1. 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

2. Trainers’ Workshop Early Diagnosis for GP trainers

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

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

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

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

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

8. Trainers’ Workshop
Why is early diagnosis important?

9. Trainers’ Workshop
Why is early diagnosis important?

10. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
(last accessed )

11. Trainers’ Workshop
Why is early diagnosis important?

12. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
(last accessed )

13. Trainers’ Workshop
Why is early diagnosis important?

14. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
(last accessed )

15. Trainers’ Workshop
Why is early diagnosis important?

16. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
(last accessed )

17. Trainers’ Workshop
Why is early diagnosis important?

18. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
All Cancers
(last accessed )

19. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
All Cancers
Stage Shift
(last accessed )

20. 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%
(last accessed )

21. Trainers’ Workshop
Why is early diagnosis important?
Cost

22. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?

23. Why is early diagnosis important?
Trainers’ Workshop
Why is early diagnosis important?
↓72.8%
↓62.7%
↓64.9%
↓38.9%

24. Trainers’ Workshop
How have we done?

25. Cancer – where have we come from?
January Improving Outcomes: A Strategy for Cancer

26. Trainers’ Workshop
How have we done?
Avoidable deaths pa if survival in England matched the best in Europe
Breast ~ Myeloma 250
Colorectal ~ Endometrial 250
Lung ~ Leukaemia 240
Oesophagogastric Brain
Kidney ~ Melanoma 190
Ovary ~ Cervix
NHL/HD Oral/Larynx 170
Bladder Pancreas

27. Trainers’ Workshop
How have we done?

28. Trainers’ Workshop
How have we done?

29. 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

30. Trainers’ Workshop
How have we done?

31. Trainers’ Workshop How have we done?

32. Trainers’ Workshop How have we done?
(last accessed )

33. Trainers’ Workshop How have we done?
(last accessed )

34. Trainers’ Workshop How have we done? ↑66.0% ↓1.2% ↑77.8%
(last accessed )

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

36. Trainers’ Workshop
NHS Stafford and Surrounds CCG – Cancer Emergency Admissions
accessed )

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

38. Trainers’ Workshop
NHS Stafford and Surrounds CCG – Cancer stage at presentation
(last accessed )

39. Trainers’ Workshop PHE Press release 16.9.15:
“Cancers are being diagnosed earlier in England”
(last accessed )

40. Trainers’ Workshop
However compared to Europe?

41. Trainers’ Workshop However compared to Europe?

42. Trainers’ Workshop However compared to Europe?

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

44. 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: /bjc (last accessed )

45. Trainers’ Workshop
Gate openers…

46. Trainers’ Workshop

47. Trainers’ Workshop

48. 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
(last accessed )

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

50. 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

51. 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

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

53. 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

54. 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

55. 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…

56. Trainers’ Workshop

57. 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

58. 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

59. Trainers’ Workshop
Value in investing in early diagnosis:

60. 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

61. 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

62. Trainers’ Workshop
Importance of bowel screening

63. Trainers’ Workshop Importance of bowel screening
(accessed )

64. Trainers’ Workshop Importance of bowel screening
(accessed )

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

66. Trainers’ Workshop Importance of bowel screening
Role of GP Endorsement

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

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

69. 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

70. 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

71. 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

72. 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

73. 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

74. 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

75. 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

76. 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

77. 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

78. 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

79. 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

80. 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

81. 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

82. 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

83. 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

84. 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

85. 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

86. 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

87. 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

88. 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

89. 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

90. Trainers’ Workshop
NG12 - Suspected cancer: recognition and referral

91. 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.

92. 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

93. 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

94. 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

95. 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

96. 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

97. 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

98. 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

99. 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

100. 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

101. 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. 

102. 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. 

103. 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. 

104. 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. 

105. 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

106. 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

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Safety netting.

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Safety netting.

109. 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.

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Value in investing in early diagnosis:
Results?

112. 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 £££

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Key to early diagnosis of cancer

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Key to early diagnosis of cancer
Education

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

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

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

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

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

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The ones who are crazy enough to think they can change the world, are the ones who do.
Steve Jobs

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Our common goal?

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Our common goal?

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and everyone should try.

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

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Thank you

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Any questions?