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Agreed by: Mr Jon Eaton, Consultant Surgeon & MDT Lead, Alexandra Hospital NHS Trust Date: 25th May 2012

Agreed by: Urology NSSG members Date: 25th May 2012 Agreed by: Mr John Strachan, Consultant Surgeon & MDT Lead, South Warwickshire NHS Foundation Trust Date: 25th May 2012 Agreed by: Mr Ike Apakama, Consultant Surgeon & MDT Lead, George Eliot NHS Hospital Trust Date: 25th May 2012 Agreed by: Mr Kieran Jefferson, Consultant Surgeon & MDT Lead, University Hospital Coventry and Warwickshire NHS Trust Date: 25th May 2012 Agreed by: Arden Cancer Network Executive Group members (with delegated

authority by the Network Board and the Network Chair as agreed at the Board Meeting on 14th December 2009) with inclusion of approval of PCT Leads and Trust Lead Cancer Clinicians. Date: August 2012

Status: Approved Version: 2012v1.0F Publication Date: August 2012 Expiry Date: May 2013

UROLOGY NETWORK SITE SPECIFIC GROUP

CONSTITUTION

INCLUDING NETWORK CONFIGURATION AND OPERATIONAL FRAMEWORK

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Contents

Section 1 ................................................................................................................................................ 3 1 – Introduction and Background ........................................................................................................ 3 Section 2 - Network Configuration ...................................................................................................... 3

2.1 Commissioning Landscape ........................................................................................................ 4 2.2 - Demographics ........................................................................................................................... 4 2.3 – Cancer Incidence and Mortality .............................................................................................. 5 2.4 Patient & Public Involvement .................................................................................................... 5

Section 3 – Configuration of the Arden Cancer Network Urological Cancer Services .................. 6 Designated Diagnostic/Local Multi Disciplinary Teams ................................................................ 6 Specialist Multi Disciplinary Team for Specialist Care .................................................................. 7 Specialist Supra Network Referral ................................................................................................... 7 Children and Young People with Urological Cancer ..................................................................... 7

Section 4 – Patients with sarcoma involving urology ....................................................................... 9 Section 5 – Terms of Reference of the Arden Cancer Network Urology Site Specific Group ...... 9

5.1. Membership .............................................................................................................................. 10 Section 5.2 - Frequency of Meetings ............................................................................................. 10 Section 5.3 – Format of NSSG Meetings ....................................................................................... 10 Section 5.4 - Names and professional role of each NSSG member ........................................... 10 5.5. Quorum ...................................................................................................................................... 12 5.6. Roles and Responsibilities ...................................................................................................... 12 5.7. Service Planning ....................................................................................................................... 12 5.8 Service Improvement/Redesign ............................................................................................... 12 5.9. Service Quality Monitoring and Evaluation ........................................................................... 13 5.10. Workforce Development ........................................................................................................ 13 5.11. Research and Development .................................................................................................. 13 Section 5.12 - Annual Work Programme and Three Year Service Development Plan and Annual Report .................................................................................................................................. 13 Section 5.13 - Governance and Communication .......................................................................... 14

Section 6 – Data Collection ................................................................................................................ 16 Section 7 – Service developments .................................................................................................... 16 Section 8 – Clinical, Referral, Imaging and Pathology guidelines ................................................. 17 Section 9 – Research and Trials ........................................................................................................ 18 Section 10 – NSSG Commissioning Influence ................................................................................. 18

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Section 1

1 – Introduction and Background Improving Outcomes: A Strategy for Cancer (DoH, 2011) set out a range of actions to be taken to improve cancer outcomes. These include earlier diagnosis, promotion of healthier living to reduce the risk of preventable cancers, improved rates of screening and the introduction of new screening programmes, and ensuring universal access to the best treatments, care and support. It is hoped that the Strategy will help improve cancer survival, with an extra 5,000 lives saved each year by 2014/2015. The function of the Network is to implement the National Cancer Plan, Cancer Reform Strategy and Improving Outcomes :A Strategy for Cancer in a locally meaningful manner, delivering high quality cancer care across traditional geographical and organisational boundaries, and thereby ensuring access, equitable service provision and an improved patient experience. The purpose of this document is to provide the Arden Cancer Network Board and Stakeholder Organisations (Service Users and their families or carers, GP Consortia, Acute Trusts, Community Health Trusts, Primary Care Clusters, Voluntary Sector Organisations and Clinicians) with an overview of how the Arden Urology Site Specific Group is structured in order to provide Improving Outcomes Guidance (IOG) compliant services, which are responsive to user identified issues and recommendations. The associated documents – Three year Service Development Plan incorporating the Annual Work Plan and Annual Report demonstrate how the Urology NSSG supports the delivery of clinically safe and effective, evidence based, IOG compliant services As from 1st April 2012, the Arden Cancer Network Director is also the interim Network Director for the Three Counties Cancer Network promoting closer working relationships between the two organisations during transition. The Urology NSSG has already held a joint developmental clinical review meeting with Three Counties Cancer Network counterparts to consolidate closer working. This document is an organic living document that is only correct at the time of publication. An annual review will ensure that relevant national and local updates are reflected in order to support changes in practice.

