Embed Size (px)
Citation preview
Skin Cancer Pathway Board Constitution
2015
_Web | manchestercancer.org
_Twitter | @GM_Cancer
_Email | [email protected]
_Phone | 0161 918 2087
Date f
Date for Review: 2017_
2
Contents
Measure number
Measure title Page
14-1C-101j Network Configuration of MDTs 3
14-1C-102j Network Configuration of Skin Cancer Services in the Community
7
14-1C-103j Agreed Network Distribution of Clinics for Immunocompromised Patients with Skin Cancer
5
14-1C-104j Network Group Membership 14
14-1C-105j Network Group Meetings 9
14-1C-106j Work Programme and Annual Report Work Plan & Annual Report
14-1C-107j Designated Hospital Practitioners for Mohs Surgery 5
14-1C-108j Training Policy for Model 2 Community Practitioners with Named Trainers / Assessors
8
14-1C-109j Clinical Guidelines 15
14-1C-110j Chemotherapy Treatment Algorithms 15
14-1C-111j Patient Pathways for Primary Care/ Community Services and MDTs
15,17
14-1C-112j Patient Pathways Between MDTs 17
14-1C-113j Patient Pathways for Supranetwork MDTs/Services 17
14-1C-114j Patient Pathways Shared with Other MDTs 17
14-1C-115j Patient Experience Annual report
14-1C-116j Clinical Outcomes Indicators and Audits Annual report
14-1C-117j Clinical Governance Arrangements for Community Practitioners
8
14-1C-118j Discussion of Clinical Trials Annual report
Appendix 1 Patient pathway 19
3
1. INTRODUCTION
Cancer services in Greater Manchester and East Cheshire changed in 2013/14. The Greater Manchester and Cheshire Cancer Network ceased to exist in March 2013 when cancer networks nationally were amalgamated into strategic clinical networks as part of the NHS reorganisation. In Greater Manchester this coincided with the creation of Manchester Cancer, an integrated cancer system for Greater Manchester and East Cheshire. Twenty Manchester Cancer Pathway Clinical Directors were appointed in late 2013 and took up their roles on 1st January 2014. These clinical leaders have formed Pathway Boards, multi-professional clinical groups from across the region. Most Pathway Boards began meeting in spring 2014. For the purposes of the National Cancer Peer Review Programme, Manchester Cancer Pathway Boards are taken to be the network group for the relevant tumour type or cancer area. 2. CONFIGURATION
2.1. MDT configuration (14-1C-101j)
2.1.1. Local skin cancer teams and contact points
Each local skin MDT
is the only skin MDT in the host hospital
is named as a component of its locality
Local skin cancer teams
MDT Lead Clinician / contact point
Facilities and services
CCGs in catchment Catchment population
Bolton Dr Corinna Mendonca full diagnostic service for skin conditions
Bolton 288,341
East Cheshire Dr Tim Kingston full diagnostic service for skin conditions
Central & Eastern Cheshire (E)
203,504
Mid Cheshire Dr Christina Wong full diagnostic service for skin conditions
Central & Eastern Cheshire (C)
267,273
Salford Dr Rebecca Brooke
full diagnostic service for skin conditions Mohs Surgery
Salford Bury 60% Manchester (N) 70% HMR
233,966 194,675 103,963 149,260
Stockport Dr John Newsham full diagnostic service for skin conditions
Stockport 298,505
South Manchester* Dr Gavin Wong full diagnostic Manchester (S) 162,603
4
service for skin conditions
Central Manchester* Dr Farzana Nyemuddin full diagnostic service for skin conditions
Manchester (C) Trafford
206,690 232,619
Tameside Dr L Gardner
full diagnostic service for skin conditions
Tameside & Glossop Oldham 40% Manchester (N) 30% HMR
240,079 238,544 69,309 63,969
Wigan Dr Elizabeth Stewart full diagnostic service for skin conditions
Ashton, Leigh and Wigan
315,766
TOTAL 3,269,066
The local skin services at South Manchester and Central Manchester have formed a joint MDT for discussion of patients. The MDT lead clinician is Dr Gavin Wong, Consultant Dermatologist at South Manchester. The named local skin teams will carry out the diagnostic process and surgical treatment for symptomatic patients from their own catchment, referring patients the Specialist Skin MDT for discussion of treatment, or to Christie Hospital for radiotherapy, and for chemotherapy if unable to provide locally. 2.1.2. Specialist skin team (incorporating the Melanoma MDT)
