Appendix D- Monoclonal Gammopathy of Undetermined Significance (MGUS)

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Appendix D- Monoclonal Gammopathy of Undetermined Significance (MGUS)"

Transcription

1 Local Enhanced Service: Primary care management of stable haematological patients Monoclonal Gammopathy of Undetermined Significance (MGUS) 1. Introduction Monoclonal Gammopathy of Undetermined Significance (MGUS) is a common condition, which increases its likelihood with age. About one in 30 people aged 50 years or older will have the condition, this rises to one in 20 people aged over 70 years, and nearly one in 10 people aged over 85 years. It is about 1.5 times more common in men than in women. The disorder also appears to be nearly twice as common in patients of African descent than in Caucasians. This disorder may progress to Myeloma in 1-2% of patients per annum and therefore requires regular monitoring. Chronic Lymphocytic Leukaemia (CLL) is the most common form of leukaemia in the Western World and is often diagnosed by chance following a routine full blood count (FBC). Stage A is the very earliest stage of the disease. Patients are often elderly and trial evidence supports no need for active treatment of early stage disease. The majority of such patients have an extremely good prognosis with slowly progressive disease over many years. Consequently they are ideal patients to be followed up in primary care. Patients with CLL can be more prone to infection and may develop autoimmune haemolytic anaemia and/or immune thrombocytopenic purpura (ITP). 2. Service Aims The aim of this service is to facilitate the management of appropriate patients with Monoclonal Gammopathy of Undetermined Significance (MGUS) and/or Stage A Chronic Lymphocytic Leukaemia (CLL) within primary care. Appropriate patients will be considered for primary care management if their disease is stable or does not require active treatment. The service will result in: Reduced number of inappropriate referrals to secondary care services Improved access and shorter waiting times for patients requiring specialist input Care closer to home for stable haematological patients 3. Service Description The care of a patient who meets the criteria contained in the GP Guidelines for the follow-up of stable haematological patients will be transferred to GP Practices in Croydon who have been commissioned to provide this service. Transfer will be by the secondary care consultant following completion of a discharge consultation. Participating GP practices will provide routine follow-ups, including the relevant tests, at the intervals specified in the GP Guidelines. Participating practices will be able to access specialist advice from a local secondary care consultant if needed (via Kinesis in the case of St George s NHS Healthcare Trust and via a dedicated in the case of Croydon Health Services NHS Trust, Kingston Hospital NHS Trust and Epsom and St Helier University NHS Trust. It will be the responsibility of the GP practice to: Contact the patient by telephone to book their first appointment with the nurse and GP for on-going primary care management, having been reminded to do so at their hospital discharge consultation. It will be at the patient s first appointment with the 1

2 GP, that the patient will be advised as to when to book future follow-up appointments. Be responsible for ensuring that failsafe and safety netting processes are in place. The Practice shall maintain a register of all patients referred into the service, which will be routinely checked by GP Practice staff. This information will be available at all times to the Commissioner. 4. Operational Service Provision Discharge from Secondary Care Secondary care providers will identify appropriate patients with low risk MGUS and/or stable Stage A CLL for management within primary care and will discharge directly to the patients GP following a discharge consultation. To ensure the patient receives a smooth discharge to primary care, the following checks will be in place at the patient s secondary care discharge consultation: o Check that the patient understands and accepts the new follow-up arrangements o Check with the patient that their GP details are correct o Send a discharge letter, which includes a fax back confirmation to the patients GP (a copy will also be given to the patient at the discharge consultation) Follow-up within Primary Care GPs will be expected to return the fax back confirmation within 1 week of receipt to accept responsibility for the patient s on-going primary care management. Please note: if the GP does not return the fax back confirmation, the relevant secondary care provider will contact the patients GP to confirm receipt. GPs will add patients with low risk MGUS and/or stable Stage A CLL to the flu vaccination list The service will be provided in GP practices in Croydon within surgery hours For both patients with low risk MGUS and/or stable Stage A CLL, if a patient is concerned about their symptoms, the patient should be encouraged to liaise directly with their GP and book an urgent review appointment. Monoclonal Gammopathy of Undetermined Significance (MGUS) Nurse appointment Patient will attend a practice nurse appointment where the following tests for patients with MGUS being managed within primary care. These will be requested every 3 to 6 months (or frequency as prescribed in the patients discharge consultation letter): Full Blood Count (FBC) Urea and Electrolytes (U&E) Calcium Paraprotein levels Urinary Bence Jones protein OR Freelite Serum free light chain estimation for patients with a significant Freelite Serum free light chain component 1 GP appointment 1 week later, the patient will attend a GP appointment to discuss their test results. GPs should monitor the following blood and urine tests in the table below: Blood tests 1 The Serum Freelite Chain blood test is equivalent to the Bence Jones Urine test. 2

3 Haemoglobin concentration Hypercalcaemia Creatinine and/or urea Paraprotein Freelite Serum free light chain (can be undertaken instead of a urinary Bence Jones test, for patients with a significant Serum Freelite Chain component) Less than 100 g/l Abnormal / deterioration (at discretion of GP) If the concentration of the M-protein increases by more than 25% (a minimum absolute increase of 5 g/l) Increases by more than 25% in either light chain Urine tests Bence Jones Increases by more than 25% Please note: In the event of suspicious symptoms, which could indicate disease progression and/or blood test results exceeding the threshold for referral back into secondary care, the GP should refer directly back to secondary care using the agreed referral proforma or utilise Kinesis (in the case of St George s NHS Healthcare Trust) or the relevant secondary care provider s dedicated rapid access for advice. Provide patients with advice on disease progression warning signs and symptoms and reiterate the importance of reporting any changes in their condition to their GP Update the patients results in the bespoke patient information leaflet as well as updating the patients practice record Advise patient as to when to book their next review appointment Chronic Lymphocytic Leukaemia (CLL) Blood tests Every 3 to 6 months (frequency as prescribed in patient discharge letter), the GP practice will be responsible for arranging Full Blood Count (FBC) tests for patients with Stage A CLL being managed within primary care GP appointment 1 week later, the patient will attend a GP appointment to discuss their test results. GPs should monitor the blood tests in the table below: Blood tests Haemoglobin concentration White cell count Platelets Lymphocyte count Less than 105 g/l Greater than 50 x 10^9/l Less than 100 x 10^9/l Doubling time of less than 12 months Please note: Patients should be referred back to the appropriate secondary care provider using the agreed proforma in the following instances: o Falling Hb < 105g/l or platelets < 100, o Development of bulky lymph nodes /splenomegaly or B symptoms unintentional weight loss, night sweats and/or unexplained fevers. o Doubling of lymphocyte count within a period of 12 months or less. If the GP requires further advice and support regarding test results and/or whether a re-referral is necessary, the GP should utilise Kinesis (in the case of 3

