1. [NAME CCG/Health Body] [DATE] [FACILITATOR]
Early Diagnosis of Cancer Quality Improvement using Cancer Significant Event Analysis
This slide set supports presenters to deliver education and training to GPs on the use of high quality cancer SEAs to promote early diagnosis. It also includes guidance for CCG/Health Body or Cancer leads to extract themes generated from SEAs in order to make recommendations that maximise impact and quality improvement in general practice and across the primary secondary care interface.
It is intended for GP cancer leads, CCG/Health Body cancer leads, trainers, programme directors, appraisers and facilitators.
The notes can be used verbatim or paraphrased. Some slides contain comments that are intended to serve as prompts or reminders. These are not visible in the main presentation.
Extra notes below provide additional knowledge and details about references quoted or how to obtain particular useful information or resources.
Underlined notes are instructions.
While you are waiting for the learners (including GPs, practice nurses, GP trainees and non clinical primary care team members) it is useful to get them to think about their current practice’s approach to new cancer diagnoses and their own experiences in using Significant Event Analysis (SEAs) as a quality improvement tool, in particular with respect to cancer. Here are a few suggestions:
In advance of todays learning event ask attendees if they wish to bring any cancer-specific SEAs that they are happy and comfortable to discuss openly with the group
Offer the GP Resource pack to look at (available here: #######)
Ask the learners to discuss emergency presentations of a new cancer diagnosis they have encountered in the past year and if there were any learning points regarding barriers and enablers towards early diagnosis of cancer
Print out and ask the group to consider and chat about some of the SEA examples that will be used for the small group workshops later on in the learning event
Let’s begin!
Slide 1 presenter notes:
Introductions should include your name, role, support staff/colleagues and general housekeeping.
Welcome to the RCGP, NHSE and Macmillan supported learning event on Early Diagnosis of Cancer Quality Improvement using Cancer SEAs. I hope you all agree primary care has a crucial and valuable role in early diagnosis of cancer.
Next slide.
[NAME CCG/Health Body] [DATE] [FACILITATOR]
[CCG/Health Body MAP]

2. Overview of learning event
Regional Cancer Stats
Cancer SEA
Quality
Themes
Quality Improvement Tools
Workshop
Plenary
Toolkit and Resources
Slide 2 presenter notes
We suggest you decide in advance of the learning event whether you wish to focus on Cancer SEA quality and themes exclusively or whether to also include additional components on Safety Netting and Cancer Decision Support Tools (Also known as Risk Assessment Tools). A sample agenda is available at ###### for you to tailor accordingly.
Safety Netting resources are available at ######
Cancer Decision Support Tools are available at #######
Explain to the group the overview of the learning event as stated in the slide.
Cancer is an emotive condition and it is likely we have all been touched by it; either personally, through family or friends and of course professionally. Many people attending today may have come across a cancer(s) where upon reflection it could have been detected sooner. These are the cases we never forget. We also know every cancer story is unique. Many of the cancers that present late or as an emergency presentation have vague and non-specific symptoms early on before disease progression. These symptoms can be challenging to identify and interpret not only for patients but also for clinicians. How can we learn as individuals, practices, within CCGs/Health Bodies or collectively from each cancer journey?
First we will take a look at our local cancer statistics to provide some context of why this is a priority for the region. Nationally cancer is the leading cause of premature deaths (those under 75 years old) and the incidence is increasing. 1 in 2 people, so half of us in the room are predicted to have cancer at some point in our lifetime.
Todays learning event will provide you with the tools and support to use Cancer SEAs as a learning and quality improvement tool. We will discover what makes a high or poor quality Cancer SEA, identify themes generated and how they can be used to target improvements.
We will review a range of Sample SEAs (Patients A, B and C) in small group workshops and then come together at the Plenary to hear from each group and feed back to the room about what we have learned in terms of using Cancer SEAs to identify barriers and enablers to early diagnosis.
All the information provided today including a GP resource pack is available online as part of this toolkit: ##########
Next slide.

