1. London Appraiser Training Cancer Case Reviews Dr Pawan Randev Transforming Cancer Services Team 11 th September 2014

2. Format Introduction and context SEA Your experiences – Cancer and SEA The proposed template Sample SEAs to consider Resource set What should our outcomes be?

4. Introduction Pawan GP Trainer and Appraiser GP Clinical Lead TCST – Education lead RCGP Cancer SEA Pilot 2013 “Improving Cancer Awareness” GP Trainers Developed resources including website Cancer Lead for 15 years

6. Significant Event Analysis An account of an SEA should not allow patients to be identified and should comprise: Title of the event Date of the event Date the event was discussed and the roles of those present A description of the event involving the GP What went well? What could have been done differently? reflections on the event in terms of: o knowledge, skills and performance o safety and quality o communication, partnership and teamwork o maintaining trust What changes have been agreed: o for me personally o for the team Changes carried out and their effect.

7. Your experiences of Cancer and SEA Have you submitted a cancer SEA? Discussed a cancer case with an appraisee? Considered a cancer SEA in your practice SEA meetings?

8. Sample SEA- 1

9. Sample SEA - 2

10. Template for Cancer SEA 1. What Happened: Facts of the Case. 2. Identification of Key Moments: Issues to Reflect upon 3. Learning, Quality improvement and Commisioning 4. Implementation of Quality Improvement 5. Development of this process Some information about the setting for this case

11. Sample SEAs Set of 6 SEAs to practice with in workshops Small groups 3-5 with activities as below: What was good/could be developed? Discuss what feedback you could give to appraisee How could you challenge/stretch appraisees? What resources may help deeper thinking? How to maximise impact of learning – personal/patient/practice/CCG 10 minutes per SEA in small group then large group discussion/feedback

12. Resources Practice Profiles Revalidation toolkit Patient perspectives Macmillan CDS RCGP Audit Educational Modules Involving the whole team

13. Practice profiles: what are they? General Practice Profiles for Cancer bring together a range of process and outcomes information relevant to cancer in primary care. Similar principle to PACT data They provide readily available and comparative information for benchmarking and reviewing variation at a general practice/CCG level. They can be used to understand the cancer burden for a population. Not performance measurement as no established/agreed normal values

14. Data domains and indicators for your practice DemographicsPractice population above 65 years Socio-economic deprivation Cancer incidence and prevalence rates Cancer mortality rates Cancer ScreeningBreast cancer screening rates Cervical screening rates Bowel cancer screening rates Cancer waiting times2ww referral rates and age standardised ratios 2ww referral conversion rates Numbers of new cancers treated (% of which are 2ww refs) Number of 2ww referrals for suspected breast, lower GI, lung and skin cancer Presentations and diagnoses Number of emergency admissions with cancer Number of emergency presentations Number of managed referral presentations (GP involvement) (Use of investigations: numbers of endoscopic procedures)

16. Using the Practice Profile Giving context to the SEA Appreciating the larger picture Understanding what happened over 1 year Comparing – like PACT data Not performance management Seeing a larger setting – practice, CCG and England levels

17. Google HEEM ICA

20. Stepped approach -5 modules

23. Audit Tool Developed by RCGP National audit 2010/11 Excel tool Easy to complete –honest!! Downloadable Tested on over 16,000 cancer journeys Strictly a survey until standards/criteria set and re-audit

29. RCGP Cancer Education Hub

31. BMJ Learning – free access London Channel

32. Doctors.net.uk

33. Macmillan Cancer Decision Support Tool CDS

42. Google HEEM ICA