Download Newsletter Summer 2016

NEWSLETTER – JULY 2016
The Framework for Cancer in Primary Care Programme is here to support GPs, and other
community based health care professionals to:
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Diagnose cancer earlier
Better integrate treatment between primary and secondary care; and
Equip GPs to be able to provide better community based support for people living with cancer.
In this Newsletter you’ll find an update on the programme’s priority areas.
One priority is early diagnosis. Earlier this year I was lucky enough to be part of a group of GPs, cancer specialists
and NHS and public health experts that visited the new diagnostic centres that have been developed in Denmark.
Denmark’s health service is similar to the NHS in Wales and 15 years ago Denmark, like Wales, was performing
poorly compared with other European countries. They decided to reorganise the way patients were diagnosed by
GPs and specialists by bringing in a new approach, especially to deal with those cancer cases which are not initially
obvious. You can read more about the Denmark trip in my blog.
We now have GP Leads working in six of Wales’ Health Boards and Velindre NHS Trust and we also have two
Regional Nurse Leads in post as well as an all Wales Nurse Lead. They are working with local Health Board teams and
GP Clusters to make sure the aims of our programme align with local cancer priorities. They are also working on
service improvement projects with Health Boards across Wales, all of which are designed to be rolled out and used
across Wales, once reviewed and deemed useful and appropriate. Contact details for the team can be found at the
end of this newsletter.
Dr Cliff Jones
All Wales GP Lead
Our priorities
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Early diagnosis
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Support through treatment
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Living beyond cancer
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Tertiary care
Additional initiatives
Cross cutting issues
Tools and Guidelines available to support Primary Care
Team contacts
Early diagnosis
Detecting cancer earlier could make it more treatable and could save a life and we are exploring how primary care
can help patients secure an earlier diagnosis.
Most people who are displaying symptoms of cancer visit their GP in the first instance. We know there are great
variations in what happens next. Some people’s symptoms sound clear alarm bells, resulting in a quick,
straightforward process of referral and an early diagnosis. For others it is not such an easy journey.
We are working with Primary Care to find out what changes need to be introduced to improve referral pathways and
access to diagnostics. And we are working with Secondary Care to make these changes happen.
Much work is already being done to improve earlier diagnosis and we are working with those involved with NICE
Guidance, public awareness campaigns, risk assessment tools, clinical priority SEAs (significant event audit) and
other relevant initiatives.
Our current diagnosis initiatives
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Lung cancer diagnosis
Dr Mary Craig is based in Aneurin Bevan UHB and is part of a team working on a project to diagnose lung cancer
earlier by creating a direct access route for diagnosis.
Lung cancer kills more people in Wales than any other cancer and getting it diagnosed quickly could make it more
treatable. We are developing ‘Right Test, First Time’ guidance for Primary Care to help them refer patients with
suspected symptoms using the most direct route.
Work includes:
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Redesigning the Lung Cancer Pathway with the ‘Straight to CT’ direct access pilot
Developing ‘Right Test, First Time’ radiology guidance for primary care
Bowel cancer screening process
Cwm Taf UHB, Aneurin Bevan UHB and Abertawe Bro Morgannwg UHB have all been working on initiatives to
increase bowel screening uptake. Dr Heather Wilkes, Dr Mary Craig and Dr Sriram Rao will be working with their
health boards and each other to assess and refine these projects, with a view to developing an ‘All Wales’ solution.
Work includes:
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Assessing the impact of the bowel cancer screening uptake initiatives
Implementing further roll out if evidence is positive
Cancer Diagnostics Project
Dr Sriram Rao is providing Primary Care input into the Cancer Diagnostics project with the team at Cwm Taf UHB.
The project is investigating the concept of Denmark’s highly successful diagnostic centres. Denmark has a similar set
up to NHS Wales and they have achieved phenomenal results since setting up their diagnostic centres in 2007. The
diagnosis centres have helped to take Denmark from the lower end of the cancer survival league to catching up with
the best performing European countries.
Dr Heather Wilkes will be working with specialist colleagues in ABM UHB to develop a ‘vague symptom’ diagnostic
service based on the Denmark model. This and the work in Cwm Taf will allow us to compare and contrast different
approaches to the same issues.
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NICE Cancer Referral Guidance
Dr Cliff Jones is developing an all Wales unified approach to implementing the NICE Cancer Referral Guidelines,
working with Primary Care, Secondary Care and Tumour Site Advisory Groups.
