Sussexwide Cancer Webinar Early Diagnosis of Cancer PCN DES Specification and QOF QI - PowerPoint Presentation

1. Sussexwide Cancer Webinar Early Diagnosis of Cancer PCN DES Specification and QOF QIThank you for joining the webinarWe will be starting shortlyPlease ensure you place yourself on mute and turn off your camera

2. The webinar is about to startPlease mute yourself to reduce background noise (there will be time for Q&A at the end)Please make use of the chat box for discussion and questions and we will answer these at the end of the main presentation – there will be more time also in the breakout sessionsThis webinar is being recorded - recording and slides will be shared afterwards

3. Before we start…. Using Microsoft TeamsTroubleshooting tech issues: Move to a place with stronger Wi-Fi signal Try headphones if no soundTurn your camera off if Wi-Fi is poorLeave and re-join the call using the initial invite linkYou should be able to see this bar in the lower centre of your screen. If it disappears just click the centre of the screen and it will reappear.To turn your Camera on/offTo mute and unmute yourselfTo raise/lower your hand To view and use the chat box – please use for discussion and questions

4. Mandeep Ahluwalia – Macmillan GP and Cancer Lead West Sussex (North)Alex Mancey-Barratt – Macmillan GP and Cancer Lead Brighton and HoveMatthew Thomas – Cancer Lead East SussexJo Thomson – Macmillan GP & Cancer Lead West Sussex (South), CRUK GP and Primary care lead Surrey and Sussex Cancer AllianceRosie Moylan – CRUK facilitator SussexWho we are

5. NHS long term plan - the contextWhat are the requirements for PCN DES?Practical advice for approaching the PCN DESQOF QI – new changes, coding, screening – how it relates to PCN DESFurther supporting resources availableQ&ABreakout sessions with Clinical Lead from your areaOutline for session

6. “By 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half now to three-quarters of cancer patients”Greater awareness of symptomsLower threshold for referral for primary care Accelerate access to diagnostics and treatmentMaximise the number of cancers identified through national screening programmesNHS long –term plan

7. ONLY 54% OF CANCERS ARE DIAGNOSED AT AN EARLY STAGETHIS VARIES BY CANCER TYPEHow are we doing currently?

8. Primary Care Network Early Cancer diagnosis service specification

9. Overview of early diagnosis specification Refer to NHS England and Improvement Network contract DES early diagnosis guidance (March 2020) for more information

10. Improving referral practice - what’s required? From the Network Contract DES Specification section 7.4.1.a - Review and improve referral practice for suspected cancers, including recurrent cancers. This will be done by:

11. 1. Increase awareness and use of the range of supporting resources available to improve knowledge and confidence using NG12. Gateway C  Clinical Decision Support tools  NG12 summary resourcesExample actions for PCNs to improve referral process

12. 2. Discuss current safety netting process and agree on standardised approach within practices Review CRUK Safety netting best practice checklistReview available clinical system safety netting tools  AccuRx, Ardens, S1, Emis.Facilitate use of new SNOMED code to record safety netting (Oct 2020)Example actions for PCNs to improve referral process

13. 3. Review information patients are receiving at referralAgree and standardise information given to patients at referral (CRUK patient webpage and leaflet available)Agree methods for ensuring patient understanding (Letter? Text? Family member?)Standardise process for recording what information patient is received and how – READ codes availableExample actions for PCNs to improve referral process

14. Reviewing your referral practice - getting started Review PCN level data reports using the PCN Data Pack or on PHE Fingertips to: benchmark your practices; understand any variation; and identify where improvements can be made.

15. Reviewing your referral practice - getting started

16. Early Diagnosis and safety netting

17. From the Network Contract DES Specification section 7.4.1.b - Contribute to improving local uptake and coverage of National Cancer Screening Programmes by:Increasing screening uptake - what’s required? Working with local partners to agree the PCN contribution to improve uptake and coverage and develop an action plan to implement. This should build on any existing actions across practices and include at least one specific action to engage with a group with low-participation locally.

