16 th May 2017

1. Greater Manchester Cancer Vanguard Innovation Faster Diagnosis ShowcaseLisa Galligan-Dawson, Bolton NHS Foundation TrustMartina Kingscott, Bolton NHS Foundation TrustMelissa Surgey, Bolton Clinical Commissioning GroupDavid McLenachan, User Involvement representative 16th May 2017

2. Greater Manchester Cancer Housekeeping Vanguard Innovation • There are no scheduled fire drills • Toilets are to the right of the exit • We will be taking pictures – please let us know if you don’t want to have your picture taken • The presentations will be circulated after the event • Phones on silent please

3. Greater Manchester Cancer The national Cancer Vanguard Vanguard Innovation 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

4. Greater Manchester Cancer Project Team Vanguard Innovation The core Faster Diagnosis team works collaboratively with strategic and operational stakeholders from the three specific tumour site projects to facilitate service delivery

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

6. Greater Manchester Cancer Project Governance Vanguard Innovation

7. Greater Manchester Cancer Lung Pathway Changes Vanguard Innovation • 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)

8. Greater Manchester Cancer Lung Pathway Changes Vanguard Innovation • 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

9. Greater Manchester Cancer Lung Pathway Flowchart Vanguard Innovation

10. Greater Manchester Cancer Upper Gastro Intestinal (GI) Pathway Vanguard Innovation • 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

11. Greater Manchester Cancer Upper Gastro Intestinal (GI) Pathway Vanguard Innovation • 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)

12. Greater Manchester Cancer Upper GI Pathway Flowchart Vanguard Innovation

13. Greater Manchester Cancer Direct to Test Colonoscopy Pathway Vanguard Innovation 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

14. Greater Manchester Cancer Direct to Test Flow chart • Vanguard Innovation

15. Greater Manchester Cancer Flow Chart for Pre-Assessment • Vanguard Innovation

16. Greater Manchester Cancer User Involvement • Vanguard Innovation • 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”

17. Greater Manchester Cancer GO LIVE! • Vanguard Innovation • Went “live” on Monday 3rd 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

18. Greater Manchester Cancer Audit Data • Vanguard Innovation • 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.

19. Greater Manchester Cancer Patient Cancer Journey • Vanguard Innovation 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

20. Greater Manchester Cancer Issues Raised • Vanguard Innovation • 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

21. Greater Manchester Cancer Moving Forward • Vanguard Innovation • 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

22. Greater Manchester Cancer Engagement with Primary Care • Vanguard Innovation • 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

23. Greater Manchester Cancer Lessons Learned • Vanguard Innovation • 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

24. Greater Manchester Cancer What Next? • Vanguard Innovation • 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

25. Greater Manchester Cancer Contact • Vanguard Innovation • Lisa Galligan-Dawson – lisa.galligan-dawson@boltonft.nhs.uk • Melissa Surgey – melissa.surgey@nhs.net • Martina Kingscott – martina.kingscott@boltonft.nhs.uk

26. Greater Manchester Cancer Questions • Vanguard Innovation

27. Greater Manchester Cancer Vanguard Innovation Vanguard Innovation Email: cancervanguard.gm.@nhs.net Web: gmcancervanguard.org Twitter: @GM_Ca_Vanguard