4 St George s NHS Healthcare Trust) or the relevant secondary care provider s dedicated rapid access . GPs should examine the patient for signs/evidence of lymphadenopathy/splenomegaly Patients should receive prompt treatment of infective episodes with antibiotics. Patients with recurrent chest infections should receive routine immunisation of the influenza vaccine +/- pneumovax/hib GPs should provide patients with advice on disease progression warning signs and symptoms and reiterate the importance of reporting any changes in their condition to their GP. Update the patients results in the bespoke patient information leaflet as well as updating the patients EMIS record Advise patient as to when to book the next review appointment 5. Eligibility Criteria Inclusion Criteria Patients registered with a GP in Croydon Patients with stable Stage A CLL and/or low risk MGUS who have been identified as being appropriate for primary care management by their local secondary care provider and have received a discharge consultation Exclusion Criteria Patients registered with a GP outside of Croydon Patients who do not have the conditions explicitly referred to in the inclusions criteria 6. Governance and Professional Standards Practices will have the following Clinical Governance processes in place: Named Lead GP On-going training and education Access to advice and support from the relevant haematology consultant Development and maintenance of clinical records and safety netting systems. Annual patient satisfaction surveys Complaints procedure Critical Incident reporting (Significant Events/Serious Untoward Incidents) 7. Monitoring Requirements The South West London Cancer Commissioning Team will be responsible for updating the GP Guidelines for stable haematological patients GP practices should take responsibility for ensuring that staff members delivering this service are appropriately trained and have the necessary skills to provide the service. A webcast educational session which has been developed by local haematology consultants to assist with any training needs. However, if your practice feels that further education and training is required, please feedback to the Commissioner. 8. Performance Monitoring Requirements The named GP stable haematological management lead is required to be the point of contact for the Commissioner for all aspects regarding this service specification. 4

5 Croydon CCG expects GP providers to report on the following key performance indicators on an annual basis: The NHS number of the discharged patient Date of discharge Disease: Stable Stage A CLL or low risk MGUS Referring Consultant and Trust Number of face-to-face review consultations agreed with the consultant per year Number of face-to-face review consultations offered over the reporting period Number of face-to-face review consultations attended over reporting period Patient continuing in Primary Care (Y or N) Number of referrals back to secondary care over the reporting period Reason for referral back to secondary care (where applicable) Patient offered referral to Croydon CReSS (Y or N) 9. Pricing and Payment 100 per patient claimable in April for the previous quarter s activity, with final payment dependent on an annual report 10. Patient information The South West London Cancer Commissioning Team has produced the following patient information leaflets - please see embedded documents. These should be used to support patient discussions. Please note that it is the patient s responsibility to notify their GP and local secondary care provider at the earliest opportunity if they change address and/or GP Practice. At this point, the patient s follow-up care will transferred back to the local secondary care provider until confirmation has been received from the patient s new GP that their on-going follow-up care will be managed by the new GP practice. 11. LES Evaluation Following the first year of service, the South West London Cancer Commissioning Team will conduct a service audit to determine whether the service is achieving the outlined aims and objectives. Audit results will be communicated back to Croydon CCG. The following would constitute evidence that the LES is effective: Reduction in the number of inappropriate referrals to secondary care services Improved access and shorter waiting times for patients requiring specialist input Patients reporting that they are receiving appropriate care closer to home. 12. Review and Future developments 5

6 Croydon CCG will evaluate the service at the end of the LES contract period and the data will be used to inform decisions about future service provision. This service specification will be reviewed on an annual basis within the contract period. Croydon CCG reserves the right to withdraw or amend this service and will give a minimum of 3 months notice of any service changes. 13. Signature of Parties The signatures below constitute an agreement between the GP Practice and Croydon Clinical Commissioning Group for the management of stable haematological patients (stable Stage A CLL and low risk MGUS) within primary care for the GP practices own registered patients. This service will be for the period 1 October 2013 to 31 March By signing this agreement the GP practice is agreeing to the CCG Commissioners extracting data on a regular basis via EMIS Web for this LES for audit and payment purposes. Lead GP Name (Print): Signature: Date: Croydon CCG (Print): Signature: Date: Please note that the LES will only be valid when the practice has received by return a signed copy by Croydon CCG. 6

