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

2. MDC Pilot Rationale: Danish experience
Like Britain strong gatekeeper role of GPs
relatively low cancer survival
Vedsted and Olesen 2011
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4. Only 10% of patients with rectal bleeding consult their GP
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5. Refer Certainly not serious Low risk but not no risk
Definitely serious
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6. Danish ‘three legged model’
Specific worrying symptoms – 2ww
Low risk but not no risk – open access/STT
Vague, non-specific but worrying symptoms - MDC
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7. 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
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10. 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
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11. results 91 patients referred to UCLH
93% offered an appointment within 5 days to see CNS
All seen by consultant within 28 days
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14. diagnosis Cancer: metastatic pancreatic lymphoma ovarian
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15. 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!
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16. diagnosis Benign: Gallstones requiring surgery 4 pancreatitis 2 TB
oesophageal pouch
renal lesions 3
bulky ovaries
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18. Resources required CNS Pathway co-ordinator Consultant time
Imaging and endoscopy access
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19. Challenges faced Job planning – and variable demand
Communication with GPs
Establishing referral criteria
Clinic space
Patient choice
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20. 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
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21. 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
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