Primary Care Regional Group Meeting
5th April 2006
NICaN
Minutes of 4th NICaN Primary Care Group Meeting
5th April 2006
Park Plaza Hotel
Record of Attendees
Denis Boyd
Janis McCulla
Ian Clarkson
Joyce McKee
Graeme Crawford
Aine McNeill
Joanne Cullen
Lisa McWilliams
Dermott Davison (Chair)
Maria Magee
Bridget Denvir
Avril Morrow
Shauna Fannin
Lorna Nevin
David Johnston
Brendan O’Hare
Gillian Lamrock
Gary Wardrop
Maggie McCarney
Apologies:
Sally Campalani, Janine Curran, Liz Henderson, Sonja McIlfatrick and Phil Mahon
Welcome and Introductions
Dr Dermott Davison welcomed everyone to the fourth Regional Primary Care Group Meeting
before roundtable introductions.
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Matters arising from Minutes of 13th January Meeting
Directors of Primary Care Forum Meeting – 10th February
This meeting had been useful and attendees had been supportive of the Regional Group.
With regards to the implementation of products one suggestion had been that they could be
incorporated into primary care software systems.
3rd Annual DHSSPSNI Primary Care Conference – 8th March
Dr Davison had delivered a presentation entitled “The Strong Voice of Primary Care within
the Cancer Network”, highlighting the work of this Group. Dr Davison was introduced to
Christine Jendoubi, the new Director of Primary Care at DHSSPSNI.
Department of General Practice Meeting – 14th March
It was reported that Ms Lorna Nevin and Dr Davison had met with Professor Reilly and other
representatives of the Department to highlight the work of this Group. The Department is
keen to develop strategic alliances and would welcome ideas to be forwarded for research
registrars.
Work Plan Updates
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GP Referral Guidance – Dr Ian Clarkson
For the benefit of new members Dr Clarkson outlined the background to this workstrand
before referring to the second and final draft of the GP Referral Guidance, which had been
emailed ahead of today’s meeting. Dr Davison thanked the working group for their hard
work before asking members if they were happy to sign the guidance off. This was
subsequently agreed and the guidance will be forwarded to the Lung Regional Group for
sign off. With regards to the implementation of this guidance it was reported that the
NHSSB is working to develop an electronic proforma to accompany this guidance as a pilot
exercise in e-referral.
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Communication
Ms Janine Curran, the Lead for this workstrand had tendered her apologies for the meeting.
It was reported that the subgroup are to meet to brainstorm how to develop strong
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communication linkages. Dr Davison proposed that this subgroup also consider the
communication/implementation of agreed guidance. This was agreed as appropriate.
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Lung Patient Pathway – Dr Dermott Davison
This paper had been circulated ahead of the meeting. Dr Davison reported on the findings of
the patient pathway exercise emphasising that GP referral guidance was not applicable to
all as 50% of patients within this exercise presented outside of expected referral pathways.
This finding had already been incorporated into the referral guidance through the inclusion
of the recommendations that GPs have a high index of suspicion for smokers and a low
threshold for referral for chest xray. Dr Davison also highlighted that this exercise did not
appear to indicate any tardiness with regards to referrals on behalf of primary care
practitioners.
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Guidance for the Ill Patient following Chemotherapy – Dr Graeme Crawford
Paper tabled at the meeting. Dr Graeme Crawford stated that the flowchart for this
guidance had been redrafted following the first consultation and now includes a red critical
care section. Comments for this second draft are to be forwarded within one week and then
the subgroup will meet to incorporate final changes. Members appreciated that this is an
important piece of clinical guidance and it was agreed that to ensure circulation to AHPs.
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Regional Telephone Advice – Ms Gillian Lamrock
Ms Gillian Lamrock reported that the telephone advice line had been operational for three
weeks before outlining the procedures and systems in place to support it. It was stated that
there are some issues to resolve including determining if it is for general advice or cancer
related medical emergencies. Ms Joyce McKee questioned if information was available for
those whose first language is not English.
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Chemotherapy in the Community – Dr Brendan O’Hare
A paper was tabled at the meeting, which described the current provision of community
delivered chemotherapy in Northern Ireland. Dr Brendan O’Hare walked through the paper
before focussing on future development of this service. Contracts are currently only
operating in the NHSSB and WHSSB areas and Dr O’Hare questioned if funding should be
sought to role this provision out across Northern Ireland.
Members flagged some concerns with regards to communication with primary care
practitioners, the assessment process (i.e. support for patient and suitable home
environment) and also clinical governance arrangements. On seeking general feedback Ms
Lamrock stated that based on anecdotal evidence the service being provided is a good
