• Consent
• 1st patient visit
• Follow up protocols

Action: Ms Henderson to arrange to meet with Mr McClelland in relation to progressing this area.

Work plan to be further discussed at October workshop once Clinical Management Guidelines document has been updated.

GG-0806-36 Dates for future meeting and close

Dr Price closed the meeting by thanking everyone for their attendance and participation.

It was noted that a dedicated Gynaecological workshop will be held on Friday 24th October, 2008, time and venue to be confirmed.

Further meeting dates to be agreed and circulated.

1