Section 2 - Network Configuration The Arden Cancer Network was established in April 2002. It is one of 28 cancer networks in England and covers a population of approximately one million. The Network population for Urological cancers is split between PCTs as follows:

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NHS Coventry -312,780

NHS Warwickshire - 535,070 comprising South Warwickshire, North Warwickshire and Rugby

NHS Worcestershire - Redditch and Bromsgrove only (172,000) Total population = 1,019.850

(* Department of Health, 2011 Health Profiles) There is a cancer centre in Coventry at University Hospitals Coventry & Warwickshire (UHCW) and three cancer units: George Eliot Hospital (GEH) in North Warwickshire, South Warwickshire Foundation Trust (SWH) in Warwickshire, the Alexandra Hospital in Redditch (AHR) and two sub-units at Solihull and Rugby St Cross. The function of the Network is to implement Improving Outcomes: A Strategy for Cancer (DoH, 2011) in a locally meaningful manner, delivering high quality cancer care across traditional geographical and organisational boundaries, and thereby ensuring access, equitable service provision and an improved patient experience. 2.1 Commissioning Landscape In October 2011, the 10 Strategic Health Authorities in England merged to form 4 clusters with will manage the NHS until April 2013. NHS Midlands and East was formed from NHS East of England, NHS East Midlands and NHS West Midlands. The Arden Cancer Network through its site specific and cross cutting groups supports commissioning processes by working closely with clinicians, service users, service managers contracting and commissioning personnel in the PCTs, collectively seeking a positive patient outcome where quality, innovation, productivity and prevention are key priorities. In addition to current commissioning agreements, the Arden Cancer Network, as part of transition, is engaging with and reporting to the newly established Clinical Commissioning Groups (CCGs). For the Arden Cluster – led by Stephen Jones, which incorporates Coventry and Warwickshire, there are six CCGs which collectively represent 133 GP practices. The Arden Cancer Network will engage with and report to the Redditch & Bromsgrove CCG which represents 24 practices1. 2.2 - Demographics The Network spreads across both highly populated inner city areas with high levels of deprivation and more affluent rural areas specifically to the south of Warwickshire. Both NHS Coventry and NHS Warwickshire (for the north of the County) are Spearhead Trusts. Ethnic mix White 88.23%, Mixed 1.44%, Asian 7.22%, Black 1.75% and Chinese/other 1.41%

1 http://www.westmidlands.nhs.uk/WhatWeDo/ClinicalCommissioningGroups.aspx 11 April 2012

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2.3 – Cancer Incidence and Mortality Within Arden cancer incidence is similar to other networks in the West Midlands, although the mortality rate is better (West Midlands Cancer Networks, Age Standardised Rates). In addition there is no statistical difference in mortality rates between the West Midlands cancer networks (West Midlands Cancer Networks Five Year Rolling Average Standardised Mortality Rates), and there is no difference in mortality rates between Arden’s network PCTs except for NHS Coventry and lung Cancer.

2.4 Patient & Public Involvement Representatives from the Arden Cancer Network Patient Partnership Group sit on the Network Board, Network Executive Group and Tumour Site Specific and Cross Cutting Groups ensuring that the patient voice is heard and acted on at all levels. The Arden Cancer Network User Partnership Group acts as a primary source of advice and representation on site specific and cross-cutting groups. Service users are core members of each site specific or cross cutting group. Patients and their

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carers are involved in the further development and implementation of Radiotherapy capacity expansion plans. Prior to all new user representatives attending site specific or cross cutting group meetings they are offered a meeting with the Network User Partnership Facilitator. This gives opportunity to discuss the role and responsibilities of user members of the site specific and cross cutting groups. The user representative is offered induction, information regarding the role specification, past meeting notes to read and offered training and development opportunities. This is being achieved by providing workshops for members, training and a Service User handbook, which has been disseminated to all service user representatives. The document is a generic guide to new and existing User representatives and gives background information about the Network, the various Network groups, an outline of the role of service users, confidentiality and code of conduct. The lead member of the Network Team who attends the site specific group will support the user representatives, ensure that they are introduced to the chair and ensure that the chair conducts formal introductions at each meeting.