18. Bowel screeningMen and women aged 60–74yrs, invited every 2 years Over 74, can request a kitFIT testing (implemented April 2019) One off bowel scope test at 55yrs – area dependent Screening programmes overviewCervical screeningWomen aged 25-64yrs Invited every 3 years age 25-49, and every 5 years age 50-64HPV primary testing for all samples. Breast screeningWomen aged 50–70yrs, invited every 3 years Women over 70 screened on request- *currently paused*.Mammography National target 80%

19. Bowel screening programme - UpdatePre-COVIDBowel screeningMen and women aged 60–74yrs, invited every 2 years Over 74, can request a kitFIT testing (implemented April 2019) One off bowel scope test at 55yrs – availability varies some areas onlyCurrent (as of August 2020)Bowel screeningInvitations have been sent to those who took part pre-Covid and required follow-up tests.Many Screening Centres have worked through their pre-Covid backlog Delayed invitations have restarted in several places

20. Pre-COVID Breast screeningWomen aged 50–70yrs, invited every 3 years Women over 70 screened on requestMammography Current (as of August 2020)Breast screeningInvitations restarting for those who took part pre-Covid and need follow-up tests.To create secondary care capacity; no self-ref for > 70; stop second timed appt in favour of open appts. Normal services may resume at different times depending on availability.Breast Screening Programme - UpdateNational target 70%

21. Cervical Screening Programme - UpdatePre-COVIDCervical screeningWomen aged 25-64yrs Invited every 3 years age 25-49, and every 5 years age 50-64HPV primary testing for all samples. Current (as of August 2020) Cervical screeningInvitations never stopped but slowed. Catch up will be complete by September NHSE advises to follow primary care recommendations on PPE for non-aerosol generating procedures

22. Increasing Screening UptakeReview PCN level reports on  SSCA data pack or PHE Fingertips. This will help you to benchmark your practices to understand any variation and to identify where improvements can be made for your PCN. NB this is not designed to compare practice achievement – rather than to recognise challengesIdentify particular groups of patients where there are inequalities in uptake and to focus their QI activity here. This can include:MenPatients from BAME backgroundsPatients where English isn’t their first languagePatients with disabilities (physical and/or learning disabilities)Download CRUK’s Reducing inequalities in bowel cancer screening guide for more information.

23. Further Ideas on how PCNs can support screening uptakeAgree a process for following up screening non-responders across PCN Support increased opportunistic endorsement of screening programmes at practice level (e.g. activate pop-up alerts, education of practice staff)Co-ordinate active endorsement and promotion of screening programmes (practice posters, charity awareness campaigns, nominate a practice cancer champion – can be non clinical – to coordinate the above.)

24. ScreeningEarly Diagnosis: GP/PCN “Nuts & Bolts” – the overlap

25. Overview of early diagnosis specification Refer to NHS England and Improvement Network contract DES early diagnosis guidance (March 2020) for more information

26. Reflective Learning and partnerships – what’s required?Support constituent practices to conduct peer to peer learning events that look at data/ trends in diagnosis across a Network, including cases where patients presented repeatedly before referral and late diagnosesSupport engagement with local system partners, including Patient Participation Groups, secondary care, the relevant Cancer Alliance and Public Health Commissioning teams.From the Network Contract DES Specification section 7.4.1.c - To build a local collaborative system of partners (Inc. patient groups) to enable reflective learning and improve outcomes

27. Example actions for PCNs to support delivery through community of practice1. Schedule cancer specific PCN wide meetings Clinical meetings to review on-going audit and LEAs findings; invite other system partners? To agree quality improvement projects; to share best practice and resources.