The specialist skin MDT, incorporating the melanoma MDT
is the only skin MDT in the host hospital
is named as a component of its locality
functions as the local skin MDT for its own local secondary referral population
has a catchment population of >3million
is the only MMDT in the network and takes all referrals for malignant melanoma for level 5 care from the catchment population
takes all referrals of malignant melanoma for level 4 care from local catchment population
Specialist skin
cancer/melanoma team
SMDT Lead Clinician
Facilities and services
Referring MDTs Catchment population
Salford Dr Vindy Ghura
full diagnostic service for skin conditions Mohs Surgery
Bolton, East Cheshire, Mid Cheshire, Salford, Stockport, South Manchester / Trafford / Central Manchester Tameside, Wigan
3,269,066
NB: Patients from Wigan Local Skin MDT are referred to the Specialist Skin MDT and plastic surgeons at Whiston Hospital, St Helens & Knowsley NHS Trust.
5
Patients may be referred to Mr Nick Telfer, Mr Vindy Ghura, Mr Vishal Madan, Mohs Surgeons at Salford Royal Hospital NHS Foundation Trust. 2.2. Distribution of clinics for immunocompromised patients (14-1C-103j)
The following localities will staff and run clinics for immunocompromised patients with skin cancer:
Salford Royal Foundation Trust
Central Manchester University Hospital Trust
University Hospital of South Manchester The localities mentioned above all host renal / cardiac transplants. Liver transplant recipients are also seen in these clinics. 2.3. Mohs surgery practitioners (14-1C-107j)
Patients may be referred to Mr Nick Telfer, Mr Vindy Ghura, Mr Vishal Madan, Mohs Surgeons at Salford Royal Hospital NHS Foundation Trust. The above named surgeons accept referrals from Greater Manchester, Lancashire and South Cumbria.
2.4. Community services
2.4.1. Policy for skin cancer services in the community
The provision of treatment for skin cancer over the network, if carried out for NHS patients in the community setting, should be drawn only from the following 4 service models only:
1. The service provided under the DES/LES contracting system, under the governance of the CCG
2. Service Model 1: ‘Group 3 GPwSIs’ trained and competent according to DH Guidance
and Competencies for the Provision of Services using GPs with special interests: Dermatology and Skin Surgery 2011, under the governance of the PCT
3. Service Model 2: Registered healthcare professionals, either medically qualified practitioners, registered nurses or surgical care practitioners, all of whom are subject to the constraints given in the rest of this model, under the governance of the acute trust associated with a named skin cancer MDT
4. Service Model 3: Hospital medical specialists, consultant core members of skin cancer MDTs practicing in the community, under the governance of the acute trust via the MDT arrangements
6
Model Governance
Arrangements Scope of Practice
DES / LES
CCG Governance, according to DES / LES framework
GPs acting within DES / LES NHS statutory framework under minor surgery
Excision (or curettage) only of BCCs on the DES/LES list, diagnosed by the practitioners themselves, either de novo of following referral for both diagnosis and management from other practitioners
Practitioners acting according to the DES / LES service model should not knowingly excise supposed neoplastic skin lesions of any higher risk than BCCs on the DES / LES list
Model 1
CCG Governance, according to the DH GPwSI guidance
Group 3 GPwSIs (dermatology & skin surgery) or GPwSIs in Skin Lesions
Excision (or curettage) only of BCCs on the Model 1 list, diagnosed by the practitioners themselves, either de novo of following referral for both diagnosis and management from other practitioners
Practitioners acting according to the DES / LES service model should not knowingly excise supposed neoplastic skin lesions of any higher risk than BCCs on the Model 1 list