Section 3 – Configuration of the Arden Cancer Network Urological Cancer Services The Arden Urological Cancer Network provides all key services related to Urological cancer. In particular there is good local access to specialised surgery, EUS, PET CT and chemo-radiation. All patients with suspected or newly diagnosed Urological cancer within the Arden Cancer Network will be promptly referred to and managed by a designated Urological cancer MDT at one of the Network’s Cancer Units. All Arden PCTs will be working with the NSSG, Clinical Commissioning Groups, PCT Clinical Governance leads and other stakeholders to discuss future service models, developing clinical protocols and governance arrangements. Designated Diagnostic/Local Multi Disciplinary Teams

NAME OF HOSPITAL/MDT

NAME OF TRUST REFERRING PCTs POPULATION REFERRED

University Hospitals Coventry and Warwickshire Local MDT

University Hospitals Coventry and Warwickshire NHS Trust

NHS Coventry

312,780

George Eliot Hospital Local MDT

George Eliot Hospital NHS Trust

NHS Warwickshire 535,070

Warwick Hospital

Local MDT

South Warwickshire NHS Foundation Trust

Alexandra Hospital Local MDT

Worcestershire Acute Hospitals NHS Trust *

Worcestershire PCT (Redditch and Bromsgrove)

172,000

Total Population 1,019,850

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Following NCAT dispensation Worcestershire Acute Hospitals NHS Trust has Associate Resection Centre

Disclaimer re population figures: Commissioned population figures for services may recognise that patients may choose to be treated elsewhere. There is equitable access to diagnostic services across the localities within the network.

Specialist Multi Disciplinary Team for Specialist Care

SPECIALIST MDT Hospital Site and Trust

REFERRING PCTs POPULATION REFERRED

University Hospitals Coventry and Warwickshire NHS Trust

Coventry Warwickshire Worcestershire(Redditch and Bromsgrove) Leicester

312,780 535,070

172,000 60,000

Total Population 1079,850 (The population exceeds the one million required for a specialist MDT)

Disclaimer re population figures: Commissioned population figures for services may recognise that patients may choose to be treated elsewhere. Specialist Supra Network Referral The Arden Cancer Network refers all histologically confirmed germ cell tumours and penile cancers to the supra network MDTs for Testicular and Penile cancers hosted by the East Midlands Cancer Network. SPECIALIST SUPRANETWORK PENILE MDT

POPULATION REFERRED

University Hospitals of Leicester NHS Trust Mr D Summerton - Lead

6.5 million with the agreed non core population inflow

(The population exceeds two million required for testicular cancer teams and four million for penile teams)

Children and Young People with Urological Cancer This group of patients will have joint discussion with Dr Nigel Coad, Paediatric Consultant UHCW NHS Trust. This will be reviewed in line with the Improving Outcomes Guidance for Children and Young People with Cancer and the establishment of a regional Teenage Young Adult MDT at UHB. The 16-18 and 19-24 year old draft regional pathways (outlined on the following page) are currently under discussion with the supra-regional group and awaiting consensus. Treatment and subsequent follow up for patients between the ages of 19 and 24 will either be delivered at the PTC or locally according to the patient’s wishes and hospital designation. All 16 to 24 year old patients will be referred to the Principal Treatment Centre psychosocial MDT.

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Section 4 – Patients with sarcoma involving urology

The regional sarcoma MDT (Birmingham) will review all cases of Urological Sarcoma. This will involve histological review by a sarcoma specific pathologist but may not require clinical review dependant on the clinical scenario. It is anticipated that surgery will be undertaken by local Urology services after discussion with the sarcoma MDT. Management will be undertaken in accordance with guidelines agreed across the Urology MDT and Sarcoma MDT.

Agreed by: Dr David Peake, University Hospital Birmingham NHS Foundation Trust, Sarcoma NSSG Chair (West Midlands Supra Network Group)

NSSG Agreements, where applicable, for the above anatomical sites are contained within the Notes section of the Portfolio of Evidence.

