Faster Diagnosis Showcase PowerPoint Presentation, PPT - DocSlides

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Slide1

Faster Diagnosis Showcase

Lisa Galligan-Dawson, Bolton NHS Foundation TrustMartina Kingscott, Bolton NHS Foundation TrustMelissa Surgey, Bolton Clinical Commissioning GroupDavid McLenachan, User Involvement representative

16th May 2017

Greater Manchester

Cancer

Vanguard Innovation

Slide2

Housekeeping

There are no scheduled fire drills

Toilets are to the right of the exitWe will be taking pictures – please let us know if you don’t want to have your picture takenThe presentations will be circulated after the eventPhones on silent please

Vanguard Innovation

Greater Manchester Cancer

Slide3

The national Cancer Vanguard

Vanguard Innovation

Greater Manchester Cancer

To develop and test new ideas to deliver more responsive and personalised cancer services, addressing inequalities and supporting the NHS in ‘

Achieving World Class Cancer Outcomes’.Two-year programme to look at improved cancer care, cancer outcomes, cancer patient experience and resource efficiency

Slide4

Vanguard Innovation

Project Team

Greater Manchester Cancer

Name

Role

OrganisationProject LeadsLisa Galligan-DawsonImplementation ManagerBolton NHS Foundation TrustMelissa SurgeyProject ManagerBolton CCGProject MembersDr Tarek BakhtGP Clinical Lead for CancerBolton CCGMr Simon HargreavesClinical Lead for CancerBolton NHS Foundation TrustMartina KingscottClinical Nurse Lead/Matron for Endoscopy (Lower and Upper GI streams)Bolton NHS Foundation Trust

The core Faster Diagnosis team works collaboratively with strategic and operational stakeholders from the three specific tumour site projects to facilitate service delivery

Slide5

Aims and Objectives

To

provide patients with either a confirmed diagnosis or exclusion of cancer within 28 days of referral on a suspected cancer pathway from a GPTo understand the impact of an accelerated diagnosis pathway on patient experience and understanding of their careTo test partnership approaches to delivering cancer diagnostics – both across secondary care providers, and across primary and secondary careTo develop recommendations for other commissioners and providers across GM as to how to streamline diagnostic pathways to support faster diagnosis

Vanguard Innovation

Greater Manchester Cancer

Slide6

Project Governance

Vanguard Innovation

Greater Manchester Cancer

Slide7

Greater Manchester

Cancer

Vanguard Innovation

Lung Pathway Changes

Patients with abnormal chest x ray retained by hospital for CT scan and onward management if cancer is diagnosed

Expected to reduce the time to CT of around 3 weeks (includes time before patient would normally be referred)

Expected to reduce the amount of appointments the patient has by approximately 3. (Primary care and secondary care)

Slide8

Greater Manchester

Cancer

Vanguard Innovation

Lung Pathway Changes

User designed patient information document for ‘chest investigations’

Go live is planned for June 17

Re-designed follow up / results process

Patient experience audit planned for patients diagnosed with cancer and those not requiring onward management by the Hospital

Slide9

Greater Manchester

Cancer

Vanguard Innovation

Lung Pathway Flowchart

Slide10

Greater Manchester

Cancer

Vanguard Innovation

Upper Gastro Intestinal (GI) Pathway

Re-design of GP referral specification

GP engagement sessions on Straight to Test OGD pathway

Introduction of rapid ‘Jaundice Pathway’ saving approximately 10 pathway days

Triage and re-direct exercise completed. ¼ of all patients referred in this period were saved from attending 1 appointment

Slide11

Greater Manchester

Cancer

Vanguard Innovation

Upper Gastro Intestinal (GI) Pathway

Patients on Straight to Test pathway are having their OGD on average 8 days sooner than those attending Outpatient first

Specialist nurse attends for results of OGD where a cancer is seen. Patient leaves with CT scan appointment (target 2 working days)

Slide12

Greater Manchester

Cancer

Vanguard Innovation

Upper GI Pathway Flowchart

Slide13

Greater Manchester

Cancer

Vanguard Innovation

Direct to Test Colonoscopy Pathway

Summary

Patient attends GP surgery

Patient appropriate for 2 ww Direct to Test colonoscopy

Patient leaves surgery with appointment for telephone assessment (within 48 hours)

Patient is contacted by Specialist Nurse and Pre-assessment completed

Slide14

Greater Manchester

Cancer

Vanguard Innovation

Direct to Test Flow chart

Slide15

Greater Manchester

Cancer

Vanguard Innovation

Flow Chart for Pre-Assessment

Slide16

Greater Manchester

Cancer

Vanguard Innovation

User Involvement

Patient Information Packs for Colorectal and Lung ‘direct to test’ developed with the involvement of the Macmillan User Involvement team and Bolton People Affected by Cancer.