3. Learning Objectives To be able to undertake a high quality Cancer SEA
To identify themes for action
To target quality improvement
To recognise the importance of proactive safety-netting (optional)
To use clinical decision support tools for earlier diagnosis (optional)
Slide 3 presenter notes
You may wish to describe the list of learning objectives.
You should amend this slide if you are also including components on Safety Netting and Cancer Decision Support Tools
The aims of today’s learning event are to demonstrate how Cancer SEAs, when done well, can be used to identify areas to target service and quality improvement measures. We hope by the end of the event you are feeling more confident in how to conduct a high quality Cancer SEA, maximising reflection and using the Cancer SEA template be able to deconstruct a patient’s route to a diagnosis of cancer taking into account all roles and responsibilities involved. This may include yourself, colleagues within the practice and secondary care, reviewing practice systems and of course the patient and family’s behaviours.
Next slide

4. Overview of learning event
Regional Cancer Stats
Cancer SEA
Quality
Themes
Quality Improvement tools
Workshop
Plenary
Toolkit and Resources
Slide 4 Presenter notes
We suggest you ask attendees when they sign up for the learning event to inform you of their affiliated CCG/Health Body in order for you to source the correct data. Ideally the learning event will be for several GPs within one CCG/Health Body however if delivering this across a sector you may wish to try to be as inclusive as possible.
We will now reflect on some cancer epidemiology specific to our locality or CCG/Health Body(s). It would be useful for you to have an overview on local cancer activity in and reflect together on the statistics.
Next slide

5. Why is cancer a priority?
Cancer is the leading cause of premature death …..and the incidence is increasing…
Cardiovascular deaths : x/100,000
Cancer deaths: x/100,000
England average x/100,000
[Access your local Health Profile here:
By 2020, almost half of those who die in that year will have had a cancer diagnosis during their lifetime.
The number of people living with cancer in
the UK will go up by 30%
between 2013 and 2020.
Slide 5 presenter notes
Using the resources below you can access CCG/Health Body or locality specific cancer epidemiology to present and reflect upon. You may wish to emphasise the point that cancer incidence and survivorship is increasing which means that early diagnosis is becoming even more essential. The green text box provides projections on cancer incidence and prevalence which affirms cancer as a primary care priority in particular early diagnosis
Public Health England have created profiles on each borough. Within each profile is data relating to cardiovascular and cancer related premature deaths (so patients under 75 years old) and the England mean in order for you to make comparisons. Please insert the relevant figures into the slide in the top left hand text box and crop the Early deaths from cancer graph also located within the Health profile.
Access your local Health Profile here:
Cancer has overtaken cardiovascular disease as the leading cause of premature deaths in England. This is due to the excellent healthcare delivery and advancements in how we manage hypertension, hyperlipidaemia and efforts towards smoking cessation. Early deaths caused by cancer exceed those caused by other long term conditions. This highlights the importance to recognise cancer as the primary care priority. Use the links in the slides to access your CCG/Health Body cancer statistics and describe these in context of the national mean.
Next slide
INSERT EARLY DEATHS FROM CANCER GRAPH
Available from your local Health Profile. Access at

6. UK outcomes lag behind
Slide 6 presenter notes
This slide provides information on the UKs position in comparison to other countries with similar healthcare systems. This data comes from the International Cancer Benchmarking Partnership. As you can see the 1 year survival for colorectal, lung, breast and ovarian for the UK (orange line) is improving however we are still much poorer in our outcomes compared with other countries with similar healthcare models and systems. Use this slide to inject positive energy. The graphs indicate that the gaps are closing and the UK is catching up however other countries are also showing improvements in survival as a whole. Breast cancer survival has improved by the largest increment compared wit other cancers. GPs are best place to improve early diagnosis and therefore survival - however this is a complex issue. SEAs can help provide intelligence for to tackle the issues leading to emergency presentations / late stage diagnoses or delayed diagnoses.
Early diagnosis matters for obvious reasons. Logically and evidentially early diagnosis leads to better outcomes, survival, quality of life and patient experience. The Cancer Task Force Report features early diagnosis and in particular Cancer SEAs and their use as a quality improvement and educational tool for emergency presentations of cancer. What can we learn from them and each other?
Next slide