Section 5 – Terms of Reference of the Arden Cancer Network Urology Site Specific Group The Arden Cancer Network Urology NSSG Terms of Reference were reviewed as part of the Urology Network NSSG Constitution at the NSSG meeting held on 25th May 2012 and ratified at the Executive Committee on August 2012. The Urology NSSG is the Arden Cancer Network Board’s primary source of clinical opinion on issues relating to urology cancer for the Network. It has corporate responsibility, delegated by the Board, for co-ordination and consistency across the Network for urology cancer policy, practice guidelines, audit, research and service improvement, and will be responsible for ensuring that the Improving Outcomes: A Strategy for Cancer in relation to urology cancer is implemented across the Network. The group will take responsibility for consulting with the relevant cross cutting Network groups on issues involving chemotherapy, cancer imaging, histopathology and laboratory investigations and specialist palliative care, and with the head of service on issues involving radiotherapy, and with PCTs on issues related to community services. This group will be expected to employ Network solutions to address challenges and issues and promote the Network culture within member organisations. Members of the group will have clear defined reporting mechanisms in place to ensure appropriate feedback between the NSSG and their own organisations. The Network Site Specific Group will be multi-disciplinary with representation from professionals across the whole care pathway, involve users in its planning and review, and have the active engagement of all MDT leads from the relevant constituent organisations in the Network.

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5.1. Membership

The MDT lead clinician from each MDT in the network

One core nurse member from a MDT within the Network*

Chair elected from members

Administrative support provided by the Network PA

2 user representatives***

Site Lead Oncologist for the NSSG**

Network Senior Management Team representative

Service Improvement Representative

Radiologist representative

Pathologist representative

Cancer Research Network representative

Commissioning representative (role may be undertake by network SMT member)

Section 5.2 - Frequency of Meetings Meetings will be held quarterly and attendance recorded. Section 5.3 – Format of NSSG Meetings There will be a minimum of two or three joint Arden and Three Counties Cancer Network Urology NSSG meetings per annum Key pieces of work may be facilitated through short term working groups (ideally electronically). Cancer commissioners and GP Consortia leads to be invited to strengthen communications and reflect changing commissioning landscape. MDT representation needs to be robust to ensure that full engagement takes place Standing agenda items will be agreed. Section 5.4 - Names and professional role of each NSSG member

Name Professional role

Mr Jon Eaton (surgeon) Chair, Consultant Urologist AHR

Mr Ike Apakama (surgeon) Consultant Urologist /MDT Lead Clinician (GEH)

Mr John Strachan (surgeon) Consultant Urologist /MDT Lead Clinician (SWH)

Mr Kieran Jefferson (surgeon) Consultant Urologist /MDT Lead Clinician (UHCW)

Dr Andy Stockdale

Consultant Clinical Oncologist

Dr Caroline Humber

Consultant Clinical Oncologist

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Dr Jane Worlding**

Consultant Clinical Oncologist

Debbie Shreeve *

CNS, UHCW

Loretta Short *

CNS, GEH

Theresa Neale *

CNS, SWFT

Jackie Askew* CNS, Alexandra

Mrs Danielle Taylor**** Network Lead Team representative

Mr Peter Smith*** User Group representation

Mrs Sue Ridgeway Service Improvement Representative

Dr Val Robson

PCT GP Cancer Lead

Dr Chris Phillips Radiologist Representation

Dr Klaus Chen

Consultant Pathologist

Dr Bidisa Sinha

Consultant Pathologist

Judith Lake

Arden Cancer Research Network

Mrs Jag Guru (Network PA) Administrative support

* One of the above members should have named responsibility for users’ issues and information for patients and carers = (CNS)

** A member of the NSSG nominated as responsible for ensuring that recruitment into clinical trials and other well designed studies is integrated into the function of the NSSG = ( Site lead oncologist)

*** The lead member of the Network team who attends the site specific group will support the user representatives, ensure that they are introduced to the chair and ensure that the chair conducts formal introductions at each meeting and actively encourages the user perspective.

****

Where further user advice or support is required, this will be sought from the Network User Partnership Group which will feed back to the NSSG in turn.

Attendance at an individual meeting need not be limited to the agreed members. Advice will be sought from other professional groups according to the agenda/work programme requirements.

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5.5. Quorum The Urology NSSG will be deemed to be quorate when the following members are present:

The Chair or a nominated deputy

A member of the Network senior management team

Representation from the majority of Trusts In the unlikely event that the chair/vice chairs are not present, the Network Executive team member will chair the meeting. 5.6. Roles and Responsibilities The Chair of the Urology NSSG will have an annual review with the network lead clinician and/or appropriate member of the Network Board.

