South West Lung Rapid Diagnostic Service Update - PowerPoint Presentation

1. South West Lung Rapid Diagnostic Service Update28/09/21Please note: This slideshow contains sensitive and unpublished data for performance management purposes and is not for sharing outside of the South West NHS. Data from April 2021 is Provisional.

2. Rapid Diagnosis Priorities – Primary CareAimMethod - PeninsulaUpdate – PeninsulaMethod - SWAGUpdate SWAGDetecting lung cancer in asymptomatic patients                 CT screening via National Targeted Lung Health Check pilotUnderstand the IT systems in GP practices that would be utilised to identify patientsHow complete these electronic records areHow local uptake of other health check programs has performedIdentify estimated numbers across the region. Cornwall has been identified as a location for TLHC. Steering group has been established and procurement of service is underway.a. With SW Respiratory Network support scope readiness of GP IT main systems for identifying TLHC cohort b. Model TLHC demand Submitted a bid for TLHC funding in the next wave and expect this to be confirmed pending the national spending review.We will be delivering TLHC to a population of 25,000 focusing on those patients who have the most to gain from a TLHC across out whole geography.Case finding of symptomatic patients who would not otherwise be contacting health services Public health messagingTargeted messaging - text messages to smokers etcDirected at high risk areas/deprived area/high levels of late presentations etc National HUHY delivered.Localised Lung Cancer Public Awareness Campaign – DIFY Targeted at specific areas / PCNs. Impact currently being measured. a. Public health messaging b. Targeted messaging - text messages to smokers etc c. Directed at high risk areas/deprived area/high levels of late presentations etc

3. Rapid Diagnosis Priorities – Primary Care cont.AimMethod – PeninsulaUpdate – PeninsularMethod – SWAGUpdate - SWAGOpportunistic case finding in patients with symptoms having health contact for other reasons, eg COPD checks,  Education  sessions for allied health professionals, respiratory nurses etc‘Make every contact count’ type approachBuilding lung cancer symptom screening into other relevant clinical pathways Regional SW webinar including: Primary care (target sites) plus pulmonary rehab, mental health teams, pharmacists, smoking cessation teams etc. a. Lung Cancer risk identification education sessions for wider health care professionals promoting ‘Make every contact count’ type approach b. Building lung cancer symptom screening into other relevant clinical pathways Promoting early referral for patients seeing health professionals with symptoms that could be lung cancer Promoting adherence to NICE lung cancer referral guidelinesGP education sessionsEase of access to CXR and CTMechanisms of safety netting for GPs, especially if telephone consultations etc GP educational session in November. Review formulary referral form and GP DA booking information underway. Exploring potential for text messaging to smokers in high risk groups.a. PCN DES opportunity for further GP education sessions b. Recovery of CXR access c. Mechanisms of safety netting for GPs, especially if telephone consultations etc We are working closely with PCNs through our PCN cancer leads network. The network has covered topics such as PCN DES requirements, Early Diagnosis QOF projects, Treatment Gap analysis, patient experience during COVID, challenges of remote consultation in early diagnosis of cancer and inequalities initiatives.

4. Rapid Diagnosis Priorities – Secondary CareAimMethod – PeninsulaPeninsulaSWAGEmbed GIRFT cancer recommendationsSee reportSecondary care Lung Clinical lead and Lead radiologist appointed.Service desktop review looking at previous Lung reviews and pathway analyser alongside GIRF recommendations. Meetings with each trust to understand service constraints and service development plans.60k provided to each trust to deliver key enablers for GIRFTRDC funding totalling 300k to providers to further improve the diagnostic end of the pathway.Task and finish group established and first meeting in October to agree action plans and have oversight of deliveryPathway confirmed as live RDC in 7/7 Providers Jan 2021. Delivering:System wide measures to increase referrals Referral quality feedback loop Protocol for internal escalation to CT CT within 72 hours OPA day 6 Bundled diagnostics requested 1st OPA Escalation protocols in place for patients who deteriorate or require urgent escalation to emergency/ specialist services Single point of contact for patient incl. MECC approach followed by handover to CSW where cancer diagnosed Coordinated testing minimising number of hospital visits MDT day 21 Communication cancer / no cancer to patients by day 28 Diagnosis report or onward referralNext steps = evaluation and ongoing support for the pathway. 6/7 providers using pathway analyser & reporting national min data set. Transform lung to a RDS pathway Embed NOLCP as per NOLCP UPDATE 2020 Version 3.0CT same day as chest x-ray. Or Outpatient appointment same day as CT with same day confirmation of ‘no cancer’Re-introduce reflex CTs for Chest X-rays coded as “CX3 - CT required”.Next day access to CT scanning for GP 2-week wait referrals Daily triage of referrals with ‘hot-reported’ CT scan (Nurse-led triage clinic in collaboration with physician & thoracic radiologist 5 days a week)Integrated nursing & navigation support for patients requiring investigation from referral to treatment (with navigators responsible for coordinating, communicating and sign-posting appointments)Ensure there is local paid dedicated time for the cancer teams to review patients on the pathway Clear care bundles produced on first clinic attendance with all appointments pre-booked Single point of contact for patients in relation to bronchoscopy/ EBUS/ interventional thoracic radiology, next-day appointment scheduling and results management (see navigator role)PET-CT requesting needs to be electronic A RAPID hub, with dedicated patient & physician hotlines, and email addresses. Triage of thoracic surgical referrals, to ensure all required diagnostic, physiological & staging source documents, image transfer are available for same-day decision making when patient attends surgical OPA. Missing information is either obtained, or additional tests requested prior to OP visit to avoid delay in decision-making.MDT Standards of Care implemented