Download The workshop agenda (see Appendix I) included

Cascade Programme workshop summary
The Studio, Glasgow, 1 December 2016
Cascade workshops are an initiative supported by the Royal College of General
Practitioners (RCGP) and Cancer Research UK (CRUK).
They provide a forum for information sharing, networking and generation of practical
ideas about how to implement cancer quality improvement activities within primary
care settings.
WORKSHOP OVERVIEW
The 9th Cancer Cascade workshop, held in Glasgow on 1 December 2016, focused on cancer as
a quality improvement topic, and the challenges of diagnosing cancer in specific populations.
The aim of the workshop was for attendees to:





gain more insight into the national cancer agenda and GP cluster working
learn about practical ways to drive improvements in cancer control
hear from and meet academics and national leaders in cancer control
network with other cancer champions from other areas
discuss and share ideas for local improvement activities
The workshop agenda (see Appendix I) included:
 A presentation on the work of the Scottish Primary Care Cancer Group by Dr Hugh
Brown.1
 An interactive session on cancer as a quality improvement topic.
 Presentations from Dr Peter Murchie2 and Dr Sara MacDonald3 on the challenge of
diagnosing cancer in rural and older populations, and group work focusing on these
challenges.
 An update on latest developments in cancer control from Dr Richard Roope.4
Presentations will be shared with workshop participants – please see attached
OBJECTIVES AND EXPECTATIONS
At the beginning of the day, delegates were asked to provide their expectations and objectives
for attending the Cascade event. These included:
1
2
3
4
Chair, Scottish Primary Care Cancer Group
Senior Clinical Lecturer in Academic Primary Care, University of Aberdeen
Senior Lecturer in Primary Care, University of Glasgow
CRUK/RCGP Clinical Champion for Cancer
Cascade Glasgow Dec 2016: summary report
Page 1 of 7












How to support a team approach to QI focused on cancer
Take back cancer learning to clusters
Share the learning of TLAT
Share NW improvement team work in deprivation and education to support
Understanding how cancer and the ageing population can be supported
Better understand the CRUK offer and explore support in Scotland
Understand cancer as a high priority within the context of capacity issues to investigate/
diagnose
How to square QI - now QOF has gone
How to address waiting times and what is the right level of referral for GPs
Realistic medicine and the importance to targeting QI at high impact interventions
Cluster group offers opportunities but need to consider secondary care
GP workforce issues and wider primary care teams roles
PRESENTATIONS
1. The work of the Scottish Primary Care Group (Dr Hugh Brown)
Dr Hugh Brown gave an overview of the work of the Scottish Primary Care Cancer Group,
including membership, meeting schedule and other groups that the SPCCG feed in to. Dr Brown
also gave examples of some of the topics discussed by the SPCCG:




Detect Cancer Early
Macmillan modules
The National Cancer Diagnosis Audit (NCDA)
Transforming Care After Treatment (TCAT)
He also discussed how primary care can contribute to the Detect Cancer Early Programme, for
example:



Bowel screening programme
- Reducing non-attendance for screening appointments.
- How do we keep the return rate high?
Direct access to certain diagnostics
Reviewing the referral guidelines
- The SPCCG was involved in the Scottish Referral Guidelines for Suspected Cancer
- This is available in hard copy, and also now as a mobile app.
2. Cancer as a Quality Improvement Topic
The interactive session on cancer as a quality improvement topic was led by Dr Richard Roope
and Michael McGrath. At the start of the session, they asked for everyone’s thoughts on the
changes to QOF in Scotland. Below are some of the thoughts and concerns that were raised on
the day:




There is a real need for a ‘buffer’ between what the Health Board deem to be a priority,
and what practices think is a priority.
The change was supposed to be driven from the bottom up rather than the top down –
but it is still early days.
Clusters are taking GPs out of the practice and they are being asked to do things that
they don’t have time for. Cluster work means that there is not enough time to do patient
work, and it’s very difficult to do this without the resources.
The guidance issued so far has been very vague – it is not clear what the next steps will
be.
Overview of the new contract arrangements (Marion O’Neill)
Cascade Glasgow Dec 2016: summary report
Page 2 of 7
Marion O’Neill (Facilitator Regional Manager, CRUK) gave an overview of the changes to QOF
in Scotland. This included criticisms of the previous QOF, the internal and external roles of GP
clusters, and timelines for the transitional year.
Why cancer? (Dr Richard Roope)
Dr Richard Roope presented on the scale and burden of cancer for primary care, and outlined
why it would be a good option for clusters to adopt as a quality improvement topic. For example
we know that:



