1. www.npca.org.uk npca@rcseng.ac.uk National Prostate Cancer Audit: Review of the Organisational Audit Dr Ajay Aggarwal Oncology Coordinator NPCA Honorary Consultant Clinical Oncologist

2. www.npca.org.uk npca@rcseng.ac.uk NPCA – Audit timeline Year 1: – National survey of service delivery (“organisational Audit”) – Analysis of existing data, provide comparative data for prospective audit – “Develop” a National Minimum Dataset (MDS) for the prospective audit Year 2: – Prospective data collection on all newly diagnosed men – Development of tool to collect PREM/PROMs

3. www.npca.org.uk npca@rcseng.ac.uk Organisational Audit National survey of all NHS Trusts and Specialist MDTs How are prostate cancer services organised? – Diagnostic and staging investigations – Radical and palliative therapeutic options (e.g. new radiation technologies) – Accessory prostate cancer services (e.g. specialist continence services) In addition, highlight efficient processes of care

4. www.npca.org.uk npca@rcseng.ac.uk Organisational Audit: Methods Two questionnaires developed and distributed via Survey Monkey in October 2013 to the Prostate cancer lead for each Trust and Specialist MDT 100% response rate and completion rate in England – 143 NHS trusts – 48 SMDTs – 55 Radiotherapy Centres 100% response and completion rate from all six health boards in Wales

5. www.npca.org.uk npca@rcseng.ac.uk Availability of diagnostic & staging investigations

6. www.npca.org.uk npca@rcseng.ac.uk Availability of Radical interventions

7. www.npca.org.uk npca@rcseng.ac.uk Availability of Personal Support Services

8. www.npca.org.uk npca@rcseng.ac.uk Results:- HDR Brachytherapy 11 Radiotherapy Centres provide HDR Brachtherapy in England Of the 48 prostate cancer Specialist MDTs in England, 20 (42%) provide HDR Brachytherapy There is significant variation in availability amongst NHS area teams in England

9. www.npca.org.uk npca@rcseng.ac.uk Single HDR Brachytherapy Centre HDR Centre covering >1 NHS area team

10. www.npca.org.uk npca@rcseng.ac.uk Further results 54% of specialist MDTs in England and 50% in Wales offer joint specialist clinics Almost all specialist MDTs in England have consultant-led follow-up clinics after radical treatment The corresponding figures for Wales are lower (post-surgery, 75% and post-radiotherapy 50%). 33% of specialist MDTs in England expects to follow up patients with low-risk localised disease longer than 5 years duration after a radical treatment.

11. www.npca.org.uk npca@rcseng.ac.uk Conclusions Overall, NHS providers in England and Wales are following guidelines for the management of prostate cancer services The Organisational audit demonstrates that for a number of providers the delivery of specialist services can be improved further: – multiparametric MRI – robot-assisted prostatectomy – HDR Brachytherapy The consequent inequity may impact on access to these evidence based technologies for the management of prostate cancer patients.

12. www.npca.org.uk npca@rcseng.ac.uk Next Steps Aim to feedback results to individual NHS providers in England and Wales by February 2015 Survey results to be publically available on NPCA website http://www.npca.org.uk http://www.npca.org.uk Prospective audit will assess patient ACCESS to different technologies given current inequity and impact on outcomes