The Urology NSSG will agree an annual work programme with the Board and will produce an annual report and a 3 year Service Development Plan for the Board. The work programme and annual report will be developed to address the following areas which should include Network solutions to challenges, spreading of good practice and service development initiatives to promote excellence in urology cancer services throughout the Network. 5.7. Service Planning The Urology NSSG will ensure that service planning:

Is in line with national guidance/standards.

Covers the whole care pathway.

Promotes high quality care and reduces inequalities in service delivery.

Takes account of the views of patients and carers.

Takes account of opportunities for service and workforce redesign.

Establishes common guidelines including clear referral guidelines.

Is based upon the Arden Cancer Network Work Programme.

In line with QIPP, local CQUINS and IOSC.

The Urology NSSG will:

Recommend priorities for service development to the Network Board.

Ensure decisions become integrated into constituent organisational structures and processes.

5.8 Service Improvement/Redesign The Urology NSSG will commit to service improvements and;

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participate in process mapping and capacity and demand analysis, with resulting action plans being endorsed by the group

any requests for additional resources from NSSGs should be accompanied by evidence of involvement in service improvement/redesign

develop/approve high quality information for patients and carers should be developed for use across the Network

5.9. Service Quality Monitoring and Evaluation The Urology NSSG will:

Agree on priorities for common data collection at least in line with national priorities.

Review the quality and completeness of data, recommending corrective action where necessary.

Produce audit data and participate in Network-wide audit

Ensure services are evaluated by patients and carers.

Monitor progress on meeting national cancer measures and ensure action plans are agreed and implemented following Peer Review.

Report identified risks / untoward incidents to ensure learning is spread.

Ensure a commitment to primary care education. 5.10. Workforce Development The Urology NSSG will:

Consider the overall workforce developments requirements for the NSSG.

Consider the education and training needs of teams and individuals where appropriate.

Liaise with the Network Board and with the Workforce Development Confederation to ensure that appropriate workforce numbers and CPD are available;

Promote links between teams through rotation of staff.

Develop common recruitment/retention strategy.

Take account of opportunity for skill mix changes. 5.11. Research and Development The Urology NSSG will agree a common approach to research and development working with the Network Research Team, participating in nationally recognised studies whenever possible. The NSSG will discuss each MDT’s response and recruitment to the approved clinical trials portfolio and will agree any remedial actions with the clinical lead of the research network. Section 5.12 - Annual Work Programme and Three Year Service Development Plan and Annual Report

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The Urology NSSG will draw and agree the above documents together in the year service delivery plan incorporating annual work programme. This will provide advice to the board for the Network proposed Urology service delivery plans. This will be in the context of a prioritised clinical governance development plan, for approval by the Network Board; and will ensure that this is fed into the commissioning process with agreement specifying standards, service developments and improvement, data collection, audit, research, education and training. The NSSG will provide an annual report of activity to feed health economy clinical governance reporting processes.

Section 5.13 - Governance and Communication

The Urology NSSG feeds into the Network Executive, where there is representation from clinicians, provider organisations and commissioners. Any pertinent issues are stratified by the Network Executive prior to presentation to the Arden Cancer Network Board. This is the mechanism for the Urology NSSG’s 3 year service development plan to feed into the annual commissioning cycle (see Matrix page 15).

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Section 6 – Data Collection In line with the terms of reference Arden Cancer Network Urology NSSG has agreed a network wide minimum dataset comprises (MDS). The MDS includes the data items required for: British Association of Urological Surgeons (BAUS) Dataset Monitoring for cancer wait times (Exeter Returns) in accordance with DSCN 20/2008 and any subsequent updates https://nww.openexeter.nhs.uk/nhsia/index.jsp Registry upload in line with the National Contract for Acute Services http://www.ic.nhs.uk/services/datasets/document-downloads/cancer v4.5b Each MDT agrees to abide with the data stipulated in the MDS. The processes involved in the storage and management of data collection are unique to each individual Trust as each hospital utilises its own databases. However, it is recognised that the person or people responsible for data collection at the identified points of the patient pathway are the same in all Trusts as follows:

Data for Cancer Waiting Times is collected by MDT Co-ordinators and validated by the Trust cancer teams.

Pathology data is collected by the pathology team working specifically for Urology cancer within each Trust.

Radiotherapy Data set is collected by the Technical Superintendent within the Radiotherapy Department at UHCW.

