West MidlandsTrainers’ Workshop Yarnfield Park Training and Conference Centre Yarnfield, Stone, ST15 0NL 18th January 2018 Dr Richard Roope RCGP and Cancer Research UK Cancer Clinical Champion Senior Clinical Advisor Cancer Research UK

Trainers’ Workshop Early Diagnosis for GP trainers

Trainers’ Workshop Early Diagnosis for GP trainers What are we there for?

Trainers’ Workshop Early Diagnosis for GP trainers What are we there for?

Trainers’ Workshop Early Diagnosis for GP trainers What are we there for?

Trainers’ Workshop Early Diagnosis for GP trainers What are we there for?

Trainers’ Workshop Early Diagnosis for GP trainers What are we there for?

Trainers’ Workshop Why is early diagnosis important?

Trainers’ Workshop Why is early diagnosis important?

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/survival#heading-Three (last accessed 3.11.17)

Trainers’ Workshop Why is early diagnosis important?

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer/survival#heading-Two (last accessed 3.11.17)

Trainers’ Workshop Why is early diagnosis important?

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/bowel-cancer/survival#heading-Three (last accessed 3.11.17)

Trainers’ Workshop Why is early diagnosis important?

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/lung-cancer/survival#heading-Three (last accessed 3.11.17)

Trainers’ Workshop Why is early diagnosis important?

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? All Cancers www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/all-cancers-combined#heading-Two (last accessed 3.11.17)

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? All Cancers Stage Shift www.cancerresearchuk.org/health-professional/cancer-statistics/incidence/all-cancers-combined#heading-Two (last accessed 3.11.17)

Trainers’ Workshop Minimum increased 5 year survival with 10% increase in stages 1 & 2 Colorectal 4.00% Ovary Breast 3.80% Endometrium 3.70% Prostate 2.40% Melanoma 2.30% Lung 2.00% Kidney Bladder 1.30% NHL 0.20% https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/388160/fourth_annual_report.pdf (last accessed 3.11.17)

Trainers’ Workshop Why is early diagnosis important? Cost

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? http://www.cancerresearchuk.org/sites/default/files/saving_lives_averting_costs.pdf

Why is early diagnosis important? Trainers’ Workshop Why is early diagnosis important? ↓72.8% ↓62.7% ↓64.9% ↓38.9% http://www.cancerresearchuk.org/sites/default/files/saving_lives_averting_costs.pdf

Trainers’ Workshop How have we done?

Cancer – where have we come from? January 2011 - Improving Outcomes: A Strategy for Cancer

Trainers’ Workshop How have we done? Avoidable deaths pa if survival in England matched the best in Europe Breast ~2000 Myeloma 250 Colorectal ~1700 Endometrial 250 Lung ~1300 Leukaemia 240 Oesophagogastric 950 Brain 225 Kidney ~700 Melanoma 190 Ovary ~500 Cervix 180 NHL/HD 370 Oral/Larynx 170 Bladder 290 Pancreas 75

Trainers’ Workshop How have we done?

Trainers’ Workshop How have we done?

Trainers’ Workshop Research stream Primary Care Engagement How have we done? Research stream Primary Care Engagement Input to Cancer Network and SCNs RCGP Education Events etc

Trainers’ Workshop How have we done?

Trainers’ Workshop How have we done? https://fingertips.phe.org.uk/profile/cancerservices

Trainers’ Workshop How have we done? https://fingertips.phe.org.uk/profile/cancerservices (last accessed 21.1.17)

Trainers’ Workshop How have we done? http://www.ncin.org.uk/publications/routes_to_diagnosis (last accessed 13.1.18)

Trainers’ Workshop How have we done? ↑66.0% ↓1.2% ↑77.8% http://www.ncin.org.uk/publications/routes_to_diagnosis (last accessed 7.11.17)

Trainers’ Workshop NHS Stafford and Surrounds CCG – Cancer Emergency Admissions

Trainers’ Workshop NHS Stafford and Surrounds CCG – Cancer Emergency Admissions http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/cancer_outcome_metrics(last accessed 13.1.18)

Trainers’ Workshop NHS Stafford and Surrounds CCG – Cancer stage at presentation

Trainers’ Workshop NHS Stafford and Surrounds CCG – Cancer stage at presentation http://www.ncin.org.uk/cancer_type_and_topic_specific_work/topic_specific_work/cancer_outcome_metrics (last accessed 13.1.18)

Trainers’ Workshop PHE Press release 16.9.15: “Cancers are being diagnosed earlier in England” https://www.gov.uk/government/news/cancers-are-being-diagnosed-earlier-in-england (last accessed 21.1.17)

Trainers’ Workshop However compared to Europe?

