Minutes of the Skin Cancer NSSG MEETNG

Thursday 18th June 2015 at 2.00pm

Lifton Strawberry Fields Farm, Lifton, Devon

Attendees:

Karen Davies (KD) Chair, NDHT / Jonathan Miller (JM) NHS England / Stephanie Hale (SH) SDHT
Laura Beer (LBe), NDHT / Sarah Sandford (SS) RDE / Clem Ng (CN) SDHT
Duncan Mackenzie (DM) PHT / Rebecca Batchelor (RB) RDE / Rosie Davies (RD) SD
Ruth Devlin (RD) PHT / Claire Facey (CF) RDE / Ben Waterfall (BW) GP Brannam
Sarah Carswell (SC) RCHT / Ann McCormack (AM) RDE / Rachel Wachsmuth (RW) YDH
Emily McGrath (EMg) RDE / Pam Lewins (PL) SDHT / Karen Curtis (KC) TST
Stephen Adcock (SA) RCHT / Jo MacDonald (JMa) TST / Liz Boylan (LB) PCN
Jill Adams (JA) TST / Wendy Cook (WC) PCRN / Sue Buddin (SB) PCN
Item / Action
1.
1.1 / Welcome/Apologies
KD welcomed members. (See Appendix A for apologies). It was confirmed that Taunton & Somerset Trust and Yeovil will be part of the SW Peninsula Skin Cancer NSSG.
Action: LB to send copy of minutes and invite TST and YDH members to attend next meeting
Actions from meeting held 27th November 2014 complete. / LB
2.
2.1
2.2
2.3 / Network Support Services
LB took up her post as Peninsula Cancer Network Manager in December 2014. The Admin Support role was filled in March 2015. These posts are funded for one year by the South West Strategic Clinical Network (SWSCN). A business case has been prepared for future funding to be provided by the local trusts, with the costs of the NSSG service divided based on trust size and the number of NSSGs within the Peninsula in which each trust will be participating.
To date all site specific groups have had one NSSG meeting with a second planned for the autumn.
Recent meeting attended by KD, chaired by Sean Duffy of NHS England, to set up a National Clinical Reference Group for skin cancer to advise commissioners. This highlighted the varied way networks are now functioning across England.
3.
3.1
3.2
3.3 / Document Review
The current Terms of Reference, Constitution and Clinical Guidelines require updating.
Terms of Reference: The draft ToR had been circulated with the agenda. This will be updated and circulated. Any comments to LB by end-September 2015
Constitution: An updated draft of the Constitution with current membership will be circulated with the agenda. All trusts to review their details and return with any comments to LB by end September 2015.
KD asked for names of MDT leads and CNS at each trust as the current list is out of date:
RDE / Chris Bower / MDT Lead / SD / Clement Ng / MDT Lead
Claire Facey / CNS / Pam Lewins / CNS
Sarah Sandford / CNS / Stephanie Hale / CNS
Kate Allington / CNS / TST / Jill Adams / MDT Lead (joint)
Jo Short / CNS / Karen Curtis / MDT Lead (joint)
PHT / Duncan Mackenzie / MDT Lead / Jo Macdonald / CNS
Ruth Devlin / CNS / Ben Hawthorne / CNS
Jill Daniels / CNS / YDH / Rachel Wachsmuth / MDT Lead
RCHT / Tom Lucke / MDT Lead / Mihaela Savu / CNS
Sarah Carswell / CNS / ND / Karen Davies
Andrew Watts / Joint MDT Lead
Joint MDT Lead
Lisa Tripp / CNS / Laura Beer / CNS
Chairmanship – KD agreed to continue as Chair – agreed by those present.
Action: Updates and comments to LB by end September 2015 / ALL
4.
4.1 / Enhanced Melanoma Follow-Up Guidelines
Proposals for CT/MRI on melanoma patients at high risk of recurrence. Some MDTs are offering regular scans for those at high risk as per the recent ‘position statement’ published by oncologists. Agreed reasonable to offer to patients if MDTs agree to, and some are already doing so, but it is not yet national guidance.
Agreed that enhanced follow-up with regular 6 mthly CT (MRI head) may be considered and offered to patients who would be fit enough to receive Ipilimumab.
SLNB Network Guidance
KD confirmed that the Skin Cancer Network has previously agreed NOT to routinely offer SLNB to patients with melanoma less than 1mm thick ( ie stage 1b with tumour less than 1mm but with raised mitotic count). This is stated in the network skin cancer guidelines.
Action: KD to review and issue network guidelines for agreement / KD
5.
5.1 / Guidelines