7 Appendix 1 Follow Up Pathway for Patients with Stage A CLL or MGUS New Patients Stage A CLL = Chronic Lymphocytic Leukaemia (CLL) MGUS= Monoclonal Gammopathy of Undetermined Significance (MGUS). Patients Discharged from Secondary Care Included: Patients with stable Stage A CLL. Low risk MGUS patients ie asymptomatic, low paraproteins. Excluded: Patients who have learning difficulties or mental health problems will be reviewed individually. Patients with multiple or severe co-morbidities. When initial investigations, treatment and follow-up in secondary care are complete, the patient has a Discharge Consultation with the responsible clinician and CNS. DISCHARGE CONSULTATION Includes: Diagnosis and explanation. What to expect with regard to frequency of blood tests by GP. Blood results that would trigger a referral back to the hospital specialist. Information about the likelihood of disease progression. What to look out for warning signs and symptoms and the importance of reporting to their GP. Supply bespoke patient information leaflets and complete results record Informing the patient that they are responsible for making their own follow-up appointments with GP. PAPERWORK COMPLETED DURING DISCHARGE CONSULTATION: Verify with patient that the GP on the patient record is correct. Discharge letter to inform GP of patient s condition and the subsequent follow-up arrangements required. Copy to patient. This includes:- Trust contact details and a fax back confirmation sheet. GPs are requested to return the confirmation sheet sent back within 24 hours of letter receipt and agree their responsibility for patient follow-up. Trust to contact GP if fax not received within 48 hours. FOLLOW-UP CONSULTATION WITH GP Includes GP reviews blood results and clinical examination results for Stage A CLL patients (lymph nodes). GP to refer back to secondary care via if there is evidence of disease progression (Blood results that would trigger a referral to a hospital specialists are listed in the GP Guidelines). GP completes specifically designed EMIS templates as a guide for tests, clinical examination (Stage A CLL patients) and safety netting. Provides advice to patients on what to look out for warning signs and symptoms and the importance of reporting to their GP. Updates the results record in the bespoke patient information leaflets Provides date for next review appointment. PATIENT RECALL Patients who are concerned about their symptoms should liaise directly with their GP. In the event of suspicious symptoms which could indicate disease progression, GP to utilise the dedicated rapid access box. Blood results meeting the threshold for referral back to secondary care trigger the GP to use the dedicated rapid access box. Following discussion with secondary care specialist, patient may be referred back to secondary care and will be treated as a new patient. Patient will be seen within 14 days if referral required. (Trusts will give guidance about referral back to secondary care and the timelines required i.e. 2-week wait). POST CONSULTATION ACTIVITIES Patient record annotated to show transfer of care to primary care. GOVERNANCE AND REPORTING FRAMEWORK Patient should be fast-tracked back into appropriate clinic within 14 days of GP contact. Dedicated rapid access box will be accessed at least twice a week. Trust to ensure that necessary cover arrangements are in place. Copies of patient discharge letters will be collated centrally. An audit will be conducted by the TWG after the first year. Results of the audit to be fed back to CCGs. GPs to be informed of any changes to national guidance. GPs to follow the fax back confirmation process. Review Date: November

CLL. Handheld record. Stockport NHS foundation trust

CLL. Handheld record. Stockport NHS foundation trust CLL 2015 Handheld record Contains- Patient information booklet, details of haematology clinic assessment and ongoing clinical assessment at GP surgery Stockport NHS foundation trust You have been diagnosed

More information

Examination. Sample. Adult- Yellow top. Sample Tube/Container

Examination. Sample. Adult- Yellow top. Sample Tube/Container Examination 17749 Protein Electrophoresis (Total protein, albumin, Bence jones protein, serum protein electrophoresis SPE, myeloma, and other B cell dyscrasias screen) Purpose of test The main reasons

More information

Smouldering myeloma. Myeloma Infosheet Series. Other related conditions Infoline:

Smouldering myeloma. Myeloma Infosheet Series. Other related conditions Infoline: Smouldering myeloma This Infosheet provides information on what smouldering myeloma is, how it is diagnosed, what the treatment is and will explain the link between smouldering myeloma and active myeloma.

More information

An overview of CLL care and treatment. Dr Dean Smith Haematology Consultant City Hospital Nottingham

An overview of CLL care and treatment. Dr Dean Smith Haematology Consultant City Hospital Nottingham An overview of CLL care and treatment Dr Dean Smith Haematology Consultant City Hospital Nottingham What is CLL? CLL (Chronic Lymphocytic Leukaemia) is a type of cancer in which the bone marrow makes too

More information

Follow-up care plan after treatment for breast cancer. A guide for General Practitioners

Follow-up care plan after treatment for breast cancer. A guide for General Practitioners Follow-up care plan after treatment for breast cancer A guide for General Practitioners This leaflet provides information for GPs on the follow-up care required by women who had breast cancer. It is for

More information

AVOIDING UNPLANNED ADMISSIONS ENHANCED SERVICE: PROACTIVE CASE FINDING AND CARE REVIEW FOR VULNERABLE PEOPLE GUIDANCE AND AUDIT REQUIREMENTS

AVOIDING UNPLANNED ADMISSIONS ENHANCED SERVICE: PROACTIVE CASE FINDING AND CARE REVIEW FOR VULNERABLE PEOPLE GUIDANCE AND AUDIT REQUIREMENTS April 2014 AVOIDING UNPLANNED ADMISSIONS ENHANCED SERVICE: PROACTIVE CASE FINDING AND CARE REVIEW FOR VULNERABLE PEOPLE GUIDANCE AND AUDIT REQUIREMENTS A programme of action for general practice and clinical

More information

Coping with. Chronic Lymphocytic Leukaemia (CLL) Patient information

Coping with. Chronic Lymphocytic Leukaemia (CLL) Patient information Coping with Chronic Lymphocytic Leukaemia (CLL) Patient information What is CLL? Your doctor will have told you that you have a condition that affects your blood called CLL. CLL is short for Chronic Lymphocytic

More information

Multiple Myeloma Patient s Booklet

Multiple Myeloma Patient s Booklet 1E Kent Ridge Road NUHS Tower Block, Level 7 Singapore 119228 Email : ncis@nuhs.edu.sg Website : www.ncis.com.sg LIKE US ON FACEBOOK www.facebook.com/ nationaluniversitycancerinstitutesingapore Multiple

More information

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE)

Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Rivaroxaban: Prescribing Guidance for the treatment of provoked venous thromboembolism (VTE) Amber Drug Level 2 Leeds We have started your patient on rivaroxaban for the treatment of provoked VTE (deep

More information

Information Pathway. Myeloma tests and investigations. Paraprotein measurement

Information Pathway. Myeloma tests and investigations. Paraprotein measurement Information Pathway Myeloma UK Broughton House 31 Dunedin Street Edinburgh EH7 4JG Tel: + 44 (0) 131 557 3332 Fax: + 44 (0) 131 557 9785 Myeloma Infoline 0800 980 3332 www.myeloma.org.uk Charity No. SC

More information

Southern Derbyshire Shared Care Pathology Guidelines. Diagnosis and Management of Myeloma

