Minutes of the Skin Cancer NSSG MEETNG
Thursday 18th June 2015 at 2.00pm
Lifton Strawberry Fields Farm, Lifton, Devon
Attendees:
Karen Davies (KD) Chair, NDHT
Laura Beer (LBe), NDHT
Duncan Mackenzie (DM) PHT
Ruth Devlin (RD) PHT
Sarah Carswell (SC) RCHT
Emily McGrath (EMg) RDE
Stephen Adcock (SA) RCHT
Jill Adams (JA) TST
Item
1.
Jonathan Miller (JM) NHS England
Sarah Sandford (SS) RDE
Rebecca Batchelor (RB) RDE
Claire Facey (CF) RDE
Ann McCormack (AM) RDE
Pam Lewins (PL) SDHT
Jo MacDonald (JMa) TST
Wendy Cook (WC) PCRN
Stephanie Hale (SH) SDHT
Clem Ng (CN) SDHT
Rosie Davies (RD) SD
Ben Waterfall (BW) GP Brannam
Rachel Wachsmuth (RW) YDH
Karen Curtis (KC) TST
Liz Boylan (LB) PCN
Sue Buddin (SB) PCN
Action
Welcome/Apologies
KD welcomed members. (See Appendix A for apologies). It was confirmed that Taunton &
Somerset Trust and Yeovil will be part of the SW Peninsula Skin Cancer NSSG.
Action: LB to send copy of minutes and invite TST and YDH members to attend next meeting
1.1
Actions from meeting held 27th November 2014 complete.
2.
2.1
Network Support Services
LB took up her post as Peninsula Cancer Network Manager in December 2014. The Admin
Support role was filled in March 2015. These posts are funded for one year by the South West
Strategic Clinical Network (SWSCN). A business case has been prepared for future funding to be
provided by the local trusts, with the costs of the NSSG service divided based on trust size and
the number of NSSGs within the Peninsula in which each trust will be participating.
To date all site specific groups have had one NSSG meeting with a second planned for the
autumn.
Recent meeting attended by KD, chaired by Sean Duffy of NHS England, to set up a National
Clinical Reference Group for skin cancer to advise commissioners. This highlighted the varied
way networks are now functioning across England.
Document Review
The current Terms of Reference, Constitution and Clinical Guidelines require updating.
Terms of Reference: The draft ToR had been circulated with the agenda. This will be updated
and circulated. Any comments to LB by end-September 2015
Constitution: An updated draft of the Constitution with current membership will be circulated
with the agenda. All trusts to review their details and return with any comments to LB by end
September 2015.
KD asked for names of MDT leads and CNS at each trust as the current list is out of date:
RDE
Chris Bower
MDT Lead SD
Clement Ng
MDT Lead
Claire Facey
CNS
Pam Lewins
CNS
Sarah Sandford
CNS
Stephanie Hale
CNS
Kate Allington
CNS
TST Jill Adams
MDT Lead (joint)
Jo Short
CNS
Karen Curtis
MDT Lead (joint)
PHT
Duncan Mackenzie MDT Lead
Jo Macdonald
CNS
Ruth Devlin
CNS
Ben Hawthorne
CNS
Jill Daniels
CNS
YDH Rachel Wachsmuth MDT Lead
RCHT
Tom Lucke
MDT Lead
Mihaela Savu
CNS
Sarah Carswell
CNS
ND
Karen Davies
Joint MDT Lead
2.2
2.3
3.
3.1
3.2
LB
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Skin NSSG Minutes 18.06.15 draft V0.1
Lisa Tripp
3.3
4.
4.1
5.
5.1
6.
6.1
7.
7.1
8.
8.1
9.
9.1
9.2
9.3
10.
10.1
10.2
11.
11.1
CNS
Andrew Watts
Laura Beer
Joint MDT Lead
CNS
Chairmanship – KD agreed to continue as Chair – agreed by those present.
