Operational Policy for the Gynaecology MDT

This Operational Policy was agreed by the Gynaecology Cancer MDT on (need to put next service
improvement meeting date in)

This Operational Policy was agreed by Mr Jed Hawe, Trust Cancer Lead for Gynaecology Cancer
Services and Mr Bo Petterson, Trust Cancer Lead.

Author: JH/HO Date: 2nd March 2009 Authorisation JH

Next Review February 2010 Revised 30th June 2009 Version 2

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 Contents Page

Operational Policy for the Gynaecology MDT.............................................................1

Introduction..................................................................................................................3
Purpose of the MDT.....................................................................................................3
Leadership Arrangements and Responsibilities .........................................................4
Membership Arrangements.........................................................................................4
Patient Pathways.........................................................................................................5
The MDT Meeting........................................................................................................8
Cancer Service Improvement Meetings......................................................................9
Operational Policy for the Key Worker........................................................................9
Communication with Primary Care............................................................................10
Patient Information.....................................................................................................10
Patient Feedback.......................................................................................................10
Relationship with the NSSG .....................................................................................11
Research and Clinical Trials......................................................................................11

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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 Introduction
The Gynaecology Multidisciplinary Team (MDT) is a multi professional group serving the city of Chester
and the surrounding areas. The Gynaecology MDT at Chester is part of the Sector MDT. The MDT takes
place fortnightly at Clatterbridge Centre for Oncology and is a joint MDT for patients from the Countess of
Chester Hospital and University Hospital of Wirral patients. Each part of the MDT is chaired by the Lead
for each unit. There is representation from the cancer centre by Gynaecological Surgical Oncologist,
Medical Oncologist and Clinical Oncologist.

This manual was produced in accordance with recommendations set out in the Cancer Services Manual
2009. All patients managed, diagnosed and treated at the Countess of Chester Hospital NHS
Foundation Trust are done so in accordance with this manual. This document outlines the Operational
Policy for the MDT, and this policy is reviewed on a yearly basis at the Service Improvement Meeting.

Purpose of the MDT

The aim of the MDT is to ensure a co-ordinated approach to diagnosis, treatment and care services for
all patients diagnosed with a gynaecological cancer. This MDT takes place fortnightly at Clatterbridge
Centre for Oncology and is a joint MDT for patients from the Countess of Chester hospital and University
Hospital of Wirral patients. Each part of the MDT is chaired by the Lead for each unit. There is
representation from the cancer centre by Gynaecological Surgical Oncologist, Medical oncologist and
Clinical Oncologist.

The MDT has the combined function of diagnosis (to rapidly assess and achieve histopathological
confirmation or radiological suspicion of cancer), treatment (discussing the management of all newly
diagnosed cancers) and communication (with the appropriate agencies e.g. primary care teams, hospice
etc). Furthermore the MDT is committed to achieving the highest standards of care and patient
outcomes by:

• Collection of high quality data

• Analysis of such data in audit cycles
• Incorporation in local, national and international research studies
• Incorporation of new research and best practice into patient care
• Providing comprehensive information to patients and their relatives
• Involving patients in assessment and redesign of the services

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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 Leadership Arrangements and Responsibilities
The Lead Clinician for the Gynaecology Cancer MDT is Mr Jed Hawe. This is agreed with the Trust Lead
Cancer Clinician. The responsibilities of the Lead Clinician are:

• Ensure that the objectives of the MDT working are met

• Overall responsibility for ensuring that MDT meeting and team meet peer review quality
measures
• Ensure attendance levels of core members are maintained in line with quality measures
• Ensure that the target of 100% of cancer patients discussed at the MDT is met
• Provide link to NSSG either by attendance at meetings or nominating another MDT member to
attend
• Lead on or nominate lead for service improvement
• Organise and chair annual meeting examining functions of the team and reviewing operational
policies and collate any activities that are required to ensure optimal functioning of the team
• Ensure MDT 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
• Produce an annual report with the support of the Cancer Management Team

