Organisational context

Constituent hospitals and workforce

1. The Alliance brings together clinicians from the following NHS Trusts: Ashford and St Peter's Hospital, Frimley Park Hospital, Royal Surrey Hospital, Surrey and Sussex Hospitals, North Hampshire Hospitals (Basingstoke), and Heatherwood and Wexham Park Hospitals. Work is also undertaken in partnership with Queen Victoria Hospital, East Grinstead, and Queen Alexandra Hospital, Portsmouth.

2. These hospitals have specialised facilities and staff for the investigation and treatment of skin cancer patients.

3. Clinicians looking after skin cancer patients should keep up to date and have the appropriate knowledge and skills required for their role. For dermatologists, diagnosing CNS’s and skin cancer surgeons, this should include proficiency in dermoscopy.

4. They are provider hospitals for primary care dermato-oncology referrals, including two-week wait referrals.

Community skin cancer services and local authority responsibilities

Community skin cancer services

1. Local agreement has been reached with the previous PCT configuration, for the provision of community services. Appropriate training, governance and audit will be put in place to ensure these are managed safely.

2. Skin cancer services in the community should adhere to current NICE, Melanoma Focus and BAD guidelines, as well as UK H&N Guidelines. It is recognized that in the context of changing evidence guidelines will not always reflect current best practice and the MDT should make informed patient centered decisions in the light of new evidence.

3. Community skin cancer clinicians are defined and bound by the following criteria:

• Enrolment on a list of accredited clinicians.

• Fulfilment of specific training requirements.

• Completion of 15 hours of Continuing Professional Development in skin cancer each year.

• Work performed to specified quality assurance measures.

• At least one session a year spent with a Consultant Dermatologist who is a core member of a skin cancer MDT.

• Appropriate MDT and Tumour Group meeting engagement.

• Participation in skin cancer audit as required.

• These criteria are contained within a service specification for the Network Community Skin Cancer Service, agreed with the CCGs.

4. Levels of community skin cancer services are recognised.

5. SASH (at Dorking Hospital) and ASPH support GPwERs carry out low risk cancer surgery, falling under the governance of the respective LSMDTs.

6. Direct referral of skin cancer cases excised in the community to the relevant LSMDT or SSMDT is expected where MDT discussion/referral is required.

7. All histologically diagnosed skin cancer (SCC, melanoma), and BCC’s with involved or close margins, which have been sent to Pathology Partnership, are curated and distributed by local and/ or specialist skin cancer MDT coordinators for potential MDT discussion.

8. Any BCC above the clavicle excise by a GP should be included in an MDT irrespective of marginal clearance.

9. NICE has issued a quality statement on the management of low-risk basal cell carcinoma by GPs.

Local authority responsibilities

1. Local authorities are responsible for health promotion activities on preventing skin cancer and recognising early signs.

2. This is subject to NICE skin cancer quality statement 1.

3. It is expected that local authorities within the areas of the Alliance will undertake health promotion activities on preventing skin cancer and recognising early signs, consistent with the messages in any national campaigns.

4. Public health activities should be based on NICE guideline [NG34] - Sunlight exposure: risks and benefits.

5. The Alliance welcomes greater partnership with local charities and support groups in this regard.

Tumour Group

• The Tumour Group comprises the clinicians and administrative staff of the Alliance SSMDT and members of the four principal affiliated LSMDTs, as well as cancer service managers and additional interested parties.

• The Chair of the Tumour Group is currently Carrie Newlands.

• The Tumour Group meets every three to four months. There must be at least one representative from each Skin MDT in the Alliance. Trust provision must be made for clinicians to attend governance and educational meetings.

• The meeting is minuted and a record of attendance for each meeting is kept.

• The Group is a primary source of advice and clinical opinion to the Surrey and Sussex Cancer Alliance on issues relating to skin cancer services.

• The Group has responsibility for the development of patient pathways and clinical guidelines for skin cancer services for the northern part of the Surrey and Sussex Cancer Alliance.

• The Group contributes responsibility for coordination and consistency across the Surrey and Sussex Cancer Alliance for cancer policy, practice guidelines, clinical and patient experience outcomes, research and service development relating to skin services.

• The Group also provides services to parts of the Wessex Cancer Alliance, notably Basingstoke and Portsmouth.

• The group is responsible for consulting with the relevant St. Luke’s Cancer Alliance Groups on issues involving oncological therapies including immunotherapy, targeted therapy chemotherapy, radiotherapy, radiology, histopathology, cytology, acute oncology, cancer of unknown primary (CUP) presenting on the skin, ( in conjunction with the CUP MDT) and specialist palliative care.

• The group is responsible for consulting with the commissioners on issues involving the community skin cancer service.

• The group has responsibility for ensuring co-ordination and consistency across the St. Luke’s Cancer Alliance for ensuring compliance with current guidelines.

• The group, in consultation with the St. Luke’s Cancer Centre, will agree the acceptable systemic anti cancer treatment (SACT) or chemotherapy algorithms. These will be reviewed every two to three years or sooner when the evidence base changes.

• The group will review any patient feedback and implemented actions where required.

• The group will continue close relations with patient support groups and charities such as Story FMR, Melanomore and Melanoma Focus.

• The group will review any Cancer Outcome Indicators associated with delivery of skin cancer care, agree an improvement programme with them and monitor progress.

• The group will ensure that skin cancer care is delivered by active and attending skin cancer MDT members.