Model 2
Under Acute Trust Governance, associated with named skin cancer MDT
Medically qualified practitioners, registered nurses or surgical care practitioners, subject to constraints in this model
Excision or curettage (as directed by referrers) of any skin cancers (other than procedures listed as hospital only – measure ?????) but with the provision that they have been previously diagnosed by and have a treatment plan agreed by legitimate referrers
Model 3
Under Acute Trust Governance
Consultant Core MDT members practicing in the community Boundaries of an MDTs clinical practice outside the hospital setting are not explicitly specified in the measures, but are constrained by:
The need for formal case discussion by the MDT for cases at level 4 and above
The requirements for certain procedures to all be performed in the same hospital for the whole of an MDTs practice
CCGs are free not to commission any community skin cancer service but to rely instead on MDTs working in the hospital setting (Model 4 – under acute trust governance)
7
2.4.2. Configuration of community skin cancer services (14-1C-102j)
The current configuration is as follows:
CCG
Model Location of Community Facilities MDT / Trust MDT Type
Catchment Population
Ashton, Wigan & Leigh
Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
Wigan Local 315,766
Bolton
Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
Bolton Local 288,341
Salford Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
Salford Local & Specialist
233,966
Bury Model 4 Patients seen locally in Bury (Fairfield Hospital) by Salford dermatologist
Salford Local & Specialist
194,675
Heywood, Middleton & Rochdale
Model 4
70% of 2WW patients are seen in Bury (Fairfield Hospital) by Salford dermatologists. 30% of 2WW patients are seen in Oldham (Royal Oldham Hospital) by Tameside dermatologists Non-2WW patients seen by Dermatology CATS clinics at: Phoenix Centre, Heywood Durnford Med Centre, Middleton Ashworth Street Surgery, Rochdale
Salford or
Tameside
Local
213,229
Oldham Model 4 Patients seen locally in Oldham by Tameside dermatologists. (Royal Oldham Hospital) Any patients seen in primary care / ICATS will be referred to Tameside MDT.
Tameside Local 238,544
Tameside & Glossop
Model 4 No cases of skin cancer managed or treated in the community. All referred to local MDT GPs involved in minor surgery required to attend MDT.
Tameside Local 240,079
Stockport
Model 2 GpwSIs Employed by Stockport FT Stockport
Local 298,505
Manchester North – Model 4
60% of patients are seen in Bury by Salford dermatologists (Fairfield Hospital) 40% of patients are seen in Oldham by Tameside dermatologists (Royal Oldham Hospital)
Salford or
Tameside
Local
173,272
Central – Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
Trafford / Central
Manchester / South
Manchester
206,690
South – Model 2
GpwSIs Employed by UHSM 162,603
Trafford Model 4 No community service Suspected cancers referred to Central Manchester and University Hospital South Manchester
Central Manchester
/ South Manchester
Local
232,619
Central & Eastern
DES/LES and
GpwSI feeding into East Cheshire or Mid Cheshire MDT
East Cheshire
Local 203,504
8
Cheshire Model 1 Suspected cancers referred to East Cheshire or Mid Cheshire NHS Trust
Mid Cheshire
Local 267,273
3,269,066
2.4.3. Governance arrangements for community practitioners (14-1C-117j)
Group 3 and skin lesion GPwSIs, and Model 2 practitioners practising in the network should each be associated with a named LSMDT or SSMDT
Community skin cancer practitioners should have their practice included in the network audit
The MDT lead clinicians should monitor the attendance of any GPwSIs associated with their MDT, at four MDT meetings a year and an annual community practitioners educational Network meeting
Group 3 GPwSIs / Model 2
practitioner CCG Associated LSMDT LSMDT lead clinician
None at present Manchester (South) UHSM / Central Manchester / Trafford
Dr Gavin Wong
None at present Stockport Stockport Dr John Newsham
