Peninsula Cancer Managers Meeting
Minutes of the meeting held on 11th September 2015
Strawberry Fields Conference Room, Lifton Farm Shop, Lifton
PRESENT:
Tina Grose – Lead Cancer Nurse (RDE) (Chair)
Pat Bartholomew – Cancer Services Manager (RCH)
Charlotte Overney – Lead Cancer Nurse (ND)
Nicola Mitchell –Cancer Services Manager (TST)
Emma Wheatfill – Cancer Services Manager (SD)
Sam Brenton - Lead Cancer Nurse/Matron (SD)
Nathan Brasington –Haematology and Oncology Service Manager (ND)
Ruth Card - Improvement Facilitator (RCH)
Katie Caley – Performance Information Analyst (RCH)
Alex Tait – Cancer Performance Manager (RDE)
Wendi Abraham - Macmillan Patient Pathway Redesign Project Manager
Jonathan Miller – South West Cancer Network Manager
Liz Boylan – Peninsula Cancer Network Manager
FREEDOM OF INFORMATION:
This group will observe the requirements of the Freedom of Information Act 2000 which allows a general right of access to recorded information including minutes of meetings, subject to specific exemptions. No one present today had any objections to their names being distributed in the minutes.
Minute No: / Action By /1. / Welcome / Apologies
Wendi Abraham, Macmillan Patient Pathway Redesign Project Manager, was welcomed to the meeting.
Apologies received from Sian Dennison (PHT), Louise Tillotson (RDE), Christine Bell (SD), Kathryn Radcliffe (RCH), Amy Charlton (RCH), Fran Lowery (RDE), Teresa Coombes (YDH)
2. / Minutes of Previous Meeting
A query was raised on minute 6.1 from the meeting held 13th March 2015. It was agreed that a completed proforma was required to process the referral. However it was noted that the clock starts when the referral arrives whether complete or incomplete.
The minutes of the previous meeting on 12th June 2015 were accepted as an accurate record, with the above exception.
3. / Matters Arising
Item 5.6.11 (12/12/15) – Action Closed. Open new action for JM/CSMs to clarify issues with Specialist Commissioners, including Head & Neck, SABR
Action: LB to create new action
Item 11.2 (13/3/15) – JM reported dwindling attendance by oncologists. Action: CSMs to ascertain any interest in trusts to lead on Radiotherapy and Chemotherapy
Item 3.1 (12/6/15) – Dates for Psychological Training to be sent out.
Action: TG to send out dates and list of nominated staff
Item 3.2 (12/6/15) – Final details of Cancer Facilitators not yet available.
Action: JM to circulate asap
Item 5.1 (12/6/15) – 2WW Guidelines not yet on trusts’ risk registers. Agreed biggest risk is effect of patients and who supports them.
Action: CSMs to identify risks
Item 6.1 (12/6/15) – SD and TG sent out KPI for feedback on Inpatient Nursing Standards.
Action: TG to resend
Item 7.1 (12/6/15) – Have received CNS Census from Cornwall, RDE, Plymouth and ND. Need remainder.
Actions: SD, TST and YDH to provide date. TG to circulate outcome.
Item 8.1 (12/6/15) – MDT proformas from each trust collated and sent out. SD said very useful in current review. Action closed. / LB
ALL
TG
JM
ALL
TG
TG
4. / Network Support /Funding
4.1
4.2 / Only confirmed support in writing from ND.
RDE happy to host if all signed up. TG sent round paper re benefits. Want to update taking into account latest document ‘Achieving World Class Cancer Outcomes’. Discussed 1-year post but felt this would not attract suitable applicants. Comments back in 10 days.
Action: CSMs to feedback comments to TG
Peer Review - Focus for next year will be on CUP and Head & Neck. Early indications are these will be risked assessed for Peer Review, probably with onsite visits.
Looking at 5-year plan and what should be centralised / CSMs
5. / NICE Referral Guidelines / Cancer Concern Form (draft)
5.1
5.2
5.3
5.4
5.5
5.6
5.7
5.8 / General consensus authors didn’t understand difference between Date to Diagnosis and Date to Treatment.
Existing site specific proformas designed to prevent GP incorrectly calling cases urgent. In future CCGs want to use single proforma. GPs say why should there be 12 forms when they may not know what type cancer is. The aim will be for a single portal from GP to hospital with appropriate information on referral form to decide treatment route on receipt. JM is expecting a national set of proformas and Macmillan have published a set of rapid referral forms, so
Referral Guidelines highlight number of problems we already know we have – poor capacity, reporting delays. CCG concern is that there now could be 3 week delay before 2WW referral. Clock doesn’t start on direct access referral but on a result that shows cancer.
In reality the trusts would treat a suspect cancer as a 2WW to maintain patient support. All trusts have concerns. Need safety net to capture cancers before going back to GPs
Issues raised:
· SD – In Upper GI goes straight to CT. Done in 2 weeks. Any suspect image referred to team as 2WW and copied to MDT coordinator.
· SD – currently have no way of managing. Present proformas go to each team. Who will do triage?
· SD – if working to 4 week DTT will need diagnostic done first. Could be lot of work before DTT
Need sign up from clinical leads. Clinicians to talk to GPs. Need to throw money as diagnostics. Send JM comments from each trust.
