The Plastic Surgery

“See and Treat” Skin Cancer Clinic

(SATSKIN)

Miss Michelle Gibson BMedSc MRCS MSc

Specialty Doctor in Plastic Surgery

South Eastern Health and Social Care Trust

Based at the Ulster hospital, Dundonald ◦ 7 Consultant Plastic Surgeons

◦ 3 SAS doctors

2 Specialty Doctors

1 Trust grade doctor

◦ 10 registrars

◦ 4 core trainees

◦ FT Equivalent 3 Consultant Plastic and Burns Surgeons at Burns Unit, Royal Victoria hospital

◦ Skin oncology

◦ Hand surgery

◦ Breast reconstruction

◦ Burns

◦ Head and neck cancer

◦ Craniofacial and cleft surgery

◦ Trauma

1 Consultant Plastic Surgeon specialising in skin oncology and head and neck skin oncology

Remaining 9

FTE Consultant Plastic Surgeons ◦ Subspecialty and skin oncology

The 2015/16 Ministerial Target for cancer waiting times states that from April 2015 ◦ At least 95% patients should begin their first

treatment for cancer within 62 days following an urgent GP referral for suspect cancer

◦ At least 98% patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat.

Suspected Cancer: recognition and referral (NG12) published 23 June 2015 ◦ 1.7 Skin Cancers

Referral using a suspected cancer (red flag) referral pathway (for an appointment within 2 weeks)

Guidance on the referral of suspected or confirmed malignant melanoma, Squamous cell carcinoma and basal cell carcinoma

The Northern Ireland Cancer Network ◦ NICaN skin cancer guidelines – May 2015

◦ Importance of clear accurate clinical information allows patients to be triaged appropriately and therefore seen in a timely manner.

◦ Patients should be referred into secondary care as a ‘Red Flag’ and seen within 2 weeks.

◦ Skin cancer is on the increase

◦ Around 10, 400 cases melanoma are diagnosed in the UK each year

◦ Melanoma is the fastest rising cancer in the Uk, causing 1800 deaths per year

◦ Early detection of melanoma greatly improves survival rates

◦ In Northern Ireland in 2012 there were 346 new cases of melanoma and 43 cancer deaths due to melanoma

Over last decade the registered incidence of Non Melanoma Skin Cancer (NMSC) has increased by over 30% within the UK and Ireland

In 2012, 3738 cases of NMSC were recorded by the NICR

NMSC is the commonest type of cancer now diagnosed in Northern Ireland and accounts for 41% of all new cancer cases

This is an underestimate of the true incidence as only the first NMSC of each histological type is recorded per person and many of these patients will have multiple tumours

The under registration of NMSC means that it is difficult to accurately assess the true burden of the rising incidence of skin cancer on healthcare resources

April 2015 – 12 weeks

April 2016 – longest waiter 6 weeks

GP Dermatologist

GP

Other

Plastic Surgeon

Plastic Surgery Unit

Ulster Hospital

OPD

SATSKIN

Theatre

Clinical Information

Previous biopsy and histology result

Photos

Patient invited to attend SATSKIN at a given time and date

Information pack sent to prepare patient of what to expect

Advised to expect to spend most of day at the hospital

Advised to phone if this option not suitable

Consultant – Mr Derek Gordon

Specialty Doctor – Miss Michelle Gibson

and Mr Andrew Moorehead (newly appointed)

Nursing staff (1 designated DPU nurse)

Theatre staff (3-4)

Admin and secretarial staff

First date 16/4/15

Based at Lagan Valley Hospital (SETRUST)

Day Procedure Unit

179 patients through SATSKIN in 1 year ◦ 5 of which did not undergo surgery

Did not require

Onward referral to Hand Surgeons

Did not want to wait

Did not read information pack

Undecided about surgery, just wanted a consultation

The latter 2 did have their surgery at a later date

5 DNAs

17 unfilled slots due to last minute cancellations

Aim to see and treat 4 patients per clinic

Initially 1 SATSKIN per week

Since January 2 SATSKIN per week

31 GP referrals

136 Dermatology Referrals

3 General Surgery referrals

1 Oncology referral

3 Other

63 SCC

58 Melanoma

4 Lentigo Maligna

8 BCC

8 Pre-malignant

42 Benign Lesions

Average time for ‘RED FLAG’ appointment in Plastic Surgery during last 12 months was 7.7 weeks (SATSKIN) ◦ Patient has definitive surgery same day

Inadvertent impact on ‘RED FLAG’ appointment at Plastic Surgery OPD ◦ Patient put on a ‘RED FLAG’ waiting list to have

surgery

Consultant list

SAS list

Aim to reduce time to ‘RED FLAG’ appointment in Plastic Surgery

Aim to reduce time to definitive surgery

Streamline treatment for skin cancer patients

With new appointment of second specialty doctor, scope for further SATSKIN clinics

Thank you very much, the experience was

fabulous WB

Great to have it all in one day rather than

going home and dwell on waiting for my

surgery MB

Excellent set up and excellent service, thank

you. RD

Re-audit

Patient satisfaction survey

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