• Ensure target of communicating MDT outcomes to primary care is met

• Complete network advanced communication skills course

Membership Arrangements
The Gynaecology Cancer sector MDT consists of the following core members:

Core Member Role Nominated Deputy

Mr Jed Hawe Lead Clinician Mr David Semple
Consultant O&G Cancer Services Consultant O&G
Mandy Myers Specialist Nurse Cancer Services Beverly Roberts
Specialist Nurse Key Worker Staff Nurse
Dr Richard Sloka Lead Consultant Radiologist Valerie Udom
Consultant Radiologist Gynaecology Cancer MDT Consultant Radiologist
Dr Jackie Elder Lead Consultant Pathologist Dr Sally Hales
Consultant Pathologist Gynaecology Cancer MDT Consultant Pathologist
Sue Clegg MDT Co-ordinator Emma Kennerley
Medical Secretary Medical Secretary
Mr Robert McDonald Sector Lead Consultant from Cancer Mr Robert Kingston
Consultant Gynaecologist Surgical Centre Consultant
Gynaecologist
Dr Khizar Hyatt Clinical Oncologist for Clatterbridge Speciality Trainee
Clinical Oncologist Centre for Oncology
Dr John Green Clinical Medical oncologist for Speciality trainee
Consultant Medical Clatterbridge Centre for Oncology
Oncologist
Author: JH/HO Date: 2nd March 2009 Authorisation JH
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 Extended Member Role Nominated Deputy
Sister Mandy Myers Lead for user issues and patient and Beverly Roberts
Specialist Nurse carer information Staff Nurse
Mr Robert McDonald Lead responsible for clinical trial Dr John Green
Consultant Gynaecologist recruitment Consultant Medical
Oncologist
Dr Jenny Smith Specialist Palliative Care Consultant
Psychosocial / Psychosexual
Counsellor

Core members or their nominated deputies must attend at least two thirds of the MDT meetings. This
attendance will be recorded and monitored via the Sector MDT co-ordinator at Clatterbridge Centre for
Oncology. Any issues with attendance will be escalated to the Lead Clinician.
Extended members are not expected to attend the sector MDT meetings. Patients requiring specialist
palliative care or psychosocial / psychosexual input will be referred directly from the MDT to the
appropriate extended members via letter from Lead Clinician or by direct communication by Lead
Clinician or Cancer Nurse Specialist.

The core nurse member of the MDT will have a set of agreed responsibilities, which includes completion
of specialist study modules and advanced communication skills. Responsibilities of the core nurse
member are:
• Contributing to the MDT discussion and patient assessment/care planning decision of the team
at their regular meetings

• Providing expert nursing advice and support to other health professionals in the nurse’s
specialist area of practice
• Involvement in clinical audit

• Leading on patient and carers’ communication issues and co-ordination of the patient pathway
for patients referred to the team, acting as the Key Worker or responsible for nominating the Key
Worker for the patient’s dealings with the team
• Facilitating access to members of the MDT where requested by patients or their carers
• Managing the nurse led holistic clinic, oncology pre-assessment clinics and other aspects of the
service

Patient Pathways
Patients referred with a suspected Gynaecological cancer to the Countess of Chester Hospital are
offered an outpatient appointment via telephone, if this date is not acceptable to the patient a second
offer is made within the 2 week timeframe. Patients are seen in all gynaecology clinics in designated ring
fenced appointments for fast track referrals. Any non-fast track referral received that the clinician
clinically suspects a gynaecological cancer will be upgraded to a RAC appointment with the clinician

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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 signing and dating when the decision was reached. Any clinician seeing a patient after referral and
clinically suspects that they have a gynaecological cancer can upgrade the patient to a 31/62 day
pathway by following the trust policy which is available in all clinical areas (? Add in appendix here)

Patient consults GP

RAC Referral Faxed

10 Days

Patient attends Gynaecology clinic

TVS / TAS and biopsy in Patient examined and listed for operative TVS, bloods, listed for
clinic diagnostics (hysteroscopy / laparoscopy) further diagnostics (Rad)

