Greater Manchester Cancer Vanguard Innovation Faster Diagnosis Showcase

Greater Manchester Cancer Vanguard Innovation Faster Diagnosis Showcase Lisa Galligan-Dawson, Bolton NHS Foundation Trust Martina Kingscott, Bolton NHS Foundation Trust Melissa Surgey, Bolton Clinical Commissioning Group David Mc. Lenachan, User Involvement representative 16 th May 2017

Greater Manchester Cancer Vanguard Innovation Housekeeping § There are no scheduled fire drills § Toilets are to the right of the exit § We will be taking pictures – please let us know if you don’t want to have your picture taken § The presentations will be circulated after the event § Phones on silent please

Greater Manchester Cancer Vanguard Innovation The national Cancer Vanguard To develop and test new ideas to deliver more responsive and personalised cancer services, addressing inequalities and supporting the NHS in ‘Achieving World Class Cancer Outcomes’. Two-year programme to look at improved cancer care, cancer outcomes, cancer patient experience and resource efficiency

Greater Manchester Cancer Vanguard Innovation Project Team Name Role Organisation Lisa Galligan. Dawson Implementation Manager Bolton NHS Foundation Trust Melissa Surgey Project Manager Bolton CCG Dr Tarek Bakht GP Clinical Lead for Cancer Bolton CCG Mr Simon Hargreaves Clinical Lead for Cancer Bolton NHS Foundation Trust Martina Kingscott Clinical Nurse Lead/Matron for Endoscopy (Lower and Upper GI streams) Bolton NHS Foundation Trust Project Leads Project Members The core Faster Diagnosis team works collaboratively with strategic and operational stakeholders from the three specific tumour site projects to facilitate service delivery

Greater Manchester Cancer Vanguard Innovation Aims and Objectives § To provide patients with either a confirmed diagnosis or § § § exclusion of cancer within 28 days of referral on a suspected cancer pathway from a GP To understand the impact of an accelerated diagnosis pathway on patient experience and understanding of their care To test partnership approaches to delivering cancer diagnostics – both across secondary care providers, and across primary and secondary care To develop recommendations for other commissioners and providers across GM as to how to streamline diagnostic pathways to support faster diagnosis

Greater Manchester Cancer Vanguard Innovation Project Governance

Lung Pathway Changes § Patients with abnormal chest x ray retained by hospital for CT scan and onward management if cancer is diagnosed § Expected to reduce the time to CT of around 3 weeks (includes time before patient would normally be referred) § Expected to reduce the amount of appointments the patient has by approximately 3. (Primary care and secondary care) Greater Manchester Cancer Vanguard Innovation

Lung Pathway Changes § User designed patient information document for ‘chest investigations’ § Go live is planned for June 17 § Re-designed follow up / results process § Patient experience audit planned for patients diagnosed with cancer and those not requiring onward management by the Hospital Greater Manchester Cancer Vanguard Innovation

Lung Pathway Flowchart Greater Manchester Cancer Vanguard Innovation

Upper Gastro Intestinal (GI) Pathway § Re-design of GP referral specification § GP engagement sessions on Straight to Test OGD pathway § Introduction of rapid ‘Jaundice Pathway’ saving approximately 10 pathway days § Triage and re-direct exercise completed. ¼ of all patients referred in this period were saved from attending 1 appointment Greater Manchester Cancer Vanguard Innovation

Upper Gastro Intestinal (GI) Pathway § Patients on Straight to Test pathway are having their OGD on average 8 days sooner than those attending Outpatient first § Specialist nurse attends for results of OGD where a cancer is seen. Patient leaves with CT scan appointment (target 2 working days) Greater Manchester Cancer Vanguard Innovation

Upper GI Pathway Flowchart Day 0 Referral Day 8 -14 OGD, results and CT booked Day 8 -12 Outpatient Appointment CT and onward management Day 16 -25 OGD, results and CT booked CT and onward management Greater Manchester Cancer Vanguard Innovation

Direct to Test Colonoscopy Pathway Summary § Patient attends GP surgery § Patient appropriate for 2 ww Direct to Test colonoscopy § Patient leaves surgery with appointment for telephone assessment (within 48 hours) § Patient is contacted by Specialist Nurse and Pre-assessment completed Greater Manchester Cancer Vanguard Innovation

