1. 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 McLenachan, User Involvement representative
16th May 2017

2. Housekeeping There are no scheduled fire drills
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

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

5. Greater Manchester Cancer
Aims and Objectives
Vanguard Innovation
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

6. Greater Manchester Cancer
Project Governance
Vanguard Innovation

7. 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

8. 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

9. Lung Pathway Flowchart
Greater Manchester Cancer
Vanguard Innovation

10. 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

11. 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

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

13. 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

14. Direct to Test Flow chart
Greater Manchester Cancer
Vanguard Innovation

15. Flow Chart for Pre-Assessment
Greater Manchester Cancer
Vanguard Innovation

16. 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

17. GO LIVE! Went “live” on Monday 3rd 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

18. 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

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

20. 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

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

22. 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

23. 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

24. 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

25. Lisa Galligan-Dawson – lisa.galligan-dawson@boltonft.nhs.uk
Contact
Lisa Galligan-Dawson –
Melissa Surgey –
Martina Kingscott –
Greater Manchester Cancer
Vanguard Innovation

26. Questions
Greater Manchester Cancer
Vanguard Innovation

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