Cancer Services Development Plan

Transcription

1 Cancer Services Development Plan This paper is for: Approval Recommendation: To note current cancer performance To approve cancer as a priority theme for improvement To approve the priority areas within the cancer development plan To approve the high level indicators For further information or for any enquiries relating to this report please contact: Dr Stefano Santini, GP Clinical lead for cancer (s.santini@nhs.net) and Sally Allen, Head of System-wide Commissioning (sallyallen2@nhs.net) Date:26 th April 2016 Reporting Officer: Dr Stefano Santini Agenda Item: 77/16 Lead Director: Gail Arnold Version: V 0.4 Report Summary: The CCG Cancer Development Plan is a response to the national cancer strategy issued by the Independent Taskforce in July 2015, entitled Achieving World Class Cancer Outcomes A Strategy for England and also responds to the deteriorating performance on cancer mandated waiting times standards. It highlights the six strategic priorities that need to be addressed and draws together the action the CCG can take over the next 4 years to achieve sustained delivery of the cancer standards and the recommendations of the national cancer strategy. Preliminary work by the National Cancer Taskforce anticipates savings overall as treating patients at an earlier stage of their disease is more cost effective than the complex and more aggressive treatment they need if diagnosed at a late stage. However this modelling is not detailed and further work is needed both nationally and locally to determine the exact impact. There is an expectation that additional diagnostic capacity will be needed and this is part of the CCG diagnostics plan. Therefore the current financial assumption is that the cancer development plan is cost neutral. April 2016 NHS West Kent CCG

2 FOI status: This paper is disclosable under the FOI Act Strategic objectives links: Board Assurance Framework links: Cancer priority theme, Diagnostics theme West Kent CCG Cancer Concept Paper, CSG November 2016 Minutes of CCG Cancer Task & Finish Group December 15 to March 2016 Strategic Clinical Network cancer dashboard ( Achieving World Class Cancer Outcomes A Strategy for England ( rld-class_cancer_outcomes_-_a_strategy_for_england_ pdf) CCG Integrated Performance Reports Identified risks & risk management actions: Resource implications: Legal implications including equality and diversity assessment Report history: Appendices Next steps: The CCG will not meet the cancer mandated standards, will fail to deliver the recommendations in the national cancer strategy and will fail to achieve the Quality Premium Staff time to progress the actions Financial implications not identifiable at this point but assuming cost neutral. Cancer diagnostics have already been the subject of EDS2 Cancer aspects of health profile have been taken in to account Cancer Concept paper on which the development plan is based approved by CSG November 2015 Development Plan developed and agreed by CCG cancer Task & Finish Group February 2016 Chair of CSG approved February 2016 Membership of the CCG Cancer Task & Finish Group Implementation, monitoring and reporting against the Cancer Development Plan will be via the CCG Cancer Task & Finish Group which is governed by CSG. Frequency of reports to CSG to be agreed but at least quarterly. April 2016 NHS West Kent CCG

3 CANCER SERVICES DEVELOPMENT PLAN Authors: Dr Stefano Santini, GP Clinical Lead for Cancer Sally Allen, Head of System-wide Commissioning Vs 0.4 April 2016

4 Table of contents Part 1- Introduction Part 2 - Our Priorities Part 3 Appendices i) Development Plan ii) List of background documents and websites iii) Acknowledgements iv) Membership of CCG Cancer Task & Finish Group

5 Part 1 - Introduction 1.1 Summary Cancer is a national priority programme due to the continued gap in outcomes compared to European counterparts (it is estimated that if the NHS were to deliver the best outcomes an additional 30,000 people a year would be surviving cancer for at least 10 years or more by 2020, which for West Kent equates to 250 people) and performance on cancer waiting times is deteriorating. By 2020 almost one in two of us will get cancer in our lifetime. However thanks to improvements in diagnosis, treatment and care, we are also living longer with the disease. This means that cancer in many cases should be treated as a long term condition. An estimated 12,788 people in West Kent are living with and beyond cancer up to twenty years after diagnosis and West Kent CCG has slightly higher recorded cancer prevalence (2.3%) than both Kent and Medway (2.2%) and England (2.1%). 1.2 Strategy Statement In July 2015 an Independent Cancer Taskforce produced a report entitled Achieving World Class Cancer Outcomes A Strategy for England which outlined 6 strategic priorities with 96 recommendations which impact significantly on the overall improvement to national cancer outcomes. This national cancer strategy has been welcomed by NHS England who have appointed a National Cancer Director and Cancer National Clinical Director to lead a National Cancer Transformation Board to drive forward the priorities.