Action: Updates and comments to LB by end September 2015
Enhanced Melanoma Follow-Up Guidelines
Proposals for CT/MRI on melanoma patients at high risk of recurrence. Some MDTs are offering
regular scans for those at high risk as per the recent ‘position statement’ published by
oncologists. Agreed reasonable to offer to patients if MDTs agree to, and some are already doing
so, but it is not yet national guidance.
Agreed that enhanced follow-up with regular 6 mthly CT (MRI head) may be considered and
offered to patients who would be fit enough to receive Ipilimumab.
SLNB Network Guidance
KD confirmed that the Skin Cancer Network has previously agreed NOT to routinely offer SLNB to
patients with melanoma less than 1mm thick ( ie stage 1b with tumour less than 1mm but with
raised mitotic count). This is stated in the network skin cancer guidelines.
Action: KD to review and issue network guidelines for agreement
Guidelines
KD to update and send out draft of new network skin cancer guidelines. When agreed will be
published on South West Cancer website http://www.swscn.org.uk/networks/cancer/sitespecific-groups/peninsula-site-specific-groups/peninsula-skin-cancer-ssg/peninsula-skin-cancerssg-information-for-members/ and links included in the updated Constitution.
Action: KD to update and send out draft guidelines
Next Annual Network Course for GPs doing skin cancer work
The next GP Course has been scheduled for 24th September 2015 at the Arundel Arms, Lifton.
Action: KD to ask Lisa Wells to send another email reminding GPs of date – and ask for
suggestions from GPs for course content.
GPs wanting to do low risk BCC work under LES agreements
Last course ran in North Devon 3 years ago. GPs currently operate on some low risk skin
cancers, but there is no funding for any new LES agreements. KD to capture issues in e-mail for
JM to follow up. JM will contact CCGs and NHS England in SW.
Action: KD to e-mail details to JM for follow up
Dermatology Day for Commissioners – 22nd April 2015
Advice given to commissioners about complexities of commissioning dermatology and skin
cancer services. Particular emphasis on the key issue of triage of referrals.
Action: JM to e-mail KD with link to documents on the website.
Devon CCG Benign Lesion Policy
KD has contacted Devon CCG to ask them to remove the skin cancer pathway which had been
inadvertently put into the Benign Lesions Policy.
Triaging through DRSS discussed. Many GP letters don’t give clear diagnosis. Consider role of
specialists in triaging. DRSS do have a pathway for directing skin referrals.
KD discussed issue of referrals potentially rejected by referral management organisations. KD
has advised DRSS that they need to ensure that they do not reject referrals where there is any
diagnostic doubt expressed.
SCC Follow Up
JM/KD – Current practice for follow-up of SCCs varies between centres and clinicians. Most GPs
can’t do follow-up – don’t have specific training, don’t have systems for recall, and concerns
about shift of workload to primary care.
Current network guidelines reflect this differing practice.
Action: Each trust to send current practice to KD.
Action: KD will re-write follow-up guidelines and issue draft for agreement.
Audit / Clinical Research Trials
Audit - KD suggested possible audit on basisquamous tumours.
RW advised re audit of SCCs being suggested by David deBerker.
Action: KD/RW to communicate with David deBerker re SCC audit.
Clinical Research - WC outlined recent changes to the research network and, on behalf of Toby
Talbot, NSSG sub-specialty lead for skin cancer, presented the latest clinical trial recruitment
data for the Peninsula.
ALL
KD
KD
KD
KD/JM
JM
ALL
KD
KD
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11.2
12.
12.1
13.
13.1
13.2
14.
The southwest has the highest incidence of skin cancer in the country, but a low numbers of
trials in proportion, as most are allocated to larger high profile centres.
TT is proactive in trying to promote the southwest to companies setting up trials.
Action: TT to provide details on open/upcoming trials and consider network-wide recruitment
Living with and beyond Cancer Programme
Some funding to support available from Macmillan. Health & Wellbeing Clinics run by CNS with
access to psychiatrists, dieticians eg: Force, Mustard Tree, the Cove. Centres, run by nurse
specialists and volunteers, provide recovery package including holistic needs assessment,
careplan and treatment summary. Request for Well-Being Video.