Action: CSMs to feedback comments to JM
Jim Farnell leading – is coming to RDE and speak to clinical team. Offer to speak to other trusts.
Action: CSMs to request visit if required
Action: TG asked RC to share their proformas with the group. / CSMs
CSMs
RC
6. / Eight Key Cancer Priorities
6.1 / Timed breast, prostate and lung pathways required by end August. SD plan to review couple of sites at a time, linked with guidance.
JM confirmed only cancer managers group can agree and sign off pathways
National meeting planned to see if they can change rules around breaches
TD/SD as tertiary centres RDE and PHT need timely information to come back, i.e. within 24 hours.
7. / National Cancer Strategy
Strategy signed off by 7 arms-length bodies. Not national policy. Timescales are what they would like to happen. NHS England are not making a formal response to the strategy. Not clear who is in a position to make things happen
Key Issues:
· 28 days RTT
· Formation of Cancer Alliances ( resources not there to support recommendations)
· Piloting budget (capilated)
44% more endoscopies predicted in next 5 years. SD have already had a 30% increase in the last 12 months.
TST have piloted colorectal triage reducing CTC waiting times. Some impact on endoscopy but coping.
MDT Review:
· Agree who has to attend
· MDTs / Specialist MDTs discuss same patients with same people in room
· MDT review could be a CIP saving
· Protocol for what would happen in certain circumstances ensuring patient care not compromised
· Put histology at beginning of meeting
If JM has clarity re budget for next year, look at it CIP saving / time saving
Action: Write to Peer Review – here is the strategy, our proposal, change measure
Action: JM to circulate Endoscopy & Radiology Reports / CSMs
JM
8. / Network Pathways
is arranging a SW Timed Pathways meeting on 29th September, 10am-2pm
Issues to be discussed
· Point on pathway where decision gets made to meet 62 day target
· SW set of timed pathways
· Share variation in activity
· Share timescales
Action: JM to send out agenda / JM
9. / Living With and Beyond Cancer
9.1 / WA described how the RDE were applying the recovery package in a phased approach with 4 sites initially, delivering the entire package and piloting holistic needs assessments. Currently being evaluating.
Phase 2 – getting ready for another 4 sites to come on board. Main champions are CNSs. Shifting thinking on how service delivered. Using IT to capture HNA and feed to CDM (Patient Information System).
Challenges:
· Cultural change over probably 3-5 years
· Win confidence of front line teams
· Use of IT
· Fear of financial implications, loss of revenue
· Tertiary referrals - how do we share HNAs across trusts. Treat as clinical document and send back to referring centre
CCG need to have CQUIN meeting – Best Practice tariff needs to be reviewed
Action: JM will set up event with contracts / clinicians.
RDE urology great success story, breast now have stratified pathways, need funding to implement
SD GPs doing cancer care review
RDE piloting treatment summary
Patient response has been fantastic without exception. No resistance and supported into self management. Pathway agreed at MDT.
ND also working in phases and other sites at different stages.
RDE doing structured feedback forms. Did baseline assessment, evaluation at each stage and evaluate patient at referral to Well Being Clinic and follow up.
Introducing KPIs one being 70% of patients have HNA. Changing CNS Job Descriptions
WA writing report and will share with group. WA to do presentation at next meeting
Action : WA to send report to LB for distribution / JM
WA
10. / MDT Roles & Responsibilities
10.1 / NM to share method for assessing workload. NB to share work done at ND.
11. / Feedback from SW SCN
Access Policy – Latest version V.5 ratified by Steering Group in July.
Chemotherapy Protocols - The Network supported the development of Chemotherapy Protocols by an oncologist and pharmacist based in Bristol. They can be found here: http://www.swscn.org.uk/guidance-protocols/cancer-protocols/ . These were discussed by the SW Chemotherapy Group and it was noted that: (a) the protocols had some risk in them
(b) some protocols are still to be completed
(c) there is no mechanism to feed back as the resource not there.
Agreed not to do any more until national algorithms published.
Agreed every provider compare own practice against published protocols by end September.
12. / AOB
12.1 / Prostate Drug - Trusts have been told by NHS England not to treat hormone sensitive prostate cancer patients with doxetaxel as there is not funding stream for it now. Patients should be advised to write to Mark Cook at NHS England requesting treatment.
Acute Oncology – it was asked if anyone is recording or getting tariff for acute oncology. Generally agreed service is qualitative not quantitative.
Palliative Care – NM drafting data set for Palliative Care that should be available in 2017.
Performance Model – NM agreed to look at setting this up on the Somerset Register if someone feeds back what they want the forms to look like.
ACE – to be included as future agenda item
13. / NEXT MEETING
Friday 11th December 2015, 10:00 – 13:00 in the Strawberry Fields Conference Room, Lifton Farm Shop, Lifton PL16 0DE
Dates / Venues for future meetings:
Friday 11th March 2016 10:00-13:00 Lifton Farm Conference Room
Friday 10th June 2016 10:00-13:00 Lifton Farm Conference Room
Friday 9th September 2016 10:00-13:00 Lifton Farm Conference Room
Friday 9th December 2016 10:00-13:00 Lifton Farm Conference Room
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Cancer Managers Meeting Minutes – 13th March 2015