6 Part 1 Introduction continued Cancer in West Kent Positives: West Kent CCG has fewer 2 week wait referrals and fewer emergency admissions for those with cancer than the England average. Screening uptake is above England average. Age standardised mortality rate for all cancers in under 75 year olds is better than England average. Could do better: The CCG is on par with England averages for the 2 week wait conversion rate and direct access for tests but on both of these the CCG is below its comparator CCG. The CCG is on par with England in respect of 1 year survival rates for all cancers. Waiting time performance on 2 week waits, 31 days and 62 days is falling 1.4 A Cancer Strategy for West Kent Objective 1: The prevention of premature morbidity and mortality from cancer delivered through a programme of raising awareness and earlier diagnosis of cancer. Objective 2: Sustained and consistent delivery of cancer waiting time standards. Objective 3: Support those Living with and beyond Cancer

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9 WEST KENT CCG MONTHLY SCORECARD PERFORMANCE : CANCER Waiting Time Measure Standard Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Two week wait from cancer referral to specalist appt Two week wait (breast symptoms - cancer not suspd) 31-day wait from diagnosis to treatment 62-day wait from referral to treatment 31-day wait for subsequent surgery 31-day wait for subsequent anti-cancer drug regimen 31-day wait for subsequent radiotherapy 62-day wait for treatment - referral from screening 62-day wait for treatment - consultant upgrade 93.0% % % % % % % % N/A

10 Part 2 Our Priorities National Cancer Priority West Kent priority 1. Prevention - Increase Smoking Cessation - Obesity Reduction 2. Early Diagnosis (including Awareness) - Implementation of revised NICE 2ww referral guidance - GP Awareness and pathway development and education - Specific cancer pathways : Colorectal, Lung, skin and breast - Linked programmes: Diagnostics, New models of primary care, Kinesis - Screening uptake - Reduce diagnosis through emergency route 3. Patient Experience - Communications with patients re 2ww referrals - Development of Cancer Patient Partnership Group - Improved results of Cancer Patient Experience Survey - Development of a Cancer Information Centre 4. Modernising cancer Services 5. Living with and Beyond Cancer 6. Commissioning, Accountability and Provision - Provider Cancer Recovery Plan - Radiotherapy review - Implement changes in Cancer Drugs Fund (CDF) - Increase Research activity - Achievement and maintenance of cancer standards - Stratified Pathways of Care to assist appropriate follow up and self management - Implementation of the Recovery Package (RP) - Develop a Cancer Alliance - Robust Performance Reporting and Assurance - Agree pathways and process for Collaborative Commissioning (NHSE and CCG)

11 We will know if we are successful if, by 2020: By 2020 Current position We have increased the proportion of cancers diagnosed at stage 1 or 2 to 62% Approx. 50% We have reduced adult smoking prevalence to less than 13% consistently Approx. 17% 95% of patients referred for testing by a GP are definitively diagnosed with cancer, or cancer is excluded, within four weeks. Not currently measured Every person with cancer has access to all four elements of the Recovery Package None not all four elements are currently in place for any cancer patient 57% of patients are surviving ten years or more Not issued by CCG yet but national figure approx. 50% One-year survival is 75% for all cancers Approx. 70% Achieved 75% uptake rate for bowel scope screening Approx. 61% GPs have direct access to diagnostic tests outlined in the NICE guidance on suspected cancer (NG12) within 2 weeks and reports within 48 hours Not all required tests and not consistently delivered for those where access is in place Mandated cancer waiting time standards are consistently met Performance has deteriorated since 2013 and none of the standards are currently consistently met

