• Dr Jaimin Patel
• Macmillan GP- Croydon
• GP Appraiser and Referral triager,
• Prostate Cancer Project lead GP
Time
Subject
Speaker
13.30 - 14.00
Registration and light lunch
14.05 - 14.20
Welcome
Setting the scene-Macmillan Resources, Croydon Priorities
Dr Jaimin Patel,
Croydon Macmillan GP
14.20 - 14.55
Early Detection of Cancer- NICE NG12 Changes in Suspected
Cancer : recognition and referral,
Pan London Strategy
Dr Ishani Patel
14.55- 15.25
Acute Oncology Services at CUH
with Q&A
Dr Tuck-Kay Loke
Clinical Head of Service for Cancer
&
Dr Nicola Beech
Acute Oncology Service
at CHS NHS Trust
15.25 - 15.40
COFFEE
15.40 – 16.25
Colorectal - New Nice Update on Lower G.I. and direct access
proctology
Q&A
Mr Muti Abulafi
Lead Colorectal Surgeon at CHS
16.25 – 16.50
Urology- NICE changes & and local pathway update- PSA &
Haematuria
Mr Babbin John
Urologist at CHS
16:50-17.00
Electronic referral update
Omar Ali & Jill Anderson CHS
Transforming Cancer Services Team, Healthy London
Partnership
Early Diagnosis of Cancer and Quality Improvement
FACTS
2 million people living in the UK with cancer, this number will
double by 2030
Around 25% people in the UK face poor health or disability
after cancer treatment
Half of people diagnosed with cancer now survive their
disease for at least 10 years
These figures highlight the importance of primary care health
care professionals being equipped to support these groups
As of the end of 2010, around 9,100 people in Croydon CCG
were living with and beyond cancer up to 20 years after
diagnosis. This could rise to an estimated 17,700 by 2030
The Importance of early
Detection of Cancer and
Screening
Why is Improving
Cancer Survival
Important?
•Cancer is leading cause of premature mortality for
)
many CCGs
•Under 75 mortality for all cancers part of CCG
Indicator Pack
• 1 year survival included in CCG 2015/16 Delivery
Dashboard -QUIPP
• As people living longer the proportion of people
getting cancer is increasing
•Emergency presentations costly &
poorer outcomes
•Improve Patient Experience
“
Safety Netting
•
The government has set a target for saving 5,000 lives a year
through earlier diagnosis of cancer by 2014. Diagnosis of
cancer in primary care is beset by three interrelated
challenges – the relative infrequency of cancer, initial nonspecific presentation of symptoms which occur relatively
commonly, and variable time course of evolution of clinical
features. Safety netting is one of the most important “tools”
that GPs and their practices can use for patients whose
presentation is not initially recognised as cancer, ensuring that
they are re-evaluated in a timely and appropriate manner.
Cancer Strategy Development and Implementation Group
•
•
Quality Premium:
For 2015/16 the CCG agreed a local Quality Premium relating to increasing the % of cancers
detected at stages 1 and 2. The data available at the time showed the following performance
of the CCG against national performance
2012 Performance
CCG
31.6% (HSCIC : CCG
Indicator:1.18)
National
41.6% (HSCIC: CCG Indicator
1.18)
The earlier detection of cancers improves the outcomes for patients in terms of treatments that can
be provided at early stages so increasing positive outcomes for patients in success of treatment
outcomes and increased levels of survivorship so decreasing the levels of mortality.
Cancer Strategy Development and Implementation Group
• In place for Croydon CCG - CHS, TCST, Croydon CCG, Macmillan GP , CRUK , Public Health.
• Key Areas defined in the strategy are :
• Early Detection
• Prevention
• Cancer Screening
•
•
•
•
Reducing Inequalities and variations
Patient Experience
Living with and beyond cancer
End of life care
Early stage cancer treatment significantly
less expensive
Treatment Costs
Stage 1 Stage 4
Colon Cancer
Rectal Cancer
Lung Cancer
Ovarian Cancer
£3,372
£4,449
£7,952
£5,328
£12,519
£11,815
£13,078
£15,081
Macmillan GPs influence change rather than provide a ‘cancer service’
5.6 Cancer
5.6.1 Prevalence and incidence
Indicator
MD
Y
TNH
WS
S
NAS
PRY
ECR
Cro
Lon
Eng
N
Ad
Sels
Cancer diagnosed (since 1st April 2003) (all ages)
1.26
%
1.46
%
1.62
%
1.95
%
2.21
%
1.34
%
1.62
%
1.46
%
2.10
%
1.12
%
2.56%
New cancer cases (incidence per 1,000)
2.77
2.96
4.19
5.22
5.06
3.47
3.89
3.28
4.90
4.98
5.38
Indicator
MD
Y
TNH
WS
S
NAS
PRY
ECR
Cro
Lon
Eng
Targ
et
N
Ad
Sels
Cervical screening coverage (last 5 yrs) (ages 25-64)
73.3
%
77.5
%
79.1
%
79.3
%
80.6
%
73.2
%
76.7
%
n/a
n/a
80
77.7
%
Cervical screening coverage (excl exceptions) (CS002)
78.9
%
80.0
%
80.9
%
84.8
%
80.4%
83.8
%
79.2
%
81.0
%
80.1
%
81.9
%
80
80.7
%
Breast screening coverage (last 3 years) (age 50-70)
59.3
%
59.8
%
63.8
%
87.7%
67.4
%
68.2
%
60.3
%
63.4
%
64.1
%
72.1
%
80
59.2
%
Bowel screening coverage (last 2.5 years) (age 60-69)
43.7
%
43.9
%
71.4%
54.0
%
55.5
%
58.9
%
45.7
%
51.2
%
49.5
%
58.8
%
39.9
%
62.1%
MD
Y
TNH
WS
S
NAS
PRY
ECR
Cro
Lon
Eng
N
Ad
Sels
Total two-week wait referrals (per 1,000)
Referrals with suspected breast cancer
13.7
18.1
18.1
23.2
22.8
16.0
18.3
17.0
21.7
16.8
28.0
1.8
3.1
2.7
3.4
3.5
2.4
2.8
3.6
4.0
3.6
3.3
Referrals with suspected lower GI cancer
3.1
2.8
3.9
4.6
4.0
2.4
3.4
3.1
4.0
5.0
4.3
Referrals with suspected skin cancer
2.0
2.5
3.4
6.0
4.1
2.9
3.4
3.4
4.0
4.0
7.1
8.9%
6.7%
10.5
%
8.7%
9.2%
10.4
%
9.1%
8.0%
10.2
%
6.4%
8.9%
50.6
%
41.0
%
54.6
%
46.2
%
51.2
%
54.1
%
50.2
%
49.1
%
48.6
%
31.6
%
48.0%
Targ
et
5.6.2 Cancer screening
The targets shown are the national targets for coverage.