Trainers’ Workshop However compared to Europe? http://scienceblog.cancerresearchuk.org/2015/08/05/cancer-survival-in-england-is-improving-but-still-lagging-behind-similar-countries/

Trainers’ Workshop However compared to Europe? http://scienceblog.cancerresearchuk.org/2015/08/05/cancer-survival-in-england-is-improving-but-still-lagging-behind-similar-countries/

Trainers’ Workshop Why do we lag behind other Health Systems?

Trainers’ Workshop Why do we lag behind other Health Systems? International Cancer Benchmarking Partnership As gatekeepers – the gate needs to be wider Outcomes closely linked to “readiness to act” Patients fear wasting GP time Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival? British Journal of Cancer (2013) 108, 292–300. doi:10.1038/bjc.2012.542 (last accessed 3.11.17)

Trainers’ Workshop Gate openers…

Trainers’ Workshop

Trainers’ Workshop

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: Save thousands more lives Transform patient experience and quality of life Invest now to save later www.cancerresearchuk.org/sites/default/files/achieving_world-class_cancer_outcomes_-_a_strategy_for_england_2015-2020.pdf (last accessed 3.11.17)

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: 1. Save more lives Early Diagnosis

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: 1. Save more lives Early Diagnosis Enhance screening uptake Implement NICE Guidance (NG12) Invest in diagnostic capacity Direct access to diagnostic capacity 28 days to diagnosis (to replace 2WW) Education – Undergraduate, postgraduate, CPD

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: 1. Save more lives Early Diagnosis Enhance screening uptake Implement NICE Guidance (NG12) Invest in diagnostic capacity Direct access to diagnostic capacity 28 days to diagnosis (to replace 2WW) Education – Undergraduate, postgraduate, CPD

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: Save thousands more lives Transform patient experience and quality of life

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: Save thousands more lives Transform patient experience and quality of life Early diagnosis determines experience throughout whole cancer pathway Mendonca SC, Abel GA, Saunders CL, Wardle J, Lyratzopoulos G. Pre-referral general practitioner consultations and subsequent experience of cancer care: evidence from the English Cancer Patient Experience Survey. European Journal of Cancer Care. 2015.

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: Save thousands more lives Transform patient experience and quality of life Invest now to save later

Trainers’ Workshop Cancer Strategy 2015-2020 has three core aims: Save thousands more lives Transform patient experience and quality of life Invest now to save later Investing in early diagnosis will save money…

Trainers’ Workshop

Trainers’ Workshop Prevention Tobacco Food Immunisations Exercise Environment Early detection Awareness Health care seeking Screening Access Diagnosis Investigations Access Technology Decision support Treatment Surgery Chemotherapy Radiotherapy Comorbidity Psychology Survivorship Follow-up Late effects Rehabilitation Health promotion End of life Basic palliation Specialised Social Bereavement

Trainers’ Workshop Prevention Tobacco Food Immunisations Exercise Environment Early detection Awareness Health care seeking Screening Access Diagnosis Investigations Access Technology Decision support Treatment Surgery Chemotherapy Radiotherapy Comorbidity Psychology Survivorship Follow-up Late effects Rehabilitation Health promotion End of life Basic palliation Specialised Social Bereavement

Trainers’ Workshop Value in investing in early diagnosis:

Trainers’ Workshop Value in investing in early diagnosis: Why? To address our lowly cancer outcomes rank How? To lower threshold/readiness to refer with consistency: Right patient, right place, right time When? Now

Trainers’ Workshop How? Bowel Cancer – survival improving: Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Importance of bowel screening

