‘Piloting change’ report on the Multi Disciplinary Diagnostic centre Ed Seward CRUK ACE Meeting April 2016

MDC Pilot Rationale: Danish experience Like Britain strong gatekeeper role of GPs relatively low cancer survival Vedsted and Olesen 2011 BMT Nursing Highlights BMT review day 01/2016

BMT Nursing Highlights BMT review day 01/2016

Only 10% of patients with rectal bleeding consult their GP BMT Nursing Highlights BMT review day 01/2016

Refer Certainly not serious Low risk but not no risk Definitely serious BMT Nursing Highlights BMT review day 01/2016

Danish ‘three legged model’ Specific worrying symptoms – 2ww Low risk but not no risk – open access/STT Vague, non-specific but worrying symptoms - MDC BMT Nursing Highlights BMT review day 01/2016

Painless jaundice with bilirubin >80 mmol/l Unexplained weight loss >3Kg or 5% of documented weight loss not previously investigated Significant abdominal pain resulting in 2 ED visits presented to A&E with abdo pain at least twice in a month not previously investigated, not a chronic recurring problem unexpected presentation of patient Non-specific abdominal symptoms lasting 3 weeks, but under 6 months not a chronic recurring problem unexpected presentation of patient If there is a strong likelihood of a known benign diagnosis please consider an alternative pathway BMT Nursing Highlights BMT review day 01/2016

BMT Nursing Highlights BMT review day 01/2016

BMT Nursing Highlights BMT review day 01/2016

Rapid Access MDC Clinic Specialist History and Examination + Navigator Bloods CT Management Plan Endoscopy A&E Letter to GP & patient Refer to MDT Admit Discharge Primary Care Rapid Access MDC Clinic Specialist History and Examination + Navigator Day 1 Day 0 By 4 weeks Day 2/4 BMT Nursing Highlights BMT review day 01/2016

results 91 patients referred to UCLH 93% offered an appointment within 5 days to see CNS All seen by consultant within 28 days BMT Nursing Highlights BMT review day 01/2016

BMT Nursing Highlights BMT review day 01/2016

BMT Nursing Highlights BMT review day 01/2016

diagnosis Cancer: metastatic pancreatic lymphoma ovarian BMT Nursing Highlights BMT review day 01/2016

diagnosis Every patient leaves with a diagnosis! Benign: Gallstones requiring surgery 4 pancreatitis 2 IPMT TB oesophageal pouch renal lesions 3 bulky ovaries Every patient leaves with a diagnosis! BMT Nursing Highlights BMT review day 01/2016

diagnosis Benign: Gallstones requiring surgery 4 pancreatitis 2 TB oesophageal pouch renal lesions 3 bulky ovaries BMT Nursing Highlights BMT review day 01/2016

BMT Nursing Highlights BMT review day 01/2016

Resources required CNS Pathway co-ordinator Consultant time Imaging and endoscopy access BMT Nursing Highlights BMT review day 01/2016

Challenges faced Job planning – and variable demand Communication with GPs Establishing referral criteria Clinic space Patient choice BMT Nursing Highlights BMT review day 01/2016

Summary 1 Cancer outcome data demonstrates a relation between diagnostic waits and outcomes A symptom spectrum exists Danish data suggests there is a need for a ‘third way’ – a ‘three legged’ model BMT Nursing Highlights BMT review day 01/2016

Summary 2 MDC established on a pilot basis at UCLH/Queens First 100 patients demonstrate a lower cancer pick up but reasonable rates of pathology GPs have reported benefit of benign diagnoses Challenges are significant – firmer referral criteria and managing demand BMT Nursing Highlights BMT review day 01/2016