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Achieving improved cancer outcomes- a pathway approach, engaging primary care and partners

Achieving improved cancer outcomes- a pathway approach, engaging primary care and partners. Kathy Elliott Programme Director – NHS Improving Quality (Delivery Team) kathy.elliott@nhsiq.nhs.uk. Declaration of Interests.

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Achieving improved cancer outcomes- a pathway approach, engaging primary care and partners

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  1. Achieving improved cancer outcomes- a pathway approach, engaging primary care and partners Kathy Elliott Programme Director – NHS Improving Quality (Delivery Team) kathy.elliott@nhsiq.nhs.uk

  2. Declaration of Interests • National programme of work, funded through national and local public sector funding. No payment for this presentation or for advice. • Partnership initiative – with contributions from cancer charities and professional organisations • Evaluation – independent, coordination of multiple data streams. Research funded by National Cancer Action Team/ Department of Health

  3. Introduction • Our aim - to improve cancer survival and ‘save 5,000 lives per year’ • Our approach - national policy, programme and leadership; public awareness; a health services pathway approach; research and evaluation • Engaging and change in primary care • Working with partners to achieve and sustain large scale change – national / local

  4. ICBP: 1 year relative survival. Coleman et al, Lancet 2011 Colorectal Cancer 1yr RS Lung Cancer 1yr RS Breast Cancer 1yr RS Ovarian Cancer 1yr RS

  5. Why are we making a difference? • Shared purpose – understanding and harnessing the different perspectives • Clinical leadership – GP, hospital, public health • ‘open approaches’ – sharing ideas and data, energy-generating • Relationships and networks with ‘reach’, building bridges and sharing knowledge for action • Patient and public focus - and outcomes • Sustaining a focus and improvement over time

  6. The NAEDI PathwayNational Awareness and Early Diagnosis Initiative Low public awareness and/ or negative beliefs about cancer Difficulty accessing primary care Late presentation to a GP Low uptake of screening Emergency presentations Delays in Primary Care Late presentation to hospital services Delays in secondary care More advanced disease at diagnosis Poor survival rates Avoidable deaths

  7. Public Awareness • Be Clear on Cancer (BCOC) – • a national campaign – tested local and regional • Tailored to specific cancer sites and symptoms • 40 complex data sets, with bespoke analysis, using control areas where possible • Alignment with other public awareness raising • Cancer Charities • Local outreach and targeting • Clinician, NHS and public health endorsement

  8. Increasing Public Awareness – impact on lung cancer • National awareness campaign for symptoms of lung cancer; 6 weeks in 2012 • Public awareness of symptoms increased from 41% to 50% • Urgent referrals for suspected lung cancer increased by 30% CRUK analysis of LUCADA data 2013

  9. Supporting Primary Care • Package of initiatives implemented at Network/ geographic area. Centrally driven/supported, locally determined and delivered • GP cancer leadership – national and local • Practice level cancer information (n=8,500) • Available to the practices and public; targeted peer (GP-GP)visits • Practical tools, resources and people to support change

  10. GP Leadership and Primary Care Support -Evaluation • Participation in any NAEDI initiative – 74% of practices (4380) returning data. Spread across 20 Cancer Networks (70%) • Significantly greater increase in 2ww referrals for practices engaging in practice plans, risk assessment tools, clinical audit, significant event analysis. • Practices that produced practice cancer plans (alone or in combination with other activities) showed the greatest change • The amount of variation in referral practice was less for intervention practices

  11. * Assumes zero activity in non-responding networks

  12. Mechanisms to facilitate change • Continued education for GPs • Improvement of accuracy and use of 2 week wait referrals • Clinical decision support tools • Face to face engagement with practices. New work investigating intensity, capacity, and impact of practice context and motivation. • Links to generic quality incentives • Shared purpose and vision • Use of tools to improve quality • Shift from projects to absorbing into mainstream practice

  13. Challenges • Short-termism • funding, fixed term contracts, organisational change, relationships between GPs and organisation of cancer services • Clarity about roles • Realism of job objectives, individual’s roles and responsibilities • Skills • Relationships between GPs and new (and changing) health care and public health organisations • Using theory and evidence • Dissemination; accessibility; easy to read and understand format for GPs • Engaging clinicians and developing clinical leaders • Work with individual GPs ‘patchy’; clinical leadership in every practice • Change takes time • ‘changing hearts and minds’ – as well as altering processes • Primary care a complex environment – isn’t a ‘one size fits all’ solution to implementing change

  14. Model of patient pathways to treatment Walter et al, J Health Serv Res and Policy 2012

  15. In conclusion • Sustaining focus on improving cancer survival over time, with changes in leadership and policy • Change, aligned across the patient pathway, including public awareness and primary care. The pre diagnosis part of the pathway is important. • Demonstrating impact - quality of care and outcomes • Applying learning from health service change to achieve improved patient care and population outcomes in specific diseases

  16. Key weblinks and papers • National (England) Cancer Policy – Improving Outcomes – a strategy for cancer • https://www.gov.uk/government/publications/the-national-cancer-strategy-3rd-annual-report--2 • NAEDI • General website - http://www.cancerresearchuk.org/cancer-info/spotcancerearly/naedi/AboutNAEDI/ • Evidence - http://www.nature.com/bjc/journal/v101/n2s/index.html and research conferences • ICBP – http://www.cancerresearchuk.org/cancer-info/spotcancerearly/ECBP/ • Be Clear on Cancer • Resources - http://www.cancerresearchuk.org/cancer-info/spotcancerearly/naedi/beclearoncancer/ • Evaluation - http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@hea/documents/generalcontent/cr_113267.pdf • Support for Primary Care • GP Practice Profiles http://www.ncin.org.uk/cancer_information_tools/profiles/gp_profiles • RCGP - http://www.rcgp.org.uk/system-pages/search-results.aspx?keywords=Cancer • Large scale change • http://www.nhsiq.nhs.uk/resource-search/publications/nhs-inst-leading-large-scale-change.aspx • NHS Change Model • http://www.nhsiq.nhs.uk/capacity-capability/nhs-change-model.aspx • Full primary care evaluation - all reports available via (archived) NCAT website and on Durham University website.

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