10 Days

5 Days
Patient attends for
hysteroscopy / laparoscopy

5-10 Days
14 Days

Histology – confirmation of
cancer

7 Days

MDT Meeting

5 Days

Review outpatient
appointment for diagnosis
And treatment discussion
(Mon Clinic with JH)

Patient referred to Liverpool Patients listed for surgery at Patient referred to

Women’s Hospital for Chester* Clatterbridge for
surgery* Chemo/Radiotherapy

*As recommended by the improving outcomes national guidance and CNG agreed referral and treatment
guidelines:
Local Surgical Treatment: Endometrial cancer – early stage 1 disease, grade 1-2
Cervical cancer – early stage 1a1 if knife cone or simple hysterectomy
recommended

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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 All patients to have network agreed minimum treatment dataset
completed and forwarded to the centre for entry onto regional database

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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 Centre Surgical Treatment: Endometrial cancer – all grade 3, > stage 1 disease.
Cervical cancer – all disease greater than stage 1a1
Ovarian cancer – all patients with RMI greater than 200 and MDT feel
that benign disease (e.g. endometriosis) unlikely
Vulval cancer – all stages
Any patient requiring enrolment into recognised national cancer study
All patients to have network agreed minimum diagnostic dataset
completed and forwarded to the centre for entry onto regional database

The MDT Meeting

The Sector MDT meetings occur fortnightly on a Thursday morning at Clatterbridge Centre for Oncology.
A list of patients to be discussed at the MDT is collated by the Specialist Nurse for Gynaecology cancer
services. Patients can be added to the list by the pathology department, radiology department, the lead
clinician for gynaecological oncology or any other Consultant via the Specialist Nurse for Gynaecological
Cancer. It is the responsibility of the MDT Co-ordinator to ensure that notes and all results are available
for the meeting to enable fully informed decision making. The meeting incorporates MDT discussions for
both the Countess of Chester and Arrowe Park Hospital, with Centre representation for surgery,
radiotherapy and chemotherapy. The Lead Clinician for Gynaecological Cancer from both Trusts chairs
their part of the MDT. A brief summary of each case will be prepared prior to the meeting by the Lead
Clinician for Gynaecological Oncology using the MDT proforma and presented to the group. Input is
provided by the Lead Clinicians in radiology and histopathology where appropriate using the audio-visual
facilities. The MDT will discuss:

• All newly diagnosed cancer patients

• All post operative patients
• All patients with recurrent disease
• Any other problematic case needing discussion

The outcomes are recorded by the Lead Clinician on the MDT proforma, the recordings are then typed
by the MDT secretary and distributed by e-mail. The regional clinical audit forms are also completed at
this time for all diagnostic and local treatment cases. Letters confirming MDT discussions / actions are
dictated to appropriate clinicians and GP’s. If a patient requires referral to another MDT this will be
organised by initial telephone call or fax followed promptly by a referral letter.

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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 Cancer Service Improvement Meetings
The local MDT at Chester will hold an operational meeting quarterly with key members of the team as
follows:
• Lead clinician for Gynaecology Cancer Services (Mr Jed Hawe)
• Lead nominated Radiologist (Dr Richard Sloka)
• Lead nominated Pathologist (Dr Jackie Elder)
• Specialist Nurse (Mandy Myers)

• Service Manager (Helen Odunaiya)

• MDT Co-ordinator / Secretary (Susan Clegg)

• Cancer Manager (Fiona Curtis)

Meetings dates for the year will be set quarterly. The purpose of the cancer service improvement
meetings are to continually review the service provided to patients to include audits, service improvement
and any operational matters.