28. Example actions for PCNs to support delivery through community of practice2. Meet local system partnersIntroductions with: CRUK facilitator, CRUK and Macmillan GPs, CCG/STP Cancer Clinical leads, CCG/STP Cancer programme managers, Patient RepsSupport and encourage Patient Participation Group engagement CRUK facilitator offer

29. CRUK Facilitators will support PCNs to improve referral process by: Providing access to the latest evidence, online resources, learning platforms and best practiceSupport with National Cancer Diagnosis Audit reports at practice and PCN levelEducation sessions for clinical & non clinical staff on safety netting

30. CRUK Facilitators will further support PCNs to improve local uptake of National Cancer Screening Programmes by: Providing training for clinical and non-clinical staff on screening programmesHelp find solutions to issues within practices by facilitating local action planning – helping them to meet and maintain screening targets Setting up a clinical and non-clinical practice cancer champion programme

31. CRUK Facilitators will support PCNs to improve outcomes through reflective learning and local system partnerships by: Remote session to help understanding your data Assist with Quality Improvement projects Support meetings to share any learning specifically from any stage 3 or 4 cancers or patients diagnosed with lung or bowel cancer. Attend community of practice/PCN-wide meetings during the year with all member practices to raise awareness, signpost to education and resources and discuss possible actionsSetting up a clinical and non-clinical practice cancer champion programme

32. QOF QI

33. QOF Quality Improvement Domain- Early Diagnosis of CancerRequirements of the QI domain have also been amended as per the below:The focus is upon the restoration of delivery of screening services and ensuring patients who require urgent referral are identified, supported and managed Specifically this includes:Restoring cervical screening uptake to pre-COVID levelsBuilding public confidence that general practice is a safe environmentReturning referrals to pre-COVID levels inc. improving referral quality, and awareness of pathwaysHaving robust and consistent systems in place for safety nettingThese actions can be supported by the sharing of best practice across the PCNPractices should consider using learning event analysis (LEA) to support actions 3 and 4Reporting templates for the QI domain have now been published for the first timeNote: The new requirements are not intended to replace QI activity that has already begun in response to the original 2020/21 QI guidance

34. Reporting templates for the QI domain have now been published:QOF Quality Improvement Domain – Early Diagnosis of Cancer ReportingWhat issues did the practice identify with the quality of referrals for early cancer diagnosis?What actions did the practice take to build confidence in primary care and to reassure patients that general practice can be accessed safely?What action did the practice take to support restoration of the cervical screening programme?What changes did the practice make to their system for safety netting?How many patients who had not attended any appointments were proactively followed up?What changes will/ have been embedded into practice systems to ensure early cancer diagnosis in the future?How did the network peer support meetings and patient participation group influence the practice’s QI plans and understanding of early cancer diagnosis?https://www.england.nhs.uk/wp-content/uploads/2020/09/C0713-202021-General-Medical-Services-GMS-contract-Quality-and-Outcomes-Framework-QOF-Guidance.pdf

35. A Plan for PCNs and PracticesHEALTH INEQUALITIES

36. Further Resourceshttps://www.sussexccgs.nhs.uk/clinical_documents/pcn-and-general-practice-cancer-support/

37. Links to resources to support you on each DES requirement CRUK GP Contract hub cruk.org/GPcontract

38. Macmillan Cancer Support

39. Primary Care Network: Directed Enhanced Service and Quality Outcomes Framework Quality ImprovementCancer Guidance and Resource PackAugust 2020

40. RCGP cancer toolkitsEarly Diagnosis of Cancer Significant Event Analysis (SEA) toolkitPrimary Care Cancer toolkit

41. Surrey and Sussex Cancer Alliance Data PackComing to a PCN near you soon….

42. Questions & AnswersPlease submit your questions in the chat box.There will be time for further questions in the breakout sessions

43. Mandeep Ahluwalia – Macmillan GP and Cancer Lead West Sussex (North)mahluwalia@nhs.net Alex Mancey-Barratt – Macmillan GP and Cancer Lead Brighton and Hovealex.mancey-barratt@nhs.net Matthew Thomas – Cancer Lead East Sussexmathew.thomas@nhs.net Jo Thomson – Macmillan GP & Cancer Lead West Sussex (South), CRUK GP and Primary care lead Surrey and Sussex Cancer Alliancejo.thomson@nhs.net Rosie Moylan – CRUK facilitator Sussexrosie.moylan@cancer.org.uk Who we are

44. We suggest you attend the breakout room with the Clinical Lead for your area