7. Early Diagnosis Stats CCG/Health Body NAME National Average
Emergency Presentations 2013 (%) X
23.7
% NON-2WW 2014/15 Q1 51
6 weeks for diagnostics
2015 (%)
98.3
bowel cancer 2015 (%)
95.6
Stage 1 or 2 at diagnosis 2015 (%)
54.5
Conversion 2ww Rate 2014/15 Q1 (CR %)
8.4
Slide 7 presenter notes
This slide allows you to present data for your CCG/Health Body or borough and compare with the national mean. Please populate the table using the links and check the National average column as data is refreshed and the dates provided may need to be updated also. You can find you local data using the resources below:
and click on the Early diagnosis tab
Describe the regional cancer statistics for your CCG/Health Body and ask the audience to comment and reflect on these figures. . This includes emergency presentation rates, cancer detection rates, access to diagnostics, early stage diagnosis rates and conversion rates for suspected cancer referrals.
By comparing emergency presentation rates with the national mean this presents an opportunity to identify an area for local improvement. The national mean is continuing to improve. As a group you should also reflect on the reasons for the data.
Lets take a moment to reflect. Ask the learners what may be contributing to:
Higher or lower emergency presentations of a new cancer rates
Higher or lower percentage of cancers NOT being diagnosed through the suspected cancer referral pathways / two-week wait routes
Access to diagnostics figures
Higher or lower numbers of Stage 1 or 2 at diagnosis
Higher or lower conversion rate (percentage of suspected cancer referrals that convert to a cancer diagnosis)
By comparing with the national average learners should now have a sense of the context of cancer epidemiology and their landscape.
Next slide

8. Colorectal cancer – survival rate plotted against stage of diagnosis
Slide 8 presenter notes
This slide shows the dramatic reduction in survival with each stage at diagnosis for colorectal. Another example is for breast cancer where 90% of women diagnosed at stage 1 will survive at least 5 years, whilst 90% of those diagnosed at stage 4 will have died before 5 years.
Early detection and treatment for cancer is critical for survival.
The Problem is complex:
Cancers are not being diagnosed early enough in primary care.
Emergency presentations of cancer comprise 20 per cent of all cancers - lung and colorectal being the most common.
It can be difficult to differentiate early symptoms of a cancer
Up to 50% of cancer patients in UK did not have NICE symptoms suspicious for cancer (Neal et al. BJC, 2014).
Next slide
If diagnosed at stage A, colorectal cancer has a 93% survival rate
Source: National Cancer Data Repository, 2009

9. Overview of learning event
Regional Cancer Stats
Cancer SEA 
Quality
Themes
Quality Improvement Tools
Workshop
Plenary
Toolkit and Resources
Slide 9 presenter notes
Here is an opportunity to ask and engage with the audience some more. We suggest you ask the audience which cancers they have seen presenting as an emergency and to list the ones most likely to do so.
Answers should include: Lung, colorectal, brain, ovarian, pancreas
Next slide

10. Cancer SEAs Quality Improvement Tool Not about blame or judgement
Case selection, Reflection, Quality, Action and Impact
Identify learnings points and share good practice
Make recommendations for quality improvement
Not about blame or judgement
Supported by NHSE, RCGP and Macmillan Cancer Support
Slide 10 presenter notes
This slide should be used to introduce and signpost the learners to the RCGP Macmillan NHSE Early Diagnosis of cancer Quality Improvement using Cancer SEAs toolkit. Available at: #####
The toolkit provide a GP Resource pack in which provides information, templates and resources to support GPs and practices to do Cancer SEAs for new cancer diagnoses. It is important to emphasise that Cancer SEAs are an opportunity to encourage debate and reflection without blame in a non-judgmental environment.
Cancer SEAs are an educational and quality improvement tool. It is an opportunity to identify learning points and share good practice. It also helps to identify enablers and barriers to early diagnosis.
The Cancer SEA itself was developed in 2012 from the generic SEA created by the National Patient Safety Agency; the Cancer SEA has been supported and developed by NHSE, RCGP and Macmillan.
SEAs are a powerful resource to identify targets for quality improvement that help patients most and can be carried out locally. An example may include CCGs/Health Bodies who do not have direct access urgent investigations as recommended by NICE, Suspected cancer and recognition, NG12 (NICE, 2015) or practices may identify sub-optimal less robust in-practice safety netting systems.

