north trent cancer network nssg constitution for head ... and neck... · the meeting is quorate...
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North Trent Cancer Network
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North Trent Cancer Network
NSSG Constitution For Head & Neck Cancer NSSG 14/05/11
Agreements / Cover Sheet The NTCN Network Site Specific Terms of Reference (Appendix one) were revised and agreed at the Network Board on in February 2009. Agreement for these terms of reference was sought from Chair Network Board, SHA Chief Executive, Trust Chief Executives, NSSG Chairs, Specialist Commissioner and Lead Cancer Clinician prior to sign off. This NSSG Constitution was agreed by Mr Austen Smith, Consultant Maxillofacial Surgeon, Sheffield Teaching Hospitals, Chair of the Head & Neck NSSG, on 14/05/10 Mr David Chadwick Consultant Surgeon Chair of Thyroid subgroup on 14th May 2010 and 25th June 2010 This NSSG Constitution was agreed by Annette Laban, Chief Executive,NHS Doncaster, Chair of the Network Board on 14/05/10
This NSSG Constitution was agreed by the NSSG members, on 14/05/10
NSSG Constitution Review Date: 1st April 2012
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11-1A-201i Terms of Reference (see appendix 1) Membership of Group The Head & Neck NSSG consists of the following agreed members
11 - 1A-201i/ 11 - 1C-104i MEMBERSHIP OF HEAD & NECK NSSG GROUP and THYROID SUB-GROUP CORE MEMBERS CHAIR
Mr Austen Smith Cons Oral Maxillofacial Surgeon
Sheffield / Barnsley
DEPUTY CHAIR
Mr Mark Watson Cons ENT Surgeon Doncaster & Bassetlaw LOCALITY LEADS & DEPUTIES
Mr Alan Paterson Cons Maxillofacial Surgeon Rotherham Mr Stuart Richards(Dep)
Cons ENT surgeon Rotherham
Mr Mark Watson Cons ENT Surgeon Doncaster & Bassetlaw Janet Ryles (Dep) ENT CNS Doncaster & Bassetlaw Mr Martin Wickham Cons ENT Surgeon Barnsley Mr Michael Nussbaumer (Dep) Cons ENT Surgeon Barnsley Mr Peter Doyle Cons Maxillofacial Surgeon Chesterfield Mr Mohammed Haneefa (Dep) Cons ENT Surgeon Chesterfield Mr Thomas Westin MDT lead Cons ENT
Surgeon Sheffield
Dr Kash Purohit (Dep) Consultant Oncologist Sheffield EXTENDED CORE MEMBERS Mr David Chadwick Cons Surgeon (Thyroid Chair) Chesterfield Mr Stuart Richards Consultant ENT Surgeon Rotherham Mr Andy Parker Cons ENT Surgeon Sheffield Mr Robert Orr Cons Maxillofacial Chesterfield Dr Martin Robinson Snr Lecturer Oncology Sheffield Dr Bernie Foran Cons Oncologist Sheffield Dr Jonathan Wadsley Cons Oncologist Sheffield Mr Aidan Fitzgerald Cons Plastic Surgeon Sheffield Mr Shahed Quraishi Consultant Otolaryngologist Doncaster Keith Hunter Cons Oral Pathologist Sheffield Mr Raj Patel Cons Restorative Dentistry Sheffield Sam Sharpe Speech & Language Therapist Doncaster & Bassetlaw Abi Miller Speech & Language Therapist Chesterfield Jane Thornton Speech & Language Therapist Sheffield Vicky Gallivan Dietitian Sheffield
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NURSE MEMBERS Janet Ryles H&N Clinical Nurse Practitioner Doncaster & Bassetlaw Tracy White Macmillan CNS H&N Sheffield Louise Marley Macmillan CNS H&N Sheffield Mary Green Head and Neck clinical nurse
practitioner Chesterfield
Sharon Stoddart Head and Neck clinical nurse practitioner
Chesterfield
Judith Lunn Macmillan CNS H&N Rotherham Lisa Smith ENT CNS Barnsley USER MEMBERS Mr Dennis Atkin Mr Malcolm Babb Mr Ray Mountain
ROLES ASSIGNED TO CORE MEMBERS NSSG member responsible for recruitment to Clinical trials Bernadette Foran Consultant Oncologist Sheffield
NSSG SERVICE IMPROVEMENT LEAD
Janet Ryles H&N Clinical Nurse Practitioner Doncaster & Bassetlaw
MEMBER RESPONSIBLE FOR USER ISSUES AND INFORMATION
Tracy White Macmillan CNS H&N Sheffield
NON-CORE MEMBERS
MANAGEMENT SUPPORT
Management support will be provided as required by either the Network Lead Nurse, or the Service Improvement Lead.
ADMINISTRATIVE SUPPORT
Administrative support will be provided by the Network Groups’ Support Officer.
