Dr Jaimin Patel Macmillan GP- Croydon GP Appraiser and Referral triager, Prostate Cancer Project...
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Transcript of Dr Jaimin Patel Macmillan GP- Croydon GP Appraiser and Referral triager, Prostate Cancer Project...
• 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 WelcomeSetting 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 PatelTransforming Cancer Services Team, Healthy London PartnershipEarly Diagnosis of Cancer and Quality Improvement
14.55- 15.25 Acute Oncology Services at CUHwith Q&A
Dr Tuck-Kay Loke Clinical Head of Service for Cancer &Dr Nicola BeechAcute Oncology Serviceat CHS NHS Trust
15.25 - 15.40 COFFEE
15.40 – 16.25 Colorectal - New Nice Update on Lower G.I. and direct access proctologyQ&A
Mr Muti AbulafiLead Colorectal Surgeon at CHS
16.25 – 16.50 Urology- NICE changes & and local pathway update- PSA & Haematuria
Mr Babbin JohnUrologist at CHS
16:50-17.00 Electronic referral update Omar Ali & Jill Anderson CHS
FACTS2 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
Why is Improving Cancer Survival
Important?
)
“
The Importance of early Detection of Cancer and Screening
•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 non-specific 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
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
CCG National2012 Performance 31.6% (HSCIC : CCG
Indicator:1.18)41.6% (HSCIC: CCG Indicator 1.18)
Treatment Costs Stage 1 Stage 4
Colon Cancer £3,372 £12,519 Rectal Cancer £4,449 £11,815 Lung Cancer £7,952 £13,078 Ovarian Cancer £5,328 £15,081
Early stage cancer treatment significantly less expensive
Macmillan GPs influence change rather than provide a ‘cancer service’
5.6 Cancer
5.6.1 Prevalence and incidence
Indicator MDY TNH
WSS NAS PRY ECR Cro Lon Eng
Target
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
5.6.2 Cancer screening
The targets shown are the national targets for coverage.
Indicator MDY TNH
WSS NAS PRY ECR Cro Lon Eng
Target
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% 80.4%
Cervical screening coverage (excl exceptions) (CS002)78.9%
80.0%
80.9%
84.8%
83.8%
79.2%
81.0%
80.1%
81.9% 80
80.7% 87.7%
Breast screening coverage (last 3 years) (age 50-70)59.3%
59.8%
63.8%
67.4%
68.2%
60.3%
63.4%
64.1%
72.1% 80
59.2% 71.4%
Bowel screening coverage (last 2.5 years) (age 60-69)43.7%
43.9%
54.0%
55.5%
58.9%
45.7%
51.2%
49.5%
58.8%
39.9% 62.1%
5.6.3 Cancer waiting times
Indicator MDY TNH
WSS NAS PRY ECR Cro Lon Eng
Target
N Ad Sels
5.6.3.1 Two-week wait (TWW) referrals
The rates are not age standardised, and are per 1,000 population per year.
Total two-week wait referrals (per 1,000) 13.7 18.1 18.1 23.2 22.8 16.0 18.3 17.0 21.7 16.8 28.0
Referrals with suspected breast cancer 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
5.6.3.2 Conversion rate
Conversion rate (% of TWW referrals with cancer) 8.9% 6.7%10.5% 8.7% 9.2%
10.4% 9.1% 8.0%
10.2% 6.4% 8.9%
5.6.3.3 Detection rate
Detection rate (new cases which are TWW referrals)50.6%
41.0%
54.6%
46.2%
51.2%
54.1%
50.2%
49.1%
48.6% 43.9
31.6% 48.0%
New cancer risk thresholds
Most significant change :are much better grounded on epidemiologicalevidence 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 withspecific 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 certaincommon 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 includingappetite 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.
What do Macmillan GPs do?
Leadership
ServiceredesignCommissioning
EducationCommunication
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
Reaching around 16,000 GPs in the UK
Small commuity...BIG POTENTIAL
20 GPAs&
150+ Mac GPs
Training
CommunicationBetter care pathways
Influence in
commissioning
Peer Support
Influencing better cancer care for half the UK population
Earlier recognition
and referral
Increased
confidence
More support
for patients
Improved services for people living
with cancer
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
Reducing Delays in Primary Care
Resources & Data
Revalidation Toolkit •http://www.macmillan.org.uk/Documents/AboutUs/Health_professionals/RevalidationToolkit.pdf Rapid Referral Guidelines•http://www.macmillan.org.uk/Aboutus/Healthandsocialcareprofessionals/Macmillansprogrammesandservices/Earlydiagnosisprogramme/Earlydiagnosisprogramme.aspxDetecting Cancer Earlier in Primary Care: Using Cancer Decision Support Tools to improve the management of cancer in primary care•[email protected]
••Primary Care Facilitator Programme http://www.cancerresearchuk.org/health-professional/early-diagnosis-activities/primary-care-engagement-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/