11. Your experiences Established method of learning
Good and unexpected outcomes can be used for learning
Insight, transparency, non-judgemental
Sharing = learning
Slide 11 presenter notes
We suggest you ask learners if they have completed a Cancer SEA on a late or delayed diagnosis of cancer
Why did they do a Cancer SEA?
Did they identify that something needed to be changed?
How valuable was it for your patient(s) and practice?
If so do they use a template? Which one?
Do they have regular practice meetings?
Encourage the audience to share their Cancer SEA experiences. This may not be early diagnosis specific as many GPs may do SEAs for patient at end of life however you can establish the learning as a result and encourage this as a quality improvement activity at practice and CCG/Health Body level.
SEAs are an established method of learning and have been used as a Quality Improvement Tool for 30 years in general practice.
Next slide

12. Why do a Cancer SEA? Evidence of reflection Appraisal Revalidation
CQC inspections
Achieving world-class cancer outcomes-a strategy for England
Recommendation 25: All GPs should be required to undertake a Significant Event Analysis for any patient diagnosed with cancer as a result of an emergency admission.
Slide 12 presenter notes
This slide shows all the reasons why GPs should undertake Cancer SEAs. From a professional development point of view Cancer SEAs can be used as evidence of active reflection for annual appraisals, revalidation and CQC inspections.
The Cancer Task Force published Achieving world-class cancer outcomes-a strategy for England It contained 96 recommendations across primary, secondary and public sectors. Recommendation 25 stated All GPs should be required to undertake a Significant Event Analysis for any patient diagnosed with cancer as a result of an emergency admission. This toolkit should be used to support CCGs/Health Bodies who wish to implement this recommendation.
Next slide

13. Why do a Cancer SEA? Done well is worth the effort
Benefits it can bring for clinicians, patients, the practice as a whole and the primary-secondary care interface.
It would generate the ‘nudge’ across the board towards reflective thinking and quality improvement.
Enhances the reflective process
Deconstruct the journey to diagnosis
Unpick themes
Lead to a range of improvements
better communication
modifying practice systems
improving documentation
proactive safety netting.
Slide 13 presenter notes
This slide lists the benefits of a Cancer SEA. You may wish to refer to some of the examples provided by the learners of how Cancer SEAs resulted in real change. This will help to keep the audience engaged.
A Cancer SEA done well is worth the effort for the benefits it can bring for clinicians, patients, the practice as a whole and the primary-secondary care interface. This toolkit drives reflective thinking and targeted quality improvement to improve early diagnosis of cancer.
Next slide

14. Case selection Choice of case is important Emergency presentation
Late stage diagnosis
Avoidable delay
RCGP cancer diagnosis audit tool to track activity in a practice
Slide 14 presenter notes
This slide can be used to support GPs how to best select a case for a Cancer SEA. A practice can keep an annual list of all new cancer diagnoses using the RCGP cancer diagnosis audit tool available at RCGP-NCATcancerdiagnosisaudittoolRevisedFeb2011.xlsx
This audit tool collates a practice’s cancer activity and auto-calculates the types of cancers as well as the various routes to diagnosis, including emergency presentations. This can be used to select cases suitable for a Cancer SEA including cases where a delay may have been avoidable.
The choice of case is important. We recommend you stay away from the ‘breast lump’ symptom which is referred appropriately at initial presentation as there may be little learning to be gained. We recommend, as doe the Cancer Task Force, to look at all emergency presentations, unexpected cancer diagnoses and late stage diagnoses. These cases will hopefully lead to a more enriched conversation within a practice and provide opportunities to make improvements.
Next slide