Clinicians acknowledged that this system for follow-up does NOT save money.
Action: LB to see if video or other media available and send links.
AOB
2WW Referral Forms – KD has been asked by DRSS if we can all have one 2ww proforma –
currently all trusts are using different forms. JM will issue draft standard proformas for use
across South West once new NICE guidance are released (this week). JM will validate with GPs
systems and issue to group.
Action: JM to send copies of draft proformas when completed.
Skin Cancer Campaign 2014 - Feedback requested re changed knowledge, behavior, increased
referrals.
Action: JM to send link to campaign feedback.
TT
LB
JM
JM
Date of next meeting:
The next meeting will be held on Thursday 12th November in the Conference Room, Lifton Farm
Shop, Lifton – 2-4pm
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APPENDIX A
Skin Cancer NSSG Meeting 18th June 2015 - Attendees / Apologies
Surname
Forename
Org
Job Title
Beer
Laura
ND
Chemotherapy staff nurse
Present
Signature
Davies
Karen
ND
Consultant
Present
Wells
Lisa
ND
Dermatology Manager
Devlin
Ruth
PHT
Clinical Nurse Specialist
Present
Mackenzie
Duncan
PHT
Consultant
Present
Chave
Toby
PHT
Consultant Dermatologist
Curnow
Alison
RCHT
Lecturer
Lucke
Tom
RCHT
Consultant
Apologies
Carswell
Sarah
RCHT
Clinical Nurse Specialist
Present
Hann
Samantha
RCHT
Consultant
Apologies
Talbot
Toby
RCHT
Consultant
Apologies
Adcock
Stephen
RCHT
Maxillofacial Surgeon
Present
Tripp
Lisa
RCHT
Clinical Nurse Specialist
McGrath
Emily
RDE
Specialist Registrar
Present
Sandford
Sarah
RDE
Clinical Nurse Specialist
Present
Allington
Kate
RDE
Clinical Nurse Specialist
Batchelor
Rebecca
RDE
Consultant Dermatologist
Present
Bower
Chris
RDE
Consultant Dermatologist
Apologies
Charman
Carolyn
RDE
Consultant Dermatologist
Apologies
Facey
Claire
RDE
Clinical Nurse Specialist
Present
Hughes
Sarah
RDE
Cluster Manager
McCormack
Anne
RDE
Consultant Oncologist
Oliver
David
RDE
Consultant
Stone
Chris
RDE
Consultant
Lewins
Pam
SD
Clinical Nurse Specialist
Present
Hale
Stephanie
SD
Macmillan Skin Cancer Support Nurse
Present
Ng
Clem
SD
Consultant
Present
Davis
Rosie
SD
Consultant
Present
Waterfall
Ben
Principal GP (Brannam - L83073)
Present
Acheson
Peter
GP (Claremont - L83056
Chamberlain
Victoria
GP (Heavitree - l83077)
Crighton
Helen
GP (Mount Pleasant - L83066)
Lawn
Noel
GP (Woodbury - L83116)
Pitt
Joe
GP (Townsend - L83054)
Willcock
William
Wachsmuth
Rachel
TST
Consultant Dermatologist
Present
Adams
Jill
TST
Consultant Dermatologist
Present
Curtis
Karen
TST
CNS
Present
Macdonald
Joe
TST
Skin Cancer CNS
Present
Barthakur
Urmila
TST
Oncologist
Barlow
Clare
TST
Consultant Oncologist
Edwards
Felicity
YDH
Consultant Dermatologist
Savu
Mihaela
YDH
CNS
Miller
Jonathan
NHS England
South West Cancer Manager
Present
Cook
Wendy
PCRN
Research Delivery Manager
Present
Buddin
Sue
PCN
Pensinsula Network Admin Support
Present
Boylan
Liz
PCN
Pensinsula Cancer Network Manager
Present
Present
Apologies
Apologies
GP (Rolle - L83053
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