The Pathway Board will hold at least one educational meeting per year to which community skin cancer practitioners are invited, and which includes:
A presentation of network skin cancer audit results. The audit and the presentation should include a topic involving BCCs, of relevance to practitioners treating them in the community and a breakdown of individual practitioner performance
A four hour CPD session on skin lesion recognition including diagnosis and management of low risk BCCs
2.4.4. Training policy for model 2 community practitioners (14-1C-108j)
The training policy for the network for Model 2 community practitioners includes:
Unless they fulfill the exemption conditions (as described in measure 11-1C-113j) practitioners should be trained and assessed in an agreed selection of the skin surgery curriculum and competencies as set out in “guidance for the accreditation of General Practitioners with a special interest in dermatology (GPwSIs) and General Practitioners performing skin surgery 2011”
The Skin NSSG will, if required in the future, after consultation with MDTs, agree named trainers / assessors of competence for the network for the
9
Model 2 practitioners training. They will be either core dermatology or surgical members of each local skin MDT
Named Trainer / Assessor MDT Professional Status
Dr Gavin Wong
UHSM / Central Manchester / Trafford
Consultant Dermatologist
Dr John Newsham
Stockport Consultant Dermatologist
2.5. Manchester Cancer
Manchester Cancer covers a population of over 3 million served by the following organisations:
Bolton NHS Foundation Trust
Central Manchester University Hospitals NHS Foundation Trust
East Cheshire NHS Trust
Pennine Acute Hospitals NHS Trust (Bury, North Manchester, Oldham, Rochdale)
Salford Royal NHS Foundation Trust
Stockport NHS Foundation Trust
Tameside Hospital NHS Foundation Trust
The Christie NHS Foundation Trust
University Hospital of South Manchester NHS Foundation Trust
Wrightington, Wigan and Leigh NHS Foundation Trust The Christie Hospital is the tertiary referral centre for the region. Radiotherapy is delivered at Christie Hospital and the satellite radiotherapy units based at Royal Oldham Hospital and Salford Royal. Some chemotherapy and clinical trials will continue to be delivered from Christie Hospital, although local chemotherapy is currently available at:
Wigan
Bolton
Oldham
East Cheshire
Mid Cheshire 2.6. Pathway Board Terms of Reference (14-1C-105j)
The Skin Cancer Pathway Board is a multi-professional group chaired by Dr John Lear, a Consultant Dermatologist from Central Manchester University Hospitals NHS Foundation Trust. These are the Board’s Terms of Reference.
10
These terms of reference were agreed in 2014 with Mr David Shackley, Medical Director of Manchester Cancer, on behalf of the Manchester Cancer Provider Board. The terms of reference will be subject to future review. 2.6.1. The Pathway Board
The Skin Cancer Pathway Board is a cancer care specific board with responsibility to improve cancer outcomes and patient experience for local people across Greater Manchester and areas of Cheshire (a catchment population of 3.2 million). This area is synonymous with the old Greater Manchester and Cheshire Cancer Network area.
The Pathway Board is led by a Pathway Clinical Director and is formed of a multidisciplinary team of clinicians and other staff from all of hospital trusts that are involved in the delivery of skin cancer care in Greater Manchester. The Pathway Board also has membership and active participation from primary care and patients representatives.
The Skin Cancer Pathway Board reports into and is ultimately governed and held to account by the Manchester Cancer Provider Board.
2.6.2. Manchester Cancer Provider Board
The Manchester Cancer Provider Board is responsible for the service and clinical delivery arm of Manchester Cancer, Greater Manchester’s integrated cancer system. Manchester Cancer has two other arms: research and education (see appendix for the structure of Manchester Cancer).