12 Appendices - Part i) Development Plan 1. Prevention Reduce Adult Smoking, tobacco control plan, National obesity plan Priority area Issue Action(s) Outcomes / Intentions Partners Timescale 1.1 Smoking Cessation 1.2 Obesity Reduction Smoking remains the major contributor to the risk of cancer and smoking cessation rates still need to be improved in targeted populations.. The WHO estimates that between 7% and 41% of certain Cancers are attributable to obesity. To link with Public Health Stop smoking and health promotion teams and Macmillan to implement a local action plan which includes events in targeted areas, e.g. libraries, one stop shops A& E dept. etc. Develop incentives for practices to identify smokers from their smoking status on patient records to create a virtual smoking register. CCG analysis to understand the prevalence in practices to develop a plan that targets initiatives and actions on those with highest rates of smoking or the poorest quit success, e.g. work places, schools, deprived areas To develop incentives for Primary Care to work with patients to stop smoking, e.g. LIS To link with public health and local authority to develop a weight management strategy which includes level 3 and 4 services, particularly the provision of level 3 to support level 4 (bariatric surgery) in line with new commissioning responsibilities for CCGs from April 2016 Create incentives for practices to identify obese patients so that the CCG can understand prevalence and develop a plan that targets initiatives and actions on those areas with highest rates of obesity To develop incentives for Primary Care to work with obese patients to lose weight., e.g. LIS To expand the reach of smoking cessation services into targeted areas Reductions in mid-long term lung cancer outcomes Reductions in mid-long term cancer outcomes Public Health Primary Care Community Providers Public Health Primary Care Community Providers April Dec 2016 Bariatric surgery commissioning commences April 2016 Integrated strategy developed for level 3 & 4 by April 2016 Implement strategy from June 2016

13 Appendices Part i) Development Plan 1. Early Diagnosis (including Awareness) Faster investigation, more diagnostic capacity, definitive diagnosis in 4 weeks Priority Area Issue Action(s) Outcomes / Intentions Partners Timescale 2.1 Implementation of revised NICE 2ww referral guidance 2.2 GP Awareness and pathway development and education The new Guidance strives to deliver earlier diagnosis through improved access to diagnostics from primary care. The impact on demand is not clear from the guidance and current AQP contracts do not accommodate those with suspected cancer so there may need to be a change in commissioning which will require a review of capacity to meet additional 2WW referrals. GPs see few patients that are diagnosed with cancer (maybe between 6-10 a year). Given the increased role of GPs in detecting cancer and supporting patients through and post treatment, as per the NICE guidance and national strategy, GPs need to be updated on cancer awareness, treatments and policy. Develop a GP education programme which includes the new 2ww NICE referral guidance and cancer developments Work with Tumour Site Specific Groups (TSSG) to review the key pathways against the new guidance to identify where practice needs to change and assess impact on demand and responsibility Review national referral proformas when they are approved by RCGP and adopt, with any locally agreed amendments, and place on DORIS Quantify and put in place commission arrangements for any identified change in demand Ensure diagnostics commissioning for direct access tests to deliver the revised 2ww guidance, i.e. review and negotiate current AQP contracts Agree headline issues to be covered in training, including cessation of use of fax for referrals and adding testing prior to or in parallel with referral, e.g. urine and blood tests Agree how training could be delivered, e.g. PLT or specific tailored course, webinars Secure resources and delivery of training Evaluate impact of training Agree what on-going training may be required and how to support it Secure appointment of Macmillan GP to work with individual GPs or practices to improve their input for best patient outcomes Link the work and support of the new local CRUK facilitators to the education needs of GPs and pracices.in m most need Increase percentage of patients diagnosed at stages 1 & 2 compared to stages 3&4. Demand and pathway Implications of the NICE guidance are reflected in commissioning plans and contracts Better one year survival GPs have direct access to appropriate tests, defined in revised 2ww guidance Targeted support and education for GPs is effective in delivering earlier diagnosis Improved one year survival rates Reduction in percentage of patients diagnosed via an emergency route Acute Providers Primary Care TSSGs Macmillan SCN Primary care CCG GP education lead From April 2016 with changes in demand accommodated by Dec 2016 From April 2016 and on-going