MEMBERSHIP OF THE WIDER GROUP
All ENT/OMFs surgeons, consultant radiologists, pathologists, specialist nurses with an interest in head and neck cancers are welcome to attend meetings. THYROID SUB-GROUP (11-1C-104i )
Mr David Chadwick (Chair)
Consultant Surgeon Chesterfield
Mr Amit Allahabadia Consultant Endocrinologist Sheffield
Mathew Bull Consultant Radiologist Sheffield Cathy Clout Consultant Radiologist Sheffield Judy Darwent Clinical Nurse Specialist Sheffield Maxine Eades Clinical Nurse Specialist Sheffield Anne French Clinical Nurse Specialist Sheffield Mr Barney J Harrison Consultant Surgeon Sheffield Mr Shahed Quraishi Consultant Otolaryngologist Doncaster
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Mr Stuart Richards Consultant ENT Surgeon Rotherham Dr Tim Stephenson Consultant Histopathologist Sheffield Mr Saba Balasubramanian
Consultant Surgeon Sheffield
Dr Jonathan Wadsley Consultant Clinical Oncologist Sheffield Mr Mark Watson Consultant ENT Surgeon Doncaster Mr Martin Wickham Consultant Surgeon Barnsley
The meeting is quorate when 50% of the constituent core members are represented at the meeting, but the chair can declare a larger meeting non-quorate if key members are not present. The mechanism for obtaining user advice if there is no user representative at the meeting is via feedback from the network representative to the network User facilitator and Partnership Group. Role / Function of the Group
The NSSG is recognised as;
• The board’s primary source of clinical opinion on issues relating to Head & Neck cancer for the network
• The group with corporate responsibility, delegated by the board, for co-ordination and consistency across the network for cancer policy, practice guidelines, audit, research and service improvement
• Consulting with the relevant ‘cross cutting’ network groups on issues involving chemotherapy, cancer imaging, histopathology and laboratory investigation and specialist palliative care; and with the head of service on issues involving radiotherapy.
• The chair facilitates the identification and agreement of the service priorities for the NSSG and recommends priorities to the network board.
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11-1C-101i
PROGRAMME OF DATES FOR 2010 NORTH TRENT HEAD & NECK CANCER NSSG MEETINGS
The following programme of dates for 2010/ 2011 meetings agreed by the NSSG.
DATE TIME VENUE
Friday 10th September 2010
2-4.00 p.m. Redmires Room Don Valley House Sheffield
Friday 10th December 2010
2-4.00 p.m Redmires Room Don Valley House Sheffield
Friday 11th February 2011 2-4.00 p.m Redmires Room Don Valley House Sheffield
Friday 13th May 2011 2-4.00 p.m Howden Room Don Valley House Sheffield
Friday 9th September 2011
2-4.00 p.m Redmires Room Don Valley House Sheffield
Friday 9th December 2011 2-4.00 p.m Redmires Room Don Valley House Sheffield
Thyroid subgroup meeting dates Date Time Venue Friday 4th December 2010 2-4.00p.m Don ValleyHouse
Sheffield
Friday 25th June 2010 (inc Business meeting)
2-4.00p.m Don Valley House Sheffield
Friday 14th January 2011 (inc Business meeting)
2-4.00p.m Don Valley House Sheffield
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Network Configuration
Scope of Service (11-1A-202i,)
The oversight of Head & Neck cancer for North Trent is via a single network group which deal with UAT cancer and has the structure, functions and terms of reference as in measure 11-1A- 201i plus a separate single sub group of the NSSG for the network which deals with Thyroid cancer 11-1C-104i.
(ii) 11-1A-203i The named hospitals, designated as in (i), for the network, distributed such that the PCTs agree that their populations have sufficient access.
• There are designated hospitals for the diagnostic and assessment service.
• The hospitals fulfil the following criteria:- o They have specialised facilities for investigation of head and neck patients. o They have contracted direct patient care sessions with at least two
designated clinicians for head and neck diagnosis and assessment o They are the only hospitals for which there are contact points specified in
the Primary Care Referral guidelines for head and neck cancer. MDT Designated Hospital
for Diagnosis & Assessment
Undertaking curative surgical Procedures
Designated Head & Neck Ward
Bassetlaw District General Hospital;
N/A N/A
Barnsley Hospitals NHS Foundation Trust
N/A N/A
Chesterfield Royal NHS Foundation Trust
Yes Barnes Ward
Doncaster Royal Infirmary
Yes (laser surgery only )
S12
Rotherham Hospitals NHS Foundation Trust
N/A N/A
NTCN Head & Neck MDT (from 1
st
December 2007)
Royal Hallamshire Hospital. Sheffield/Charles Clifford Dental Hospital
Yes Head & Neck Centre I Floor RHH.
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• There is agreement on those hospitals where the curative surgical treatment for head and neck cancer takes place
• They have a designated head and neck ward
• There is one named MDT based at Sheffield Teaching Hospitals NHS Foundation Trust which carries out all their surgical procedures for Head and Neck cancer
MDT Host
Organisation Designated Hospital for Diagnosis & Treatment
Referring PCT Catchment Population (resident)…
Bassetlaw District General Hospital;
NHS Bassetlaw 107,261 NTCN Specialist UAT MDT
Barnsley Hospitals NHS Foundation Trust
NHS Barnsley 233,261
Chesterfield Royal NHS Foundation Trust
NHS Derbyshire County (excl.High Peak & Dales)
361,832
NTCN Specialist Skull base MDT
Doncaster Royal Infirmary
NHS Doncaster 293,316
Rotherham Hospitals NHS Foundation Trust
NHS Rotherham
244,053
NTCN Specialist Thyroid MDT
Royal Hallamshire Hospital Sheffield
Royal Hallamshire Hospital. Sheffield/Charles Clifford Dental Hospital
NHS Sheffield 538,270
1,777,993
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11-1A-204i Designated hospitals for referrals with neck lumps The network board, in consultation with the NSSG(s) for head and neck cancer and the NSSG for haematological malignancy, should agree with the PCTs in the network the distribution of neck lump clinics as specified in measure 1A-204i. They should fulfill the following criteria: - • They should be the clinics named for referral of patients with neck lumps in the
primary care referral guidelines. • They should be hosted by a designated hospital. • They should be distributed such that the PCTs agree that their populations have
sufficient access. • It should be agreed for each clinic whether it will have clinicians designated for thyroid
cancer and assess patients with thyroid lumps.