The Provider Board is independently chaired and consists of the Chief Executive Officers of the ten acute hospital trusts in the Greater Manchester area:
Bolton NHS Foundation Trust
Central Manchester University Hospitals NHS Foundation Trust
East Cheshire NHS Trust
Pennine Acute NHS Trust
Salford Royal NHS Foundation Trust
Stockport NHS Foundation Trust
Tameside Hospital NHS Foundation Trust
The Christie NHS Foundation Trust
University Hospital of South Manchester NHS Foundation Trust;
Wrightington, Wigan and Leigh NHS Foundation Trust; The Provider Board regularly invites representatives of commissioners, the Strategic Clinical Network, and Manchester Cancer to its meetings.
2.6.3. Purpose of the Pathway Board
11
The purpose of the Pathway Board is to improve cancer care for patients on the Greater Manchester skin cancer pathway. Specifically, the Pathway Board aims to save more lives, put patients at the centre of care, and improve patient experience. The Board will represent the interests of local people with cancer, respecting their wider needs and concerns. It is the primary source of clinical opinion on this pathway for the Manchester Cancer Provider Board and Greater Manchester’s cancer commissioners.
The Pathway Board will gain a robust understanding of the key opportunities to improve outcomes and experience by gathering and reviewing intelligence about the skin cancer pathway. It will ensure that objectives are set, with a supporting work programme that drives improvements in clinical care and patient experience.
The Pathway Board will also promote equality of access, choice and quality of care for all patients within Greater Manchester, irrespective of their individual circumstances. The Board will also work with cancer commissioners to provide expert opinion on the design of any commissioning pathways, metrics and specifications.
2.6.4. Role of the Pathway Board
The role of the Skin Cancer Pathway Board is to:
Represent the Manchester Cancer professional and patient community for skin cancer.
Identify specific opportunities for improving outcomes and patient experience and convert these into agreed objectives and a prioritised programme of work.
Gain approval from Greater Manchester’s cancer commissioners and the Manchester Cancer Provider Board for the programme of work and provide regular reporting on progress.
Design and implement new services for patients where these progress the objectives of commissioners and Manchester Cancer, can be resourced, and have been shown to provide improvements in outcomes that matter to patients.
Ensure that diagnosis and treatment guidelines are agreed and followed by all teams in provider trusts, and are annually reviewed.
Ensure that all providers working within the pathway collect the pathway dataset measures to a high standard of data quality and that this data is shared transparently amongst the Pathway Board and beyond.
Promote and develop research and innovation in the pathway, and have agreed objectives in this area.
Monitor performance and improvements in outcomes and patient experience via a pathway scorecard, understanding variation to identify areas for action.
12
Escalate any clinical concerns through provider trusts.
Highlight any key issues that cannot be resolved within the Pathway Board itself to the Medical Director of Manchester Cancer for assistance.
Ensure that decisions, work programmes, and scorecards involve clearly demonstrable patient participation.
Share best practices with other Pathway Boards within Manchester Cancer.
Contribute to cross-cutting initiatives (e.g. work streams in living with and beyond cancer and early diagnosis).
Discuss opportunities for improved education and training related to the pathway and implement new educational initiatives.
Develop an annual report of outcomes and patient experience, including an overview of progress, difficulties, peer review data and all relevant key documentation. This report will be published in July of each year and will be the key document for circulation to the Provider Board. A template for this report is available so that all Pathway Boards complete the report in a similar manner.
2.6.5. Membership principles
All member organisations of Manchester Cancer will have at least one representative on the Pathway Board unless they do not wish to be represented.
Provider trusts not part of Manchester Cancer can be represented on the Pathway Board if they have links to the Greater Manchester skin cancer pathway.
All specialties and professions involved in the delivery of the pathway will be represented.
The Board will have at least one patient or carer representative within its membership
One professional member of the Pathway Board will act as a Patient Advocate, offering support to the patient and carer representative(s).
The Board will have named leads for:
Pathology
Radiology
Surgery
Teenagers and young adults
Specialist nursing
Living with and beyond cancer (‘survivorship’)
Research
13
Data collection (clinical outcomes/experience and research input).
It is possible for an individual to hold more than one of these posts. The Pathway Clinical Director is responsible for their fair appointment and holding them to account.