service and Mr David Johnston stated that he has estimated that the NHSSB have saved
~£500k through this service.
Dr Davison highlighted that this work would feed into the Chemotherapy Services workshop,
which is being held on 5th May. Dr O’Hare has agreed to provide the community perspective
at this meeting and as such members were asked to complete a short proforma to capture
their vision for the future. The submissions are included in Appendix 1.
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Oesophageal & Gastric Patient Narrative – Ms Janis McCulla
At the last meeting Dr Sonja McIlfatrick had advocated the collection of patient narrative to
inform work such as referral guidance. To this end Dr Davison introduced Ms Janis
McCulla, the NICaN Public and Patient Involvement Co-ordinator. Ms McCulla reported that
she had attended a meeting of the Oesophageal Patients Association and had captured
some narrative with regards to their experience.
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Ms McCulla gave brief feedback (more detailed feedback will be given at the upcoming
Oesophageal & Gastric Cancer Regional Group meeting) highlighting that at presentation to
Primary Care only 3 of the 21 patients were concerned about cancer. It was suggested that
this demonstrated a need for public education re symptom awareness.
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Oesophageal & Gastric Patient Pathway – Dr Aine McNeill
Dr Aine McNeill reported that a template had been devised to capture patient pathways,
using a similar process to that used for lung cancer. It was determined that this template
had only been circulated to subgroup members and is to be forwarded to appropriate
members of this Group. Dr McNeill briefly shared the pathways of 3 patients stating that
early findings show that whilst procedures were similar the sequencing of them appeared
haphazard. It was also suggested that a problem is late presentation to GPs.
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Oesophageal & Gastric Referral Guidance – Dr Graeme Crawford
A copy of the DOH referral guidelines for Upper GI Cancers was tabled by Dr Crawford who
stated that a subgroup will use these as the basis for the referral guidance. Dr Crawford
then expressed concern at the DOH age threshold of 55yrs and stated that this would be
one of the areas to explore with the subgroup. Clinician involvement in this subgroup is to be
secured at the Oesophageal & Gastric Cancer Regional Group Meeting.
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Regional Group Updates
A paper summarising developments since the last e-update in December was tabled at the
meeting. Reference was made briefly to the Haematology Regional Group currently being
established and the request for a Primary Care Nomination. Members were asked to give
this some consideration and forward nominations to the NICaN office.
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Emerging Issues
ICATS
Dr Davison reported that ICATS is being rolled out across the four Board Areas.
Extraordinary Local Lead Cancer Teams Meeting
An invitation had been forwarded to the Macmillan GP Facilitators to attend the Local Lead
Cancer Teams Meeting (28th February) as an opportunity had arisen to present cancer
targets to Dr Martin Connor and the DHSSPSNI Permanent Secretary.
Palliative Care Local Enhanced Service (LES)
Mr Gary Wardrop outlined that a business case is being developed for a locally enhanced
palliative care service in conjunction with members of this Group. Mr Wardrop stated that
the feedback to date has been positive and that they are currently trying to secure funding
for a pilot in the South Antrim area.
BCH Process Mapping – 12th May
Ms Beth Malloy had contacted Dr Davison to request a GP attendance at an upcoming
process mapping exercise for GI services in BCH. Dr Graeme Crawford agreed to attend.
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Network Developments
NICE Guideline Development Group – Clinical Guidance on Advanced Breast Cancer
Dr Davison is to join this development group following a nomination from the Department of
General Practice.
NICaN Annual Report
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The Annual Report for 2006-2007 is currently being prepared and as such a reporting
template will be forwarded to workstrand leads to facilitate the succinct capture of progress
against agreed workplans.
Public & Patient Involvement Events
Ms McCulla outlined that a number of open meetings was being held across the region for
anyone interested in cancer services. Copies of the flyer were available and Ms McCulla
stated that everyone would be very welcome to attend.
NICaN Conference – 7th June
A conference flyer had been forwarded to all and it was stated that further details will follow
in due course
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Dates of Future Meetings
13th September 2006
29th November 2006
28th March 2007
It was also agreed to start future meetings at 2.30 pm rather than 2.00pm
Meeting Close
Dr Davison thanked all for their participation before closing the meeting.
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5th April 2006
NICaN
APPENDIX 1
“The Community Perspective for future models of Chemotherapy delivery
in Northern Ireland”
choice of place for chemotherapy delivery for patients (near site delivery or cancer unit).
Provided by outreach service with close links to Oncology service – formal lines of
communication, governance – training / education and standards
(Senior Clinical Nurse)