Chemotherapy Data set is collected by the chemotherapy delivery areas. For Cancer Waiting Times (CWT) data if the patient is a 2ww referral then the Trust that receives that referral and first sees the patient is responsible for collecting and uploading the CWT dataset. Trusts are also responsible for uploading the treatment section of the CWT dataset for all patients they provide first treatment for. MDTs need to ensure that the relevant data items are available on the appropriate Trust IT systems. Information must be relayed to the specialist centre where a patient is referred across for treatment or further assessment. The specialist centre will then continue to collect further data relating to ongoing management on the patient and will ensure that this information is fed back to the referring Trust.

Section 7 – Service developments In line with the NSSG terms of reference the NSSG will take responsibility for formulating proposals for urology cancer service developments. This will include the Annual Work Programme and agreed 3 Year Service Development Plan.

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Section 8 – Clinical, Referral, Imaging and Pathology guidelines The Arden Cancer Network Urology Cancer NSSG has agreed that the referral guidelines for Urology Cancer are those contained in the NICE Guidance on Referral of Suspected Cancer. The point of contact for Referral for Suspected Cancer has been agreed in each Trust as follows:

Trust Department Fax

University Hospital Coventry and Warwickshire NHS Trust

2 Week Wait Office 02476 968520

South Warwickshire NHS Foundation Trust 2 Week Wait Office 01926 482665

George Elliot NHS Trust

2 Week Wait Office 024 7686 5670

Worcester Acute Hospital NHS Trust 2 week Wait Office 01562 754312 01562 513021

In line with the terms of reference the NSSG will take responsibility for agreeing network clinical, referral follow up, imaging and pathology guidelines that are kept up to date and reflect current practice. The Arden Cancer Network Clinical Guidelines for the Management of Urological Cancer, the primary care referral guidelines and the Imaging and Pathology guidelines are included within the Portfolio of Evidence The guidelines were reviewed, amended and approved by the NSSG on 25th May 2012 and ratified by the Network Executive on behalf of the Network Board on August 2012.

These serve as the ‘Named Teams’ in respect of 11-1A-202g. The policy for onward referral to another MDT within or out with the Network is included in Urology Clinical Guidelines. Full Clinical Guideline is available within the Portfolio of Evidence. The Arden Cancer Network Urology Cancer Pathology Guidelines were accepted as: Royal College of Pathologists Dataset for the histopathological reporting of Urological carcinoma (2nd Edition) September 2007 http://www.rcpath.org/resources/pdf/G013UrologyDatasetFINALSept07.pdf The Arden Cancer Network Urology Cancer NSSG Imaging Guidelines were accepted as:

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Royal College of Radiologists: Recommendations for Cross Sectional Imaging in Cancer Management (RCR(06)1) www.rcr.ac.uk/publications.aspx?PageID=310 UK PET CT Advisory Board Revision January 2009 Standards for communication of critical, urgent and unexpected significant radiological findings www.rcr.ac.uk/publications.aspx?PageID=310 Non-surgical oncology guidelines will be reviewed as part of the NSSG Work Plan by the Network Radiotherapy and Network Chemotherapy Group.

Section 9 – Research and Trials The NSSG will agree a common approach to research and development working with the Arden Cancer Research Network, participating in nationally recognised studies whenever possible. The trials portfolio will be kept under review to ensure that:

There is equity of access to trials across the Arden Cancer Network

There is equity of funding across the Arden Cancer Network

Barriers to recruitment are minimised

Good practice is shared

Clinical trials and research are a regular agenda item at each NSSG.

Section 10 – NSSG Commissioning Influence The Arden Cancer Network as a whole and it constituent groups feed into the commissioning process at several levels: The NSSG development plans are presented formally to the Arden Cancer Network Executive upon which sit the Cancer Commissioners for each PCT. Commissioning of drugs has and agreed process with the Network. The submissions have to be supported by and Arden Cancer Network wide, co-ordinated by the Network Pharmacist and show clear reference to: NICE http://www.nice.org.uk London Cancer New Drugs Group http://www.nwlm.nhs.uk/search Scottish Medicines Consortium (SMC) http://www.scottishmedicines.org.uk All Wales Medicines Strategy Group http://wales.nhs.uk/siies3/home.cfm?OrgID=37

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National Prescribing Centre http@//www.npc.co.uk Specific local development issues will be discussed at the Executive. All NSSG members through their MDT roles contribute to the Trust cancer planning process