These named leads will link with wider Manchester Cancer Boards for these areas where they exist.
All members will be expected to attend regular meetings of the Pathway Board to ensure consistency of discussions and decision-making (meeting dates for the whole year will be set annually to allow members to make arrangements for their attendance).
A register of attendance will be kept: members should aim to attend at least 5 of the 6 meetings annually and an individual’s membership of the Pathway Board will be reviewed in the event of frequent non-attendance.
Each member will have a named deputy who will attend on the rare occasions that the member of the Board cannot.
2.6.6. Frequency of meetings
The Skin Cancer Pathway Board will meet every two-three months.
2.6.7. Quorum
Quorum will be the Pathway Clinical Director plus five members of the Pathway Board or their named deputies.
2.6.8. Communication and engagement
Accurate representative minutes will be taken at all meetings and these will be circulated and then validated at the next meeting of the Board.
All minutes, circulated papers and associated data outputs will be archived and stored by the Pathway Clinical Director and relevant Pathway Manager.
The Pathway Board will design, organise and host at least one open meeting per year for the wider clinical community and local people. This meeting or meetings will include:
An annual engagement event to account for its progress against its work programme objectives and to obtain input and feedback from the local professional community
An annual educational event for wider pathway professionals and interested others to allow new developments and learning to be disseminated across the system
14
Representatives from all sections of the Manchester Cancer professional body will be invited to these events, as well as patient and public representatives and voluntary sector partners.
An annual report will be created and circulated to the Medical Director of the Manchester Cancer Provider Board by 31st July of each calendar year.
The agendas, minutes and work programmes of the Pathway Board, as well as copies of papers from educational and engagement events, will be made available to all in an open and transparent manner through the Manchester Cancer website once this has been developed.
2.6.9. Administrative support
Administrative support will be provided by the relevant Pathway Manager with the support of the Manchester Cancer core team. Over the course of a year, an average of one day per week administrative support will be provided.
2.7. Pathway Board membership (14-1C-104j)
Andrew Sykes Consultant Clinical Oncologist Christie
Chris Duff Consultant Plastic Surgeon UHSM
Corinna Mendonca Consultant Dermatologist Bolton
David Mowatt Consultant Plastic Surgeon SRFT
Deemesh Oudit Consultant Plastic Surgeon Christie
Elaine Hodkinson Divisional Manager SRFT
Elizabeth Stewart Consultant Dermatologist WWL
Gavin Wong Consultant Dermatologist UHSM
John Newsham Consultant Dermatologist Stockport
Julie Colins Clinical Nurse Specialist UHSM
Katie Bailey Dermatology CNS Tameside
Loma Gardner Consultant Dermatologist Tameside
Louisa Motta Consultant Dermato-Pathologist SRFT
Neil Cutler Patient Representative -
Nick Telfer Consultant Dermatologist / Mohs Lead SRFT
Paul Lorigan Consultant Medical Oncologist Christie
Rebecca Brooke Consultant Dermatologist SRFT
Sue Taylor Skin Cancer Nurse Specialist WWL
Tim Woolford Consultant ENT Surgeon CMFT
Timothy Kingston Consultant Dermatologist East Cheshire
Vindy Ghura Consultant Dermatologist SRFT
Vishal Madan Consultant Dermatologist SRFT
15
3. PATHWAYS AND GUIDELINES
3.1. Clinical guidelines (14-1C-109j)