Direct to Test Flow chart Greater Manchester Cancer Vanguard Innovation

Flow Chart for Pre-Assessment Greater Manchester Cancer Vanguard Innovation

User Involvement § Patient Information Packs for Colorectal and Lung ‘direct to test’ developed with the involvement of the Macmillan User Involvement team and Bolton People Affected by Cancer. Feedback § § “Fantastic Service” “Wish this had been available when I had been diagnosed” “Can I have my follow-up colonoscopy at this site please? !! “Proactive to Patient needs, quality and safety first” Greater Manchester Cancer Vanguard Innovation

GO LIVE! § Went “live” on Monday 3 rd April 2017 § First Patient feedback outstanding : § “Had procedure done before, nothing like this” § “Fast, safe, fully informed, excellent service” § Teething Problems : § Slow start from GP Practices referring into the System Greater Manchester Cancer Vanguard Innovation

Audit Data § § § Snap Shot Audit 4 – 29 April 2017 17 patients referred into Service 6 patients had procedures performed (at time of audit) 1 cancer was detected Average wait time for the patients was 8 days from telephone clinic. Average time to colonoscopy from referral via traditional route was 18 days. Greater Manchester Cancer Vanguard Innovation

Patient Cancer Journey TIMELINE § § § § 19. 4. 17 Consultation, Nurse Telephone Assessment D. T. T 25. 04. 17 Colonoscopy 29. 4. 17 C. T. Scan - thorax, abdomen, pelvis 29. 4. 17 M. R. I. - Pelvis/rectum 2. 5 17 Colo-rectal MDM Meeting 3. 5. 17 O. P. Appt with Mr Harris 5. 5. 17 Colo-rectal MDM Meeting Greater Manchester Cancer Vanguard Innovation

Issues Raised § § Incorrect Referral Form Patient Information Leaflets not given Patients not informed 2 WW All patients received prescription for bowel prep BUT issues in obtaining bowel prep Greater Manchester Cancer Vanguard Innovation

Moving Forward § Issues to overcome with G. Ps § Bowel prep § Communication, communication § Continued collaboration With CCG § Continued Audit § Changes along the way § Patient first – data proves it’s working Greater Manchester Cancer Vanguard Innovation

Engagement with Primary Care § Used established CCG forums – Clinical Leads, Practice Managers, Informal Local Medical Council (LMC) § Progressing new pathways through CCG governance – Demand Management Group, Clinical Standards Board § Promotion through GP newsletter, direct communications via GP Clinical Lead for Cancer Greater Manchester Cancer Vanguard Innovation

Lessons Learned § Should have begun GP engagement at an earlier stage § Formal endorsement through CCG governance important § Support from CCG clinicians does not always represent support from wider GP membership § Be willing to listen and adapt – pathways hinge on GPs supporting and referring into them; find neutral ground § Engage with Practice Managers and admin staff on logistics of referring into new pathways, issuing patient information, booking appointments – essential to facilitate efficient and effective turnaround time § Make change as easy as possible – don’t overlook the “small issues” such as printing patient information booklets § Patient engagement critical to getting pathways right Greater Manchester Cancer Vanguard Innovation

What Next? § Re-launch Direct to Test Colonoscopy pathway with revised process for issuing bowel prep § Agree lung x-ray and CT element of pathway through CCG governance and go live § Upper GI further GP engagement events § Continued audit and monitoring of all three work streams, with dedicated project management oversight § Consider options for continuing with successful elements of the pilot post-Cancer Vanguard funding and document roll out options for GM Greater Manchester Cancer Vanguard Innovation

Contact § Lisa Galligan-Dawson – lisa. galligandawson@boltonft. nhs. uk § Melissa Surgey – melissa. surgey@nhs. net § Martina Kingscott – martina. kingscott@boltonft. nhs. uk Greater Manchester Cancer Vanguard Innovation

Questions Greater Manchester Cancer Vanguard Innovation

Greater Manchester Cancer Vanguard Innovation Email: cancervanguard. gm. @nhs. net Web: gmcancervanguard. org Twitter: @GM_Ca_Vanguard