Trainers’ Workshop Importance of bowel screening http://www.ncin.org.uk/home (accessed 13.1.18)

Trainers’ Workshop Importance of bowel screening http://www.ncin.org.uk/home (accessed 13.1.18)

Trainers’ Workshop Importance of bowel screening Screening presentations – hugely better outcomes Should be area of priority

Trainers’ Workshop Importance of bowel screening Role of GP Endorsement

Trainers’ Workshop Importance of bowel screening Role of GP Endorsement – increases uptake by 8%1 Br J Cancer. 2017 Jun 6;116(12):1551-1557. doi: 10.1038/bjc.2017.129. Epub 2017 May 18.

Trainers’ Workshop Importance of bowel screening Role of GP Endorsement – increases uptake by 8%1 Rolled out by some Screening Hubs

Trainers’ Workshop National Cancer Diagnosis Audit Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings Data was completed on 17,064 tumour records 439 practices submitted data Number of records per practice ranged from 1 to 156 Median number of records was 34 139 CCGs had at least one practice that submitted data 6 CCGs have 10+ practices participating Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings NCDA CRUK Breast 15.9% 15.2%   NCDA CRUK Breast 15.9% 15.2% Lung 12.5% 12.8% Prostate 12.9% Colorectal 11.6% 11.4% Melanoma 4.9% 4.3% NHL 3.9% 3.8% Kidney 3.7% 3.5% H+N 3.0% 3.2% Bladder 2.9% 2.8% Leukaemia 2.7% 2.6% Pancreas Oesophagus 2.5% Uterus 2.3% Ovary 2.1% 2.0% Stomach 1.8% CNS 1.6% Liver 1.5% Myeloma Cervix 0.8% 0.9% Other 9.2% 9.1% Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings – all are “pre-NG12” Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Consultations prior to referral Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Consultations prior to referral (where recorded) Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Consultations prior to referral (where recorded) Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Presentation to referral time: Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Presentation to referral time: Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Presentation to referral time: Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Place of presentation Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Place of first presentation Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Types of referrals (of those recoded) Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Types of referrals (of those recoded) Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Types of referrals (of those recoded) Patient self-referred - no prior consultation 4.2% Referred as emergency by GP - no prior consultation 3.2% Patient self-referred while waiting for tests 1.8% Referred as emergency by GP while waiting for tests 1.4% Patient self-referred - previously seen in same episode 1.7% Referred as emergency by GP - previously seen in same episode 3.0% Other 0.7% Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Early NCDA findings: Types of referrals (of those recoded) Patient self-referred - no prior consultation 4.2% Referred as emergency by GP - no prior consultation 3.2% Patient self-referred while waiting for tests 1.8% Referred as emergency by GP while waiting for tests 1.4% Patient self-referred - previously seen in same episode 1.7% Referred as emergency by GP - previously seen in same episode 3.0% Other 0.7% Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NG12 - Suspected cancer: recognition and referral

Trainers’ Workshop NG12 - Suspected cancer: recognition and referral Recommendation 16: We recommend the following to take forward the new NICE guidelines: • NICE should work with organisations such as Cancer Research UK, the Royal College of GPs and Macmillan Cancer Support to disseminate and communicate the new referral guidelines to GP practices as quickly as possible.

Trainers’ Workshop NICE Guidance (NG12) Aim The aim of the guidelines is to improve cancer diagnosis: The timeliness The quality The consistency Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) Implementation “While guidelines assist the practice of healthcare professionals, they do not replace their knowledge and skills.” Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) Implementation “For all clinical scenarios it is assumed that the health professional will have a discussion with the patient about the risks and benefits of intervention, enabling the patient to exercise a fully informed decision.” Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) Implementation The guideline focuses on those areas of clinical practice: That are known to be controversial or uncertain Where there is identifiable practice variation Where there is lack of high quality evidence Where NICE guidelines are likely to have the most impact. Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) Implementation It is assumed that: an appropriate history and physical examination are undertaken urinalysis is undertaken where appropriate simple blood tests (Fbc, biochemistry and inflammatory markers) are done Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) What is new? This is the first guidance that uses primary care evidence, which is available for the first time Adds symptom pathways for the first time Uses the same referral thresholds for all cancers Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) What is new? This is the first guidance that uses primary care evidence, which is available for the first time Adds symptom pathways for the first time Uses the same minimum referral thresholds for all cancers (PPV 3%) Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) What is new? (General) Many – being symptom centred and using 3% PPV, the ages vary (range 30-60) Some criteria have been dropped (no evidence to support them) Timeline specifics have gone – replaced with “recurrent” or “persistent”. Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics) Relevance of ↑ Platelet count Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics) Relevance of ↑ Platelet count Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first Br J Gen Pract 2017; 67 (659): e405-e413. 