Southern Derbyshire Shared Care Pathology Guidelines. Diagnosis and Management of Myeloma Southern Derbyshire Shared Care Pathology Guidelines Diagnosis and Management of Myeloma When to screen for Myeloma and related disorders Not recommended to screen the normal population Clinical Symptoms,

More information

Patient Electronic Alert to Key-worker System (PEAKS) Guidelines

Patient Electronic Alert to Key-worker System (PEAKS) Guidelines Patient Electronic Alert to Key-worker System (PEAKS) Guidelines This procedural document supersedes: PAT/EC 4 v.1 Guidelines for Patient Electronic Alert to Key-worker systems (PEAKS). Did you print this

More information

Things You Don t Want to Miss in Multiple Myeloma

Things You Don t Want to Miss in Multiple Myeloma Things You Don t Want to Miss in Multiple Myeloma Sreenivasa Chandana, MD, PhD Attending Hematologist and Medical Oncologist West Michigan Cancer Center Assistant Professor, Western Michigan University

More information

Guidelines for the Management of Chronic Lymphocytic Leukaemia (CLL)

Guidelines for the Management of Chronic Lymphocytic Leukaemia (CLL) Guidelines for the Management of Chronic Lymphocytic Leukaemia (CLL) Version History Version Date Summary of Change/Process 2.0 08.05.08 Endorsed by the Governance Committee 2.1 16.02.11 Circulated at

More information

Monoclonal Gammopathy of Undetermined Significance (MGUS) Facts

Monoclonal Gammopathy of Undetermined Significance (MGUS) Facts Monoclonal Gammopathy of Undetermined Significance (MGUS) Facts Normal plasma cells (a type of white blood cell) produce antibodies (also known as immunoglobulins) which help fight infection. Each type

More information

Myeloma pathways to diagnosis UCLP audit

Myeloma pathways to diagnosis UCLP audit Myeloma pathways to diagnosis UCLP audit Dr Neil Rabin Consultant Haematologist University College London Hospitals & North Middlesex University Hospital Myeloma Clinical Features Bone pain (70%) High

More information

Multiple Myeloma Understanding your diagnosis

Multiple Myeloma Understanding your diagnosis Multiple Myeloma Understanding your diagnosis Multiple Myeloma Understanding your diagnosis When you first hear that you have cancer you may feel alone and afraid. You may be overwhelmed by the large amount

More information

Patient Choice Strategy

Patient Choice Strategy Patient Choice Strategy Page 1 of 14 Contents Page 1 Background 4 2 Putting Patients and the Public at the Heart of Health and 5 Healthcare in West Lancashire 3 Where are we now and where do we need to

More information

Measuring quality along care pathways

Measuring quality along care pathways Measuring quality along care pathways Sarah Jonas, Clinical Fellow, The King s Fund Veena Raleigh, Senior Fellow, The King s Fund Catherine Foot, Senior Fellow, The King s Fund James Mountford, Director

More information

UNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and

UNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and UNDERSTANDING MULTIPLE MYELOMA AND LABORATORY VALUES Benjamin Parsons, DO bmparson@gundersenhealth.org Gundersen Health System Center for Cancer and Blood Disorders La Crosse, WI UNDERSTANDING MULTIPLE

More information

Service Specification Template Department of Health, updated June 2015

Service Specification Template Department of Health, updated June 2015 Service Specification Template Department of Health, updated June 2015 Service Specification No. : 2 Service: Commissioner Lead: Provider Lead: Period: Anti-coagulation monitoring Date of Review: 31 st

More information

Guidelines for Management of Renal Cancer

Guidelines for Management of Renal Cancer Guidelines for Management of Renal Cancer Date Approved by Network Governance July 2012 Date for Review July 2015 Changes Between Versions 2 and 3 Section 5 updated bullets 5.3 and 5.4 Section 6 updated

More information

Inpatient and Outpatient. Waiting Times & Patients Access Policy

Inpatient and Outpatient. Waiting Times & Patients Access Policy Inpatient and Outpatient Waiting Times & Patients Access Policy Authors Piers Young Author s Job Title Interim Planned Care Programme Lead Department Surgery Version number Version 14 Ratifying Committee

More information

Investigation into the death of Mr George Joseph, a prisoner at HMP Belmarsh, in April 2015

Investigation into the death of Mr George Joseph, a prisoner at HMP Belmarsh, in April 2015 Investigation into the death of Mr George Joseph, a prisoner at HMP Belmarsh, in April 2015 Crown copyright 2015 This publication is licensed under the terms of the Open Government Licence v3.0 except

More information

CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE

CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE CROSS HEALTH CARE BOUNDARIES MATERNITY CLINICAL GUIDELINE Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Obstetric Early Warning Score Guideline Implementation

More information

PATIENT ACCESS POLICY

PATIENT ACCESS POLICY . PATIENT ACCESS POLICY TITLE Patient Access Policy APPLICABLE TO All administrative / clerical / managerial staff involved in the administration of patient pathway. All medical and clinic staff seeing

More information

Fast Track Pathway Tool for NHS Continuing Healthcare

Fast Track Pathway Tool for NHS Continuing Healthcare Fast Track Pathway Tool for NHS Continuing Healthcare DH INFORMATION READER BOX Policy Clinical Estates HR / Workforce Commissioner Development IM & T Management Provider Development Finance Planning /

More information

Publications Gateway Ref No. 04365. Patient Online: MAKING THE MOST OF ONLINE APPOINTMENTS AND REPEAT PRESCRIPTIONS

Publications Gateway Ref No. 04365. Patient Online: MAKING THE MOST OF ONLINE APPOINTMENTS AND REPEAT PRESCRIPTIONS Publications Gateway Ref No. 04365 Patient Online: MOST OF ONLINE AND REPEAT Equality and Health Inequalities Statement Promoting equality and addressing health inequalities are at the heart of NHS England

More information

Gilenya. Exceptional healthcare, personally delivered

Gilenya. Exceptional healthcare, personally delivered Gilenya Exceptional healthcare, personally delivered Your Consultant Neurologist has suggested that you may benefit from treatment with Gilenya. The decision to start this form of treatment can be difficult.