14 Appendices Part i) Development Plan 2.3 Lower GI cancers Abdominal cancer pathways are most affected by the new 2ww guidance with an impact on endoscopy capacity which is already under pressure due to lack of endoscopists and gastroenterologists. Diagnostic access should be considered as adding value to a pathway and not a cost as earlier diagnosis relates to treatment at earlier stage of disease is proven to be a more cost effective pathway and improves patient experience Work with MTW to streamline pathway Include in GP awareness plan (see 2.2 above) CCG to commission any increase in capacity identified through review of pathways against 2ww guidelines and general increase in demand Include in CCG initiative to achieve 2 week turnaround on diagnostic testing and reporting Work with AQPs to explore potential for inclusion of suspected cancer to accommodate new NICE 2ww guidelines CCG with SCN to hold an economy-wide learning event for lower GI Review of the pathway to accommodate scans for vague abdominal symptoms Delivery of 2ww mandated standard for lower GI Providers Primary Care National ACE programme National PMO for endoscopy From April Lung cancer Survival rates are poor for lung cancer patients who are more likely to be diagnosed at a later stage of disease and also via an emergency route. Need earlier diagnosis and fast track treatment pathways. 2.5 Skin cancer The CCG is undertaking a procurement process for integrated dermatology level 3 and 4 services, to include cancer 2ww. Level 4 cancer services must be supported by local MDT approved by TSSG which limits the providers who can comply with standards. Work with MTW to streamline pathway, i.e. straight to scan under certain criteria Analyse data to enable the CCG to target areas with poorest outcomes and highest emergency referral rates Link to CCG and public health inequalities work Link to GP awareness and training ( 2.2 above) To work with TSSG and BAD to ensure that tender process reflects the IOG requirements To ensure that only IOG compliant bids from providers are considered for level 4 cancer procurement To work with Medway FT to ensure that if no appropriate providers come forward through tender, it is able to continue to provide level 4 cancer s services which can be IOG assured. Reduction in lung cancer mortality and all-cause mortality by 6.7% by 2020 Level 4 skin cancer service that is assured for providing IOG compliant service Redcued wiwitng times and higher conversion rates for skin cancer 2ww MTW AQP providers Primary Care National ACE programme Procurement team BAD TSSG for skin Medway FT Successful bidder if awarded April 2016 onwards Summer 2016

15 Appendices Part i) Development Plan 1.6 Linked programmes: - Diagnostics - New models of primary care - Kinesis A number of programmes in the CCG impact on or could be used to support improving cancer outcomes and initiatives should be coordinated across them. Ensure diagnostics and cancer leads work together on establishing the impact on demand of cancer pathways, particularly the new 28 days to diagnosis cancer standard, and include this in the implementation of the CCG selfimposed target of 2 weeks. Ensure that the new models of primary care being developed include the changing responsibilities of GPs in diagnosing cancer Explore how Kinesis can support cancer referral pathways Effective use of CCG resources to improve cancer outcomes across its lead programmes of work Providers Primary Care On-going 2.7 Screening This is not currently commissioned by the CCG but as Collaborative Commissioning develops with NHSE this may change so the CCG may need to prepare and be aware of any issues and change in the programme 2.8 Diagnosis through emergency route Audit During 2015/6 the CCG operated a LIS for audit of patients diagnosed with cancer via an emergency route over the previous 12 months to support GPs to change practice through shared learning of issues identified along the pathway. Other CCGs have also undertaken similar audits supported by SCN Monitor uptake rates and engage with NHS England and Public heath England on any prosed changes to commissioning responsibilities Identify programmes where uptake is low and target initiatives to increase, jointly with PHE Develop a local strategy to improve screening uptake in specific programmes for vulnerable populations, e.g. learning disability Review the findings of the LIS supported audits and develop a plan locally in response to findings, particularly to support a reduction in delays found though late diagnosis or treatment. Link with GP awareness plan in 2.2 above Reduction in percentage of patients diagnosed through emergency route Diagnosis at earlier stages of disease Improvement in one year survival rates NHS England Public Health England Primary care Secondary care SCN Summer 2016

16 Appendices Part i) Development Plan 1. Patient Experience Electronic access to treatment records, Access to CNS, Continue cancer patient experience survey, metrics to drive improvement Priority Area Issue Action(s) Outcomes / Intentions Partners Timescale 3.1 Communications with patients re 2ww referrals Improve attendance within 2 weeks to meet mandated standard on 2ww waits 3.2 Patient Partnership Group 3.3 Cancer Patient Experience Survey 3.4 Cancer Information Centre Acute trusts report a high number of delays in 2ww target due to patient choice, i.e. patient does not appreciate urgency to attend for diagnostics and 2ww appointment. K&M Collaborative have supported a West Kent Patient Group but its function and support is under review as commissioners have not been engaged CCG does not currently make use of this survey Macmillan Cancer Support and MTW are in negotiation around the building and resourcing of a Cancer Information Centre based on Maidstone Hospital site Develop material to support GPs in communicating the importance and urgent nature of 2 ww appointment and attendance link with GP Education programme in 2.2 above. To work with Macmillan, who are leading the review of the patient groups, to develop a revised terms of reference and engagement programme which includes the CCG Review findings and outcomes of survey for West Kent to inform areas for development and improvement. CCG to support the development of a Centre funding and resourced by Macmillan and MTW CCG to have access to patient engagement through a local cancer patient partnership group Services more responsive to the areas highlighted in the survey Cancer Information with open access for Patients, carers and family Macmillan Patient groups Acute Trust GPs K&M Cancer Collaborative Macmillan West Kent cancer patient group SCN Comms lead for CCG Macmillan MTW From April 2016 From April 2016 and on-going 2018/19

