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Trust Cancer Lead Clinician
Presented by:
Professor Clem F. Kiire – MD, FRCP
Consultant Physician & Gastroenterologist
Southport & Ormskirk Hospital NHS Trust
www.southportandormskirk.nhs.uk
15 September 2008
Southport & Ormskirk Hospital Trust
Background
• A merger of two trusts, formerly West Lancashire NHS
Trust and Southport & Formby Trust took place on 1 April
1999; the new Trust being named Southport & Ormskirk
Hospital NHS Trust.
• Southport & Ormskirk Hospital NHS Trust consists of two
hospitals, one in Southport (Southport & Formby District
General Hospital) and one in Ormskirk (Ormskirk &
District General Hospital), some eight miles apart. The
Trust provides a wide range of clinical services to the
resident population of Southport & Formby and Ormskirk
and surrounding districts, the catchment population
being approximately 240,000 – the figure being equally
divided between the two areas.
Cancer Management Team Structure
Southport & Ormskirk Hospital NHS Trust
CANCER SERVICES ORGANISATION
Executive Lead
DEPUTY CHIEF EXECUTIVE
Lead Clinician (Breast)
Lead Clinician (Cancer)
Lead Clinician (Lung)
Cancer Services Manager
Lead Clinician (Colorectal)
Lead Nurse (Cancer)
Lead Clinician (Gynaecology)
Lead Clinician (Upper GI)
Service Improvement Facilitator
Lead Clinician (Urology)
Cancer Service Support Manager
(MDT Co-ordination/Cancer Patient Tracking)
MDT Cancer Support Officers & Assistants
(team of x 6)
PA/Cancer Services Secretary x 2
Lead Clinician (Skin)
Lead Clinician (Haematology)
Lead Clinician
(Palliative Care)
Cancer Services
Cancer Services
Manager
PA to Cancer Management Team
PA to Cancer Lead Clinicians (x2)
Cancer Research Nurse
Practitioner
Cancer Services
Support Manager
(employed
& funded by Merseyside &
Cheshire Cancer Research Network)
Lead Cancer
Nurse
Clinical Trials Data
Co-ordinator
(funded by Cancer Research Network)
Cancer Services
Support Officer
Cancer Services
Support Officer
Cancer Services
Support Assistant
Cancer Services
Support Officer
Cancer Services
Support Assistant
Cancer Services
Support Officer
Trust Cancer Lead Clinician
Main Duties
• Ensure site specific specialist MDTs are established.
• Ensure there are mechanisms in place for the care of
cancer patients to be formally reviewed by a specialist
MDT either through direct assessment or through formal
discussion with the team by the responsible clinician.
• Ensure there is adequate non-surgical oncology support
for cancer care.
• In collaboration with the Lead Nurse, Lead Manager and
other colleagues, supports and advises on the
implementation of the national cancer services
standards.
Trust Cancer Lead Clinician Main Duties Cont:
• Work with the Lead Nurse and Lead Manager to coordinate the preparation for peer review visits, including
self-assessment against the national standards.
• Work with the Lead Nurse and Lead Manager to ensure
the implementation of the resulting action plans for
continuous quality improvement.
• To take part in the NHS Trust’s clinical governance
activities which are of relevance to the cancer services of
the Unit.
• Ensure arrangements are in place for audit and
continuing medical education with reference to cancer
services.
Trust Cancer Lead Clinician Main Duties Cont:
• Meet regularly with colleagues from cancer centres/units
and primary care representatives within the network to
enable working to uniform standards.
• Meet regularly with at least some representation from the
community (eg patients and users and representatives).
• Advise on and support the development of data collection
on cancer services, in collaboration with the Cancer
Registry and with cancer services in the network.
• Develop the network wide services of the Cancer Unit
MDT Lead Clinician Responsibilities
• Ensure that objectives of MDT working (as laid out in
Manual of Cancer Service Standards) are met:
• To ensure that designated specialists work effectively
together in teams such that decisions regarding all
aspects of diagnosis, treatment and care of individual
patients and decisions regarding the team’s operational
policies are multidisciplinary decisions.
• To ensure mechanisms are in place to support entry of
eligible patients into clinical trials, subject to patients
giving fully informed consent.
MDT Lead Clinician Responsibilities continued:
• Ensure that target of 100% of cancer patients discussed
at the MDT is met.
• To ensure that care is given according to recognised
guidelines (including guidelines for onward referrals)
with appropriate information being collected to inform
clinical decision making and to support clinical
governance/audit.
• Overall responsibility for ensuring that MDT meeting and
team meet Peer Review Quality Measures.
MDT Lead Clinician Responsibilities continued:
• Ensure attendance levels of core members are
maintained, in line with Quality Measures.
• Provide link to CNG, either by attendance at meetings or
by nominating another MDT member to attend.
• Lead on, or nominate lead for service improvement.
MDT Lead Clinician Responsibilities continued:
• Organise and chair annual meeting examining
functioning of team and reviewing operational policies,
and collate any activities that are required to ensure
optimal functioning of the team (e.g. training for team
members).
• Ensure MDT’s activities are audited and results
documented
• Ensure that the outcomes of the meeting are clearly
recorded and clinically validated and that appropriate
data collection is supported.
• Ensure target of communicating MDT outcomes to
primary care is met.