More information

INFORMATION SHARING AGREEMENT. Multi-Disciplinary Team (MDT): Service Information Sharing

INFORMATION SHARING AGREEMENT. Multi-Disciplinary Team (MDT): Service Information Sharing INFORMATION SHARING AGREEMENT Multi-Disciplinary Team (MDT): Service Information Sharing SCOPE NAME OF LEAD Multi-Disciplinary Team (MDT) for high risk people: this agreement is for the patient and management

More information

Waldenström Macroglobulinemia: The Burning Questions. IWMF Ed Forum May 18 2014 Morie Gertz MD, MACP

Waldenström Macroglobulinemia: The Burning Questions. IWMF Ed Forum May 18 2014 Morie Gertz MD, MACP Waldenström Macroglobulinemia: The Burning Questions IWMF Ed Forum May 18 2014 Morie Gertz MD, MACP Are my kids going to get this? Familial seen in approximately 5 10% of all CLL patients and can be associated

More information

Patient Access Policy

Patient Access Policy Patient Access Policy NON-CLINICAL POLICY ACE 522 Version Number: 2 Policy Owner: Lead Director: Assistant Director of Operations Director of Operations Date Approved: Approved By: Management Executive

More information

Managing and Minimising Appointment Slot Issues

Managing and Minimising Appointment Slot Issues NHS e-referral Service Managing and Minimising Appointment Slot Issues What is an Appointment Slot Issue? When no clinic appointment is available for patients to book in the NHS e-referral Service, the

More information

Coventry and Warwickshire Repatriation Programme

Coventry and Warwickshire Repatriation Programme NHS Arden Commissioning Support Unit Coventry and Warwickshire Repatriation Programme Large-scale service redesign and innovation to benefit patients Arden Commissioning Support Unit worked with Coventry

More information

Treatment of low-grade non-hodgkin lymphoma

Treatment of low-grade non-hodgkin lymphoma Produced 28.02.2011 Due for revision 28.02.2013 Treatment of low-grade non-hodgkin lymphoma Lymphomas are described as low grade if the cells appear to be dividing slowly. There are several kinds of low-grade

More information

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia

Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Shared Care Guideline-Use of Donepezil, Galantamine, Rivastigmine and Memantine in Dementia Version: 3.0 Ratified by: Medicines Committee Date ratified: 16 th November 2011 Name of originator/author: James

More information

Dear Colleague Forthcoming national Be Clear on Cancer symptom awareness campaign

Dear Colleague Forthcoming national Be Clear on Cancer symptom awareness campaign NHS England Publications gateway reference:03156 PHE gateway reference: 2014-806 To: Clinical Commissioning Group Clinical Leads Strategic Clinical Network Associate Directors Local Authority Chief Executives

More information

What is chronic lymphocytic leukaemia?

What is chronic lymphocytic leukaemia? Revised October 2011 What is chronic lymphocytic leukaemia? The diagnosis of a blood cancer can be a devastating event for patients, families and friends. It is therefore vital for everyone to have access

More information

Who is affected by HCL and what causes it?

Who is affected by HCL and what causes it? Freephone helpline 0808 808 5555 information@lymphomas.org.uk www.lymphomas.org.uk Hairy cell leukaemia Hairy cell leukaemia (HCL) is a rare and very distinctive cancer of blood cells called B lymphocytes

More information

Outpatient and Inpatient Waiting Times. & Patients Access Policy

Outpatient and Inpatient Waiting Times. & Patients Access Policy Outpatient and Inpatient Waiting Times & Patients Access Policy Date Approved by Version V2 Procedure/Policy Number Procedure/Policy type Date Equality impact assessment completed: Issue Date September

More information

Summary of EWS Policy for NHSP Staff

Summary of EWS Policy for NHSP Staff Summary of EWS Policy for NHSP Staff For full version see CMFT Intranet Contact Sister Donna Egan outreach coordinator bleep 8742 Tel: 0161 276 8742 Introduction The close monitoring of patients physiological

More information

Patient Access. UCLH policy

Patient Access. UCLH policy Patient Access UCLH policy Version 3.2 Version Date June 2014 Version Approved By EB Policy Approval Sub-Group Publication Date July 2013 Author Kevin Nicholson Review By Date June 2016 Responsible Director

More information

Chapter 15 Multiple myeloma

Chapter 15 Multiple myeloma Chapter 15 Multiple myeloma Peter Adamson Summary In the UK and in the 199s, multiple myeloma accounted for around 1 in 8 diagnosed cases of cancer and 1 in 7 deaths from cancer. There was relatively little

More information

HealthCare Partners of Nevada. Heart Failure

HealthCare Partners of Nevada. Heart Failure HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with

More information

MANAGEMENT OF TUBERCULOSIS IN PRISONS: Guidance for prison healthcare teams

MANAGEMENT OF TUBERCULOSIS IN PRISONS: Guidance for prison healthcare teams MANAGEMENT OF TUBERCULOSIS IN PRISONS: Guidance for prison healthcare teams Document control Title Type Author/s Management of tuberculosis in prisons: Guidance for prison healthcare teams Operational

More information

FastTest. You ve read the book... ... now test yourself

FastTest. You ve read the book... ... now test yourself FastTest You ve read the book...... now test yourself To ensure you have learned the key points that will improve your patient care, read the authors questions below. Please refer back to relevant sections

More information

2. The aims of this enhanced service in 2013/14 are to encourage GP practices to:

2. The aims of this enhanced service in 2013/14 are to encourage GP practices to: ENHANCED SERVICE SPECIFICATION RISK PROFILING AND CARE MANAGEMENT SCHEME Introduction 1. This enhanced service has been designed by the NHS Commissioning Board (NHS CB) to reward GP practices 1 for the

More information

PCA3 DETECTION TEST FOR PROSTATE CANCER DO YOU KNOW YOUR RISK OF HAVING CANCER?

