ensuring the commissioning priorities for cancer are the right ones

Ensuring the commissioning priorities for cancer are the right ones

10 July 2012

© PA Knowledge Limited 2011

Draft

Overview of process to date

Welcome

Background to the project

Review and next steps

Discussions

Potential priorities for South East London


Draft

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.


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Five key themes from the model of care


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UK Cancer Initiatives summary

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

Both associated with lifestyle choices and therefore easier to risk stratify


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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.


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Agenda



Discussions



DraftWe developed a process to understand GP perceptions of cancer priorities across NW, SW and SE London

Held to date: 9 discussions with NW

14 discussions with SE

6 discussions with SW

1:1 calls, face to face meetings, attend existing meetings

Gather local priorities from South and North

West CCGs

North West and South consolidation

event

Agree NW & S draft priorities to share with

LCA

SE Network

SW Network

NW Network

Local meetings with key

individuals from each cluster

Scheduled:

SE London: 10th July

NW London: 11th July

SW London: 16th July

Scheduled:

Thursday 26th July, 6pm – 8pm

Victoria


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Our discussions have covered a number of areas with GPs

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)?

In your opinion what are the key issues in

delivering improvements in cancer care in your area

In your opinion what should the vision of

cancer care in London (query focus S&W) be?

What would success look like?

Which priorities which do you

see as having the most positive

impact on health whilst also

being realistic to resolve?


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Agenda



Discussions



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What we heard across London: A vision for cancer delivery

"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"

“New landscape using better data building on the new wave of GPs that are open to moving Cancer to cancer (big C little c)”

“A behavioural change around disease management”

“Understanding cancer is a long-term condition”

"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”

“Need to risk stratify cancer services to ensure that they match patient needs and are delivered in the most appropriate way”


DraftTo analyse discussions we grouped responses into three groupings to allow the identification of high (1) medium (2) and low (3) priorities

Primary care• Comments heard across interviewees and

agreed by GPs who when asked agreed with colleagues views

• Priorities mentioned by a number of interviewees but a consensus view not generally found

• Infrequent comments that were not heard across the distribution of interviewees

1

2

3

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


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The key issues and priority areas for South East London GPs

Primary Care Secondary care Primary and secondary care• 2 week wait works well, but need to

consider GP and provider behaviour against over-referral and under-referral, and the impact on costs

• Breast service is good at GSTT, SLHT, King’s and Barts, and the breast pathway works well

• Providers should be smarter about follow ups –need to consider what is clinically appropriate for patient

• Repatriation of work closer to home

• Communications between secondary and primary care (poor during treatments and often on discharge)

• Communications with the patient about expectations, purpose of treatment, transition to palliative care

• Referrals back into the system if don’t meet the 2 week wait criteria, poor access

• Improving awareness especially in disadvantages groups, and specifically for lung and colorectal cancer

• Patient experience, especially outside secondary care – the care delivered once in the system is usually very good but it’s the patient experience outside this that suffers

• Palliative care – secondary care need to get better and discussing with the patient, and deciding, when to stop treatment

• Palliative care – providers need to work with local teams, and GPs, in advanced care planning

• Palliative care – variable, some areas work well but also many areas where it is a real concern – issues with communications, expectations, dying at home figures

• Management of chronic cancer patients and supporting those in survivorship – need pathway and practical support

• Improve screening – especially cervical• Concern about commissioning and

delivery of screening services in future• GP awareness, and GP training in

diagnostics

• Pathways tend to be one way – good referral routes into secondary care, but poorer (and great variation) at transfer back to primary

• Once in secondary care, provision of services needs to be coordinated

• Outcomes for bowel cancer and breast cancer are poor and need to be improved

1

2

3


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Improved communication

from 20 care

20 care centralised where

necessary, localised where

possible

Clear pathways for survivorship and EoL care,

with GP engagement

Potential priority areas for South East London

Building on the success of the two week wait referral route, ensuring that areas of over-referral and under-referral are addressed

Areas of success that could be built uponAreas that are not working well at present Areas of success that could be built upon


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Agenda



Discussions



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Comparison priorities across North West and South London

South West London North West London

There are a number of similarities across the three regions including, but not limited to:

o Better use of Dx and the two week waito Communication from 20 care

o Cancer as a long term conditiono GP engagement in palliative care


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The key steps that follow this session today are:

• Consolidation event for CCGs and GPs from North West and South London – Thursday, July 26 th 6pm – 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

Next steps

ensuring the commissioning priorities for cancer are the right ones

Documents

cancer pathway

suspected cancer

cancer care commissioning

diagnosis of brain cancer

london cancer alliance

risk factors of cancer

commission cancer services

commissioning priorities