Management Meetings
Internal
External
• Chair – Cancer Lead Clinicians’
Group (meets 3 x year)
• PCT Locality Implementation
Team meetings
• Cancer Services Manager weekly update meetings
• Merseyside & Cheshire Cancer
Network:-
• Tumour Groups:
–
–
–
–
–
Breast (meets 2 x year)
Colorectal/Upper GI (quarterly)
Urology (3 x year)
Lung (quarterly)
Gynaecology (quarterly)
– Taskforce Group
– Lead Clinician/CNG
– Clinical Network Groups
Multi-disciplinary Teams (MDTs)
Southport & Ormskirk Hospital NHS Trust has well-established
MDT’s in the following specialties. In addition, members of the
teams also provide input into specialist multi-disciplinary
teams (MDT’s) within the Network.
•
•
Colorectal
Upper Gastrointestinal (Liver & Pancreatic input into Aintree
Hospitals & Royal Liverpool Hospital sMDTs)
•
•
•
•
•
•
•
Breast
Urology
Lung
Gynaecology (input into Liverpool Women’s Hospital sMDT)
Haematology (input into Aintree Hospitals sMDT)
Skin (input into Royal Liverpool/Broadgreen sMDT)
Head and Neck (input into Aintree Hospitals sMDT)
Ten Most Common Cancers
Southport & Formby Residents
Pie chart of the 10 most common cancers occurring in Southport & Formby residents, 2001-2005
Females
Males
Pancreas
2%
other
19%
Non Melanoma
skin cancer
23%
Malignant
melanoma
2%
Non Melanoma
skin cancer
24%
Rectum
2%
Malignant
Oesophagus
3%
neoplasm without
specification of
Ovary
site
3%
3%
Rectum
3%
Stomach
3%
Bladder
5% Colon
7%
Liver
2%
other
20%
Prostate
22%
Lung
11%
Source: North West Cancer Intelligence Service
(NWCIS) – data based on PCT geographic
boundaries as at 2001-2005
Malignant
melanoma
3%
Uterus
4% Colon Lung
6%
9%
Breast
24%
Ten Most Common Cancers
West Lancashire Residents
Pie chart of the 10 most common cancers occurring in West Lancashire residents, 2001-2005
other
17%
Pancreas
Malignant 2%
melanoma
3%
Males
Non Melanoma
skin cancer
24%
Oesophagus
3%
Rectum
4%
Bladder
4% Stomach
4%
Colon
6%
Females
Prostate
21%
Lung
12%
Source: North West Cancer Intelligence Service
(NWCIS) – data based on PCT geographic
boundaries as at 2001-2005
other
21%
Breast
26%
Pancreas
2%
Malignant
melanoma
2%
Rectum
3%
Uterus
3%
Malignant neoplasm
without specification
of site 4%
Ovary
4%
Colon
6%
Lung
9%
Non Melanoma
skin cancer
20%
Cancer Waiting Time Targets
During 2007/08 the Trust was successful in delivering all of the National Cancer
Treatment Times targets. This was achieved following detailed work to
streamline patient pathways, examine capacity and demand, establish a tracking
system for all cancer patients and adopt other service improvement methodology.
Targets Met
• 14 Day Target - (A 2 week maximum wait for urgent GP referrals) – 100%
compliance maintained throughout the year.
• 31 Day Target - (A maximum waiting time of 1 month from diagnosis to
treatment for all cancers) – Exceeded the national standard of 98% and
England average performance, by achieving an overall compliance of 99.6%.
• 62 Day Target - (A maximum waiting time of 2 months from urgent GP referral
to treatment for all cancers) – Exceeded the national standard of 95% and
England average performance, by achieving an overall compliance of 97.6%.
Extended waiting times standards
• By Dec 2008 - patients will wait no longer than 31 days
for second or subsequent surgery & chemotherapy.
• By Dec 2008 – all patients with a suspected cancer
detected through screening programmes or by a hospital
consultant will be treated within 62 days.
• By Dec 2009 - all women referred by their GP with
breast symptoms will be seen within 2 weeks.
• By Dec 2010 – where radiotherapy is a second or
subsequent treatment this will be done within 31 days.
Peer Review
• The Cancer Peer Review programme aims to improve care
for people with cancer & their families. The process involves
teams of specialist reviewers who are responsible for making
judgements on the level of compliance against National
Measures for each of the tumour sites. Qualitative elements
of care & treatment are explored, including governance,
leadership, teamwork, research, patient involvement & end of
life care.
• Following the two day Peer Review visit to the Hospital Trust
in Autumn 2005 the final report highlighted that the review
team considered the Locality/NHS Hospital Trust as an
exemplar in its approach to Cancer Services Peer Review and
its Palliative Care Services in particular. The service also had
a successful peer review appraisal visit in 2007.
Trust Cancer Lead Clinician
In Summary:
• Essentially the role is that of Lead Clinician for a Hospital
Trust. Reporting to the Executive Director for Cancer,
the Lead Clinician will ensure that cancer services are
managed and organised effectively to support high
quality care. The role is to provide clear leadership of
the cancer unit and working with the Lead Manager and
Lead Nurse to deliver the increasing agenda set out in
the National Cancer Plan and Cancer Services
Standards.