PCA3 DETECTION TEST FOR PROSTATE CANCER DO YOU KNOW YOUR RISK OF HAVING CANCER? PCA3 DETECTION TEST FOR PROSTATE CANCER DO YOU KNOW YOUR RISK OF HAVING CANCER? PCA3 DETECTION TEST FOR PROSTATE CANCER There is a range of methods available to your healthcare professional to verify the

More information

SOP for Screening of Adult Chemotherapy Electronic Prescriptions

SOP for Screening of Adult Chemotherapy Electronic Prescriptions SOP for Screening of Adult Chemotherapy Electronic Prescriptions Contents The following steps should be followed in screening a chemotherapy prescription on ARIA: 1. Patient details 2 2. Patient medical

More information

Guideline for the Follow Up of Patients Following Treatment for Breast Cancer

Guideline for the Follow Up of Patients Following Treatment for Breast Cancer Guideline for the Follow Up of Patients Following Treatment for Breast Cancer Date Approved by Network Governance July 2012 Date for Review July 2015 Page 1 of 6 1 Scope of the Guideline This guideline

More information

BMI Werndale Hospital Quality Accounts April 2013 to March 2014

BMI Werndale Hospital Quality Accounts April 2013 to March 2014 BMI Werndale Hospital Quality Accounts April 2013 to March 2014 Chief Executive s Statement Welcome to our Quality Accounts 2014, the fifth year we have published this data. The information presented here

More information

Reference: NHS England B04/P/a

Reference: NHS England B04/P/a Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation (HSCT) (All Ages): Revised Reference: NHS England B04/P/a 1 NHS England Clinical Commissioning Policy: Haematopoietic Stem Cell Transplantation

More information

Keeping patients safe when they transfer between care providers getting the medicines right

Keeping patients safe when they transfer between care providers getting the medicines right PART 1 Keeping patients safe when they transfer between care providers getting the medicines right Good practice guidance for healthcare professions July 2011 Endorsed by: Foreword Taking a medicine is

More information

Board Assurance Framework

Board Assurance Framework Meeting Title Joint Commissioning Committee Meetingg Date 13/05/20155 Title of Report: Author (Job title) Head of Practice Supportt and Development Management Lead (Job title) Area Team Proposals forr

More information

Guidelines for Nurse Led HIV Clinic

Guidelines for Nurse Led HIV Clinic Guidelines for Nurse Led HIV Clinic Produced and approved by (Committee and Date) Kieran Sharkey Ratified by (Committee and Date) Reviewed Review date: Guidelines for Nurse Led HIV Clinic Introduction

More information

Malignant Lymphomas and Plasma Cell Myeloma

Malignant Lymphomas and Plasma Cell Myeloma Malignant Lymphomas and Plasma Cell Myeloma Dr. Bruce F. Burns Dept. of Pathology and Lab Medicine Overview definitions - lymphoma lymphoproliferative disorder plasma cell myeloma pathogenesis - translocations

More information

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE

SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT ALCOHOL MISUSE SPECIFICATION FOR THE LOCAL COMMISSIONED SERVICE FOR THE MANAGEMENT OF ALCOHOL MISUSE Date: March 2015 1 1. Introduction Alcohol misuse is a major public health problem in Camden with high rates of hospital

More information

Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 7pm 8.30pm Wednesday 30 th July 2014

Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 7pm 8.30pm Wednesday 30 th July 2014 Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 7pm 8.30pm Wednesday 30 th July 2014 Attendance from the Practice: Dr Elizabeth McGinn (GP Partner), Sandra Connolly (Practice

More information

Dr N Hussain & Partners. Park View Group Practice. Patient Participation Group Action Plan 2014/15

Dr N Hussain & Partners. Park View Group Practice. Patient Participation Group Action Plan 2014/15 Dr N Hussain & Partners Park View Group Practice Patient Participation Group Action Plan 2014/15 Improving Access I don t have a problem with access to the Practice. I m happy with the Practice, the staff

More information

About this bulletin. Contents

About this bulletin. Contents 18 th September 2015/Issue 127 About this bulletin This bulletin contains important information for practice managers, including requests for information and deadlines, as well as updates on issues relating

More information

Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 6.30-8pm Wednesday 8 th July 2015

Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 6.30-8pm Wednesday 8 th July 2015 Minutes of Patient Participation Group (PPG) Meeting Beckett House Practice 6.30-8pm Wednesday 8 th July 2015 Attendance from the Practice: Dr Elizabeth McGinn (GP Partner), Sandra Connolly (Practice Manager)

More information

The diagnosis of dementia for people living in care homes. Frequently Asked Questions by GPs

The diagnosis of dementia for people living in care homes. Frequently Asked Questions by GPs The diagnosis of dementia for people living in care homes Frequently Asked Questions by GPs A discussion document jointly prepared by Maggie Keeble, GP with special interest in palliative care and older

More information

REFERENCE CODE GDHCER083-15 PUBLICAT ION DATE JULY 2015 MULTIPLE MYELOMA EPIDEMIOLOGY FORECAST TO 2023

REFERENCE CODE GDHCER083-15 PUBLICAT ION DATE JULY 2015 MULTIPLE MYELOMA EPIDEMIOLOGY FORECAST TO 2023 REFERENCE CODE GDHCER083-15 PUBLICAT ION DATE JULY 2015 MULTIPLE MYELOMA Executive Summary Multiple myeloma (MM) (International Statistical Classification of Diseases and Related Health Problems, 10th

More information

Connection with other policy areas and (How does it fit/support wider early years work and partnerships)

Connection with other policy areas and (How does it fit/support wider early years work and partnerships) Illness such as gastroenteritis and upper respiratory tract infections, along with injuries caused by accidents in the home, are the leading causes of attendances at Accident & Emergency and hospitalisation

More information

CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE

CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE Outline I. Introduction II. Identifying Members with Kidney Disease III. Clinical Guidelines for Kidney Disease A. Chronic Kidney Disease B. End Stage Renal Disease

More information

PATIENT ACCESS POLICY V3

PATIENT ACCESS POLICY V3 PATIENT ACCESS POLICY V3 State whether the document is: x Trust wide Business Group Local State Document Type: x Policy Standard Operating Procedure Guideline Protocol APPROVAL & VALIDATION Assurance Risk