KD to update and send out draft of new network skin cancer guidelines. When agreed will be published on South West Cancer website http://www.swscn.org.uk/networks/cancer/site-specific-groups/peninsula-site-specific-groups/peninsula-skin-cancer-ssg/peninsula-skin-cancer-ssg-information-for-members/ and links included in the updated Constitution.
Action: KD to update and send out draft guidelines / KD
6.
6.1 / Next Annual Network Course for GPs doing skin cancer work
The next GP Course has been scheduled for 24th September 2015 at the Arundel Arms, Lifton.
Action: KD to ask Lisa Wells to send another email reminding GPs of date – and ask for suggestions from GPs for course content. / KD
7.
7.1 / GPs wanting to do low risk BCC work under LES agreements
Last course ran in North Devon 3 years ago. GPs currently operate on some low risk skin cancers, but there is no funding for any new LES agreements. KD to capture issues in e-mail for JM to follow up. JM will contact CCGs and NHS England in SW.
Action: KD to e-mail details to JM for follow up / KD/JM
8.
8.1 / Dermatology Day for Commissioners – 22nd April 2015
Advice given to commissioners about complexities of commissioning dermatology and skin cancer services. Particular emphasis on the key issue of triage of referrals.
Action: JM to e-mail KD with link to documents on the website. / JM
9.
9.1
9.2
9.3 / Devon CCG Benign Lesion Policy
KD has contacted Devon CCG to ask them to remove the skin cancer pathway which had been inadvertently put into the Benign Lesions Policy.
Triaging through DRSS discussed. Many GP letters don’t give clear diagnosis. Consider role of specialists in triaging. DRSS do have a pathway for directing skin referrals.
KD discussed issue of referrals potentially rejected by referral management organisations. KD has advised DRSS that they need to ensure that they do not reject referrals where there is any diagnostic doubt expressed.
10.
10.1
10.2 / SCC Follow Up
JM/KD – Current practice for follow-up of SCCs varies between centres and clinicians. Most GPs can’t do follow-up – don’t have specific training, don’t have systems for recall, and concerns about shift of workload to primary care.
Current network guidelines reflect this differing practice.
Action: Each trust to send current practice to KD.
Action: KD will re-write follow-up guidelines and issue draft for agreement. / ALL
KD
11.
11.1
11.2 / Audit / Clinical Research Trials
Audit - KD suggested possible audit on basisquamous tumours.
RW advised re audit of SCCs being suggested by David deBerker.
Action: KD/RW to communicate with David deBerker re SCC audit.
Clinical Research - WC outlined recent changes to the research network and, on behalf of Toby Talbot, NSSG sub-specialty lead for skin cancer, presented the latest clinical trial recruitment data for the Peninsula.
The southwest has the highest incidence of skin cancer in the country, but a low numbers of trials in proportion, as most are allocated to larger high profile centres.
TT is proactive in trying to promote the southwest to companies setting up trials.
Action: TT to provide details on open/upcoming trials and consider network-wide recruitment / KD
TT
12.
12.1 / Living with and beyond Cancer Programme
Some funding to support available from Macmillan. Health & Wellbeing Clinics run by CNS with access to psychiatrists, dieticians eg: Force, Mustard Tree, the Cove. Centres, run by nurse specialists and volunteers, provide recovery package including holistic needs assessment, careplan and treatment summary. Request for Well-Being Video.
Clinicians acknowledged that this system for follow-up does NOT save money.
Action: LB to see if video or other media available and send links. / LB
13.
13.1
13.2 / AOB
2WW Referral Forms – KD has been asked by DRSS if we can all have one 2ww proforma – currently all trusts are using different forms. JM will issue draft standard proformas for use across South West once new NICE guidance are released (this week). JM will validate with GPs systems and issue to group.
Action: JM to send copies of draft proformas when completed.
Skin Cancer Campaign 2014 - Feedback requested re changed knowledge, behavior, increased referrals.
Action: JM to send link to campaign feedback. / JM
JM
14. / Date of next meeting:
The next meeting will be held on Thursday 12th November in the Conference Room, Lifton Farm Shop, Lifton – 2-4pm