Designated Hospital
Referring PCT
Resident Population
Type of Clinic
Frequency of Clinic
Designated Thyroid Clinician
Bassetlaw District General
NHS Bassetlaw
107,261 Head & Neck Screening clinic
Twice weekly Mr MG Watson Mr Quraishi
Barnsley Hospitals NHS Foundation Trust
NHS Barnsley
233,261 Neck Lump Fortnightly Mr Wickham
Chesterfield Royal Hospital NHS Foundation Trust
NHS Derbyshire County (Excl High Peak & Dales )
361,832
Neck Lump
Weekly Mr D Chadwick
Head & Neck Screening clinic
Twice weekly Mr MG Watson Mr Quraishi
Doncaster Royal Infirmary
NHS Doncaster
293,316
Thyroid Lump (includes Bassetlaw patients)
Twice monthly Mr S Quraishi
Rotherham Hospitals NHS Foundation Trust
NHS Rotherham
244,053 Neck Lump (including thyroid lumps)
Twice weekly Mr S Richards
Charles Clifford Dental Hospital, Sheffield
??Called Weekly Dr Allahabadia
Royal Hallamshire Hospital. Sheffield
NHS Sheffield
538,270
ENT based Neck Lump clinic
Twice weekly Mr B Harrison
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11-1A -205i The distribution of specialist thyroid clinics as specified in measure. The network board in consultation with the NSSG responsible for thyroid cancer agrees with the PCTs in the network that there will be a mixture of thyroid clinics and neck lump clinics which assess thyroid lumps. They should fulfil the following criteria: - These clinics are: • Named in the primary care referral guidelines, for referral of patients with thyroid lumps • They are hosted by a designated hospital. • They are distributed such that, their populations have sufficient access to thyroid
cancer diagnosis and assessment. Designated Hospital
Referring PCT
Resident Population
Type of Clinic
Frequency of Clinic
Designated Thyroid Clinician
Bassetlaw District General
NHS Bassetlaw
107,261 Head & Neck Screening clinic
Twice weekly Mr MG Watson Mr Quraishi
Barnsley Hospitals NHS Foundation Trust
NHS Barnsley
233,261 Neck Lump Fortnightly Mr Wickham
Chesterfield Royal Hospital NHS Foundation Trust
NHS Derbyshire County (Excl High Peak & Dales )
361,832
Neck Lump
Weekly Mr D Chadwick
Head & Neck Screening clinic
Twice weekly Mr MG Watson Mr Quraishi
Doncaster Royal Infirmary
NHS Doncaster
293,316
Thyroid Lump (includes Bassetlaw patients)
Twice monthly Mr S Quraishi
Rotherham Hospitals NHS Foundation Trust
NHS Rotherham
244,053 Neck Lump (including thyroid lumps)
Twice weekly Mr S Richards
Charles Clifford Dental Hospital, Sheffield
Dr Allahabadia
Thyroid Clinic Weekly
?????? Royal Hallamshire Hospital. Sheffield
NHS Sheffield
538,270
Thyroid Clinic Twice weekly Mr B Harrison
• All the units have established standardised referral processes in place for all urgent head and neck cancer referrals.
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• All the clinic have access to facilities for urgent ultrasound and fine needle aspiration
11-1C-109i
The agreed policy with regard to named surgeons performing lymph node
resections on Thyroid Cancer patients is that:-
i) Any surgeon should be a core member of UAT MDT or Thyroid MDT.
ii) This does not apply to the simple excision of lymph nodes for diagnosis purposes.
iii) Patients are not referred from other networks for this procedure.
The named surgeons within North Trent Cancer Network to undertake these procedures
are:-
Mr B.J. Harrison
Mr S. Balasubramanian
11-1A-206i Referral guidelines for primary care practitioners regarding patients with head and neck symptoms are included in the clinical and management guidelines
(see Appendix 10) Distribution process of referral guidelines The NSSG have agreed that the referral guidelines for primary care will be distributed to the following in the network
• Primary care medical practices ( via PCT )
• Primary dental practices (via PCT)
• Designated consultant clinicians
• Non-designated head and neck consultant clinicians o ENT surgeons o Endocrine surgeons o OMFS surgeons o Oral medicine specialists o Endocrinologists o Restorative dentistry consultants
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11-1A-207i Referral proforma for routine referrals The referral proforma for UAT routine referrals is included in the Referral and Management guidelines for head and neck cancers within North Trent (Appendix 9)
• It is used for patients with UAT symptoms which are outside the “ the urgent suspicion of cancer’ definition and who have no neck lumps
• It allows for the referrer to categorize a patient by presenting features, so that the hospital can direct the referral to the relevant speciality (eg. ENT OMFS)
• The network-wide format is made locally specific by identifying a single referral point for each designated hospital to which proformas can be sent for direction to individual specialists.
