Greater Manchester Commissioning Hub: Cancer Programme. The ACE Programme. Wave 2 Multidisciplinary Diagnostic Centres

Transcription

1 Greater Manchester Commissioning Hub: Cancer Programme The ACE Programme Wave 2 Multidisciplinary Diagnostic Centres

2 Background / Context GM Pilot focuses on 2 areas of Greater Manchester: Oldham South Manchester

3 Flagship patient 67 year old female Attended for analgesia after knee replacement Weight loss 52kg to 45kg Smoker No other symptoms Screening bloods normal 7 referral pathways

4 88 referrals reviewed Results of Notes Audit All referred to gastroenterology 11 would qualify for vague symptoms pathway 2 cancers diagnosed- pancreatic and renal. Presenting symptoms: 5 weight loss, 5 vague abdominal pain/ nausea/ bloating, 1 persistent hip pain Before yes/ no diagnosis: Hospital visits ranged from 3 to 5 visits, 2 presented in A&E Times to diagnosis ranged from 2-6 weeks

5 Pathway Design Development of a clinically agreed pathway for patients with non-specific but concerning symptoms Agreed primary care triage tests and symptom checklist Referral form and GP guide developed

6 Referral Criteria The reason I am concerned this patient has cancer is.. Example symptoms to investigate through this route (non-exhaustive list) Decreased appetite Non-specific abdominal Persistent pain pain Nausea Lymphadenopathy Unexplained DVT Non-specific iron Hepatomegaly Continued patient or deficiency anaemia family concern Fatigue Splenomegaly GP concern Weight loss Bloating

7 Exclusion Criteria Some symptoms point towards a specific cancer. These should be investigated or referred in accordance with the NICE NG12 guideline and not considered for this pathway: Post-menopausal bleeding Melaena Shortness of breath Abnormal vaginal bleeding Dysphagia Cough Rectal bleeding Haematemesis Haemoptysis Altered Bowel habits Haematuria

8 Primary Care Urgent Investigations Urgent CXR: within 1 working day of the GP appointment. Urinalysis: same-day Urgent blood test: including FBC, U&E, LFT, Bone profile, TFT, LDH, PV/CRP, Ferritin, Glucose, HbA1c, Mononucleosis test, Coeliac screen, Myeloma screen. Also PSA (male only), beta- HCG (male only), CA125 (female only).

9 Multidisciplinary Diagnostic Clinics Appointments offered within 14 days Navigator key to co-ordination of appointment One-stop clinic model Consultant or specialist nurse appointment Diagnostic tests: CT thorax abdomen pelvis OGD Most patients will receive the results on the same day

10 Results South Manchester seen 187 patients Oldham seen 115 patients 61% of practices have used the service

11 Top Symptoms South No. of cases Oldham No. of cases Abdominal pain: Weight loss: Nausea / appetite loss: Fatigue: GP gut feeling: 55 90

12 Average No. of secondary care consultations: Diagnostic Activity South Diagnostic tests CT 130 OGD 55 Days from referral to (cancer) diagnosis: (as per 28 days target definition) 1 1 Oldham CT 112 OGD days (median) 21 days (median)

13 Diagnoses MDC Site South Oldham Cancer conversion: 13/187 (6.95%) 17/115 (14.8%) Early stage I & II: 6/13 (46 %) 2/17 (11.8%) What did we expect? More cancers at early stage Non-cancer diagnoses: (diagnosed by MDC) Non cancer 112/187 (53%) All tests normal 57/187 (33.15%) Under investigation 5/187) (2.67%) Non cancer 40/115 (34.78%) All test normal 48/115 (41.73%) MDC Site South Oldham Cancer type & number (summary both sites) 1 Pancreatic Cancer 1 Metastatic Breast Cancer 1 CUP 1 Hodgkins lymphoma 4 Lung Cancer 3 Prostate Cancer 1 Renal cell Cancer 1 Metastatic Melanoma 2 stomach cancer 4 Lung cancer 1 Bladder cancer 1 Non Hodgkins Lymphoma 2 Colon cancer 2 Renal Cancer 2 HPB cancer 1 Prostate cancer 1 Liver cancer What did we find? Advanced cancers Conversion rate to mirror the Danish model -

14 Verdict so far All went smoothly very impressed well done NHS Just keep doing what you do BRILLIANT Everything worked well today a very good system and helps people to get help sooner Speed in which I was seen in each area was great, as was how quick the results were back. The Nurse and Navigator were very supportive. Liked one to one contact with the Specialist Nurse and Navigator. Clear explanations of test and the programme throughout the day. Ensuring patients were took to the correct department could not have been more helpful and supportive.

15 GP feedback Unusual case -?skin metastases Where to send him - dermatology, plastics, general surgery? One initial appointment for the patient -he felt extremely well looked after and informed Clear information back to me very quickly - it is always a little embarrassing when the patient expects us to have the information from the hospital If this clinic had not been there I am certain he would have bounced around the system for some time before we got the answer - this would have been difficult for him and I would most probably been chasing up appointments

16 Next Steps Rollout across Greater Manchester Referrals from Emergency Departments MUO patients Secondary care triage of all eligible patients

17 Questions?