1 in 2 will be diagnosed with cancer in their lifetime
Incidence of cancer is increasing
Cancer survival in the UK still lags behind comparable health economies
Dr Roope focused on where primary care could make a difference here – earlier diagnosis
leading to stage shift.
Cancer as a quality improvement topic: group work (Facilitated by Michael McGrath)
Delegates were asked to work in small groups (2 tables of GPs and 3 tables of other health
professionals) to answer the following questions:
GPs



Why should you elect cancer as a QI topic? What are the pros and cons?
You have selected cancer as a QI focus:
- What would you do first?
- What would success look like?
What do you need from whom to make the QI focus work for you?
Outcome of this session:
 Delegates were confident about the pros of choosing cancer as a quality improvement
topic; for example cancer has a high prevalence and mortality rate, and there are lots of
opportunities for improvement work that can be tracked.
 Some of the concerns were that as cancer is such a large area, it could be hard to decide
where to focus and where to start, and could raise expectations that primary care can
pick up cancers.
 In order to do something meaningful, it is important to look at what data is available, and
what is doable and demonstrable.
 Ideas for potential QI work included: screening uptake and comparison with local
practices; appropriateness of referrals; access to diagnostics.
 Success would include sharing experiences with peers; understanding the reasons for
differences; working in partnership; targeting hard to reach groups.
 Support and resources could include tools such as the NCDA; liaison with and support
from secondary care; sharing learning from SEAs; increased diagnostic capacity and
support to understand guidelines.
Non-GPs



What would be the benefit of a QI focus for you?
What impact will a cancer QI focus have on your area? What are the opportunities and
fears?
What do you need to do when you get back to the ranch in preparation for a lot of cancer
QI focus decisions coming your way?
Outcome of this session:
Cascade Glasgow Dec 2016: summary report
Page 3 of 7
 The benefits of clusters choosing cancer as a QI focus would be a potential impact on
addressing health inequalities; get more GPs interested in screening; align with other
agendas such as older populations; potential for teachable moments; improve data and
increase primary care influence on secondary care.
 Fears included the lack of staffing and capacity in services to cope with increased
demand; a fear that other areas may be neglected; lack of useful data; and an
expectation on supporting services.
 Opportunities identified were the chance to tackle inequalities; an ability to be flexible to
local needs; prevention and lifestyle focus would impact across many diseases not just
cancer; the opportunity to work with the most motivated practices and linking with
community and 3rd sector.
 In order to support clusters choosing cancer as a QI topic, it would be necessary to have
effective communication between strategic groups and local influencers; cascade the
message that the QI topic is a choice for GPs; have a more informed conversation with
GP practices; make more contacts and talk more about how can capitalise in this
opportunity.
What’s New? (Dr Richard Roope)
Dr Richard Roope gave an update on some of the latest developments in cancer control,
including:
 Breast cancer presentation: 1 in 6 cases of breast cancer begin with non-lump symptoms
 Very brief intervention: Very brief advice from GPs can have an impact on weight loss
 Colorectal cancer: routes to diagnosis, increasing incidence and key symptoms.
 E-cigarettes: concerns, effectiveness, increased usage and an update on the CRUK-
RCGP position statement which can be seen here.
 Dismantling Scottish QOF and formation of GP clusters: RCGP publication Setting the
Strategy for Quality in Scotland’s General Practices
 New CRUK stats and infographics: New infographics on screening, obesity, alcohol and
inactivity are all available now online.
Updates from CRUK and RCGP
Patricia Barnett (Cancer Intelligence Relationship Manager at CRUK) outlined CRUK’s strategic
priorities within policy and information for the next two years. This includes:




Optimising the wider CRUK environment
Optimising the pathway across prevention, early diagnosis and treatment
Building our profile as an authoritative health and science brand
Ensuring that we follow our key principles:
- We are evidence-based
- We are audience-focussed
- We tackle inequalities in all of our work
Marion O’Neill then gave an overview of the CRUK Facilitator Programme in Scotland and the
work that they do with primary care.
Recently this has included the National Cancer Diagnosis Audit (NCDA), which uses primary
and secondary care data relating to patients diagnosed with cancer, and will start this year
looking at cases diagnosed in 2014. This is to help us to understand patterns of diagnosis for all
cancer types, and will give a benchmark against we can eventually measure the impact of the
new referral guidelines. This will have numerous benefits to patients, GPs and clinical practice.
To register your interest in the audit, please visit the link above or email [email protected].
Cascade Glasgow Dec 2016: summary report
Page 4 of 7
For more information on the Facilitator Programme, see here.
The challenge of diagnosing cancer in specific populations (Dr Peter Murchie and Dr Sara
MacDonald)
Dr Sara MacDonald (Senior Lecturer in Primary Care) presented on the challenge of diagnosing
cancer in older populations, and her research in this area.
Dr Peter Murchie (Senior Lecturer in Academic Primary Care) then presented on rurality and
cancer in Scotland – focussing in particular on two important pieces of research, the CRUX studies
(2002-2016) and the NASCAR study (2014-ongoing).
Delegates then worked in small groups to provide their thoughts on the following questions:
 Can you perceive challenges to diagnosing cancer in your practices or area in
patients living further away? What are they, and what could you do about them?
 Based on your experience do patients from further away receive less input following
cancer treatment? If no, why not? If so why, and what could we do about it?
 Can you perceive challenges to diagnosing older and or comorbid patients in your
practice or area? What are they, and what could you do about them?
 Based on knowledge of your own practice or area, what is your own experience of
referring frequent attenders? More or less likely to be referred?
 Based on your experience can you think about cancers diagnosed via emergency
presentation? Could something else have happened?
TAKEAWAY ACTIONS
At the end of the workshop attendees were invited to identify one action or area worthy of further
consideration that they would take away from the day. Below is a list of just some of the key
actions highlighted by participants:









When next in practice, raise the issue of cancer as a quality work priority for practice and
cluster [GP]
Email primary care cancer lead in Forth Valley to express interest [GP]
Try to set up more robust practice policy to ensure that bloods/investigations are
recorded, results looked for and acted upon in a timely manner [GP]
Try to improve prevention of cancer by smoking cessation/weight loss/ alcohol reduction
encouragement in patients and encouraging other practice members to do the same [GP]
Suggest to the Cluster group to consider a cancer topic as a QI
Aim for consistency between GP Practices across my HSCP and joined up working
Keep the profile of cancer high on the agenda at locality/cluster meetings
Decide what we can do differently across Lanarkshire
Share my learning and information gathered with colleagues and partners. Also, within
my geographical area I will aim to provide any support I can offer to cluster groups
[Health Improvement]
ACTIONS FOR CRUK
We will do the following:


Feedback to CRUK what health professionals are saying locally
Share the learnings from the event with colleagues and externally
Cascade Glasgow Dec 2016: summary report
Page 5 of 7


Follow up requests from delegates for an A4 summary sheet for cancer QI topics
Take the feedback on board from the Glasgow event for our 2017 Cascade event in
Aberdeen.
Contact: [email protected]
Cascade Glasgow Dec 2016: summary report
Page 6 of 7
APPENDIX: 1
CANCER CASCADE WORKSHOP
Thursday 1 December 2016
The Studio, Glasgow, G2 6AE
AGENDA
10:00 – 10:35
Arrival and registration
Marketplace: Tools to help Primary Care diagnose cancer earlier
10:35 – 10:40
Welcome
Dr Richard Roope – CRUK / RCGP Clinical Lead for Cancer
10:40 – 11:00
Your expectations/ objectives for the day
Michael McGrath – Cascade Advisor
11:00 – 11:20
The work of the Scottish Primary Care Cancer Group
Presentation by Dr Hugh Brown – Chair of the Scottish Primary Care
Cancer Group
Cancer as a Quality Improvement Topic – interactive session
Group work facilitated by Dr Richard Roope and Michael McGrath
11:20 – 12:30
12:30 – 13:30
13:30 – 14:00
Lunch and networking
Marketplace: Tools to help Primary Care diagnose cancer earlier
What’s new?
Dr Richard Roope – CRUK / RCGP Clinical Lead for Cancer
14:00 – 14:20
Updates from Cancer Research UK and the Royal College of General
Practitioners
14:20 – 15:30
The challenge of diagnosing cancer in specific populations –
interactive session
Dr Peter Murchie - Senior Clinical Lecturer in Academic Primary
Care, University of Aberdeen: The rural challenge
Dr Sara MacDonald - Senior Lecturer in Primary Care, University of
Glasgow: Cancer and the older population
15:30 – 16:00
16:00
16:00 – 16:30
Action planning and wrap up
Michael McGrath – Cascade Advisor
Close
Dr Richard Roope – CRUK / RCGP Clinical Lead for Cancer
Tea and networking
Marketplace: Tools to help Primary Care diagnose cancer earlier
Cascade Glasgow Dec 2016: summary report
Page 7 of 7