Operational Policy for the Key Worker

For the purpose of this policy the Key Worker will be defined as “the person who, with the patient’s
consent and agreement, takes a key role in co-ordinating the patients care and promoting continuity,
ensuring the patient knows who to access for information and advice” (NICE 04 as cited in the M.C.S).
Main responsibilities of the Key Worker with the agreement of the patients are to:

• Act as the main contact person for the patient and carer at a specific point in the pathway.
• Offer support, advice and provide information for patients and their carers, accessing services as
required.
• Ensure continuity of care along the patient’s pathway and that all relevant plans are
communicated to all members of the MDT involved in that patient’s care.
• Ensures that the patient and carer have their contact details, that these contact details are
documented and available to all professionals involved in that patients care.
• Ensure that when handover of Key Worker role is indicated, it is implemented in full consultation
with the patient and carer and the patient is provided with revised contact details.
• Ensure that the next Key Worker has the appropriate information about the patient to fulfil the
role.
• Support the patient in identifying their needs, review these as required and co-ordinate care
accordingly.
• Liaise and facilitate communication between the patient, carer and appropriate health
professionals and vice versa.

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 • Assist to empower patients as appropriate.

The nominated Key Worker is the Specialist Nurse for Gynaecology Cancer Services, Mandy Myers.
The name of the Key Worker will be clearly documented within the patient’s case notes. It is important to
ensure that the patient and carer understand the role of the Key Worker as early as possible on the
patient’s pathway of care.

Communication with Primary Care

Where a patient is given a diagnosis of cancer, the patient’s GP will be informed within 24 hours of the

diagnosis being given to the patient. A proforma will be completed by the Specialist Nurse and passed to

the MDT co-ordinator to fax to the patient’s GP. Copies of the confirmed faxes are retained by the MDT

co-ordinator for audit purposes. This policy applies both to inpatients and outpatients. The compliance

with this measure will audited and will be the subject of annual review by the cancer service improvement

meeting.

The MDT will provide information to referring GPs and other PCT’s on the appropriateness and

timeliness of urgent suspected cancer GP referrals i.e. the appropriateness of the referral against the

agreed referral criteria, the number of patients referred as urgent or routine who are subsequently found

to have cancer.

Patient Information
Relevant members of the MDT will offer the patient a permanent record of the consultation at which

treatment options for their condition is discussed. Written information is available for patients and is

usually offered by their key worker, but can be given by any member of the MDT. All patient information

provided to patients is in line with the Cheshire and Merseyside Cancer Network. This pack contains the

patient record of the consultation, the name of and contact details for the key worker, their disease and

treatment options, information about local and regional services providing treatment for cancer (including

Countess of Chester Hospital, Clatterbridge Centre for Oncology and the Liverpool Women’s Hospital),

information about patient involvement and self help groups and other holistic services.

Patient Feedback
Feedback from users will be obtained on a regular basis. This may be from patient surveys, focus

groups or participation in the Patient Partnership Forum (PPF). Such feedback will be discussed at the
Author: JH/HO Date: 2nd March 2009 Authorisation JH
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 Cancer Service Improvement Meetings. Any actions arising from the feedback for improvement will be

covered by an action plan with leads and timescales for the improvements.

Relationship with the NSSG

• The MDT will provide representation to the Gynaecology NSSG meetings.

• The MDT will engage with the NSSG to develop and implement network wide clinical, referral,

imaging and pathology guidelines.

• The MDT agrees to collect the NSSG agreed minimum dataset.

• The MDT will participate in an annual network audit project and will present the results for

discussion at the NSSG audit meeting

• The MDT will engage with the NSSG to develop and agree an approved list of clinical trials

relationship with primary care.

Research and Clinical Trials

The majority of research / clinical trails are co-ordinated through the treatment centres at the
Clatterbridge Centre for Oncology and the Liverpool Women’s Hospital. Patients potentially felt to be
suitable for clinical trials will be identified at the MDT. The Lead Unit Clinician will inform the patient,
when they are seen locally for diagnosis, of the MDT discussions, treatment recommendations and
whether or not they may potentially be asked to enter a study. The MDT will be kept up to date regarding
clinical trials by the Centre leads attending the MDT, by the research nurse and the NSSG.

Author: JH/HO Date: 2nd March 2009 Authorisation JH

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