More information

Joint Surrey Carers Commissioning Strategy for 2012/3 to 2014/5 Key Priorities for Surrey Multi Agency Delivery Plan - May 2012

Joint Surrey Carers Commissioning Strategy for 2012/3 to 2014/5 Key Priorities for Surrey Multi Agency Delivery Plan - May 2012 Joint Surrey Carers Commissioning Strategy for 2012/3 to 2014/5 Key Priorities for Surrey Multi Agency Delivery Plan - May 2012 Note this Delivery Plan will be updated & republished 3 times a year throughout

More information

Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15

Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15 Wandsworth Respiratory Clinical Reference Group Annual Progress Report 2014/15 April 2015 Dr Kieron Earney & Kate Symons Acknowledgements Dr Sarah Deedat Public Health Lead for Long Term Conditions 1 1.

More information

Quality Report. Boultham Park Road Lincoln LN6 7SS Tel: 01522 874444 Website: www.boulthamparkmedicalpractice.co.uk

Quality Report. Boultham Park Road Lincoln LN6 7SS Tel: 01522 874444 Website: www.boulthamparkmedicalpractice.co.uk Boultham Park Medical Centre Quality Report Boultham Park Road Lincoln LN6 7SS Tel: 01522 874444 Website: www.boulthamparkmedicalpractice.co.uk Date of inspection visit: 07 May 2014 Date of publication:

More information

Guide for general practice staff on reporting patient safety incidents to the National Reporting and Learning System

Guide for general practice staff on reporting patient safety incidents to the National Reporting and Learning System Guide for general practice staff on reporting patient safety incidents to the National Reporting and Learning System NHS England INFORMATION READER BOX Directorate Medical Commissioning Operations Patients

More information

Symptoms of Hodgkin lymphoma

Symptoms of Hodgkin lymphoma Produced 28.02.2011 Revision due 28.02.2013 Symptoms of Hodgkin lymphoma Lymphoma is a cancer of cells called lymphocytes. These cells are part of our immune system, which helps us to fight off infections.

More information

chronic leukemia lymphoma myeloma differentiated 14 September 1999 Pre- Transformed Ig Surface Surface Secreted Myeloma Major malignant counterpart

chronic leukemia lymphoma myeloma differentiated 14 September 1999 Pre- Transformed Ig Surface Surface Secreted Myeloma Major malignant counterpart Disease Usual phenotype acute leukemia precursor chronic leukemia lymphoma myeloma differentiated Pre- B-cell B-cell Transformed B-cell Plasma cell Ig Surface Surface Secreted Major malignant counterpart

More information

Your patient-held blood monitoring record book. Disease-modifying treatment for multiple sclerosis (MS)

Your patient-held blood monitoring record book. Disease-modifying treatment for multiple sclerosis (MS) Your patient-held blood monitoring record book Disease-modifying treatment for multiple sclerosis (MS) Your details Your current therapy: Name: Date of birth: Hospital/clinic: Hospital number: NHS number:

More information

Integrating NHS 111 and out-of-hours services in North Central London. Dr Denise Bavin

Integrating NHS 111 and out-of-hours services in North Central London. Dr Denise Bavin Integrating NHS 111 and out-of-hours services in North Central London Dr Denise Bavin NHS 111 and GP Out of Hours NHS 111 NHS 111 is a free telephone number to help people with urgent, but not lifethreatening,

More information

Leukaemia and lymphoma what s the difference?

Leukaemia and lymphoma what s the difference? Freephone helpline 0808 808 5555 information@lymphomas.org.uk www.lymphomas.org.uk Leukaemia and lymphoma what s the difference? This is a difficult question to answer simply but it is one that is often

More information

If you require any further information, or have any queries, please contact the Quality Improvement and Change Management Unit on 9222 2197.

If you require any further information, or have any queries, please contact the Quality Improvement and Change Management Unit on 9222 2197. Clinical Review and Audit Committee Annual Report to the Public for 2015 On Quality Improvement Activities Undertaken or Overseen By Clinical Review and Audit Committee Department of Corrective Services

More information

LOCAL PRIMARY CARE GUIDELINES USE OF FAECAL CALPROTECTIN IN THE ASSESSMENT OF PATIENTS WITH LOWER GASTROINTESTINAL SYMPTOMS

LOCAL PRIMARY CARE GUIDELINES USE OF FAECAL CALPROTECTIN IN THE ASSESSMENT OF PATIENTS WITH LOWER GASTROINTESTINAL SYMPTOMS LOCAL PRIMARY CARE GUIDELINES USE OF FAECAL CALPROTECTIN IN THE ASSESSMENT OF PATIENTS WITH LOWER GASTROINTESTINAL SYMPTOMS Dr. James Turvill (MD FRCP) James Turvill, York NHSFT Page 1 14/01/2014 Directive

More information

Chronic Prostatitis: Patient information

Chronic Prostatitis: Patient information Chronic Prostatitis: Patient information There are two main types of chronic prostatitis - chronic bacterial prostatitis (caused by chronic bacterial infection) and chronic prostatitis/chronic pelvic pain

More information

HOW WE USE YOUR PERSONAL INFORMATION

HOW WE USE YOUR PERSONAL INFORMATION HOW WE USE YOUR PERSONAL INFORMATION Information Leaflet Your Health. Our Priority. Page 2 of 9 Introduction This Leaflet explains why the NHS collects information about you and how it is used, your right

More information

This information explains the advice about tuberculosis (TB) that is set out in NICE guideline 33.

