London Appraiser TrainingCancer Case Reviews

Dr Pawan RandevTransforming Cancer Services Team

11th September 2014

Format

• Introduction and context• SEA • Your experiences – Cancer and SEA• The proposed template• Sample SEAs to consider• Resource set• What should our outcomes be?

https://www.youtube.com/watch?v=7Tp5JRDH_v8

Introduction

• Pawan• GP Trainer and Appraiser• GP Clinical Lead TCST – Education lead• RCGP Cancer SEA Pilot 2013• “Improving Cancer Awareness” GP Trainers• Developed resources including website• Cancer Lead for 15 years

Significant Event Analysis• An account of an SEA should not allow patients to be identified and should comprise:• Title of the event• Date of the event• Date the event was discussed and the roles of those present• A description of the event involving the GP• What went well?• What could have been done differently?• reflections on the event in terms of:• o knowledge, skills and performance• o safety and quality• o communication, partnership and teamwork• o maintaining trust• What changes have been agreed:• o for me personally• o for the team• Changes carried out and their effect.

Your experiences of Cancer and SEA

• Have you submitted a cancer SEA?• Discussed a cancer case with an appraisee?• Considered a cancer SEA in your practice SEA

meetings?

Sample SEA- 1

Sample SEA - 2

Template for Cancer SEA

• 1. What Happened: Facts of the Case.

• 2. Identification of Key Moments: Issues to Reflect upon

• 3. Learning, Quality improvement and Commisioning

• 4. Implementation of Quality Improvement

• 5. Development of this process

• Some information about the setting for this case

Sample SEAs

• Set of 6 SEAs to practice with in workshops• Small groups 3-5 with activities as below:• What was good/could be developed?• Discuss what feedback you could give to appraisee• How could you challenge/stretch appraisees?• What resources may help deeper thinking?• How to maximise impact of learning –

personal/patient/practice/CCG• 10 minutes per SEA in small group then large group

discussion/feedback

Resources

• Practice Profiles• Revalidation toolkit• Patient perspectives• Macmillan CDS• RCGP Audit• Educational Modules• Involving the whole team

Practice profiles: what are they?

• General Practice Profiles for Cancer bring together a range of process and outcomes information relevant to cancer in primary care.

• Similar principle to PACT data • They provide readily available and comparative

information for benchmarking and reviewing variation at a general practice/CCG level.

• They can be used to understand the cancer burden for a population.

• Not performance measurement as no established/agreed normal values

Data domains and indicators for your practiceDemographics Practice population above 65 years

Socio-economic deprivation Cancer incidence and prevalence ratesCancer mortality rates

Cancer Screening Breast cancer screening rates Cervical screening ratesBowel cancer screening rates

Cancer waiting times 2ww referral rates and age standardised ratios2ww referral conversion ratesNumbers of new cancers treated (% of which are 2ww refs)Number of 2ww referrals for suspected breast, lower GI, lung and skin cancer

Presentations and diagnoses

Number of emergency admissions with cancerNumber of emergency presentationsNumber of managed referral presentations (GP involvement)(Use of investigations: numbers of endoscopic procedures)

Using the Practice Profile

• Giving context to the SEA• Appreciating the larger picture• Understanding what happened over 1 year• Comparing – like PACT data• Not performance management• Seeing a larger setting – practice, CCG and

England levels

Google HEEM ICA

http://em.hee.nhs.uk/resources-and-references-for-the-increasing-cancer-awareness-train-the-trainer-programme/

http://www.gp-update.co.uk/files/docs/Macmillan_Revalidation_Toolkit_.pdf

Stepped approach -5 modules

http://healthtalkonline.org/peoples-experiences/cancer

Audit Tool

• Developed by RCGP• National audit 2010/11• Excel tool• Easy to complete –honest!!• Downloadable • Tested on over 16,000 cancer journeys• Strictly a survey until standards/criteria set

and re-audit

https://www.dur.ac.uk/school.health/erdu/cancer_audit/cancerdiagnosisaudittool/

http://em.hee.nhs.uk/resources-and-references-for-the-increasing-cancer-awareness-train-the-trainer-programme/

http://em.hee.nhs.uk/resources-and-references-for-the-increasing-cancer-awareness-train-the-trainer-programme/

http://em.hee.nhs.uk/resources-and-references-for-the-increasing-cancer-awareness-train-the-trainer-programme/

http://em.hee.nhs.uk/resources-and-references-for-the-increasing-cancer-awareness-train-the-trainer-programme/

RCGP Cancer Education Hub

BMJ Learning – free access London Channel

Doctors.net.uk

Macmillan Cancer Decision Support Tool

• CDS

http://cancerawarenesstoolkit.com/training

Google HEEM ICA