11-1A-208i Internal referral guidelines for non designated hospital clinicians Internal referral guidelines for non designated hospital clinicians for the onward referral of patients presenting with features suspicious of head and neck cancer are included in the Referral and Management guidelines for head and neck cancer in North Trent ( Appendix 9) There is no network proforma, it is agreed that each locality will use their own clinical referral guidelines and schemas in the guidelines Distribution process of internal referral guidelines The internal referral guidelines are distributed to the following in the network
• Designated consultant clinicians
• Non-designated head and neck consultant clinicians o ENT surgeons o Endocrine surgeons o OMFS surgeons o Oral medicine specialists
• Endocrinologists
11-1A-209i Designated hospitals for referrals with thyroid lumps (see 10-1A-204i and 11- 1A-205i) 11-1A- 210i The named hospitals and ward with the named MDTs associated with each hospital (see10-1A-203i) 11-1A-211i Network MDT configuration There is a single Upper Aero-digestive Tract team (UAT MDT) embracing all units, with a nominal surgical “centre” comprising STH and Chesterfield Hospital for all simple cancer surgery. Thyroid Cancer and Skull base MDTs at Sheffield have evolved well, with consolidated links to the MDT and some shared membership
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11-1A-212i Named MDTs dealing with thyroid cancer configuration
11-1A-213i Distribution of local support teams The network board, in consultation with the NSSG, agrees the locality groups, and the distribution of local support teams in the network, for patients with head and neck cancer. The distribution fulfills the following: - • One or more teams should be established by each designated hospital for head and
neck cancer in the network. • Each team should cover a named geographical area.
• The whole network should be covered by means of such areas 11-1A – 214i The role of the local support team Local Support Teams - see extract below from rehabilitation guidelines
All five areas of Trent Region I.e.; Barnsley, Doncaster, Rotherham, Sheffield and Chesterfield must have a local support team, consisting of core members of the MDT. Each local support team should include speech and language therapists, dietitians, clinical nurse specialists and restorative dentists. All must specialise in head and neck cancer rehabilitation
Name of locality
Type of team Host Organisation Referring PCT Catchment Population
Barnsley Local support
Barnsley Hospital NHS Foundation Trust
NHS Barnsley 233,261
Chesterfield Local support
Chesterfield Hospital NHS Foundation Trust
NHS Derbyshire County (excludes High Peak & Dales)
361,832
Doncaster & Bassetlaw
Local support
Doncaster & Bassetlaw NHS Foundation Trust
NHS Doncaster NHS Bassetlaw
293,316 107,261
Rotherham Local support
The Rotherham NHS Foundation Trust
NHS Rotherham 244,053
Sheffield MDT
Local support Specialist MDT
Sheffield Teaching Hospital Foundation Trust
NHS Sheffield 538,270
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Extended members of the team may include; anaplastologist, clinical psychologist/counsellor, dental hygienist, occupational therapist and physiotherapist
There should be robust communication and referral pathways between the cancer
centre and the local support services to ensure that patients’ rehabilitation needs are met throughout the patient journey and in a seamless manner.
All patients should have their rehabilitation needs monitored and assessed
throughout their pathway by core members of the head and neck cancer team and/ or extended team members as appropriate using an assessment protocol agreed across the cancer network.
Every patient who is to be considered for head and neck surgical or oncological treatment should have;
• A full consultation with a clinical nurse specialist
• Pulmonary and respiratory functioning testing, including full tracheostomy care
• If speech or swallowing may be affected then full assessment by a speech and language therapist
• Nutritional status should be assessed and any supplementary and/ or enteral feeding requirements identified prior to any treatment.
• Dental assessment and restorative needs identified.
• Prosthetic assessment.
• Psychological evaluation using a recognised screening tool.
• Identification of Social support requirements
• Assessment of physical needs and Activities of daily Living.
• Referral to Smoking Cessation / Alcohol addiction support services if required.
• Assessment for referral onto specialist services including palliative care, pain management, and lymph oedema etc.
All patients should also be given access to the following information
• Local patient visitor and peer support groups e.g.; cancer support or laryngectomy groups, buddy system
• Cancer information support centre offering psychological, social and spiritual/cultural support, and other complimentary therapies.
• Information specific to the site of the disease and treatment options
• Contact information for relevant core members and extended team members, and information on their roles in treatment.
• Guidance/outline of the likely nature, timing and duration of the treatment(s) of choice and the short/long term effects of treatment.
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During any modality of treatment, patients need to have access to consultants, specialist nurses and therapists wherever that treatment is being delivered. Assessment of all the above areas must be ongoing and must include tracheostomy and speech prosthesis management.
11-1A 215i Guidelines for referral of patients with UAT These will be reviewed in December 2012 to assure current clinical practice 11-1A- 216i Guidelines for referral of patients with Thyroid Cancer These are included in the Head & Neck management guidelines were reviewed in December 2009 Data Collection 11-1C-110i Minimum dataset The agreed minimum dataset and policy regarding collection of the individual components is attached (Appendix 2 ) 11-1C-111i Data collection Each Trust has mechanisms in place to capture data items to facilitate monitoring against the Going Further for Cancer Waits targets. The NSSG have signed up to support collection of this data. The registry dataset is collected in part by the trusts and there is an action plan to have all data items collated by 2011 when electronic upload is mandated. 11- 1C- 112i The NSSG works closely with Service Improvement team within the network (Please see Work programme document for 3year development plan) and details Service development is a standard item on the NSSG agenda and is regularly reviewed. The main development has been the strengthening of the Central MDT and ensuring effective working practices within it IOG
Head and Neck cancer Improving Outcome Guidance
In April 2007, a network Implementation Group was set up to oversee and support the implementation of the head and neck cancer improving outcomes guidance including the necessary service changes.. As part of this work a number of governing principles were agreed with clinicians and managers in order to take the work forward a) Equal priority is given to enhancing and sustaining local services, and centralising radical
surgery.