15. Practice activity Practice meeting
Inclusive of all staff – clinical and admin
Involve hospital where relevant
Liaise with CCG/Health Body cancer lead if needed
‘Actions the actions’ agreed in the discussion
Slide 15 presenter notes
This slide focusses on Cancer SEAs as a whole practice team activity. It should include clinical and administrative colleagues as areas of improvement may be to address in-practice systems which affect the entire practice team. You should encourage GPs and practices to escalate Cancer SEAs to their CCG/Health Body cancer lead and to involve secondary care colleagues where necessary. You should emphasise the importance of the last bullet point as that is the key outcome of completing a Cancer SEA: to effect real change.
A Cancer SEA is best done as a practice activity, perhaps in the course of a practice team meeting. It should specify who participated and who was responsible for implementing any changes. The Cancer SEA should document whether all relevant individuals attended and whether the conclusions should be discussed with any other staff inside or outside the practice. An effective SEA not only identifies the learning points and actions to be taken but also puts changes into effect and monitors their impact.
Specifying practice staff member or groups who will be responsible for the agreed action points and deciding how their impact will be monitored comprises a high quality Cancer SEA.
Next slide

16. What is a Cancer SEA?
An account of an SEA should not allow patients to be identified and should comprise:
Title and date of the event
Date the event was discussed and the roles of those present
A description of the event involving the GP(s) and other colleagues
What went well?
What could have been done differently?
Slide 16 presenter notes
This slide summarises the components of a Cancer SEA
The toolkit available at ####### contains the Cancer SEA template which prompts guided reflection.
The Cancer SEA template was first developed in after a pilot conducted by Macmillan and RCGP. The outcome of the pilot was a bespoke Cancer SEA template for new diagnoses. This template was developed from the original significant event analysis designed by the National Patient Safety Agency. For this toolkit, the cancer SEA template has been adapted to include an ‘outcomes’ section focussing on changes carried out as a result of the cancer SEA and the impact or potential impact(s) on the GP, practice team and patient(s). Traditionally SEAs are recommended when any event is thought to be significant in patient care or in the running of the practice.
An account within a Cancer SEA should not allow patients to be identified and should also comprise:
Title and date of the SEA discussion and subsequent events
Date the event was discussed and the roles of those present
A description of the event involving the GP(s) and other colleagues
Next slide

17. What is a Cancer SEA? Reflections on the event in terms of:
knowledge, skills and performance
safety and quality
communication, partnership and teamwork
maintaining trust
What changes have been agreed:
for me personally
for the team
Changes carried out and their IMPACT
Slide 17 presenter notes
This slide shows how Cancer SEAs align with the GMC’s Good Medical Practice Guide.
You may wish to remind learners that best practice includes maintaining knowledge, skill and performance, improving safety and quality, reviewing and maintaining a high standard of communication, partnership and teamwork and sustaining trust for patients and within the team.
Whether clinical, administrative or organisational, the SEA process enables the following questions to be answered:
What happened and why?
What was the impact on those involved (patient, carer, family, GP, practice)?
How could things have been different?
What can we learn from what happened?
What needs to change?
What changes have been agreed for me personally and the practice team, roles and agreed timelines for action(s)
Changes carried out and their impact
Specifying practice staff member or groups who will be responsible for the agreed action points and deciding how their impact will be monitored comprises a high quality Cancer SEA.
Next slide

