Network Site Specific Group for Gynae-Oncology

Peninsula Cancer Network (North, East & West Devon, South Devon & Torbay, Somerset, Cornwall and Isles of Scilly)

Constitution Approval Date: December 2015

Review Date: September 2018

Constitution of the Peninsula Cancer Network Site Specific Group for Gynae-Oncology

VERSION CONTROL THIS IS A CONTROLLED DOCUMENT - PLEASE ARCHIVE ALL PREVIOUS VERSIONS ON RECEIPT OF THE CURRENT VERSION.

Please check the website for the latest version available: http://www.swscn.org.uk/networks/cancer/site-specific-groups/peninsula-site-specific-groups/gynae-ssg/

VERSION DATE ISSUED SUMMARY OF CHANGE OWNER 0.1 June 2015 1st draft PCN Gynaecology NSSG 0.2 3rd August 2015 2nd draft PCN Gynaecology NSSG

Agreement cover sheet

This constitution was prepared by: Khadra Galaal, Consultant Gynae-Oncologist, Royal Cornwall Hospital NHS Trust (NSSG Chair) Liz Boylan – Peninsula Cancer Network Manager

This constitution has been agreed by:

Name Position Organisation Date agreed

David Milliken Consultant Gynae- Taunton & Somerset NHS (Chair) Oncologist Foundation Trust Mike Hannemann Consultant Gynae- Royal Devon & Exeter NHS Oncologist Foundation Trust Stephen Bennett Consultant Obstetrician Northern Devon Healthcare & Gynaecologist NHS Trust Morven Leggott Consultant Gynae- South Devon Healthcare NHS Oncologist Foundation Trust Lydia Karamura Consultant Gynaecologist Yeovil District Hospital

Miss Khadra Galaal Consultant Gynae- Royal Cornwall Hospitals NHS Oncologist Trust 2 Peninsula Cancer Network Gynae-Oncology NSSG Constitution Mr Geoff Hughes Consultant Gynaecologist Plymouth Hospitals NHS Trust

3 Peninsula Cancer Network Gynae-Oncology NSSG Constitution Contents

4 Peninsula Cancer Network Gynae-Oncology NSSG Constitution 1 Statement of Purpose

The Peninsula Cancer Network exists to secure equal access to high quality care for all cancer patients; strive for better clinical outcomes and improve the experience of patients, their carers and families throughout screening, diagnosis, treatment, aftercare and survival.

The Network has an increasing role in the prevention of cancer and reducing health inequalities. To achieve these goals it collaborates with all healthcare providers, commissioners, patients and their carers throughout Devon, Cornwall and Somerset

The Peninsula Cancer Network serves a population of 2.2 million people and is comprised of the following organisations:

Clinical Commissioning Groups Northern, Eastern & Western Devon CCG South Devon & Torbay CCG NHS Kernow CCG Somerset CCG

Acute Hospitals Northern Devon Healthcare NHS Trust Plymouth Hospitals NHS Trust Royal Cornwall Hospitals NHS Trust Royal Devon & Exeter NHS Foundation Trust South Devon Healthcare NHS Foundation Trust Taunton & Somerset NHS Foundation Trust Yeovil District Hospital

Hospices Hospiscare, Exeter Mount Edgcumbe Hospice, Cornwall North Devon Hospice Rowcroft Hospice, Torquay St Julia’s Hospice, Cornwall St Luke’s Hospice, Plymouth St Margaret’s Hospice, Yeovil

The following document outlines the constitution, roles and responsibilities of the Group.

2 Terms of Reference for the Group

In response to the publication of the Manual for Cancer Services (2004) a number of clinical sub- Groups were established to address services for specific types of cancer.

Peninsula Cancer Network Gynaecology NSSG 2015 Network Site Specific Groups have collective responsibility, delegated by the Network Executive Board, for coordination and consistency across the Network for cancer policy, practice guidelines, audit, research and service improvement for each type of cancer.

Network site specific Groups are multidisciplinary with representation from professionals across the patient care pathway as well as involvement and representation from patients and carers.