Feedback

“Fantastic Service”

“Wish this had been available when I had been diagnosed”

“Can I have my follow-up colonoscopy at this site please?!!

“Proactive to Patient needs, quality and safety first”

Slide17

Greater Manchester

Cancer

Vanguard Innovation

GO LIVE!

Went “live” on Monday 3

rd

April 2017

First Patient feedback outstanding :-

“Had procedure done before, nothing like this”

“Fast, safe, fully informed, excellent service”

Teething Problems :-

Slow start from GP Practices referring into the System

Slide18

Greater Manchester

Cancer

Vanguard Innovation

Audit Data

Snap Shot Audit 4 – 29 April 2017

17 patients referred into Service

6 patients had procedures performed (at time of audit)

1 cancer was detected

Average wait time for the patients was 8 days from telephone clinic. Average time to colonoscopy from referral via traditional route was 18 days.

Slide19

Greater Manchester

Cancer

Vanguard Innovation

Patient Cancer Journey

TIMELINE

19.4.17 Consultation, Nurse Telephone Assessment D.T.T

25.04.17 Colonoscopy

29.4.17 C.T. Scan - thorax, abdomen, pelvis

29.4.17 M.R.I. - Pelvis/rectum

2.5 17 Colo-rectal MDM Meeting

3.5.17 O.P. Appt with Mr Harris

5.5.17 Colo-rectal MDM Meeting

Slide20

Greater Manchester

Cancer

Vanguard Innovation

Issues Raised

Incorrect Referral Form

Patient Information Leaflets not given

Patients not informed 2 WW

All patients received prescription for bowel prep

BUT

issues in obtaining bowel prep

Slide21

Greater Manchester

Cancer

Vanguard Innovation

Moving Forward

Issues to overcome with G.Ps

Bowel prep

Communication, communication, communication

Continued collaboration With CCG

Continued Audit

Changes along the way

Patient first – data proves it’s working

Slide22

Greater Manchester

Cancer

Vanguard Innovation

Engagement with Primary Care

Used established CCG forums – Clinical Leads, Practice Managers, Informal Local Medical Council (LMC)

Progressing new pathways through CCG governance – Demand Management Group, Clinical Standards Board

Promotion through GP newsletter, direct communications via GP Clinical Lead for Cancer

Slide23

Greater Manchester

Cancer

Vanguard Innovation

Lessons Learned

Should have begun GP engagement at an earlier stage

Formal endorsement through CCG governance important

Support from CCG clinicians does not always represent support from wider GP membership

Be willing to listen and adapt – pathways hinge on GPs supporting and referring into them; find neutral ground

Engage with Practice Managers and admin staff on logistics of referring into new pathways, issuing patient information, booking appointments – essential to facilitate efficient and effective turnaround time

Make change as easy as possible – don’t overlook the “small issues” such as printing patient information booklets

Patient engagement critical to getting pathways right

Slide24

Greater Manchester

Cancer

Vanguard Innovation

What Next?

Re-launch Direct to

Test

Colonoscopy pathway

with revised process for issuing bowel prep

Agree lung x-ray and CT element of pathway through CCG governance and go live

Upper GI further GP engagement events

Continued audit and monitoring of all three work streams, with dedicated project management oversight

Consider options for continuing with successful elements of the pilot post-Cancer Vanguard funding and document roll out options for GM

Slide25

Greater Manchester

Cancer

Vanguard Innovation

Contact

Lisa Galligan-Dawson –

lisa.galligan-dawson@boltonft.nhs.uk

Melissa Surgey –

melissa.surgey@nhs.net

Martina Kingscott –

martina.kingscott@boltonft.nhs.uk

Slide26

Greater Manchester

Cancer

Vanguard Innovation

Questions

Slide27

Vanguard Innovation

Greater Manchester Cancer

Vanguard Innovation

Email

:

cancervanguard.gm.@nhs.net

Web

: gmcancervanguard.org

Twitter

: @GM_Ca_Vanguard

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