18. Practice process Slide 18 presenter notes
1. LEADERSHIP
Develop a primary care offer for GP practices. This will maximise engagement and sustainable interest
2. EDUCATION
Deliver education to GPs on Cancer SEAs as a quality improvement tool
3. SHARE LEARNING
Encourage honest reflection and facilitate non-judgemental discussion from Cancer SEAs
4. THEMATIC ANALYSIS
Analyse themes using the checklist
5. ACTIONS
Discuss themes and actions taken affecting multiple practices or at Trust level; share learning, identify good practice
6. IMPACT
Implement improvements. Demonstrate real impact to improve patient care. Improve interface with secondary care
Slide 18 presenter notes
This slide offers a suggestion of how GPs may wish to run Cancer SEAS in their practice. The flow diagram can assist you to navigate the GPs through this suggested practice process. Encourage GPs to appoint a practice cancer lead to oversee and lead on this as part of their commitment to early diagnosis. You may wish to encourage trainers to suggest this as a project of GP trainees.
CASE SELECTION
Case selection is important. GPs should be encouraged to conducts Cancer SEAs on emergency presentations of a new cancer diagnosis, late stage cancers or patients who incurred an avoidable delay
2. CANCER SEA
The toolkit available at ##### contains the Cancer SEA template which contains prompts for supported reflection and discussion
3. FEEDBACK INSTRUMENT
The toolkit contains a feedback instrument which can be used to self-appraise the quality of reflection. This may also be useful for appraisers and trainers when offering feedback to colleagues
4. THEMATIC ANALYSIS
The toolkit contains a checklist of themes that have been or could be explored within a Cancer SEA. Examples include documentation quality or safety netting systems
5. PRACTICE TEAM MEETING
This is where themes, shared learning, identifying improvements and good practice is discussed
6. ACTIONS and IMPACT
This is the most important part of the Cancer SEA process. Practice teams should implement improvements and clearly set out roles and timelines agreed. This is where practice teams can effect real impact to improve patient care. GPs may wish to look at the RCGP Quality Improvement in General Practice Guide (available at
Next slide

19. What happened? Slide 19 presenter notes
This slide shows a screenshot of the Cancer SEA template available in the toolkit. It demonstrates the prompt questions within each of the six sections
Section 1 is titled WHAT HAPPENED?
GPs should describe the process to diagnosis for the patient in detail, including dates of consultations, referral and diagnosis and the clinicians involved in that process.
Consider the following:
The initial presentation and presenting symptoms (including where if outside primary care)
The key consultation at which the diagnosis was made
Consultations in the year prior to diagnosis and referral.
How often the patient had been seen by the practice and the reasons
The type of consultation held: telephone, face-to-face, home visit and who consulted with the patient (GP1, GP2, Nurse 1)
Whether s/he had been seen by the Out of Hours service, at A&E, or in secondary care clinics
If there appears to be delay on the part of the patient in presenting with their symptoms
What the impact or potential impact of the event was.
Next slide

20. Why did it happen? Slide 20 presenter notes
This slide shows a screenshot of the Cancer SEA template available in the toolkit. It demonstrates the prompt questions within each of the six sections
Section 2 is titled WHY DID IT HAPPENED?
GPs and practice teams should reflect on the process of diagnosis for the patient and consider:
If this was as good as it could have been (and if so, the factors that contributed to speedy and/or appropriate diagnosis in primary care).
How often / over what time period the patient was seen before a referral was made and the urgency of referral
Whether proactive or electronic safety-netting / follow-up was used (and if so, whether this was appropriate)
Whether there was any delay in diagnosis and if so, the underlying factors that contributed to this
Whether appropriate diagnostic services were used with adequate access or availability
Whether the reason for any delay was acceptable or appropriate
Next slide

21. What has been learned? Slide 21 presenter notes
This slide shows a screenshot of the Cancer SEA template available in the toolkit. It demonstrates the prompt questions within each of the six sections
Section 3 is titled WHAT HAS BEEN LEARNED?
GPs should be able to demonstrate that reflection and learning have taken place, and that team members have been involved in considering the process of cancer diagnosis.
Consider the following:
Education and training needs around cancer diagnosis and/or referral.
The need for protocols and/or specified procedures within the practice for cancer diagnosis and/or referral.
The robustness of follow-up and safety netting systems within in the practice.
The importance and effectiveness of team working and communication (internally and with secondary care).
GPs should reference the literature, guidance local pathways and protocols that support the learning points
The role of NICE guidelines, NG12 Suspected cancer: recognition and referral (2015)
Next slide

