The Clinical Governance committee is involved in all aspects of Governance in Urogynaecology, setting standards and commenting on documents from the RCOG, NICE and also the DoH on a regular basis.
The main work recently has been in developing and implementing the Accreditation of Units for BSUG, which requires the committee to score the application files from units around the country, using a standardised scoring system, following which a visit by 2 assessors is arranged. The document which describes this process can be accessed on the website and any queries may be directed to the Chair.
We have also developed a raft of information leaflets which cover all the continence procedures and prolapse surgeries in order to help standardise the information given to patients and help members with accreditation. However this role is now handed over to the Information committee. We will have a repository of useful evidence such as MDT proforma, audit templates, history sheet , consent forms etc. which BSUG members can use for the purpose of collecting evidence for their own accreditation application.
Finally, the Governance committee meet regularly either in person or via teleconferences in order to discuss any aspects where an opinion on governance is required and may also be asked for a Medico-legal opinion, if members have been trained in expert report writing.
We are happy to accept new members who wish to take an active role in the committee, either in document preparation or in carrying out accreditation visits. All committee members are happy to be informal mentors for any unit preparing for accreditation and are happy to be contacted for advice.
The Scottish Independent Review of the use, safety and efficacy of transvaginal mesh implants in the treatment of stress urinary incontinence and pelvic organ prolapse in women
Final Report March 2017 has now been published and can be accessed HERE The review highlights both positive and negative aspects in relation to vaginal mesh usage for the treatment of stress urinary incontinence and prolapse. In line with other reports produced it separates out treatment of stress incontinence from treatment of prolapse.
The report emphasises the following which we feel that the BSUG membership should be fully aware of:
Ensuring that patients are clear about all the different treatment options.
This is in line with the Montgomery ruling and GMC guidance and must include the option of doing nothing and also conservative measures.
Working in an MDT.
This is in line with modern practice and is art of the working practice required for BSUG accreditation of units.
Reporting adverse events.
Again demonstration of this is part of BSUG accreditation as is data entry onto the database.
This is also required for the GMC and forms part of the duty of candour.
Unit identification on the BSUG database for the removal of mesh requires data to be entered into the BSUG database and MHRA reporting.
Importance of informed consent.
This is supported by BSUG. The governance committee are working with members to produce information leaflets for all aspects of urogynaecology care.
The leaflet endorsed by NHS England and Scotland and RCOG and BSUG for tapes in now recommended for use when women are considering a mesh tape for the management of incontinence.
Lack of research regards outcome data.
If all members were to use the database then there would be a very large cohort that could inform practice moving forward.
They also identify difficulty in coding as poor coding or lack of appropriate codes makes data collection and analysis difficult.
Recommendation of retropubic tape rather than the obturator technique where a mesh tape is to be used for the treatment of stress urinary incontinence.
This is not in line with current Nice guidance.
The Nice review is currently underway and the document related to management of incontinence and prolapse is due in 2019.
Mesh for management of prolapse should not be used in primary treatment and its use should be undertaken only after MDT discussion.
Again it is not for BSUG to direct clinical practice and we await the new Nice guidance. BSUG accreditation requires MDT working.
We would encourage reading the report as it helps inform practice and highlights areas that members should be aware of. The findings are applicable to practice in the whole of the UK and not just Scotland.
For further information please contact us here.
For Terms of Reference click here
Barking Havering and Redbridge University hospitals NHS Trust
Buckinghamshire hospitals NHS Trust
Queens University Hospital Romford
Dr Smita Rajshekhar