APPENDIX A

Skin Cancer NSSG Meeting 18th June 2015 - Attendees / Apologies
Surname / Forename / Org / Job Title / Signature
Beer / Laura / ND / Chemotherapy staff nurse / Present
Davies / Karen / ND / Consultant / Present
Wells / Lisa / ND / Dermatology Manager
Devlin / Ruth / PHT / Clinical Nurse Specialist / Present
Mackenzie / Duncan / PHT / Consultant / Present
Chave / Toby / PHT / Consultant Dermatologist
Curnow / Alison / RCHT / Lecturer
Lucke / Tom / RCHT / Consultant / Apologies
Carswell / Sarah / RCHT / Clinical Nurse Specialist / Present
Hann / Samantha / RCHT / Consultant / Apologies
Talbot / Toby / RCHT / Consultant / Apologies
Adcock / Stephen / RCHT / Maxillofacial Surgeon / Present
Tripp / Lisa / RCHT / Clinical Nurse Specialist
McGrath / Emily / RDE / Specialist Registrar / Present
Sandford / Sarah / RDE / Clinical Nurse Specialist / Present
Allington / Kate / RDE / Clinical Nurse Specialist
Batchelor / Rebecca / RDE / Consultant Dermatologist / Present
Bower / Chris / RDE / Consultant Dermatologist / Apologies
Charman / Carolyn / RDE / Consultant Dermatologist / Apologies
Facey / Claire / RDE / Clinical Nurse Specialist / Present
Hughes / Sarah / RDE / Cluster Manager
McCormack / Anne / RDE / Consultant Oncologist / Present
Oliver / David / RDE / Consultant
Stone / Chris / RDE / Consultant
Lewins / Pam / SD / Clinical Nurse Specialist / Present
Hale / Stephanie / SD / Macmillan Skin Cancer Support Nurse / Present
Ng / Clem / SD / Consultant / Present
Davis / Rosie / SD / Consultant / Present
Waterfall / Ben / Principal GP (Brannam - L83073) / Present
Acheson / Peter / GP (Claremont - L83056
Chamberlain / Victoria / GP (Heavitree - l83077) / Apologies
Crighton / Helen / GP (Mount Pleasant - L83066)
Lawn / Noel / GP (Woodbury - L83116) / Apologies
Pitt / Joe / GP (Townsend - L83054)
Willcock / William / GP (Rolle - L83053
Wachsmuth / Rachel / TST / Consultant Dermatologist / Present
Adams / Jill / TST / Consultant Dermatologist / Present
Curtis / Karen / TST / CNS / Present
Macdonald / Joe / TST / Skin Cancer CNS / Present
Barthakur / Urmila / TST / Oncologist
Barlow / Clare / TST / Consultant Oncologist
Edwards / Felicity / YDH / Consultant Dermatologist
Savu / Mihaela / YDH / CNS
Miller / Jonathan / NHS England / South West Cancer Manager / Present
Cook / Wendy / PCRN / Research Delivery Manager / Present
Buddin / Sue / PCN / Pensinsula Network Admin Support / Present
Boylan / Liz / PCN / Pensinsula Cancer Network Manager / Present

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Skin NSSG Minutes 18.06.15 draft V0.1