Manchester Cancer Pathway Boards have been in place since spring 2014 and are going through the process of reviewing the clinical guidelines and patient pathways inherited from the old cancer network groups. Where they exist, updated guidelines and pathways have been posted to the relevant pages of the Manchester Cancer website www.manchestercancer.org. Where guidelines and pathways are yet to be reviewed and updated then the legacy documents from the cancer network continue to be current. Where they exist, these legacy documents have also been posted to the relevant pages of the Manchester Cancer website www.manchestercancer.org. The combined skin cancer legacy clinical guideline can be found at http://manchestercancer.org/services/skin/. 3.2. Chemotherapy algorithms (14-1C-110j)
All chemotherapy algorithms can be accessed via the intranet of The Christie NHS Foundation Trust. These are live documents: http://nww.christie.nhs.uk/documents/default.aspx?Category=Y&Category1=1 Search for: Policies & Guidelines Sub-category 1: Chemotherapy protocols 3.3. Primary care referral guidelines (14-1C-111j)
Actinic keratoses and precancerous lesions may be dealt with by any GP (level 1 care)
GPs should refer suspected cases of skin cancer requiring treatment, including BCCs, to the contact point of the relevant named MDTs in the network configuration (as described in measure 11-1A-204j. For cases of low risk BCC there is the option of referral to the contact point of a relevant GP based service
Contact points for relevant community services are shown below
Guidance for GPs on clinically identifying BCCs in shown below
It is inevitable that SCCs and other tumours outside the remit of GPs will be excised accidentally by them, when diagnosis is not clinically apparent. The guidelines are
16
underpinned by an assumption that GPs will not knowingly treat patients beyond their remit
CCG
Model Community Facilities Contact Point MDT
Ashton, Wigan & Leigh
Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
NA Wigan
Bolton
Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
NA Bolton
Salford Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
NA Salford
Bury Model 4 Patients seen locally in Bury by Salford dermatologist
NA Salford
Heywood, Middleton & Rochdale
Model 4
70% of patients are seen in Bury by Salford dermatologists. 30% of patients are seen in Oldham by Tameside dermatologists
NA Salford or
Tameside
Oldham Model 4 Patients seen locally in Oldham by Tameside dermatologists. Any patients seen in primary care / ICATS will be referred to Tameside MDT.
NA Tameside
Tameside & Glossop
Model 4 GPs involved in minor surgery required to attend MDT. Awaiting NICE guidance to finalise governance for low risk BCCs
NA Tameside
Stockport
Model 2 GpwSIs Employed by Stockport FT NA Stockport
Manchester North – Model 4
60% of patients are seen in Bury by Salford dermatologists. 40% of patients are seen in Oldham by Tameside dermatologists
NA Salford or
Tameside
Central – Model 4
No cases of skin cancer managed or treated in the community. All referred to local MDT.
NA Central Manchester /
South Manchester South –
Model 2 GpwSIs Employed by UHSM NA
Trafford Model 4 No community service Suspected cancers referred to Central Manchester and University Hospital South Manchester
NA Central Manchester /
South Manchester
Central & Eastern Cheshire
DES/LES and Model 1
GpwSI feeding into East Cheshire or Mid Cheshire MDT Suspected cancers referred to East Cheshire or Mid Cheshire NHS Trust
Tracey Wright, Cancer
Commissioning Manager
East Cheshire
Mid Cheshire
Guidance for GPs on clinically identifying potential high risk BCCs (level 2 care)
Clinical features of BCCs at high risk of recurrence (any of these):
17
Site Face, scalp, ears
Size 2cm or more
Circumstances Immunocompromised patients Genetically pre-disposed patients (eg Gorlins syndrome) Previously treated lesion Flat lesion, hard thickened skin (appearance of morphoeic BCC)
For the purpose of GP referral, ‘low risk BCC’ is considered to be any BCC, other than those above. Distribution process
The above guidance was circulated to all Skin Cancer MDT Clinical Leads, Acute Trust Cancer Managers and Primary care Trust Cancer Managers on 20 June 2012. 3.4. Patient pathways 14-1C-111j