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b) There will be two or more designated head and neck surgeons in each cancer unit that provide diagnostic services for symptoms. This will ensure there is a strong focus on and commitment to robust local diagnostic, assessment and follow-up services. This will also facilitate continuity of patient care.
c) There will be stronger links between the local services and the centre. Designated
clinicians will refer patients who have cancer to the MDT d) Formal links will be established between designated clinicians and the MDT. Working Assumptions
(a) There would be a single specialist MDT meeting in the centre held weekly. (b) All the designated unit head and neck clinicians would be able to participate in the centre
MDT to discuss all cases. (c) Diagnostic neck lump clinics should be established in all DGHs (d) Specialised teams would be formalised for thyroid cancer.
Salivary gland, skull based tumours and rare cancers of the head and neck would be dealt with by subgroups of the parent Upper Aerodigestive Tract and Head and Neck MDT. For skull based tumours, interested clinicians would be represented at both MDTs
(e) Local support teams would be established established to provide rehabilitation and support
within the locality. These teams would work closely with primary care and link to the specialist MDT
(f) Where appropriate ,the visiting oncologist would initiate / review non-surgical treatments. (g) A working algorithm would be developed to define a threshold for minor work above which
a centre referral would be appropriate. Subsequent work determined the unit of surgery within the centre based on complexity, workload and geography etc.
(h) Patients requiring treatment which was restricted to the centre would initially be reviewed centrally until it was felt appropriate to refer them back to the DGH with agreed limitations
(i) The surgeons would retain an involvement in the direction of their patients’ management Workforce Issues In order that Sheffield Teaching Hospital and the Chesterfield Royal Hospital were compliant with the Improving Outcomes Guidance and therefore able to develop as head and neck cancer surgery sites it was essential that a range of additional staff were recruited including:
• Additional administrative support to the MDT
• Clinical oncology session
• Rehabilitation staff
• Nursing staff
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This involved:-
STH Posts
1.0 wte Dietician
1.0 wte Speech Therapist
1.0 wte CNS
CRH Posts
0.5 wte Dietician
1.0 wte Speech Therapist
0.2 wte Physiotherapist
At Chesterfield:
• An OMFS surgical team was in place and there were already two cancer surgeons employed within the trust
• A ENT surgical team was in place and an additional cancer surgeon was needed to complete the team
To ensure that the service was developed according to the NICE guidance additional external advice was sought from the Professor of Otorhinolaryngology at Nottingham University particularly in relation to the on call arrangements Following discussions between STHFT and CRHFT a pragmatic solution was agreed. The key features of the new arrangements are as follows
a) The STH ENT surgeons proposed that each of them in turn would work a full day at CRHT, 2 sessions per week
b) Each surgeon would be available for a theatre session in the morning and clinic in the
afternoon. c) The preference was for each of them to be available on a Wednesday and work on a two–
weekly rotation d) Each of the STH surgeons could provide telephone support to the on call Chesterfield
consultant surgeon and attend for any immediate post-operative medical emergencies occurring on the first post-op night
e) It was agreed that there should be a training post based at CRHFT to work closely with the
STHFT surgeons and co-ordinate the management of the patients at CRHT on behalf of the STH surgeons
f) There would be regular reviews of the arrangements throughout the year including an
audit of the first 6 months data
g) The start date of the new arrangements was determined by the recruitment of an appropriate Trainee who started in the summer 2009
h) The start date was delayed due to sickness (consultant surgeon) but became fully
operational in November 2009
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There will be a formal review of the arrangements in June/July 2010 Kim Fell Cathy Edwards Network Director Director North Trent Cancer Network Yorkshire & the Humber SCG
Clinical and Referral Guidelines 11-1A-207i 11-1A-208i 11-1A-209i 11-1A-210i 11-1A-211i 11-1A-215i 11-1A-216i 11-1C-103i 11-1C-105i 11-1C-106i 11-1C-107i 11-1C-108i 11-1C-109i (Central MDT Operational Policy has been removed from the Referral and management guidelines for up date and will be appended prior to the Peer Review visit) Include responsibility for agreeing network clinical and referral guidelines and that they are up to date and reflect current practice. These are included in Appendix 1 document on CQUINs The Thyroid guidelines were reviewed in 2009 and PEG guidelines were also incorporated into the document. The list of personnel identified was updated in 2010 The guidelines are for full review in December 2012
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Appendix 1 – NTCN Network Site Specific Terms of Reference
NAME OF GROUP: Network Site Specific Group (NSSG) Cross Cutting Group (CCG)
ACCOUNTABLE TO:
The North Trent Cancer Network Board The NSSG/CCG Chair is a member of the Network Clinical Strategy Group and as such is responsible for ensuring risks associated with the delivery of services across the relevant pathway are fed into the network planning process.
