lung cancer best timed pathway · @gmceducation i lung cancer challenges •poor outcomes compared...

Lung Cancer Best Timed Pathway

Greater Manchester’s approach

Dr Seamus Grundy

Consultant Respiratory Physician

Salford Royal

© Copyright Greater Manchester Cancer. All rights reserved.

@GMCEducation I

Overview

• National and Regional ‘best timed pathways’

• GM Cancer Project

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Lung Cancer: The Facts

Greater Manchester Cancer

Current National Targets

https://www.nuffieldtrust.org.uk/news-item/cancer-waiting-times-how-has-nhs-performance-changed-over-time

Target: 85%

Target: 93% Target: 96%

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Lung Cancer Challenges

• Poor outcomes compared with European Countries

• Significant variation in practice/outcomes

• Failure to meet NHS England Cancer Targets

• RCT evidence that shorter diagnostic pathways associated with significantly improved long term outcomes

62 day performance Q1 19/20

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10

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90

Bolton Pennine East Cheshire WWL Stockport Salford Tameside MFT GM

Greater Manchester Cancer

National ‘Optimal’ Pathway

Triaging Test

Greater Manchester Cancer

National ‘Optimal’ Pathway

Staging/Diagnostic tests

Clinical Triage/ Filter out non-cancer

MDT discussion

Greater Manchester Cancer

National ‘optimal’ pathway

Greater Manchester Cancer

National ‘optimal’ pathway

• 52 day pathway

• Taken a ‘pragmatic approach’ to timings

• Sets out clear principles with which to work

• But is 52 days really ‘optimal’?

(Optimal: adj. best or most favourable)

Greater Manchester Cancer

GM ‘Optimal’ Lung Pathway

Greater Manchester Cancer

GM Optimal Lung Pathway

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Standardised staging bundles

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GM Cancer Best timed Pathway Project

• Resource Gap Analysis

• Investment of £1.3M

• Clinical Leadership with Project Management Support

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GM Cancer Best timed Pathway Project

• Invested in all Secondary care trusts in GM & East Cheshire + specialist treatment centres

• Pathway Navigators (9 across GM)

• Specialist Nurses (11 across GM)

• Clinical Fellows (1 @ MFT)

• Point of care eGFR testing

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GM Cancer Best timed Pathway Project

Outcome measures:

• Complete achievement of 62 day standard

• 90% staging CT within 72 hrs of referral

• 80% discussed at MDT by day 21

• Reduced median time from referral to treatment

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Lessons Learnt

• Prompt access to initial ‘diagnostic test’ essential

• Immediate Specialist triaging • Job planned ‘virtual DCC’

• Thorough resource gap analysis

• Pathway Navigators are key to success

Q&A

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