See appendix 1 for the skin cancer pathway. For the teenage and young adult cancer pathways developed under the old Greater Manchester and Cheshire Cancer Network see http://manchestercancer.org/services/teenagers-and-young-adults/. 3.5. Pathways between teams and for supranetwork MDTs/services (14-1C-112j; 14-1C-113j;
14-1C-114j)
All the named local skin cancer MDTs (Bolton; East Cheshire; Mid Cheshire; Salford; Stockport; Tameside; Central Manchester/South Manchester/Trafford) will refer cases of the types of skin cancer needing care level 5 to:
Specialist skin cancer MDT based at Salford Royal Foundation Trust
Specialist T-cell Lymphoma MDT at Christie Hospital
Supra-network sarcoma MDT at Christie Hospital
Skin cancer cases needing care level 5
Specialist Team MDT Lead Clinician
Cutaneous lymphoma
Specialist T-cell Lymphoma MDT at Christie Hospital
Dr Richard Cowan
Kaposi’s Sarcoma
Specialist Skin cancer MDT at Salford Royal Foundation NHS Trust
Dr John Lear
Cutaneous sarcoma above superficial fascia
Supra-network sarcoma MDT at Christie Hospital
Dr James Wylie
Other rare skin cancers
Specialist Skin cancer MDT at Salford Royal Foundation NHS Trust
Dr John Lear
18
Mycosis fungoides (including Sezary syndrome) Mycosis fungoides, stage IA, in addition to lymphomatoid papulosis can be discussed and managed by the Local Skin MDT (LSMDT). If the patient is not referred, the Supra-network T-cell lymphoma MDT (STLMDT) should still be notified so that the histological diagnosis can be confirmed, and that accurate figures of new diagnoses can be recorded. Mycosis fungoides stage IB and above, must be discussed at the local Skin Cancer MDT and referred to the STLMDT as follows: Referrals of Stage IB, IIA and III to be referred to: Dr. Eileen Parry at Salford Royal Hospital (NB; Prognosis of stage III is greater than IIB (ISCL / EORTC updated guidelines, Blood 2008). Stage III patients are considered for photopheresis, which is managed by Dr Parry at Salford. Patients are referred on to Dr Cowan at Christie Hospital if further systemic treatment is needed) Stage IIB and IV to be directed to: Dr. Richard Cowan at the Christie Hospital For mycosis fungoides stage IIB and over, treatment options will include Total Surface Electron Beam Therapy (TSEBT), extracorporeal photopheresis (ECP), Bexarotene, radiotherapy, chemotherapy (oral / intravenous) and clinical trials. TSEBT is performed at the Christie Hospital under Dr Cowan. Requests are made by/via the STLMDT.
Photophoresis Cases of erythrodermic cutaneous T-cell lymphoma, stages III & Iva, are suitable for consideration of ECP. All referrals should come via the STLMDT from Salford or Christie, and should be discussed with the clinician in charge of the ECP facility. The named facility for extra corporeal photophoresis is: Manchester Blood Centre, Plymouth Grove, Manchester, M13 9LL. The clinician in charge is: Dr Deepak Sadani.
19
Appendix 1 – Patient pathway Skin Cancer Pathway
62 day target for patients referred as suspected cancer
Day 0
GP Referral
Referral to Surgical Specialist (includes plastics, ENT, Maxilo-facial,
opthal/oculoplastic and general surgery)
Peri-ocular tumour patients should be referred directly to the oculoplastics team
at MREH, or if BCC may be referred directly to Mohs Clinic at SRFT
By Day 14
First seen Outpatient Appointment: Dermatology Secondary Care Suspected
Cancer Clinic
Biopsy (May also be first treatment)
Minor Ops List
Other treatment without Biopsy
Discuss with Patient
Biopsy May also be first treatment
Minor Ops List
By Day 31
Discuss with Patient – Decision to Treat
Pathology
By Day 31
Discuss with Patient – Decision to Treat
Referral to Surgical Specialists / Oncologists / Other Service Providers
Treatment Options: - Surgery - Radiotherapy - Systemic Therapy
Agree Treatment with Patient
By Day 62 First Definitive Treatment
By Day 62 First Definitive Treatment
Patients diagnosed with SCC in situ, BCC and non-cancer patients are stepped
off the 62 day pathway
By Day 62
Dermatologist Appt for Excision