PURPOSE: The NSSG/CCG has responsibility, delegated by the Board, for ensuring the co-ordination of the cancer pathway and the consistency of care for the relevant client group within the cancer network. This includes:
• Service planning
• Service Improvement / Redesign
• Service Quality Monitoring and evaluation including clinical performance and outcomes
• Workforce Development
• Research and Development The Network tumour-site specific groups should have the active engagement of all MDT leads from the relevant constituent organisations in the network. NSSGs should ensure that all agreed operational changes are discussed with local managers to ensure that changes are integrated into constituent organisational structures and processes. Discussions to explore other changes to existing patient pathways may be initiated by commissioners including Primary Care. NSSG provides advice in respect of all significant service changes (e.g. IOG) particularly if there are financial consequences, and will make recommendations to the Cancer Board. The NSSG has a key role in:
1 Peer review measures 1A -202 and -203 refer
NORTH TRENT CANCER NETWORK (NTCN)
NETWORK SITE SPECIFIC / CROSS CUTTING GROUP(s) COMMON TERMS OF REFERENCE 1
February 2009
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Developing plans to implement Improving Outcomes Guidance Monitoring the implementation of the agreed Improving Outcomes guidance action plans. Raising concerns and areas of risk to the Board via the agreed governance arrangements.
COMPOSITION OF NSSG:
• Chair of the NSSG
• The MDT lead clinician from each MDT in the network
• Nominated Oncologist
• Pathologist
• Specialist Surgeons / Physicians
• At least one nurse core member of a MDT
• A service improvement staff representative
• Two user representatives* All the above are core members common to every NSSG . The following members are optional: As many other members of those MDTs e.g. Physiotherapy, Speech and Language therapy as appropriate
• A representative of palliative care
• A Primary Care Cancer Lead
• A manager representative (from a PCT, provider or NORCOM HQ)
• As a minimum, involve users in their service planning and review * For any one NSSG, the network partnership group can agree an alternative mechanism for obtaining user advice.
Each NSSG will list all its members.
COMPOSITION OF CCG:
The composition of each cross cutting group includes a representative from each locality of each specific cross cutting group, and where appropriate wider membership will reflect National Guidance. All groups will review membership annually, and record attendance as per National Guidance.
CHAIR: The NSSG/CCG will select its own chair and deputy. Tenure in each role should be reviewed after 3 years. The Chair should have an annual appraisal.
CHAIR’S EXTRA-MEETINGS ROLE
The Chair will: -
• Ensure engagement of constituent members.
• Attend development programmes organised for the Lead Clinicians
• Facilitate the identification and agreement of the service priorities for the NSSG/CCG
• Recommend priorities via the Network Strategy group to the Network Board.
• Ensure an annual report of the NSSG’s work is written
• Have an annual (review) meeting with the Network Lead Clinician and the outcomes agreed by the Network Chair.
• Be an ambassador for service improvement locally and the
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NSSG/CCG, regionally and nationally. INDIVIDUAL ROLES:
Each core member should attend 50% or more of the NSSG/CCG meetings. It is assumed that their employers will protect the time commitment entailed. One of the NHS-employed NSSG members will be named as having specific responsibility for users' issues. One of the NHS-employed NSSG members will be named as having specific responsibility on information for patients and carers. One of the NHS-employed NSSG members will be named as having specific responsibility on service improvement* ie being a champion for it. None of the above three roles are mutually exclusive. Members should ensure that all decisions become integrated into constituent organisational structures and processes * but not the member of service improvement staff.
DECISION MAKING PROCESS:
All attendees at the NSSG meeting will have a vote. Recommendations to the Board will normally be achieved through consensus; however, when a vote is required it is essential that the split of votes is recorded to aid the understanding of the Board in the decision making process
QUORUM: The meeting is quorate when 50% of the constituent core members are represented at the meeting, but the chair can declare a larger meeting non-quorate if key members are not present.
RESPONSIBILITIES:
NB this (long) list of responsibilities assumes the regular input of provider managers and network officers. Service Planning is in line with: 1 National guidelines and advising commissioners and provider
trusts of the implications of that guidance for the whole network. 2 Identifying any risks within the service and developing a network-
wide service delivery plan to deliver the NHS Cancer Plan. 3 Responding to Improving Outcomes Guidance recommendations
and advising commissioners on appropriate patient pathway (or model options) developments within North Trent, which will deliver patient care within those recommendations. Developing efficient working models aligned to good practice guidance and national policy drivers.
4 Agreeing common standards including referral pathways, revised
in light of national policy or guidance, patient care pathways (from primary care, both into and out of tertiary services). This includes updating and revising referral guidelines as appropriate. In time a service specification will be generated.
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5 Agree on priorities for data collection, produce audit data and participate in open review including the user experience and service user evaluation
6 Monitor progress on meeting national cancer measures, trial entry
and ensure action plans agreed at Peer Review are implemented. 7 Reviewing approved clinical trials, and other research, once a year.
Agreeing a single list of clinical trials and studies into which the network’s MDTs should give priority for patient entry.
8 Develop clear cancer workforce recommendations that foster new
ways of working so that services are robust in the face of recruitment difficulties and emergent technologies.
9 Foster strong working relationships to develop network-wide
resolution to workforce issues 10 Liaising and consulting with the relevant "cross cutting" network
groups to identify issues that have wider implications and consequent knock on effects. This includes chemotherapy; imaging; histopathology (and other laboratory investigations); specialist palliative care, with the Head of Service for radiotherapy, Children and Young People and Primary Care.