22. What has been changed? Slide 22 presenter notes
This slide shows a screenshot of the Cancer SEA template available in the toolkit. It demonstrates the prompt questions within each of the six sections
Section 4 is titled WHAT HAS BEEN CHANGED?
This section outlines the action(s) agreed and/or implemented and who will/has undertaken them. Consider the following:
If a protocol is to be introduced, updated or amended, how it will be implemented.
Which staff members or groups will be/were responsible (GPs, Nurses, Receptionist) and how the related changes will be monitored.
If there are ‘actions’ that individuals or the practice as a whole will do differently detail the level at which changes are being made and how are they being monitored
What improvements will result from the changes; will the improvements benefit diagnosis of a specific cancer group, or will their impact be broader.
Clinical, administrative and cross-team working issues.
Next slide

23. Impact Slide 23 presenter notes
This slide shows a screenshot of the Cancer SEA template available in the toolkit. It demonstrates the prompt questions within each of the six sections
Section 5 is titled WHAT HAS BEEN THE IMPACT AS A RESULT OF THE CANCER SEA?
GPs should outline here the impact or potential impact on the patient, family/carer(s), GP and practice. Practice teams should consider the following:
How did the pathway to diagnosis impact the patient and their family/carer(s)
Has the pathway to diagnosis affected the patient–GP (or practice) relationship, and in what way (positive or negative).
Has the pathway to diagnosis for this patient impacted on how individual GPs or the practice as a whole deal with other patients
What is the potential impact of any changes on the systems within the practice?
Next slide

24. Was it effective? Slide 24 presenter notes
This slide shows a screenshot of the Cancer SEA template available in the toolkit. It demonstrates the prompt questions within each of the six sections
Section 6 is titled WHAT HAS BEEN EFFECTIVE ABOUT THIS CANCER SEA?
Practice teams are asked to consider how carrying out this SEA has been valuable to individuals, to the practice team and/or most importantly to patients/families/ carer(s). This section prompts GPs to document and reflect on the following:
Who attended and whether the relevant people were involved
Duration of practice team meeting
What was effective about the SEA discussion and process
What could have made the SEA more effective in terms of encouraging reflection, learning and action.
Next slide

25. Themes Checklist (1) Avoidable or unavoidable delays
Clinical Presentation
Communication
Co-morbid long term conditions
Complexity of the case
Consultation activity
Continuity
Documentation quality
Education and guidelines
Slide 26 presenter notes
These next three slides list a number of themes that can be explored and targeted for quality improvement. In efforts to maximise reflection and identify areas for development and improvement generated from a Cancer SEA we suggest you use the SEA thematic checklist in the toolkit available at #######. It may help to explore whether reflection has been extensive enough and also to prompt themes that could have been discussed or actioned more proactively.
The list of themes include:
Avoidable or unavoidable delays
Clinical Presentation
Communication
Co-morbid long term conditions
Complexity of the case
Consultation activity
Continuity
Documentation quality
Education and guidelines
Next slide

26. Themes Checklist (2) History of a previous cancer In-practice systems
Investigations and access to diagnostics
Patient education and awareness
Patient safety
Practice staff issues
Practitioner issues
Primary-secondary care interface
Slide 27 presenter notes
This slide continues to list a number of themes that can be explored and targeted for quality improvement. In efforts to maximise reflection and identify areas for development and improvement generated from a Cancer SEA we suggest you use the SEA thematic checklist in the toolkit available at #######. It may help to explore whether reflection has been extensive enough and also to prompt themes that could have been discussed or actioned more proactively.
The list of themes include:
History of a previous cancer
In-practice systems
Investigations and access to diagnostics
Patient education and awareness
Patient safety
Practice staff issues
Practitioner issues
Primary-secondary care interface
Next slide