This information explains the advice about tuberculosis (TB) that is set out in NICE guideline 33. Tuberculosis: prevention, ention, diagnosis, management and service organisation Information for the public Published: 13 January 2016 nice.org.uk About this information NICE guidelines provide advice

More information

Mifamurtide (Mepact ) for Osteosarcoma

Mifamurtide (Mepact ) for Osteosarcoma Mifamurtide (Mepact ) for Osteosarcoma Mifamurtide (Mepact ) for Osteosarcoma This leaflet is offered as a guide to you and your family. Your treatment will be fully explained to you by your doctor or

More information

PATIENT ACCESS POLICY

PATIENT ACCESS POLICY PATIENT ACCESS POLICY Document Type Policy Document Number Version Number 1.0 Approved by NHS Borders Board on 18 October 2012 Issue date Nov 2012 Review date Nov 2013 Distribution Prepared by Developed

More information

Quality summary report:

Quality summary report: Quality summary report: PMS Practices CLCH Quality Report Jan Dec 2011 Service exact name Personal Medical Services Practices Address line 1 Address line 2 Town/city County Postcode No. beds Website London

More information

Anaemia Patient information

Anaemia Patient information Anaemia Patient information What is anaemia? Anaemia is the result of either not having enough red cells to take oxygen around the body, or having faulty red cells that are unable to carry enough oxygen.

More information

Patient Guide. Important information for patients starting therapy with LEMTRADA (alemtuzumab)

Patient Guide. Important information for patients starting therapy with LEMTRADA (alemtuzumab) Patient Guide Important information for patients starting therapy with LEMTRADA (alemtuzumab) This medicinal product is subject to additional monitoring. This will allow quick identification of new safety

More information

Health Care Homes Certification Assessment Tool- With Examples

Health Care Homes Certification Assessment Tool- With Examples Guidelines: Health Care Homes Certification Assessment Form Structure: This is the self-assessment form that HCH applicants should use to determine if they meet the requirements for HCH certification.

More information

THORACIC ONCOLOGY MULTIDISCIPLINARY TEAM MEETINGS: OPERATIONAL POLICY

THORACIC ONCOLOGY MULTIDISCIPLINARY TEAM MEETINGS: OPERATIONAL POLICY THORACIC ONCOLOGY MULTIDISCIPLINARY TEAM MEETINGS: OPERATIONAL POLICY EXECUTIVE SUMMARY 1. All patients in Lothian with thoracic malignancies should be discussed at designated times in pathway (see App

More information

National Clinical Programmes

National Clinical Programmes National Clinical Programmes Section 3 Background information on the National Clinical Programmes Mission, Vision and Objectives July 2011 V0. 6_ 4 th July, 2011 1 National Clinical Programmes: Mission

More information

Consultation on amendments to the Compliance Framework. Dated 31 January 2008

Consultation on amendments to the Compliance Framework. Dated 31 January 2008 Consultation on amendments to the Compliance Framework Dated 31 January 2008 1. Introduction 1.1. Developing the regulatory framework Monitor continues to develop a regulatory framework within which boards

More information

TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG

TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG TUBERCULOSIS (TB) SCREENING GUIDELINES FOR RESIDENTIAL FACILITIES AND DRUG Tx CENTERS Tuberculosis Control Program Health and Human Services Agency San Diego County INTRODUCTION Reducing TB disease requires

More information

Waiting Times for Suspected and Diagnosed Cancer Patients Annual Report. Waiting Times for Suspected and Diagnosed Cancer Patients

Waiting Times for Suspected and Diagnosed Cancer Patients Annual Report. Waiting Times for Suspected and Diagnosed Cancer Patients Waiting Times for Suspected and Diagnosed Cancer Patients Waiting Times for Suspected and Diagnosed Cancer Patients 1 Waiting Times for Suspected and Diagnosed Cancer Patients Prepared by Jonathan Pearson,

More information

General Practice Referral Guidelines Haematology Department Southend University Hospital NHS Foundation Trust March 2014

General Practice Referral Guidelines Haematology Department Southend University Hospital NHS Foundation Trust March 2014 General Practice Referral Guidelines Haematology Department Southend University Hospital NHS Foundation Trust March 2014 Dear Colleague The attached protocols have been designed with the aim of streamlining

More information

Teriflunomide (Aubagio) 14mg once daily tablet

Teriflunomide (Aubagio) 14mg once daily tablet Teriflunomide (Aubagio) 14mg once daily tablet Exceptional healthcare, personally delivered Your Consultant Neurologist has suggested that you may benefit from treatment with Teriflunomide. The decision

More information

Incident reporting policy National Chlamydia Screening Programme

Incident reporting policy National Chlamydia Screening Programme Incident reporting policy National Chlamydia Screening Programme Date of publication: November 2014 Date for review: November 2016 About Public Health England Public Health England exists to protect and

More information

The Marlborough Medical Practice Patient Participation Group (PPG) Survey 2015 RESULTS

The Marlborough Medical Practice Patient Participation Group (PPG) Survey 2015 RESULTS The Marlborough Medical Practice Patient Participation Group (PPG) Survey 2015 RESULTS Introduction The PPG Survey was carried out to allow patients and their carers to feedback on key aspects of the service

More information

Using hydroxycarbamide (hydroxyurea)

Using hydroxycarbamide (hydroxyurea) Using hydroxycarbamide (hydroxyurea) Information for adult patients with sickle cell disease This information sheet has been given to you to help answer some of the questions you may have about taking

More information

Guide to Ensuring Data Quality in Clinical Audits

Guide to Ensuring Data Quality in Clinical Audits Guide to Ensuring Data Quality in Clinical Audits Nancy Dixon and Mary Pearce Healthcare Quality Quest Clinical audit tool to promote quality for better health services Contents 1 Introduction 1 1.1 Who

More information

Thatcham Medical Practice Local Participation Report March 2014

Thatcham Medical Practice Local Participation Report March 2014 Thatcham Medical Practice Local Participation Report March 2014 Thatcham Medical Practice (TMP) is participating in an enhanced service initiative commissioned by NHS England. It ensures patients are involved

More information

POAC CLINICAL GUIDELINE

POAC CLINICAL GUIDELINE POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal

More information

LOCSU Enhanced Services

LOCSU Enhanced Services LOCSU Enhanced Services Glaucoma Repeat Readings & OHT Monitoring Enhanced Service Pathway Issued by Local Optical Committee Support Unit May 2009 [Revised June 2012] Contents Page Executive Summary...

More information