Modernising Endoscopy Services Project

Group / Project Team Meeting
Date & Time / Wed 18th March 2009, 2 – 4 pm
Venue / Bretten Hall Conference Centre, AntrimHospital


Mr Kourosh Khosraviani / (Chair) NICaN
Dr Myles Nelson / NHSCT
Ms Beth Malloy / SDU
Mr Paul Kavanagh / NICaN
Mrs Sarah Liddle / NICaN
Mr Michael Megaw / NICaN
Dr Michael Gibbons / SHSCT
Dr Chris Steele / WHSCT
Dr Colin Rodgers / NICaN
Mrs Avril Kirkpatrick / DIS
Mr Finbar O’Kane / DIS
Margaret O’Hagan / NHSCT


Ms Rosemary Hulatt / SDU
Mr Chris Thomas / BHSCT
Dr Simon Johnston / BHSCT
Ms Alison McFerran / NHSCT
Dr Margaret Boyle / DHSSPSNI
Ms Karen Simpson / DHSSPSNI
Dr Maurice Loughrey / BHSCT

1.0Welcome and Introductions

1.1Mr Khosraviani welcomed everyone to the meeting and a round of introductions was carried out.

2.0Summary of Actions from last meeting

2.1Dr Myles Nelson raised the issue of dealing with patients not fit for colonoscopy. He highlighted that research shows that CTC would be a better option than barium enema, but noted that capacity on CT machines could be a limiting factor. Dr Nelson felt both CTC and double contrast barium enema should be utilised. Dr Chris Steele agreed that this approach as reasonable. Dr Colin Rodgers noted that CTC’s are operator dependent, and until local expertise is available double contrast barium enema should be used.

3.0Draft Screening Pathways for Secondary Care

3.1Mr Khosraviani highlighted pathway 4 as problematic and complex. Mrs Sarah Liddle agreed to liaise with Dr Nelson to simplify.

4.0Quality Assurance Standards

4.1Mr Khosraviani asked everyone to read the Quality Assurance Standards and forward comments to Mrs Liddle by the end of the week.

5.0Screening Colonoscopy Centres

5.1Mr Khosraviani outlined each trusts nominated Screening Units. Dr Rodgers emphasised BSG guidelines for Nurse Endoscopists and the need to have a supervising Consultant on site. Dr Rodgers noted the importance of adhering to these guidelines in order to protect Nurse Endoscopists. Mr Khosraviani and Dr Owen agreed that this should be highlighted in a letter to go back to trusts.

5.2Mr Khosraviani noted that three nominated screening units are within the greater Belfast area, and emphasised that nominated screening units have to be approved by the Bowel Cancer Screening Project Board. Dr Rodgers highlighted that over time, more units will achieve JAG accreditation and trusts will be able to alternate screening lists between different sites.

5.3After discussion, it was agreed that patients will be followed up in the same trust as they were screened in. Dr Rodgers emphasised the need for all information to be communicated back to the home trust that would have to deal with any emergencies at a later date. Future cycle patients will also go back to the site of screening colonoscopy.

6.0GRS Scores / Unit Action Plans

6.1Mr Khosraviani highlighted that a number of centres have resubmitted the same MES Action Plans. Mr Khosraviani explained that the aim of the MES Action Plans is to take the process forward and not just tick boxes.

7.0Pre JAG Visits

7.1Mr Khosraviani outlined the dates for Pre-JAG visits, and explained that they will concentrate on the nominated screening centre.

8.0GRS / JAG Improvement Forum

8.1Mr Paul Kavanagh informed the group of the first meeting of the GRS/JAG Improvement Forum on 21st April. Mr Khosraviani urged clinical leads to encourage local staff to attend the forum.

9.0ICT Secondary Care

9.1Mrs Liddle requested a date to look at information to be collected from secondary care with regards to call/recall. This will enable the development of standards and information requirements from secondary care.

9.2Mrs Kirkpatrick noted that this would require input from all members of the group. Mrs Kirkpatrick and Mrs Liddle agreed to draft pre work for the meeting.

9.3Dr Rodgers noted that the training and development of SSP needs developed as a vital part of the service. Dr Owen noted that the service needs developed to give a clearer view of our own service needs before this can be addressed.

9.4It was agreed that this work will be carried at the next scheduled meeting, on Wednesday 6th May, 2.00pm – 4.00pm.

10.0Surveillance waiting times standard

10.1Mr Khosraviani highlighted that surveillance patients have to be included in existing waiting times and asked for suggestions on how to take this forward.

10.2Dr Steele noted that the Western Trust is currently booking surveillance patients on a normal list. All referrals are now validated administratively and clinically, within 2 months.

10.3Dr Michael Gibbons noted that there is clinical validation in the Southern Trust, but highlighted that there are still a lot of patients being sent to the private sector. Mr Khosraviani asked Dr Gibbons to flag this with trust management.

10.4Ms Lorraine McDonnell added that surveillance patients in the Belfast Trust have taken a back seat due to the Cancer Access Targets. Mr Khosraviani asked Ms McDonnell to make Chris Thomas aware of this.

10.5Ms Margaret O’Hagan noted that the Northern Trust is struggling at the minute but an action plan is being developed to take work forward and surveillance is part of this.

10.6Dr Gibbons emphasised the need for clinical validation to ensure all patients on the list should be on it. Dr Nelson reinforced this and felt a timeframe needed enforced with funding from the Department of Health.

11.0Approval of Colonoscopists Training Schedule

11.1Dr Rodgers outlined that that there will now be five Approval of Colonoscopist courses run in 2009. This will give the capacity to train 20 people within 2009, and these places will be split equally among trusts to help with the onset of Bowel cancer Screening.

12.0Colonoscopy Practice Audit Report

12.1Dr Colin Rodgersnoted that the colonoscopy practice audit had been successful, and had brought unit audit to the forefront of endoscopy practice. Dr Rodgers added that the quality of the data varied, and a plan is in place to run a further audit towards the end of 2009.

12.2Dr Rodgers highlighted that the overall Caecal Intubation rate for Northern Ireland was 87%, and added that the audit showed an inverse relationship between the number of procedures carried out and the caecal intubation rate.

12.3Dr Rodgers explained that the audit highlighted to trusts that there may be too many people doing too few colonoscopies, and a redistribution of job plans may need carried out, but added that this audit would be too small to base this on.

13.0Any other Business

13.1Mr Khosraviani highlighted that a meeting is being held with the developers of TMS regarding a unified reporting system, and invited other clinicians to attend.

13.2Dr Rodgers queried if this process will have to go to procurement. Mrs Kirkpatrick highlighted that there is an existing contract in place and something may be able to be arranged through change control.

13.3Mrs Kirkpatrick highlighted that the purpose of the meeting is to see if an endoscopy

module linked to TMS is worth scoping.

13.3Mr Khosraviani asked Mrs Kirkpatrick to clarify if the process will have to go through tendering.