a multiplicity of provision (inpatient, day case and community)
community chemo as an “out-reach” service kept for “lower risk” regimes
robust clinical governance and risk management with clinical responsibility to be retained by
oncology services
 timely and effective communication to PHCTs re. involved patients
(Macmillan GP)



an integrated chemo service with nurses employed by Community/Hospital trust who will
rotate accordingly
 improved communication network between all care providers
(Macmillan Nurse Facilitator)


patient choice:
where circumstances appropriate (chemo type, family support, suitable home situation) and
adequate central support and communication.
Delivered at home or primary care treatment centres and community hospitals
(Macmillan GP)




(Senior
mixture of home and chemo unit as appropriate
mixed economy - private statutory providers
staff who can work both in unit and community
delivery in chemo unit, home, or in health and care centres across board’s area
Nurse Advisor)
to provide a patient-centred service, reflecting choice and responsiveness and encapsulated
in safe practice and information provision at all levels
 mindful primary care should be the focus of cancer services
(S&PC coordinator)

that chemotherapy is available to people with cancer close to their own home. But that if
there is a move towards availability in the community, that staff are adequately trained and
staffing levels sufficient. Also if it is provided through private companies that staff within the
community are made aware of cases in case of need for follow-up eg gps/DNs/O.H
(Specialist Occupational Therapist)





(GP)
patient seen by oncologist and chemo nurse – 1st treatment in hospital and if all ok and home
assessment ok then chemo at home or local centre by Healthcare or H/ACAHT – staff with
laptop with IT connection to hospital
patient’s treatment record – updated contemporary and summary emailed to GP practice
blood taken appropriately: hospital, home, GP
treatment decided at initial assessment and agreed with all involved – part of “Planned
Programme of Care”
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near patient or in patient’s home, but delivered by teams outreached from Cancer
Centre/unit
 I feel that communication needs to be addressed with Primary Care Team. I do not feel
GP/DN should be directly involved in these treatments. There has to be clear accountability,
clinical governances, pathways, etc
 locally based Health Care Centres would be ideal centres for delivery of these treatments
under DBS
(Macmillan GP)

policy and strategy to be produced by DHSSPS and SHA and then commissioned and
implemented via LHSCS based on main Cancer Centres as providers
 service overseen by main Cancer Centres from operational standpoint
 Cancer Centre to use three levels of care:
I. plain centre (very complex cases)
II. outreach centre based on new “Health Centre” as per DBS (using local personnel on
part-time basis as much as possible)
III. domiciliary basis using Health Care at Home in contract to Oncology service
 robust lines of communication to practices and OoH
(Medical Adviser, Primary Care)
