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Tuesday 14th October 2014

Response to TPFS submission re E10sb & E10sd Complex Gynae Service Spec.

E10sb and E10sd CRG stakeholder product response to queries 10.10.2013

Who delivers the service?
1. All patients who suffer from conditions included in the specification should be presented to the MDT (which includes members able to deliver all the treatment options). In the majority of cases only one of the MDT members will provide the treatment which the MDT considers the most appropriate. Referral into the service should probably be through the MDT but in reality a triaging process is often required.
2. It has become clear, as the Complex Gynaecological Services CRG and the Colorectal CRG have developed their specifications that there is a considerable amount of overlap and ultimately it may be more appropriate to produce a combined specification. It was the view of Tony Smith (Chair E10) and Mark Chapman (Chair A08) that this year the specifications should be produced by the different CRGs partly because there is no mechanism in the new structure to produce a combined specification and partly because each of the CRGs has needed time to work out the specification within its own CRG.
3. It is not clear whether men and women with FI and pelvic floor dysfunction should be treated in a similar fashion. At this stage it has been agreed by the CRG that we should keep the management of men and women separate.
4. It is agreed that conservative treatment has a very important role in the management of patients with pelvic organ prolapse and FI. The optimal conservative therapy regime including the role of biofeedback is still poorly defined.
5. Surgery for pelvic organ prolapse and FI has poorly defined efficacy and there is little doubt that the value of surgery in producing a good functional outcome has been grossly overstated in both Gynaecology and Colorectal surgery. Techniques such as laparoscopic ventral rectopexy need more research to define the optimal technique and the appropriate patient.
6. The main value of the MDT is not only in defining the most appropriate treatment for an individual patient but also in preventing clinicians with an over enthusiastic belief in their own favoured treatment modality pursuing an inappropriate course of treatment.
7. The CRG also believe that more research is needed on sexual function when ventral rectopexy is performed to address middle and posterior compartment issues

8. The CRG has decided to continue with the specifications for 13/14 with a view to aligning the A08 and E10 specifications, where possible, for 14/15 with the support of NHS England

Professor Anthony R B Smith
Chair Complex Gynaecology Services CRG