5.6.3 Cancer waiting times
Indicator
Targ
et
5.6.3.1 Two-week wait (TWW) referrals
The rates are not age standardised, and are per 1,000 population per year.
5.6.3.2 Conversion rate
Conversion rate (% of TWW referrals with cancer)
5.6.3.3 Detection rate
Detection rate (new cases which are TWW referrals)
43.9
New cancer risk thresholds
Most significant change :are much better grounded on epidemiological
evidence from primary care, rather than the old guidelines that relied
predominantly on secondary care data.
This new evidence enabled the guideline developers to identify the
patterns of symptoms, signs, and simple investigations associated with
specific levels of risk of an undiagnosed cancer.
It recognises the importance of combinations of symptoms in predicting
risk of cancer. The guidelines also account better for age and smoking as
the most important underlying risk factors when considering certain
common symptoms.
For example, someone aged >40 years with abdominal pain and weight
loss should be investigated urgently for colorectal cancer.
If they are aged >60 years, they should also be investigated for pancreatic
cancer by CT or ultrasound.
There is a section relating to non-specific features of cancer including
appetite loss, weight loss, and fatigue. Weight loss is associated with a
7% overall risk of cancer but this includes colorectal, gastrooesophageal,
lung, prostate, pancreatic,and urological cancers.
Leadership
Commissioning
Service
redesign
What do Macmillan GPs do?
Education
Communication
Variation in Awareness of Increased Risk
Early Diagnosis is a complex, multifaceted challenge The NAEDI
hypothesis
Developing practical solutions…
Developing practical solutions…
Starting different conversations…
“
What could Primary Care be doing to
Reduce Cancer Risk?
•Delivery of Very Brief Advise for
Smoking (VBA)
•Delivery of Alcohol Advise
opportunistically & at all Health Checks
•Signpost & increase uptake of smoking
& weight management services
•Implement Primary Care Cancer
Screening Best Practice Guidance to
Promote Uptake
What can Primary Care do to Improve Access?
• •Support national BCOC & locally tailored campaigns &
encourage presentation of symptomatic population
• •Patient Participation Groups & User Groups supporting national,
local & tumour specific campaigns
• •Case Finding & Review High Risk Patients (Proactive Care)
• •Increase awareness of Cancer Screening Programmes to over
70s when delivering Flu and Shingles vaccines
...BIG POTENTIAL
Small commuity
20 GPAs
&
150+ Mac
GPs
Reaching around 16,000 GPs
in the UK
Influencing better
cancer care for half
the UK population
Reducing Delays in Primary Care
Education
•Annual Audit & share outcomes at Practice Meeting
•All PCHT attend cancer training to include non-clinical staff
•Use of Practice Profiles to reduce variation in cancer outcomes
Raising Awareness
•Cancer regular agenda item at Practice Meetings
•Endorse screening communications, clean lists, flag & ensure DNAs
followed up
•Use of Decision Support Tools
•Agree & implement Safety Netting Protocols
Developing Practice
•Practice Nurses to raise cancer awareness at LTC appointments
•Upload revised 2ww referral forms
•Use pan-London ED colorectal, gynaecological & lung pathways
•Agree & Implement Safety Netting Protocols
Resources & Data
Revalidation Toolkit
• http://www.macmillan.org.uk/Documents/AboutUs/Health_professionals/RevalidationToolkit.p
df
Rapid Referral Guidelines
• http://www.macmillan.org.uk/Aboutus/Healthandsocialcareprofessionals/Macmillansprogramm
esandservices/Earlydiagnosisprogramme/Earlydiagnosisprogramme.aspx
Detecting Cancer Earlier in Primary Care: Using Cancer Decision Support Tools to improve the
management of cancer in primary care
• SECSU.tcstlondon@nhs.net
• •Primary Care Facilitator Programme
http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/primary-careengagement-facilitator-project
• •Talk Cancer
http://www.cancerresearchuk.org/health-professional/prevention-and-awareness/talk-cancer
• •Cancer Data
Cancer Commissioning Toolkit - http://www.ncin.org.uk/cancer_information_tools/cct
• Public Health Profiles - http://fingertips.phe.org.uk/profile/
• http://www.cancerresearchuk.org/cancer-info/cancerstats/local-cancer-statistics/