Work includes:
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Identifying with Site Specific Groups where current practice in Wales differs from the NICE guidance
Agree standard guidance with Local Health Board Cancer Lead Clinicians on the information that should be
provided to GPs and primary care
Produce a summary document and educational resources for primary care on the implementation of the NICE
Cancer Referral Guidance
Support through treatment
Patient feedback about the support they receive during treatment is fundamentally good. Macmillan’s latest Patient
Experience Survey in 2013 showed that 89% of patients surveyed rated their care as excellent or good. But there is
more to be done, especially to improve the shared processes and information flow between Primary and Secondary
Care.
We are looking at what needs to happen to ensure GPs receive the relevant information on the patient’s treatment
plan, and at how GPs can contribute to Multi Disciplinary Teams when appropriate and relevant. We’re looking at
raising awareness in primary care about oncological emergencies and making sure primary care has clear access to
urgent and emergency services. We’re also looking at what needs to happen to ensure secondary care
communicates effectively with Primary Care about potential complications.
We need to ensure that Primary Care remains engaged during the patient’s treatment, and be clear on what the role
of Primary Care is, or should be, during treatment. We need to address inequalities during treatment and know how
Primary Care can help empower patients to alert health professionals about their needs.
Again, much work is already being done in this area and we’ll be working with those involved in the Enhanced
Recovery / Optimisation of Treatment programme, the Acute Oncology Programme, Chemotherapy Alerts, MSCC
and Treatment Summaries.
Our current support through treatment initiatives
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Follow up Pathways
Dr Hayley Crumpton is working on a Follow Up Pathway review and re-design project with Betsi Cadwaladr UHB.
Work includes:
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Review of follow up arrangements for cancer (focusing on a specific tumour site initially)
Developing multi-professional guidance on long term consequences, complications and monitoring
Cancer service models and pathways
Dr Rachel Lee is working on a development and implementation of cancer pathways with Cardiff & Vale UHB, looking
developing practical Primary care IT solutions. Work includes:
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Inform development of cancer site service models (how referrals are received, signposted, access to tests and
diagnostics, follow up arrangements) including how advice can be given to GPs, for example email advice.
Supporting development of IT tools to support GP consultations
Developing IT solutions to support National Clinical Priority for Early Diagnosis of Cancer (SEA) work
Living beyond cancer
Around four out of ten people in Wales will be diagnosed with cancer during their lifetime, and the
incidence rate is increasing. The number of people surviving cancer has increased. For many people cancer
is now a “chronic condition” which requires a new approach to longer term care. However, the ongoing
needs of patients that survive cancer are not always recognised and met to best effect.
We are looking at how we can improve the transition for patients from acute treatment to the recovery phase where
they are living with a stable disease with support from Primary Care. We are looking at the long term consequences
of treatment, how we can embed long term cancer care into everyday practice and how we can help to prevent and
identify recurrence.
We’ll be working with those involved in Treatment Summaries, Cancer Care Reviews, Recovery Packages, Exercise
Referral Schemes, HOPE courses, Follow Up protocols and pathways and the Consequences of Cancer Toolkit.
Our current Living beyond cancer initiatives
Our Nursing team is currently reviewing existing resources (e.g Recovery Package) to assess their applicability and
usability in the Primary Care and Community setting.
Tertiary Care
This priority is led by Dr Elise Lang and looks at:
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Treatment summaries
Reviewing communication systems between Cancer Specialists and Primary Care with recommendations for
quality and efficiency improvements
Providing Primary Care support and advice to the education programme of ‘Transforming Cancer Services’
Cross cutting issues across all priority areas
Specific Groups: Looking at younger patients, patients with learning disabilities, patients with mental health issues,
older adult patients, patients in prisons and deprivation.
Education: Looking at education delivery methods and how best to support different professional groups
Out of Hours: Looking at IT and communication and Clinical Guidance
Cancer tools and guidelines to support Primary Care
Initial findings from our review of cancer tools and guidelines currently available to support Primary Care are
showing that there are a wide range of well received tools already available. However, the utilisation of these
existing tools is variable.
We are looking more closely at the barriers for uptake and use to assess if it would be beneficial to have a single
point of access for all tools and guidelines.
Team contacts
All Wales GP Lead: Dr Clifford Jones
GP Lead Aneurin Bevan UHB: Dr Mary Craig
GP Lead Abertawe Bro Morgannwg UHB: Dr Heather Wilkes
GP Lead Betsi Cadwaladr UHB: Dr Hayley Crumpton
GP Lead Cardiff & Vale UHB: Dr Rachel Lee
GP Lead Cwm Taf UHB: Dr Sriram Rao
GP Lead Hywel Dda UHB: Dr Savita Shanbhag
GP Lead Powys HB: post advertised
GP Lead Velindre: Dr Elise Lang
All Wales Nurse Lead: Sue Llewellyn
East Wales Regional Nurse Lead: Juliet Norwood
North Wales Regional Nurse Lead: post advertised
West Wales Regional Nurse Lead: Hayley Phillips