1. Old Trafford 21 September 2017
Greater Manchester Cancer
Vanguard Innovation
Showcase: Patient self-referral Tony Bishop, service user representative Professor Kenneth Muir, Professor of Epidemiology, University of Manchester
Old Trafford
21 September 2017

2. Housekeeping There are no scheduled fire drills
Greater Manchester Cancer
Vanguard Innovation
Housekeeping
There are no scheduled fire drills
We will be taking photos – please let us know if you don’t want your picture taken
The presentation will be online after the event
Phones on silent, but follow us on

3. The national Cancer Vanguard
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

4. Two times cancer patient!
Greater Manchester Cancer
Vanguard Innovation
Two times cancer patient!
Catching the cancer early was vital to the outcome for me
So I feel strongly that early diagnosis is the answer

5. Whose job is it to ‘find’ cancer?
Greater Manchester Cancer
Whose job is it to ‘find’ cancer?
Vanguard Innovation
In the 1970s, aged 28, I kept getting a hoarse voice
My GP advised throat lozenges, no other investigations
Unhappy with that, I resorted to going to see my company doctor. He took it seriously and did appropriate referrals
I was diagnosed with cancer of the larynx.

6. What ifs…… What do you think of my voice?
Greater Manchester Cancer
What ifs……
Vanguard Innovation
What do you think of my voice?
If cancer of the larynx hadn’t been found when it was, my treatment would have had to be more radical, for example to have my voice box removed and I wouldn’t even have the voice I have now!
Persistent patient!!! Describe what that would have been like as a young man, early in your career, newly married….. emphasise how it would have affected you and in turn effected your family, your future.

7. A job for the persistent patient?
Greater Manchester Cancer
A job for the persistent patient?
Vanguard Innovation
In 2008, once retired, I was concerned at not getting a routine medical check up, so I took up an offer of a BUPA health check which included blood tests
An examination and the PSA test found prostate cancer
No screening for prostate cancer even though PSA provides an indicator
Prostate cancer detected early so I've survived with minimal effects on my lifestyle
Emphasis on the minimal effects – treatment while in the early stages much more effective.

8. Why am I here? Being heard speaking up Having a voice
Greater Manchester Cancer
Why am I here?
Vanguard Innovation
speaking up
Having a voice
Being heard
Make the point that apart from literally not being heard by GP, having a voice through the User Involvement programme is important to me because cancer can have such a big impact on your life and the earlier it is caught and treated the better the result for the patient.
It is through the User Involvement team I have been working with the team on this project and I am really interested to see if people will have a go at this self referral. I see your role as essential in getting the message out to people.

9. Greater Manchester Cancer
Vanguard Innovation
Importance of early diagnosis: survival time is more than three times higher when cancer is diagnosed early
10 year survival data from East of England for eight major cancers
(bladder, bowel, breast, cervical, womb, malignant melanoma, ovarian and testicular )

10. Question? – show of hands, please
Greater Manchester Cancer
Vanguard Innovation
Question? – show of hands, please
How many of you went to a travel agent to choose/book your last holiday?
How many of you used the internet to choose/book your last holiday?

11. Greater Manchester Cancer
Vanguard Innovation
The aim of this program of work is to derive an effective and cost-effective way to increase the direct referral for timely investigation of patients with potentially indicative cancer symptoms and thereby reduce delays in receiving a definitive diagnosis or discharge.
To do this we will perform within the current cancer Vanguard funding envelope a one-year pilot with the following objectives:
To develop a risk-based approach to direct symptom-based referral from the community.
To widen access to community-based engagement opportunities to pilot the model.
To assess users’ views and experiences of using the approach.

12. Current Pathway Greater Manchester Cancer Vanguard Innovation
illustrates the status quo from patient becoming symptomatic to being seen in a hospital cancer clinic
Bold black text: factor that determines the length of each interval. Green: positive influences. Red: Negative influences. Lists are non-exhaustive.
Ignorance is the time until patient realises that the symptom is relevant / significant
Hesitancy is when they know but don’t act yet
Primary Care Access is between contacting the surgery and when the actual appointment takes place. “Receptionist interval”
Primary Care interval is the time that the GP investigates / reviews / assesses until they come to the conclusion that an urgent referral is needed. This is often zero where there are specific symptoms but could be weeks or months where symptoms are less clear
2WW standard is the NHS constitution guaranteed waiting time of no more than 14 days for a suspected cancer clinic appointment, usually 7-14 days.
We know very little about the first three intervals, as they are difficult to measure (outside a dedicated research project that surveys patients, that is. And that would still not tell us anything about the Ignorance interval).

13. Proposed Pathway Enhancement
Greater Manchester Cancer
Proposed Pathway Enhancement
Vanguard Innovation
Thus as the figures demonstrate there are a number of steps in the process before the patient is referred on that we could potentially affect in a number of different ways. One important way is a more direct referral route by assessing the risk of people based on indicative symptoms. Such symptoms have been identified as indicative of an undiagnosed cancer. Identifying these symptoms to the individual concerned and facilitating further checking can help identify earlier people that may otherwise delay engagement with the medical profession until later.
The key implementation step though is assessing how this approach can be used in the community and that is what we will do in this project.

14. Greater Manchester Cancer
Does it work?
Vanguard Innovation

15. Yin/Yang Prevention/Early detection
Greater Manchester Cancer
Vanguard Innovation
Yin/Yang Prevention/Early detection

16. REFLECT –Manchester website
Greater Manchester Cancer
Vanguard Innovation
REFLECT –Manchester website

17. Greater Manchester Cancer
Vanguard Innovation

18. Greater Manchester Cancer
Vanguard Innovation
Acknowledgements

19. Thank you Follow us on Twitter @GMCancerUI
Greater Manchester Cancer
Thank you
Vanguard Innovation
More information on the User Involvement Programme, including Vanguard projects
gmcancer.org.uk/our-areas-of-work/user-involvement
Follow us on

20. Greater Manchester Cancer
Vanguard Innovation

21. Greater Manchester Cancer
Panel
Vanguard Innovation
Professor Ken Muir, Professor of Epidemiology, University of Manchester
Tony Bishop, Service User Representative
Marzena Nieroda, Lecturer in Marketing, University of Manchester
Dr Artitaya Lophatananon, Research Fellow, University of Manchester
James Clark, Programme Manager, Greater Manchester Cancer Vanguard Innovation

22. Greater Manchester Cancer Vanguard Innovation
Web: gmcancervanguardinnovation.org