The current Gynae-Oncology NSSG Terms of Reference are available on the SWSCN website: http://www.swscn.org.uk/networks/cancer/site-specific-groups/peninsula-site-specific- groups/gynae-ssg/peninsula-gynaecological-cancer-ssg-information-for-members/

3 Structure and Function

3.1 Role and Function of the Group

Network Site Specific Groups have been established to:  Act as the Network Executive Board’s reference group for advice on all issues relating to gynaecological cancer;  Ensure coordination and consistency for cancer policy, governance, guidelines, audit, research and service improvement relating to gynaecological cancer;  Monitor progress on meeting National Cancer Standards and ensure action plans agreed following Peer Review are implemented;  Promote links between teams and other relevant Network Groups.

The key objectives of Network Site Specific Group will be to:  Establish common referral and clinical guidelines for the Network/South West;  Agree a minimum data set for gynaecological cancer and a policy for consistent data collection across the Network/South West;  Engage in service improvement by using appropriate mapping and other service improvement processes to understand patient flows and make recommendations for improvement to the patient pathway;  Agree and support an annual audit programme both at regional and local level;  Consult with relevant cross-cutting groups on issues involving chemotherapy, radiotherapy, cancer imaging, histopathology, genetics, laboratory investigation and specialist palliative care;  Identify emerging new cancer drug treatments and technologies which require appraisal by commissioners through the Peninsula Health Technology Appraisal process;  Support the development of education and training programmes for teams;  Support effective patient and carer involvement in service planning and delivery; 6

Peninsula Cancer Network Gynaecology NSSG 2015  Promote research and clinical trials;  Produce an annual work plan.

3.2 Network Configuration 14-1C-101e

The Peninsula Gynae-Oncology Network Group embraces the services provided across the peninsula and managed by two discrete MDTs, comprised as follows:

West Peninsula Gynae-Oncology Central Peninsula Gynae-Oncology SMDT SMDT Plymouth Hospitals NHS Trust Royal Devon & Exeter NHS Foundation Trust Royal Cornwall Hospitals NHS Trust Taunton & Somerset NHS Foundation Trust South Devon Healthcare NHS Foundation Trust Northern Devon Healthcare NHS Trust Yeovil District Hospital

The MDTs review the presentation, diagnosis, treatment, subsequent assessment, follow up and supportive care of all patients with Gynaecological malignancies.  Each trust has dedicated diagnostic services for gynaecological cancer.  Each trust (except North Devon) has a weekly MDT meeting and attend their respective joint SMDTs  North Devon has a fortnightly local MDT meeting.  South Devon has a weekly MDT meeting and core members also join the weekly Royal Devon and Exeter MDT meeting via video link. Royal Cornwall Healthcare NHS Trust and Plymouth Hospitals NHS Trust hold weekly local MDT meetings and via video link between the two sites to discuss all confirmed cancers .

3.3 Local Gynaecological Cancer Teams 14-1C-101e

Distribution and Role of Local Support Teams 14-1C-103i

Trust Team Curative Locality Referring CCG Surgical Centre Populatio n Plymouth Hospitals Joint MDT with Cornwall 349,481 NHS NEW Devon NHS Trust CCG Royal Cornwall Joint MDT with 534,503 NHWesternS Kernow Locality Hospitals NHS Plymouth CCG Trust Northern Devon Joint MDT with Royal Devon 164,997 NHS NEW Devon CCG Healthcare NHS Exeter, South Devon & Exeter NHS Northern Locality Trust and Taunton Foundation Eastern Locality Trust 7

Peninsula Cancer Network Gynaecology NSSG 2015 South Devon Joint MDT with Exeter, South Devon 286,000 NHS South Devon & Healthcare NHS North Devon and Taunton Healthcare NHS Torbay CCG Foundation Trust Foundation Trust Royal Devon & Joint MDT with North Royal Devon 383,040 NHS NEW Devon Exeter NHS Devon, South Devon & Exeter NHS CCG Foundation Trust and Taunton Foundation Eastern Locality Trust Taunton and Joint MDT with Royal Devon 544,000 NHS Somerset CCG Somerset Exeter, South Devon & Exeter NHS NHS Foundation Trust and North Devon Foundation Trust 2,262,021 Total

3.4 Network Group Members (14-1C101e, 14-1C-103e)

Membership of the Group will be multi-disciplinary in nature with representation from professionals across the care pathway. All core and extended members of the relevant Acute Trust MDT(s) are invited to participate in Group activities via Group meetings, working parties and email communications as appropriate.

