Ensuring the commissioning priorities for cancer are the right ones

1. Ensuring the commissioning priorities for cancer are the right ones 10 July 2012

2. Welcome Background to the project Overview of process to date Potential priorities for South East London Discussions Review and next steps

3. Project background • Cancer is a priority for the NHS in London and all are keen to ensure that the commissioning priorities for cancer care in the future are informed by the experience of GPs • Need to support the transition from the traditional PCT/provider relationship to one where clinical commissioning groups act to commission cancer services aligned with implementation of the Cancer Model of Care • Recognition that there is a need to build awareness and understanding of the Model of Care across South and West London • Essential that CCGs are involved in designing and agreeing the necessary decision making structures to ensure that local priorities for cancer care are identified, agreed and inform commissioning intentions. These decision making structures will also fit with and feed into the new pan-London Cancer Clinical Leadership and Advisory Group. • Given the rapidly evolving commissioning landscape and embryonic organisations involved a project was designed to engage and promote discussion of local cancer priorities and facilitate agreement of pan South and West London priorities. • The aim of this work is to create a set of draft priorities for cancer care commissioning for South and West London that will provide the starting point for commissioning intentions for 2013/14 • These priorities will subsequently be discussed with the London Cancer Alliance.

4. Five key themes from the model of care

5. UK Cancer Initiatives summary Both associated with lifestyle choices and therefore easier to risk stratify UK Cancer Initiatives An urgent two-week referral pathway for suspected cancer has now been in operation since 2000, with supporting criteria for referral being provided by NICE - but in London only 10-20% of these patients are normally confirmed with Cancer, resulting in ~80% being referred for the wrong reason (cancer network GP lead comment). In 2007, the NHS Cancer Reform Strategy published by the Department of Health, emphasised the importance of raising awareness of the early warning signs and risk factors of cancer within the general population A programme of activities spanning the cancer pathway from first suspicion of bodily change to confirmation of cancer diagnosis, the NAEDI, was launched in 2008 to better understand and address reasons for late diagnosis in England Direct access to diagnostic tests for cancer 2011/2012, commissioners and local providers will consider the four priority areas for diagnostics for improving earlier diagnosis of cancer • Lung: Chest X-ray: to support diagnosis of lung cancer • Colorectal: Flexible-sigmoidoscopy: to support the diagnosis of colorectal cancer • Ovarian: Non-obstetric ultrasound: to support diagnosis of ovarian cancer • Brain: MRI to support diagnosis of brain cancer

6. Purpose of this evening The purpose of this evening is to ensure that the future commissioning priorities for cancer care are informed by your experience as GPs. We will discuss and agree potential priority areas for cancer care for South East London.

7. Agenda Background to the project Overview of process to date Potential priorities for South East London Discussions Review and next steps

8. We developed a process to understand GP perceptions of cancer priorities across NW, SW and SE London • SE Network • SW Network • NW Network • Local meetings with key individuals from each cluster • Scheduled: • Thursday 26th July, 6pm – 8pm • Victoria • Scheduled: • SE London: 10th July • NW London: 11th July • SW London: 16th July Held to date: 9 discussions with NW 14 discussions with SE 6 discussions with SW

9. Our discussions have covered a number of areas with GPs In your opinion what are the key issues in delivering improvements in cancer care in your area In terms of Cancer care management (and delivery) what systems and processes have you seen work well and why? What could be done to help spread successful practice? In your opinion what are the key issues surrounding the provision of cancer care in your area (SW, SE and NW)? Which priorities which do you see as having the most positive impact on health whilst also being realistic to resolve? In your opinion what should the vision of cancer care in London (query focus S&W) be? What would success look like?

10. Agenda Background to the project Overview of process to date Potential priorities for South East London Discussions Review and next steps

11. What we heard across London: A vision for cancer delivery “New landscape using better data building on the new wave of GPs that are open to moving Cancer to cancer (big C little c)” "We need to deliver the same level and standard of care that we deliver for palliative patients to those early diagnoses and those living with chronic cancer” “GPs need to see cancer as their problem too, especially in terms of co-morbidities and integrated care" “A behavioural change around disease management” “Understanding cancer is a long-term condition” “Need to risk stratify cancer services to ensure that they match patient needs and are delivered in the most appropriate way” "Ensuring more service is delivered in the community, closer to home and that only the high risk patients and services are carried out in acute settings” "Ensuring that primary care has the capacity to undertake the work that is being (or at least is being suggested”

12. To analyse discussions we grouped responses into three groupings to allow the identification of high (1) medium (2) and low (3) priorities 1 The aim of this process is to test the priorities identified through one-to-one discussions allowing you to comment on how priorities should be ranked locally 2 3

13. The key issues and priority areas for South East London GPs 1 2 3

14. Potential priority areas for South East London Areas that are not working well at present Areas of success that could be built upon Areas of success that could be built upon Building on the success of the two week wait referral route, ensuring that areas of over-referral and under-referral are addressed 20 care centralised where necessary, localised where possible Improved communication from 20 care Clear pathways for survivorship and EoL care, with GP engagement

15. Agenda Background to the project Overview of process to date Potential priorities for South East London Discussions Review and next steps

16. Agenda Background to the project Overview of process to date Potential priorities for South East London Discussions Review and next steps

17. Comparison priorities across North West and South London North West London South West London There are a number of similarities across the three regions including, but not limited to: • Better use of Dx and the two week wait • Communication from 20 care • Cancer as a long term condition • GP engagement in palliative care

18. Next steps • The key steps that follow this session today are: • Consolidation event for CCGs and GPs from North West and South London – Thursday, July 26th6pm – 8pm • Pre-commissioning intentions discussion with the London Cancer Alliance - August • Drafting of commissioning intentions for 2013/14 • Formally sharing commissioning intentions for 2013/14 with the London Cancer Alliance - Autumn