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics) Relevance of ↑ Platelet count 7.8% of patients (11.6% of males, 6.2% of females) will have a 1 year cancer incidence: Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first Br J Gen Pract 2017; 67 (659): e405-e413. 

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics) Relevance of ↑ Platelet count 7.8% of patients (11.6% of males, 6.2% of females) will have a 1 year cancer incidence: If a second blood test shows platelet count to be the same or higher: 18.1% of males and 10.1% of females will have a 1 year cancer incidence Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first Br J Gen Pract 2017; 67 (659): e405-e413. 

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics) Relevance of ↑ Platelet count Seen in cancers of: Lung Lower GI Prostate Breast OG Ovarian Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first Br J Gen Pract 2017; 67 (659): e405-e413. 

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics - examples) 2ww lung - Haemoptysis only in 40+ Mesothelioma now covered Lower GI – high risk groups (eg ulcerative colitis) not mentioned. 2ww breast: unexplained axillary lump Haematuria and ↑platelets →gynae ultrasound Dermatoscopy suggestive of melanoma → 2ww dermatology Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop NICE Guidance (NG12) What is new? (Specifics - examples) Persistent bone pain, unexplained fracture: do Fbc + ESR 60+ with hypercalcaemia/↓wbc: electrophoresis and BJP within 48h Palpable abdominal mass <16 (used to be under 1y) Start with some background. Cancer strategy for England in July 2015, developed by an Independent Cancer Taskforce (on which RCGP was represented), presents a vision for cancer control in the next five years. These are strategies that lay out a vision and plan for the future: a framework to guide our thinking. But what do these strategies mean in practice? And more specifically what does this mean for primary care? Let’s consider the scale of the challenge first

Trainers’ Workshop Safety netting.

Trainers’ Workshop Safety netting.

Trainers’ Workshop Safety netting. If I’m right what do I expect to happen? 2. How will I know if I’m wrong? 3. What would I do then? Neighbour, R. The inner consultation. Oxford, England: Radcliffe Publishing, 2004.

Trainers’ Workshop .

Trainers’ Workshop Value in investing in early diagnosis: Results?

Trainers’ Workshop Value in investing in early diagnosis: Results? Better medicine – earlier diagnosis (not just of cancer) Fewer consultations Better outcomes Less complaints/litigation Less £££

Trainers’ Workshop Key to early diagnosis of cancer

Trainers’ Workshop Key to early diagnosis of cancer Education

Trainers’ Workshop Key to early diagnosis of cancer Education – public Education – patients Education – profession

Trainers’ Workshop Key to early diagnosis of cancer Education – public Education – patients Education – profession Education – policy makers

Trainers’ Workshop Key to early diagnosis of cancer Education – public Education – patients Education – profession Education – policy makers Education – politicians

Earlier Diagnosis of Cancer Trainers’ Workshop Earlier Diagnosis of Cancer Cancer: why all the interest? Why is it important? How have we done? How could we do even better?

Trainers’ Workshop The ones who are crazy enough to think they can change the world, are the ones who do.

Trainers’ Workshop The ones who are crazy enough to think they can change the world, are the ones who do. Steve Jobs 1955-2001

Trainers’ Workshop Our common goal?

Trainers’ Workshop Our common goal?

Trainers’ Workshop One person can make a difference, and everyone should try.

Trainers’ Workshop One person can make a difference, and everyone should try. John F Kennedy 1917-1963

Trainers’ Workshop Thank you

Trainers’ Workshop Any questions?