Best Practice

Best practice guidance.

There are a number of national bodies within health care that undertake enquiries and surveys which are relevant to the governance of clinical practice within Primary Care Trusts. In addition to providing information of importance to clinicians and managers, it is important that Primary Care Trusts assimilate, and, where necessary, act upon published findings. This ensures that high quality evidence based clinical practice and information is disseminated effectively so that current practice reflects nationally accepted and applicable best practice guidance.

National Institute of Clinical Excellence

Children’s and Young People’s Improving Outcome’s Guidance

In August 2005 the NICE Children’s and Young People’s Improving Outcome’s Guidance (CYPIOG) was published and made recommendations for the treatment and care of Teenagers and Young Adults with cancer, aged 16 to 24 years. The underpinning principle evidenced in the IOG is the requirement that all young people should be offered care in a young people’s cancer facility and be referred to a specialist TYA Multidisciplinary Team. It also states that this age group should have access to “age appropriate, safe and effective care as locally as possible”, as well as recognising the crucial role psychosocial support has to play in patients at this life stage.

The guidance was developed by the National Cancer Action Team, with advice and support from an expert working group and has been reviewed by clinicians from different disciplines as well as Specialised Commissioners and Cancer Network Leads. It highlighted the essential need for all young people with cancer to benefit from the expertise of both site-specific multidisciplinary teams (MDTs) and the new Teenage/Young Adult MDTs and have unhindered access to an age-appropriate care environment and psychosocial support.

Specialised Commissioning Groups are currently working with Cancer Networks to produce a summary about how they intend to configure and commission services for their area to comply with the NICE Improving Outcomes Guidance’s recommendations.

Key Principles

In order to provide equitable access to services that are compliant with the National Institute of Health and Clinical Excellence's Improving Outcomes Guidance for Children and Young People with Cancer, it is strongly recommended that the following principles be applied when commissioning cancer services and care pathways for young people with cancer.

• All patients aged 16-18 years inclusive should be referred to a Principal Treatment Centre (Young People) for treatment.
• All patients aged 19-24 years inclusive should be offered referral to a Principal Treatment Centre (Young People) for treatment.
• All patients aged 16-24 years inclusive should be discussed at both a site-specific MDT meeting and a TYA MDT meeting.
• Referral of patients to a PTC (Young People), or review by both a site-specific and a TYA MDT should not be allowed to delay the start of urgent cancer treatment.
• For each patient, a lead medical clinician should to be identified, who will have overall responsibility for their treatment.
• The provision of treatment on a shared care basis is not precluded in delivering CYPIOG–compliant services for young people. These arrangements should be developed in partnership with the PTC (Young People) and agreed by commissioners.
• The TYA MDT at the PTC (Young People) should have a role in coordinating treatment, psychosocial care and peer contact/support for young people wherever they are treated.
• It is recognised that all the core defining services required of a PTC (Young People) may not be available in a single location. Provision of PTC services may involve more than one Trust, but these should not cross city boundaries.
• Robust arrangements should be in place for planned transition between children and young people’s services and between young people’s and adult services.