Draft 5 – January 2007

3.6 ROLE OF THE LOCAL CLINICAL TEAMS

The role of local clinical teams is to:

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  Deliver care in line with the agreed MDT operational policy
  
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  Review all patients, establish and record a diagnosis and agree a treatment plan
  

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  Discuss responses to treatment during and at the end of therapy and agree any necessary changes in management
  
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  Consider all facets of individual patient’s needs including their psychological needs and liaise with primary care, palliative care, elderly services, voluntary organisations as appropriate
  

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  Identify requirements for staff and facilities for the treatment it offers
  
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  Ensure adequate information, advice and support is given to patients and carers
  
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  Ensure GPs are given prompt and full information on patient management and contact details of relevant clinical team members
  
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  Record the minimum data set for all haematological malignancies
  
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  Identify members’ training needs and ensure these are met
  
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  Participate in clinical trials and research
  
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  Collaborate in MDT audit
  
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  Lead local service improvement initiatives and participate in MDT wide initiatives
  
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  Review any local clinical governance issues including untoward incidents ensuring appropriate action is taken
  

3.7 LOCAL CLINICAL TEAM LEAD CLINICIAN

Each of the three sites where care is delivered has a lead clinician who is also a member of the core MDT. He/she is responsible for ensuring that:

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  The delivery of care at a local level is compliant with the policies, guidelines and protocols adopted by the North Wales MDT
  
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  The local team at all levels of involvement are familiar and compliant with the policies, guidelines and protocols adopted by the North Wales MDT
  
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  Local clinical governance issues are addressed
  
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  Any conflict between local requirements and that of the MDT are raised with the MDT lead and the employing Trust is informed of the need to do so.
  

4.0 ACCESSING THE SERVICE

4.1 URGENT ‘SUSPECTED CANCER’ GP REFERRALS

All patients meeting the criteria set out in the NICE ‘Referral for suspected cancer’ guidelines (www.nice.org.uk) should be referred to the appropriate local clinical haematological cancers team without delay, as set out in each Trust’s Directory of Cancer Services. This Directory is available on each Trust intranet site and is circulated to local GP practices.

All referrals are reviewed by a consultant within 24 hours and if deemed to be appropriate, the patient will be seen within a maximum of 10 working days. If the referral is inappropriate, an alternative course of action is offered eg a routine appointment.

4.2 OTHER REFERRALS

Many patients with haematological malignancies, in particular lymphomas, are referred initially to other specialty teams. As soon as a haematological malignancy is diagnosed, a copy of the pathology report should be sent to the local haematological cancers team; in addition any abnormal electropherysis result should be copied by the biochemistry laboratory to the haematology department to follow-up.

4.3 EMERGENCY ACCESS TO CLINICAL TEAM

All patients and their GPs should be given details of how to access members of the local clinical team in an emergency. North Wales triage standards are currently being developed and will be implemented by each team.

4.4 WAITING TIMES

All patients diagnosed with a haematological malignancy will, where appropriate, start definitive treatment within national waiting times targets. In reality treatment usually begins much earlier than this in line with clinical need.

5.0 TREATMENT PLANNING DECISIONS

All patients with haematological cancers should be managed by a member of the North Wales Haematological Cancers MDT. Any patient with a haematological malignancy initially presenting to another speciality should be referred to the Haematological Cancers MDT without delay.

All patients should be reviewed by their local clinical team and multi-disciplinary treatment planning decisions made in line with agreed MDT clinical guidelines and protocols through daily ward rounds and weekly clinical meetings held on each site.

5.1 YSBYTY GWYNEDD

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  All patients are reviewed on daily consultant-led ward rounds
  
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  A clinical team meeting is held every Wednesday morning to review all new malignancies, pre-malignancies and other complex cases; the outcomes are recorded on an MDT proforma. This meeting is attended by all members of the local clinical team (see section 3.5) with the exception of the histopathologists and consultant oncologist
  
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  A pathology meeting is held on alternate Mondays with the haematologists and pathologists
  

5.2 YSBYTY GLAN CLWYD

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  All patients are reviewed on daily consultant-led ward rounds
  
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  A clinical team meeting is held every Friday to discuss all new cancer patients; a list of patients to be discussed is sent out in advance of the meeting, based on new diagnoses made in clinics or via emergency admissions and any additional cases highlighted by histology. The meeting is recorded with minutes circulated to all members of the team; a register of attendance is kept. This meeting is attended by all members of the core local clinical team (see section 3.5) with the exception of the histopathologist, palliative care consultant and ward sister
  
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  A pathology meeting is held every Tuesday with the haematologists and histopathologist