• The group will organise at least one multi-professional education meeting per year.

• MDT and TGM/Educational sessions attendance will be audited and data supplied to members to support the appraisal process and ensure good governance. As per National MDT Guidance, attendance at least 2 TGM’s per year and more than 60% of MDT meetings is the standard of care for MDT membership.

• The group will agree network audits. The progress of audits will be reviewed regularly. Completed audits will be presented and improvement programmes agreed and monitored.

• The group will discuss at least annually research reports on recruitment to trials and any barriers to recruitment.

• The group will, in partnership with the SSMDT, SSCA and additional stakeholders, produce a Work Programme and Annual Report. Due to high workload this has not been produced to date. The group will work with other regional tumour groups to establish a harmonised programme.

Surrey and Sussex Cancer Alliance

The Surrey and Sussex Cancer Alliance (SSCA) is a collective of NHS organisations responsible for commissioning and providing services; local councils who commission and provide social care and public health services; charities, community and voluntary organisations; patient representatives and groups; and academic organisations. It is one of the South East Cancer Alliances which are part of NHS England and NHS Improvement South East. The Chair of the SSCA is Louise Stead, who is also Chief Executive of the Royal Surrey NHS Foundation Trust. The Medical Director is Fiona McKinna, who is a Consultant Clinical Oncologist at the Sussex Cancer Centre.

The SSCA gives its mission statement as follow:

• Reduce variation and inequalities in the delivery of cancer services across Surrey and Sussex.

• Improve accessibility of cancer services across Surrey and Sussex.

• Improve survivorship and outcomes for patients diagnosed with a cancer.

• Ensure patients have a personalised plan for their cancer treatment and recovery that reflects their wishes.

• Share best practice, innovation, and learning.

A map of SSCA and neighbouring cancer alliances is given below.

Organisations contributing to the Surrey and Sussex Cancer Alliance are given below

NICE

In development

NHS

Commissioning Following the 2012 Health and Social Care Act, responsibility for commissioning healthcare services rested with the National Commissioning Board of NHS England and Clinical Commissioning Groups. In 2013, the National Commissioning Board issued an NHS Standard Contract for Cancer: Skin (Adult). The Health and Bill was passed in early 2022, and Integrated Care System boards are in the process of assuming commissioning functions from CCGs. Notably, NHS England will continue to commission specialised services including systemic anticancer therapy, radiotherapy and specialised cancer surgery.

Data collection The National Cancer Registration and Analysis Service (NCRAS) is part of the National Disease Registration Service, which is part of NHS Digital. It collects data on all cancer cases. The Cancer Outcome and Services Data Set (COSD) has been the national standard for reporting cancer in the NHS since 2013. Data collection is obligated by the NHS contract and is a principal part of the function of the MDT and Tumour Group.

Quality assurance The National Cancer Peer Review board, part of the National Cancer Action Team, carried out a rolling programme of peer review using quality measures defined by CQUIN, incorporated into the Manual for Cancer Services (2008). Peer review remains suspended at present. CQUIN also provides an incentive scheme. This was suspended during the COVID pandemic and is being reintroduced from 2022/23. Skin cancer is not currently an identified Clinical Priority Area.

Alignment with national strategy A new 10-year cancer plan is in development during early 2022. Together with institutional partners, the Alliance will align regional skin cancer strategy with this review on publication.

Professional organisations, literature surveillance and conferences

Professional organisations and membership

BAD Cliff, Newlands, Sworm

Melanoma Focus Ajaz, Clayton, Donlon, Newlands, Pakzad, Powell, Sworm

ESMO Ajaz, Koliou

ASCO Koliou

ESTRO Lynch

ASTRO -

BASCNS/ BAD NG Sworm (chair), Upshon (committee member), Donlon

BAOMS Newlands, Gurney, Sloane, Walsh

BAAPS Powell, Lohn, Green

EORTC Cook

SMR -

EADO -

UKONS Sworm

Core literature surveillance

Journal of Clinical Oncology

Annals of Oncology

European Journal of Cancer

British Journal of Surgery

Clinical Oncology

British Journal of Dermatology

Melanoma Research

Lancet Oncology

Active pubmed search

Aggregation and alert services

Conferences, meetings and Alliance attendees (in development)

2014 Edinburgh WCCS Walsh (presn)

2015 Munich Post-ASCO melanoma Ajaz

Aug 2016 Vienna EADO/ WCCS Ajaz

Sep 2016 London EACMFS Ajaz (presn)

Oct 2016 London Melanoma Focus Ajaz

Feb 2017 Reigate SW Thames Dermatology Ajaz (presn)

May 2017 Athens EADO Ajaz

Oct 2017 London Melanoma Focus Ajaz

Mar 2018 Marseille BMS Immuno-oncology Ajaz

May 2018 Cambridge Melanoma Focus Ajaz, Pakzad

Mar 2019 London Novartis AIM Higher Ajaz, Powell

May 2019 London MSD Melanoma Ajaz

May 2019 London Non-melanoma skin cancer Ajaz

Jun 2019 Munich Post-ASCO melanoma Ajaz

Jul 2019 Birmingham BAOMS Ajaz (presn)

May 2020 Chicago ASCO (website, proceedings) -

Jun 2021 Virtual ASCO (website) -

Jun 2022 Virtual/ Chicago ASCO (website) -

Oct 2022 Edinburgh SMR (website) -

Jan 2023 Berlin ESDO (programme) -

Apr 2023 Rome EADO (website) -