The Plastic Surgery See and Treat Skin Cancer Clinic (SATSKIN)

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1 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

2 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

3 Skin oncology Hand surgery Breast reconstruction Burns Head and neck cancer Craniofacial and cleft surgery Trauma

4 1 Consultant Plastic Surgeon specialising in skin oncology and head and neck skin oncology Remaining 9 FTE Consultant Plastic Surgeons Subspecialty and skin oncology

5 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.

6 Suspected Cancer: recognition and referral (NG12) published 23 June 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

7 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.

8 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

9 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

10 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

11 April weeks April 2016 longest waiter 6 weeks

12 GP Dermatologist GP Plastic Surgeon Other

13 Theatre OPD Plastic Surgery Unit Ulster Hospital SATSKIN

14 Clinical Information Previous biopsy and histology result Photos

15 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

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18 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

19 First date 16/4/15 Based at Lagan Valley Hospital (SETRUST) Day Procedure Unit

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25 179 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

26 Aim to see and treat 4 patients per clinic Initially 1 SATSKIN per week Since January 2 SATSKIN per week

27 31 GP referrals 136 Dermatology Referrals 3 General Surgery referrals 1 Oncology referral 3 Other

28 63 SCC 58 Melanoma 4 Lentigo Maligna 8 BCC 8 Pre-malignant 42 Benign Lesions

29 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

30 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

31 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

32 Re-audit Patient satisfaction survey More See and Treat clinics