Minutes of the Inaugural Clinical Governance Committee

of the Pelvic Floor Society

held at 8pm on Thursday 18th June 2015

In attendance:Mark Chapman (chair) – Consultant Colorectal Surgeon (Birmingham)

Steve Perring – Medical Physicist (Poole, Dorset)

Abdul Sultan – Consultant Urogynaecologist (Mayday Hospital)

Carolynne Vaizey – Consultant Colorectal Surgeon (St Marks Hospital)

Tony Dixon – Consultant Colorectal Surgeon (Bristol)

Arvind Pallan – Consultant Radiologist (University Hospital Birmingham)

1. Scene setting

MC explained that the pelvic floor society was a relatively new organisation inaugurated by Tony Dixon and is a grouping within the auspices of the Association of Coloproctology of Great Britain and Ireland. We are aware of a number of other organisations within the UK with an interest in pelvic floor disorders. These are the United Kingdom Continence Society (UKCS), the British Society of Urogynaecologists (BSUG) and the female section of the British Association of Urological Surgeons (BAUS). There are also a number of other organisations such as the Association of Gastrointestinal Physiologists (AGIP), the Association of Continence Advisors (ACA). We were also made aware of a significant number of pan European and international societies which are interested in pelvic floor matters including International Continence Society (ICS) and International Urogynaecology Association (IUGA). We noted that the Pelvic Floor Society was very much the new organisation in an already crowded area. We also noted that there was much duplication of effort across these societies.

There was a consensus that rather than start from scratch in clinical governance and setting standards it would be very sensible to learn from the experience of our other organisations especially BSUG. Abdul Sultan kindly agreed to talk to Ash Monga and Alfred Cutner who are president and president in waiting of BSUG with regard to joint working and standard setting. Carolynne Vaizey also will speak to Alfred Cutner. We felt rather than establish different standards from BSUG with regard to pelvic floor treatment we should aim to work with BSUG in setting specific colorectal standards.

Action: Carolynne & Abdul

2. Composition of the Clinical Governance Committee

We agreed with the premise that it would be good to have a multidisciplinary approach with physiology representative, professions allied to medicine (PAM) representative, and representatives from BSUG, BAUS and UKCS as well as 2 colorectal surgeons. There was debate about whether there should be a third surgeon but the view was that as our deliberations would need to be approved by the Pelvic Floor Committee further surgical input was probably not needed at the moment.

3. Standard Settings

We discussed standardisation of ano-rectal physiology testing. Carolynne Vaizey appraised us that there has been one international conference to set ano-rectal physiology standards. She was on this group as was Mark Scott and Charles Knowles. It is being led by Mark Fox. Currently the nomenclature for ano-rectal physiology testing is being decided before proceeding to how values are obtained and definition of the normal range. This is similar to the Chicago group for upper GI standards. Steve sits on the council of AGIP. We felt it was important that Steve and Carolynne discussed further the international standard setting process for ARP to share information and to disseminate the findings of this international working party.

Action:Steve & Carolynne

Abdul informed us that work was advanced on defining terminology of female ano-rectal dysfunction. Documentation is on the ICS and the IUGA websites. There was concern that perhaps there was not a credible colorectal presence on this group. We felt as a Pelvic Floor Society that we should review this document and if appropriate adopt it.

Action:All

We were also made aware that there is IQUIP accreditation for ano-rectal physiology units. This has been set up by the United Kingdom accreditation service. Currently it costs £2500 for units to be accredited and there was concern about the credibility of this programme. However, we felt it was important that there were standards for ano-rectal physiology and we were concerned by small stand-alone ano-rectal physiology units where there is perhaps a lack of standardisation. We felt that the Pelvic Floor Society should be setting standards which are attainable by most ano-rectal physiology units, not putting unreasonable burdens upon them but also ensuring that reasonable standards are maintained.

4. Radiology Standardisation

Arvind Pallan, a GI radiologist at University Hospital Birmingham, explained that pelvic floor radiology was rather a niche area and currently there was little standardisation or unified practice. Abdul Sultan informed us that currently there is a working party trying to define an international consensus on pelvic floor ultrasound. Interestingly we understand there are no UK radiologists on this group. Perhaps this reflects the fact that pelvic floor ultrasound in the UK is very under-developed. We felt we should be concentrating on MRI and contrast proctography in the first instance. We were informed that the following have an interest in pelvic floor radiology: David Tarver (Poole), Eric Loveday (Bristol), Arun Gupta and David Burling (St Marks), Steve Halligan and Stuart Taylor (UCH), Paul Tanquiez. We understand that individual units have individual protocols and Arvind expressed a concern that radiologists did not fully understand what surgeons wanted from radiological imaging.

We felt it may be sensible to convene a panel of interested GI radiologists to develop some form of consensus statement at the October pelvic floor meeting. Similarly a forum for GI physiologists to establish standards and understand the variation in practice across England would be a worthwhile event.

Action:Mark, Arvind, Steve

5. Data Collection

The matter of data was briefly discussed. BSUG have a mature database and have overcome much of the problems with confidentiality and data protection. We discussed whether it would be possible to approach the BSUG database co-ordinators (Paul Moran, Worcester) and to consider whether it would be feasible to bolt on a colorectal section to this database rather than develop our own database.

The point was made that cases need to be entered consecutively rather than just cherry picked as this would skew the results and also the added advantage of entering data is for individual consultant appraisal needs.

6. The Way Forward

We felt that this meeting had aired a number of substantial issues with regard to the management of pelvic floor disorders. Currently before standards could be developed there needs to be engagement and interaction between the various interested parties who needed to be signed up to the process. We felt we should continue to try and liaise as much as possible with BSUG, BAUS and UKCS.

Action:Mark and Tony

It was suggested that we meet either at the October meeting face to face or just prior by telephone conference.