The Chair of the Group will be elected from within the membership of the Group. The term of office will be for three years.

The Group will work towards developing patient and carer involvement in to the Group. Patient and carer representatives will be appointed when possible. In addition to this a Group member will identified who will have specific responsibility for patient issues and information for patients and carers.

A Group trial Recruitment Clinical Lead will be identified from within the membership of the Group. This person will work with the Research Network team and liaise with MDT Research Representatives on research issues.

A Group Patient Champion and Information Lead will be identified from within the membership of the Group. This person will work with the Network User Facilitator and Network Patient Information Manager with specific responsibility for users’ issues and information for patients and carers.

Gynaecology NSSG Chairperson Khadra Galaal NSSG Trial Recruitment Clinical Leads Jenny Forrest Subspecialty Lead RDEHT Khadra Galaal Consultant Gynae-oncologist RCHT

Peninsula Cancer Network Gynaecology NSSG 2015 Patient Champion & Information Leads Zoe McCullogh Cancer Nurse Specialist RCHT Fran Jones Cancer Nurse Specialist PHT Emma Kent Cancer Nurse Specialist RCHT Patient and Carer Representatives Vacant

Northern Devon Healthcare NHS Trust Stephen Bennett Consultant Gynaecologist MDT Lead Mary Alexander Consultant Jo Gordon Clinical Nurse Specialist James Rhymer Consultant Radiologist

Plymouth Hospitals NHS Trust Geoff Hughes Consultant Gynaecologist MDT Lead Paul Dubbins Consultant Radiologist Diane de Friend Consultant Radiologist Petra Williams Consultant Radiologist Ahmed Talaat Consultant Oncologist Fran Jones Clinical Nurse Specialist Adewunmi Oriolowo Histopathologist/Cytopathologi Dennis Yiannakis st Sidharth Dubey Consultant Oncologist Martin Highley Clinical Oncologist Ann Jones Medical Oncologist Cathy Herd Consultant Radiologist Clinical Nurse Specialist Royal Cornwall NHS Hospitals Trust Khadra Galaal Consultant Gynae Oncologist MDT Lead Nigel Bailey Consultant Medical Oncologist Alistair Thomson Consultant Clinical Oncologist Nagindra Das Consultant Gynae Oncologist Emma Kent Clinical Nurse Specialist Zoe McCullough Clinical Nurse Specialist Hayley Carey Clinical Nurse Specialist Simon Thorogood Consultant Radiologist Amanda Liddacott Consultant Radiologist John McGrane Oncologist Juliane Stolte Histopathologist Rachel Newman Consultant in Palliative Samy Bishieri Medicine Associate Specialist Royal Devon & Exeter NHS Foundation Trust

Peninsula Cancer Network Gynaecology NSSG 2015 Mike Hannemann Consultant Gynae-oncologist MDT Lead John Renninson Consultant Gynaecologist Kate Scatchard Consultant Medical Oncologist Peter Bliss Consultant Clinical Oncologist Jenny Forrest Clinical Oncologist Jacky Stewart Clinical Nurse Specialist Katharine Edey Consultant Gynae-oncologist Trupti Mandalia Consultant Histopathologist Nicole Dorey Consultant Clinical Oncologist Ann Hong Consultant Carole Brewer Consultant Clinical Geneticist Jacky Coote Consultant Radiologist Tom Clark Clinical Director of Diagnostics Nichola Cope Consultant Laura Gellett HistoCytopathologist Lisa Joels Consultant Radiologist Jane Ferguson Consultant Consultant Radiologist South Devon NHS Foundation Trust Morven Leggott Consultant Gynaecologist MDT Lead Nangi Lo Consultant Medical Oncologist Debbie Fitzgerald Gynae-oncology Nurse Specialist Sarah Higgins Consultant Radiologist Tracy Hill Clinical Nurse Specialist Raj Ranjit Consultant Sarah Harrison Consultant Radiologist Suzanne Hill Radiographer John Bridger Consultant Pathologist Pat Lye Clinical Nurse Specialist Ryley Nick Consultant Tanwen Wright Consultant Maria Consuelo Garrido Consultant Pathologist Taunton & Somerset NHS Trust David Milliken Consultant Gynae-oncologist MDT Lead Clare Barlow Consultant Medical Oncologist Jo Morrison Consultant Gynae-oncologist John Hunter Consultant Radiologist Paul Burn Consultant Radiologist Kirsty Coomber Clinical Nurse Specialist Petra Jankowska Consultant Clinical Oncologist Surabhi Agrawal Consultant Pathologist Sue Slater Consultant Pathologist Sue Golby Gynae-oncology CNS Emma Cattell Consultant Medical Oncologist Yeovil District Hospital

