Microsoft word - ecn urology nssg minutes 130212.doc
ESSEX CANCER NETWORK UROLOGY NSSG MEETING
Monday 13th February 2012
14.00 – 16.00 hrs
Swift House, Middle & Annexe
Chelmsford CM2 5PF
Tom Carr (Chair)
Medical Director, ECN
Consultant Urologist, BTUHFT
Clinical Oncologist, SUHFT
Consultant Urologist, SUHFT
Research Manager, ECRN
Consultant Urologist, BTUHFT
Consultant Urologist, MEHT
Consultant Urologist, MEHT
Network Director, ECN
F M McQueen
Clinical Services Manager, BTUHFT
Helen Hegarty, Lucy Powell, Jo Cook, Martin Nuttall, Kiran Kancherla, Kate Patience, Sampi
Metha, Alan Lamont, Brian Liversage, Dr Kumar, Olivia Chan, Petra Orebanwo, Bruce Sizer, Andrew Tanqueray, Rachael West, and John Corr.
It was agreed that it would be useful to avoid dates that fell in the school holiday if at all
Reconstruction Audit- Deferred until next time. Miss Hegarty unable to present.
Previous Minutes – 15th December 2011
The minutes required 2 corrections before they could be considered to be a true reflection of
Rebecca Dale was the SpR who had attended the meeting from MEHT Section 4.2, the CNS’s had not been able to meet due to sickness.
IOG Compliant Arrangements
The letter from NCAT had been discussed at the ECNB. The board had asked that the NSSG
give it further consideration and report back.
TC produced a discussion document. There was a general discussion. The consensus was
that a working party be established outside of the NSSG to consider this and report back. The
discussion document will be distributed with the minutes.
SM to establish a work group.
The work to include the pathways within the Constitution is outstanding. A small group to
meet to review the Clinical Guidelines. Action:
SM to facilitate.
RT queried if the patients need to go through both the ECN SMDT and the Chase Farm
SMDT. Currently these patients are only going through the ECN SMDT. Action:
RT to confirm with Chase Farm.
Peer Review Programme 2011 and 2012
There had been 2 serious concerns noted. The first had been dealt with in Section 3.1 With regard to Histopathology, a letter had gone out to all trusts informing them of the
requirement for all slides to be reviewed by the SMDT pathologist. This applies to all
specialties. Also, where specimens are removed at a centre they need to remain again for the
interpretation of the local pathologist. SUHFT suggested that this may cause them some
short term operational issues but should have them resolved soon. The processes to be established between pathology services and not add extra burden to
There will be no visits to the Urology teams or NSSG this year.
All teams, with the exception of MEHT, need to do the Self-assessment process who also
SM suggested that although there is no requirement to upload and link documents, uploading
them so that they are publically available is good practice.
The deadline for completing the process is the 30th September, but all teams to check with
their local management as some set their own internal targets.
• Update on 2011 Audit actions
Acute Oncology Presentation:
• All teams to ensure that they put in place the fast track appointments required to
• All teams to ensure that local processes are reflected in revised Ops policies.
Patient experience of being referred to a Cancer Centre Audit:
• CNS group to review the information given to patients on discharge.
• NSSG to agree for a target time for follow up post surgery.
There were discussion amongst the group and the following post surgical follow up was
Target times for follow up to be included in the next version of the clinical guidelines. TWOC clinics:
Network-wide BCG Audit:
• MEHT only unit now not getting written consent.
AT to share Southend documentation with MEHT CNS’s
All Cancer Managers to ensure that this is put in place.
Audit of RT late Toxicity effects:
• Audit to be extended to cover both RT centres in 2012.
• Daily use of Cialis- see section 3.4
The roll out of standard ERP pathways across the Network to be added to the Service Delivery Plan. Still outstanding.
• Repeat of late toxicity audit- Lead PL
• Repeat Patient experience of being referred to a Cancer Centre-CNS group to lead
• Rehabilitation services Gap analysis- Kate Patience
• Research presentation- AS to confirm lead
• Neoadjuvant chemo for cystectomy- Lead MD and MB
3.4 Penile Rehabilitation Programme
TC and SM had met with Commissioning Pharmacists in respect of the daily use of Cialis.
They had also discussed the Penile Rehabilitation paper produced by Mr Garaffa. They
suggested that this protocol was not acceptable as they would not commission the use of Cialis outside of its licensed dosage. They have asked the NSSG to produce a pathway
SM reported that the Chemo Board, subject to ECNB approval, will have a wider remit to
include commissioning decisions on other Cancer Pathway related drugs to be renamed the
ECN Medicines Management Board. Once a protocol for the use of cialis is agreed it will need to be presented to this Board.
Working group to be established to develop a Penile Rehabilitation
SM, at the request of the CNS’s, had asked for the contact details of the CNS at the centre.
This was discussed at the Sarcoma NSSG at the centre who fed back that they will not
provide this information and that all contact should be through the MDT Co-ordinator. All felt
that this was unacceptable. DT suggested that this could be overcome with a CNS in the Network taking responsibility for
Sarcoma. Southend had made attempts in the past to do this but with no luck.
RL to write to the Chair of the Sarcoma Advisory Group.
MD provided feedback to the group. At the outset there had been concerns about the impact
on Radiology. They have found that 80% of the MRI scans were proven to have cancer on
biopsy. They have since revised their protocol further. Those that have the following have MRI prior to TRUS Bx:-
MD said that in their experience you cannot judge suitability from the referral letter so all are
seen in clinic prior to the MRI. In some cases the MRI where suspicious had encouraged early
re-biopsy in the face of a normal/negative first biopsy. Several cancers have been diagnosed in this way indicating that the MRI and TRUS/Bx may become complimentaruy.
All agreed that a Network-wide policy would be advantageous.
MD to prepare a protocol for discussion at the next meeting.
3.7 Feedback from Zonal Team meeting
Standing Agenda Items
RB reported that there had many changes in the Network User Partnership. He also reported that Brian Liversidge will be taking a back seat for a while. AT asked of the chair could write
to Brian with well wishes and thanks for his help to date.
The Southend Group had now secured funding from Macmillan for an Information Centre,
which should be completed by December 2012. Support has been offered to MEHT who are
4.2 CNS update
The CNS’s had not been available to meet as a group, it had been hoped that this would have been earlier today.
4.4 Agree Action points from Audit:
RT would like to open the Hymn commercial study at MEHT. Will require support from all
Trusts if this is to be pursued given the numbers that would need to be recruited to justify
The group was not sure that there would be the numbers. However, all agreed to retrieve potential numbers from their trusts and feedback.
Any other Business
SM described how the default position had been that if the chair is not available then she had
been asked to chair. Today it had been necessary for TC to chair as she was taking minutes.
Other NSSG’s have a Vice chair from the membership entirely for this purpose. SM to email out to the whole membership for nominations, and subsequently for a ballot if
Date of Meetings for 2012
All 2.00pm – 4.00pm, Middle and Annexe, Swift House
Wednesday 9th May
Wednesday 11th July – Swift Middle & Annexe Please note extra date
Wednesday 24th October Audit and NSSG- 9.30 – 5.00pm venue tbc
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