27. Themes Checklist (3) Read coding Referrals management
Risk assessment tools
Routes to diagnosis
Safety netting
Screening
Teamwork
Training
Slide 28 presenter notes
This slide continues to list a number of themes that can be explored and targeted for quality improvement. In efforts to maximise reflection and identify areas for development and improvement generated from a Cancer SEA we suggest you use the SEA thematic checklist in the toolkit available at #######. It may help to explore whether reflection has been extensive enough and also to prompt themes that could have been discussed or actioned more proactively.
The list of themes include:
Read coding
Referrals management
Risk assessment tools
Routes to diagnosis
Safety netting
Screening
Teamwork
Training
Next slide

28. Actions & Impact Communication protocols Primary care team involvement
Continuity approach
Documentation improved
 Identify learning needs within the team
In-practice systems modified
Investigations protocols
Guidelines refresh and team education
Patient education and awareness
Primary care team involvement
Quality improvement tools
Read coding
Referrals read coding and tracking
Risk assessment tools or clinical decision support tools
Safety netting
Screening protocols
Training
Slide 29 presenter notes
This slide lists a range of targeted actions for GPs, practice teams and colleagues across a CCG/Health Body or sector, within both primary and secondary care. The final step when undertaking a Cancer SEA should specify the key roles and responsibilities in the practice team for implementing improvements and changes. It is considered good practice to share the outcomes of a Cancer SEA with the patient where appropriate.
A range of QUALITY IMPROVEMENT actions to impact early diagnosis can be generated from a Cancer SEA and may include the following:
Communication protocols
Continuity approach
Documentation improved
 Identify learning needs within the team
In-practice systems modified
Investigations protocols
Guidelines refresh and team education
Patient education and awareness
Primary care team involvement
Quality improvement tools
Read coding
Referrals read coding and tracking
Risk assessment tools or clinical decision support tools
Safety netting
Screening protocols
Training
Next slide

29. Workshop Use the workshop brief as a guide
Reflect on three Cancer SEAs of differing quality and impact
Patient A
Patient B
Patient C
Review the differences
Discuss themes identified
Explore actions taken as a result of the SEA
Slide 31 presenter notes
Now lets break into small groups.
Before the learning event you should organise the attendees into small groups of 4-6 GPs. You will need to ask each small group to appoint a spokesperson to feeback to the room at the plenary
The train the trainer resource pack within the toolkit contains a workshop brief and 3 examples of cancer SEAs with differing quality (available here ####) These should be printed out and given to each attendee as part of the delegate pack. Each SEA has an accompanying notes section and offers suggestions for improvement as well as highlighting high quality Cancer SEAs.
The workhop should last an hour, spending minutes on each Cancer SEA and working through the brief.
Next slide

30. Plenary
Thoughts? Concerns? Questions? Motivated to do Cancer SEAs? Access the toolkit at
Slide 32 presenter notes
After an hour reconvene the small groups back to the main room and ask each nominated spokesperson to feedback on what their ‘takeaways’ from todays learning event are.
This is also an opportunity to answer questions or concerns from the room.
We suggest you signpost the attendees to the RCGP Cancer QI using Cancer SEAs toolkit available at ######
Next slide

31. Use the toolkit Access the toolkit here: #######
Slide 33 presenter notes
Encourage positive energy for Cancer SEAs as QI tools and to improve cancer outcomes and reduce emergency presentations by learning from cases
You may wish to remind GPs to look at Cancer SEAs as an in-practice protocol and encourage them to approach this as a sustainable quality improvement exercise, rather than just a single event
Signpost GPs to the Toolkit available at #######

32. Thank you
Please complete the evaluation form, so we can send you your CPD certificate
Slide 36 presenter notes
You may wish to list the ‘takeaway’ learning items that are discussed at the plenary onto the CPD certificate and send it electronically.
End presentation