Peninsula Cancer Network Gynaecology NSSG 2015 Lydia Karamura Consultant Gynaecologist MDT Lead Sally Keates-Porter Clinical Nurse Specialist Cenydd Thomas Consultant Radiologist Hany Omran Ass Specialist Obs & Gynae Peninsula Cancer Network Liz Boylan Peninsula Cancer Network Manager Melanie Chandler Network Admin Support CCG Managers for Cancer Lynne Kilner NHS NEW Devon CCG Western Locality Yash Patel NHS NEW Devon CCG Eastern Locality Sara Wright NHS NEW Devon CCG Northern Locality Emma Herd NHS South Devon & Torbay CCG Andy Gordon NHS Kernow CCG Amelia Randle Somerset CCG

3.5 Network Agreed Authorised Surgeons for Diagnostic Service 14-1C-102e

Below is a list of named surgeons in the hospitals that provide stand-alone diagnostic services and who are authorised to operate on low risk endometrial carcinoma within the Peninsula Cancer Network. Local Hospital Named Surgeon MDT attended as core member Northern Devon Healthcare NHS Stephen Bennett North Devon Trust Gynaecology MDT South Devon Healthcare NHS Morven Leggott SDHT Gynaecology MDT Foundation Trust Raj Ranjit SDHT Gynaecology MDT

3.6 Network Group Meetings

Meetings will be held at least twice per annum. Liz Boylan, Peninsula Cancer Network Manager and the NSSG Admin Support Office will provide managerial and administrative support at Group meetings.

3.7 Reporting Arrangements

Notes of the Group will be circulated to all Group members, Cancer Service Managers and other interested parties. They will also be published on the Network website: http://www.swscn.org.uk/networks/cancer/site-specific-groups/peninsula-site-specific- groups/gynae-ssg/ The Group will provide a Peninsula Cancer Network annual report for Peer Review purposes.

Peninsula Cancer Network Gynaecology NSSG 2015 4 Service Mapping

The Gynaecology service has been mapped in previous years, and a full portfolio of gynaecological cancer services across the Network is available. This informs future service development and delivery planning and will be updated when required.

5 Network Guidelines

5.1 Primary Care Referral Guidelines

Primary Care practitioners will refer all patients defined by the ‘urgent, suspicious of cancer’ guidelines for Gynaecological cancer to the contact point of a single local Gynaecology team as agreed in each local MDT operational policy.

General practitioners and nurse practitioners should be aware of the various routes by which patients satisfying the high-risk criteria can gain access to diagnostic services in their locality. All suspected gynaecological cancers are referred to a central point in all 5 acute hospitals via one of the 3 routes below:

1. All such referrals should be made (via primary care proforma within 24 hours usually through a dedicated fast track system. The patient will be offered a date within 2 weeks of referral (2 week wait). 2. Patients who describe symptoms which don’t entirely fulfill the criteria but are a source of concern to the GP can be referred urgently to the gynaecology service via the fast track system (Choose & Book).

5.2 Referral Guidelines for Patients moving between Teams

Referring clinicians should ensure that all relevant information is provided in a timely fashion to facilitate the continuity of care and avoid unnecessary delays.

Any patient suspected of having cancer but not referred via the urgent referral route may be upgraded by a consultant member of the MDT at any time prior to decision to treat. The upgrade should be undertaken using the internal upgrade referral proforma and following processes outlined in individual Trust operational policies.

The Peninsula Tertiary Referral Form (TRF01) should be used when referring patients to another Acute Trust for specialist investigation or treatment and sent within one working day of the referral being made.