17 Appendices Part i) Development Plan 1. Modernising cancer Services Fix workforce deficits, Update radiotherapy machines, streamline access to drugs, support research Priority Area Issue Action(s) Outcomes / Intentions Partners Timescale 4.1 Provider Cancer Recovery Plan for MTW 4.2 Radiotherapy review 4.3 Cancer Drugs Fund (CDF) To deliver the mandated cancer standards, MTW have identified a number of pathways which have not consistently met the cancer standard for 62 days due to workforce and capacity issues. These are: - lower GI - Breast - Gynecology - Urology - Haematology - Head and neck - Lung There is a national review of radiotherapy provision which may impact on replacement programmes for LINACS and funding for new sites or equipment. The CCG needs to ensure that it is up-to-date with the Review and inputs as required. Changes will be made to how the CDF is accessed and managed from April 2016 and the CCG needs to know the impact on its responsibilities and population CCG to monitor closely the progress on delivery of the recovery plan and align CCG activities to support it where there are actions for primary care or commissioners. To work with MTW to develop an open access follow-up service for breast cancer patients that is risk stratified and offers an alternative to traditional automatic consultant led follow-up Cancer Prog Lead to work with SCN and NHSE as Review progresses to understand the implications for the CCG and also to reflect the needs of the CCG population. Input to consultation process led by NHS England on the new policy Ensure commissioners and providers locally understand the changes and implications in the CDF, particularly as drugs are removed from the list and incorporated in to baseline funding. Delivery of 62 day cancer target Improved survival rates at 1 and 5 years Reduced number and ratio of consultant-led follow-ups for breast patients. Improvement in 2ww standard performance, particularly for breast cancer Population of West Kent has appropriate access to up-todate radiotherapy equipment and treatment MTW NHSE NHS Improvement HEE NHSE Providers SCN On-going On-going until review complete (date unknown) NHSE April 2016 onwards

18 Appendices Part i) Development Plan 4.4 Research Research trials can impact on commissioners and the CCG needs to be aware of what developments may need to be considered for future commissioning plans. Cancer and meds Management leads to keep appraised of research developments and trials both locally and nationally which can impact on commissioning plans. No surprises when research trials report and the CCG is prepared NHSE AHSN TSSGs Local Clinical Research Network On-going and linked to commissioning cycle 4.5 Achievement and maintenance of cancer standards Since 2013, performance both locally and nationally on the cancer mandated standards has fallen and whilst recovery plans have been developed and are closely monitored a new standard of 28 days to definitive diagnosis is expected (national strategy recommendation). Conduct analysis of the numbers of patients and the pathways which will be affected by the new 28 day standard Develop a plan with local providers to deliver 28 day standard Expectation that 95% of patients will be diagnosed within 28 days and that 50% of patients will be diagnosed with 2 weeks by ww Providers GPs Diagnostic providers March 2020

19 Appendices Part i) Development Plan 1. Living with and Beyond Cancer Recovery Package, tailored follow-up, measure and incentivise quality of life Priority Area Issue Action Outcomes / Intentions Partners Timescale 5.1 Stratified Pathways of Care to assist appropriate follow up and self - management 5.2 Implementati on of the Recovery Package (RP) The use of risk stratified pathways can release some patents from routine followup which is not proven to be effective in picking up secondary cancers. This releases more clinic capacity for new referrals and for those who need more intensive follow-up. This would be supported by a system to allow rapid access back into the specialist team. An audit by the SCN in 2015 indicated that the use of the recovery package is not complete across West Kent. The Recovery Package is a key strand of the national strategy and the recommendation has already been supported by Jeremy Hunt and Simon Stevens. There are four elements to the Recovery Package and each is addressed in the actions. Review current performance on use of risk stratified pathways Work with MTW to expand the range of cancers that use risk stratification for follow-up Monitor the follow-up rates and those on selfmanagement Develop an open access follow-up service at MTW for breast patients For all 4 elements of the RP (Holistic Needs Assessment, Treatment summaries, cancer care reviews and patient education and support), agree with primary care and MTW a local plan which identifies which tool or method will be used for each element of RP, who will complete or process it and by when Agree a phased implementation by tumour site to achieve full implementation by 2020 agree a training plan for HNAs including communication skills training for CNSs secure patient engagement to the design and running of education and support Clarify who can conduct a Cancer Care Review (CCR), what it what it should comprise. Encourage uptake of the practice nurse course on CCRs Encourage practices to use the CCR templates on EMIS & INPS More patient centered follow-up Improved new to follow-up ratios Improved 2ww performance Acute Providers Primary Care National Cancer Survivorshi p Initiative Macmillan Primary Care Acute, community and mental health Providers 3 rd Sector providers Macmillan Patients 2017/8 Full implementation by 2020

