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Thoracic Surgery Commissioning: Service Specification & Recommendations

This update provides a detailed service specification for thoracic surgery, including the required number of surgeons, on-call cover, minimum lung resections, second opinion protocols, surgical job plans, and recommendations for practice improvement. It also highlights the importance of efficient bed management, sub-specialisation, VATS for lung resection surgery, and consolidation of good practices such as VATS, ERAS, and care closer to home.

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Thoracic Surgery Commissioning: Service Specification & Recommendations

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  1. Surgical update

  2. Commissioning

  3. Specialised commissioning – service specification for thoracic surgery • Minimum of three full time general thoracic surgeons leading thoracic surgical services. • 24/7 on call cover should be provided by either general thoracic surgeons or mixed cardiothoracic surgeons only. • Thoracic centres must undertake 70 lung resections for primary cancer per annum. This figure rises to 150 lung resections per annum by the end of 2018/19. • Providers will need to ensure they have protocols in place to facilitate the provision of a second opinion as to the patient’s suitability for surgery for patients with early stage disease who are turned down for surgery. • Surgical job plans should support the organisation of the service (includes 95% MDT attendance).

  4. Scrutiny of practice and outcomes • LCCOP • NLCA • GIRFT

  5. Recommendations • More efficient bed management by ensuring surgery on day of admission is delivered routinely • Ring-fencing beds on ICU and general wards • Sub-specialisation for certain critical procedures • Use of VATS for lung resection surgery

  6. VIOLET study

  7. Aspirations • Consolidate good practice: • VATS • ERAS • Care closer to home: • 95% MDT attendance • Virtual POAC • Shorter pathway • Patient outcomes • Sublobar resections (CALGB, JCOG) • Robotic surgery

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