Patients with synchronous cancers at Gynaecological and other site(s)

Peninsula Cancer Network Gynaecology NSSG 2015 Such patients will be discussed in the Gynaecology MDT. Lead responsibility will be shared with the other site-specific MDT, until it becomes clear which MDT would be best to lead in each individual case.

5.3 Network policy on named medical practitioner with clinical responsibility

The network policy on the named medical practitioner with responsibility for the patient at each stage is that unless already under a named clinician, the responsible clinician will be determined after discussion at the MDT. The radiologist does not take clinical responsibility for the patients at any stage of the pathway.

5.4 Network Agreed Onward Referral Policy

All patients who have gynaecological diagnostic procedures are discussed at the Gynaecology MDT. The responsible clinician identified at the MDT will take responsibility for informing the patient of the diagnosis and the GP within one working day after the patient has been informed. The radiologist does not take responsibility for the patient at any stage of the clinical pathway.

5.5 Clinical Guidelines

The Group has agreed to adopt the NICE clinical guidelines as below for ovary, endometrial and cervical cancer which includes follow up, and the SWICS guidelines for other tumour sites. Patients suitable for cytoreductive (surgical or non-surgical) treatment for recurrent cancer are referred to the named specialist teams from the named local teams as listed in 3.3.

Ovary

http://www.nice.org.uk/guidance/cg122

Endometrial - TBC

Cervical - TBC

Network guidelines will be reviewed at least every three years or on the publication of new guidance.

It is the responsibility of the Chair of the Group to ensure that all Network guidelines are up to date and reflect current practice.

For Peninsula Cancer Network Gynaecology guidelines click link below: http://www.swscn.org.uk/networks/cancer/site-specific-groups/peninsula-site-specific- groups/gynae-ssg/

Peninsula Cancer Network Gynaecology NSSG 2015 Pathology guidelines The Group has adopted the guidelines of the Peninsula Cancer Network Pathology Group which follow the latest Royal College of Pathologist Guidelines 2014. The Network Pathology Leads Group is responsible for producing all Network pathology guidelines for all tumour sites.

5.6 Chemotherapy Algorithms

The Group does not yet have agreed network chemotherapy treatment algorithms.

5.7 The Teenage and Young Adult pathway for initial management

The pathway for initial management of teenagers and young adults as specified by the TYACNCG is as below. The pathway for cases involving NHS specialist services is indicated in the operational procedures policy. Distribution of the pathway to all MDT leads is verified through their agreement to the PCN Gynaecology NSSG Constitution. Click here for South West TYA Patient Pathway for Initial Management of Cancer for 15 – 24 year olds. http://www.swscn.org.uk/networks/cancer/children-young-people/

5.8 The TYA pathway for follow up on completion of first line of treatment

The pathway for follow up on completion of first line treatment of teenagers and young adults as specified by the TYACNCG is as below; distribution of the pathway to all MDT leads is verified through their agreement to the PCN Gynaecology NSSG Constitution.

http://www.swscn.org.uk/networks/cancer/children-young-people/

6 Data Collection

6.1 Network-wide Minimum Data Set

All Trusts have previously confirmed their compliance with data collection requirements for cancer waiting times and the Cancer Registry, together these constitute the MDS for the Gynaecology Group. Link for Minimum dataset to be confirmed

6.2 Network policy for collection of the MDS

Responsibility for data

Peninsula Cancer Network Gynaecology NSSG 2015 The Acute Trust first treating or giving subsequent treatment to a patient in a particular month or quarter is responsible for ensuring that the mandated data fields are complete on the database by the national deadline.

The multidisciplinary team responsible for the care of the patient should ensure that information is made available to allow it to be recorded prospectively and electronically. Cancer Services teams in each Acute Trust should ensure that the information is transferred within the timescales specified and should establish robust lines of communication with their colleagues in other Acute Trusts.

7 Distribution of Guidelines and Protocols

Once agreed by the NSSG, documents will be circulated to all core and extended members of the local MDTs. The MDT Lead for each locality is responsible for forwarding them to relevant clinical colleagues within their organisation and publishing on local document libraries where applicable. All network agreed documents will be added to the Network website: http://www.swscn.org.uk/networks/cancer/site-specific-groups/peninsula-site-specific- groups/gynae- ssg/

Peninsula Cancer Network Gynaecology NSSG 2015