FREQUENCY OF MEETINGS:
At least once every 6 months to a maximum of 4 times per year. Additional meetings may be necessary for short term task and finish projects e.g Peer Review preparation, IOG implementation
SERVICED BY: Cancer Network Office (2 days per meeting, but 9 days pa max) 2
COMMUNICATIONS:
Outward – NSSG/CCG lead to give feedback to the Lead Clinicians Forum and present findings, with recommendations, to the Network Strategy Group
- MDT leads to share items of news with fellow MDT members and with local managers
- NSSG (lead) to write an annual report - NSSG to write an annual work programme for Board endorsement
News can be placed on the network’s website
http://www.northtrentcancernetwork.nhs.uk Agreed guidelines will be downloadable from there.
MINUTES CIRCULATED TO:
NSSG members Network Lead Clinician Cross-Cutting Groups Leads Primary Care Cancer Leads
REVIEW DATE: January 2010
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Appendix 2 11-1C- 110i Minimum dataset
Head & Neck / Thyroid Data Collection Matrix
Data Item Dataset
Surname Registry
Forename Registry
Sex Registry
Date of Birth Registry
Marital Status Registry
Place of Birth Registry
Ethnic Origin Registry
NHS Number Registry
Address Registry
Date of Diagnosis Registry
Morphology Registry
Site Registry
Laterality Registry
Basis of Diagnosis Registry
Sex at Diagnosis Registry
Diagnosing Hospital Registry
Hospital Number Registry
Clinician Registry
Clinician Specialty Registry
Surgery Treatment Indicator Registry
Radiotherapy Treatment Indicator Registry
Chemotherapy Treatment Indicator Registry
Hormonal Treatment Indicator Registry
Other Treatment Indicator Registry
Organisation Code Waiting Times
Source Of Referral For Cancer Waiting Times
Delay Reason Referral To First Seen (Cancer And Breast Symptoms)
Waiting Times
Delay Reason Comment (First Seen) Waiting Times
Urgent Cancer Or Symptomatic Breast Referral Type Waiting Times
Cancer Or Symptomatic Breast Referral Patient Status Waiting Times
Waiting Time Adjustment (First Seen) Waiting Times
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Waiting Time Adjustment Reason (First Seen) Waiting Times
Source Of Referral For Out-Patients Waiting Times
Primary Diagnosis (ICD) Waiting Times
Multidisciplinary Discussion Indicator Waiting Times
Multidisciplinary Team Discussion Date (Cancer) Waiting Times
Recurrence Indicator Waiting Times
Decision To Treat Date (Surgery) Waiting Times
Start Date (Surgery Hospital Provider Spell) Waiting Times
Primary Diagnosis (Icd) Waiting Times
Decision To Treat Date (Anti-Cancer Drug Regimen) Waiting Times
Start Date (Anti-Cancer Drug Regimen) Waiting Times
Decision To Treat Date (Teletherapy Treatment Course) Waiting Times
Start Date (Teletherapy Treatment Course) Waiting Times
Decision To Treat Date (Brachytherapy Treatment Course) Waiting Times
Start Date (Brachytherapy Treatment Course) Waiting Times
Decision To Treat Date (Specialist Palliative Treatment Course) Waiting Times
Waiting Time Adjustment (Treatment) Waiting Times
Waiting Time Adjustment Reason (Treatment) Waiting Times
Delay Reason Referral To Treatment (Cancer) Waiting Times
Delay Reason Decision To Treatment (Cancer) Waiting Times
Delay Reason Comment (Referral To Treatment) Waiting Times
Delay Reason Comment (Decision To Treatment) Waiting Times
Decision To Treat Date (Active Monitoring) Waiting Times
Start Date (Active Monitoring) Waiting Times
Patient Pathway Identifier Waiting Times
Organisation Code (Patient Pathway Issuer) Waiting Times
Priority Type Waiting Times
Cancer Referral To Treatment Period Start Date Waiting Times
Consultant Upgrade Date Waiting Times
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Organisation Code (Provider Consultant Upgrade) Waiting Times
Metastatic Site Waiting Times
Cancer Treatment Event Type Waiting Times
Cancer Treatment Period Start Date Waiting Times
Treatment Start Date (Cancer) Waiting Times
Cancer Treatment Modality Waiting Times
Cancer Care Setting (Treatment) Waiting Times
Clinical Trial Indicator Waiting Times
Organisation Code (Provider Treatment Start Date (Cancer)) Waiting Times
Radiotherapy Priority Waiting Times
Radiotherapy Intent Waiting Times
Delay Reason (Consultant Upgrade) Waiting Times
Delay Reason Comment (Consultant Upgrade) Waiting Times
Organisation Code (Provider Decision To Treat) Waiting Times
Decision To Refer Date (Cancer Or Breast Symptoms) Waiting Times
NHS number DAHNO
Hospital identifier (Submitting organisation) DAHNO
Hospital identifier DAHNO
Patient case record number DAHNO Surname DAHNO Forename DAHNO
Patient post code DAHNO Patient sex DAHNO
Date of birth DAHNO GP Practice Code DAHNO Patient case record number DAHNO
Date of Diagnosis DAHNO Source of Referral DAHNO
Referral priority DAHNO Referral for cancer decision date DAHNO
Date referral request received DAHNO Date first seen DAHNO Date symptoms first noted DAHNO
MDT discussion indicator DAHNO MDT discussion date DAHNO
Care Plan agreed date DAHNO Cancer Care Plan intent DAHNO Planned cancer treatment type 1 DAHNO
Planned cancer treatment type 2 DAHNO Planned cancer treatment type 3 DAHNO