20 Appendices Part i) Development Plan 1. Commissioning, Accountability and Provision Guidance on commissioning, new improvement alliances, new models of care Priority Area Issue Action(s) Outcomes/Intentions Partners Timescales 6.1 Cancer Alliances 6.2 Performance reporting 6.3 Performance Assurance National Strategy recommendation is for the development of cancer Alliances on a bigger footprint than health economy. NHSE require set-up from April 2016 CCG is not yet sighted on new KPIs and national dashboard development. New reporting process through Cancer alliances to National Cancer Board expected through 2016/7 Cancer Recovery Plans for mandated standards are not coordinated across Kent & Medway so interlinked pathway issues are not triangulated by commissioners or NHS Improvement. Work with CCGs and providers across Kent & Medway to agree the footprint and scope for the Alliance, membership and initial remit Work with Business Intelligence to include new KPIs and dashboard on Integrated performance report Agree process and format of monthly reporting to CCG Board and emerging Cancer Alliance Development of a K&M Cancer Performance Group to share plans and agree joint co-ordinated actions, linked with development of Cancer Alliance Ensure robust formal and informal assurance processes are in place with local providers. Functioning Cancer Alliance Streamlined and clear process for local reporting and also to NHSE All CCGs and providers in K&M SCN NHSE CSU NHS Improvement From April 2016 From April 2016 and reviewed as national requirements change On-going but adapted to meet requirements of new Cancer Alliance 6.4 Collaborative Commissioning (NHSE and CCG) NHSE work programme to share commissioning arrangements with CCGs for listed specialised services by CCG needs to prepare and set-up for this transfer of responsibility There is a need for better engagement with specialised commissioning on redesign of pathways to support sustainability and affordability CCG to work with NHSE on collaborative commissioning programme, particularly initially on articulation of issues, development of vision and buy-in, priority areas for phased implementation, development of capacity and capability Include NHS England in all local pathway redesign work locally and develop integrated plans Smooth agreed pathways that are not fragmented by disjointed commissioning CCGs across K&M NHSE Specialised Commissioning NHSE Policy Unit NHS Improvement 2016/7 through to 2020

21 Appendices Part ii) List of background documents & websites Achieving World-Class Cancer Outcomes A Strategy for England , Report of the Independent Cancer Taskforce, July 2015 West Kent CCG Cancer Strategy Concept Paper, November 2015 NHS Five Year Forward View, October 2014 West Kent CCG Mapping the Future, August 2013 West Kent Population Needs Assessment, Public Health, 2015 National Cancer Survivorship Initiative Cancer Research UK Macmillan Cancer Support South East Strategic Clinical Network Right Care Commissioning for Value Pack

22 Appendices Part iii) Acknowledgements Members of the West Kent CCG Cancer Task and Finish Group Dr Sanjay Singh, Chief GP Commissioner, West Kent CCG Ben Wright, Head of Performance & PMO, West Kent CCG Ian Vousden, South East Strategic Clinical Networks

23 Appendices Part iv) Membership CCG Cancer Task & Finish Group GP lead for cancer GP lead for diagnostics GP lead for end of life Programme lead for cancer Programme lead for diagnostics Programme lead for LTC Public health Lead Meds Optimisation lead Cancer drugs lead Business Intelligence (CSU) Finance lead Quality lead Stefano Santini Andrew Roxburgh Andy Cameron Sally Allen James Ransom Rachel Parris Malti Varshney Priscilla Kankam Karen Davies Barry Thomas Lan Xiao Stacy Washington