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Planned cancer treatment type 4 DAHNO
Comorbidity index DAHNO
Performance status at present DAHNO Primary care communication sent date DAHNO
Dental assessment date DAHNO Speech and Language assessment date DAHNO
Clinical trial patient status DAHNO
Recurrence Indicator DAHNO
Primary diagnosis (primary site) DAHNO
Pre-Treatment Tumour Site T category DAHNO Pre-Treatment Staging certainty T category DAHNO
Pre-Treatment Tumour site N category DAHNO Pre-Treatment Staging certainty N category DAHNO Pre-Treatment Tumour site M category DAHNO
Pre-Treatment Staging certainty M category DAHNO Pre-Treatment Overall Stage pre-treatment DAHNO
Pre-Treatment Staging certainty TNM category DAHNO Professionals present at breaking of bad news DAHNO
Date patient advised of cancer diagnosis DAHNO Clinical intervention date (cancer imaging) DAHNO Cancer imaging modality DAHNO
Anatomical examination site DAHNO Image request date DAHNO
Date of image report DAHNO Diagnostic Procedure Date DAHNO Diagnostic Procedure DAHNO
Cancer treatment intent DAHNO Pathology specimen type DAHNO
Date of Pathology Report DAHNO (Investigation Result Date) DAHNO
Histology DAHNO Exision margin DAHNO Specimen nature DAHNO
Primary diagnosis (primary site) DAHNO Tumour laterality DAHNO
Basis of diagnosis DAHNO Histology DAHNO Final Integrated Tumour site T category DAHNO
Final Integrated Staging certainty T category DAHNO Final Integrated Tumour site N category DAHNO
Final Integrated Staging certainty N category DAHNO Final Integrated Tumour site M category DAHNO
Final Integrated Staging certainty M category DAHNO Final Integrated Overall Stage pre-treatment DAHNO Final Integrated Staging certainty TNM category DAHNO
Date Pathology Report DAHNO Care Plan agreed date DAHNO
Cancer treatment intent DAHNO Date of decision to treat DAHNO [Date of decision to operate] DAHNO
Procedure Date DAHNO Primary procedure code (Main Surgical Procedure) DAHNO
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Secondary procedure code (s) (Other procedure DAHNO
Secondary procedure code (s) (Other procedure DAHNO
Secondary procedure code (s) (Other procedure DAHNO Secondary procedure code (s) (Other procedure DAHNO
Secondary procedure code (s) (Other procedure DAHNO
Discharge destination DAHNO
Primary Site Tumour DAHNO TNM stage category (pathological) DAHNO Tumour site T category (pathological) pT DAHNO
Tumour site N category (pathological) pN DAHNO Tumour site M category DAHNO
(pathological) pM DAHNO Date of Pathology Report DAHNO Histology DAHNO
Excision margin DAHNO Date teletherapy decision DAHNO
Cancer treatment intent DAHNO Teletherapy treatment to DAHNO
Radiotherapy treatment site DAHNO
Teletherapy start date DAHNO Date brachytherapy decision DAHNO
Cancer treatment intent DAHNO Brachytherapy treatment to DAHNO
Radiotherapy Treatment Site DAHNO
Brachytherapy start date DAHNO Date Chemotherapy decision to treat DAHNO
Chemotherapy drug type DAHNO Chemotherapy drug treatment intent DAHNO
Chemotherapy start date DAHNO Clinical status assessment date DAHNO
Primary tumour status DAHNO Nodal status DAHNO Metastatic status DAHNO
Morbidity code chemotherapy DAHNO Morbidity code radiotherapy DAHNO
Morbidity code combination DAHNO
Date of death DAHNO Contact date DAHNO
[Date of contact] DAHNO Speech & swallowing assessment date DAHNO
Normalcy of Diet [Post Treatment] DAHNO SVR contact professional involvement DAHNO
[Who actioned contact] DAHNO SVR contact purpose (Type of contact) DAHNO Patient follow-up status DAHNO
[Follow-up status] DAHNO SVR communication post operative method DAHNO
[Proposed method of post-operative communication] DAHNO SVR communication primary method DAHNO [primary method of communication at contact] DAHNO
SVR communication other method DAHNO [Other methods of communication] DAHNO
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Post operative voicing DAHNO
[Post-operative voicing] DAHNO
SVR permanent valve removal reason (reason for permanent removal) DAHNO
Patient estimated normal weight (Kg) DAHNO Person observation (weight) (Kg) DAHNO
Date weight measured DAHNO Person observation (height) (M) DAHNO Date height measured DAHNO
Contact date dietician post treatment DAHNO Contact date (dietitian initial) DAHNO
Date nutritional support instigated DAHNO Nutritional Support Type DAHNO Date nutritional support remains in place DAHNO
Date nutritional support withdrawn DAHNO Procedure date [Date nutritional procedure] DAHNO
Procedure (OPCS) [Nutritional Procedure Type] DAHNO Date palliative decision DAHNO
Palliative care start date DAHNO Source of referral for cancer to ClinNS DAHNO [Source of referral to ClinNS DAHNO
Cancer referral decision date to ClinNS DAHNO [Date of decision to refer to ClinNS] DAHNO
Reason for referral to ClinNS DAHNO Contact date (ClinNS initial) [Dte of first assessment with ClinNS] DAHNO Date patient advised of cancer diagnosis DAHNO
Professionals present at breaking of bad news DAHNO Date of ClinNS intervention DAHNO
Type of ClinNS intervention DAHNO Date of discharge from ClinNS DAHNO