1. [NAME CCG] [DATE] [FACILITATOR] Early Diagnosis of Cancer Quality Improvement using Cancer Significant Event Analysis [CCG MAP]

2. Overview of learning event Regional Cancer Stats Cancer SEA Quality Themes Quality Improvement Tools Workshop Plenary Toolkit and Resources

3. Learning Objectives To be able to undertake a high quality Cancer SEA To identify themes for action To target quality improvement To recognise the importance of proactive safety-netting (optional) To use clinical decision support tools for earlier diagnosis (optional)

4. Overview of learning event Regional Cancer Stats Cancer SEA Quality Themes Quality Improvement tools Workshop Plenary Toolkit and Resources

5. Why is cancer a priority? Cancer is the leading cause of premature death …..and the incidence is increasing… Cardiovascular deaths : x/100,000 Cancer deaths: x/100,000 England average x/100,000 [Access your local Health Profile here: http://www.apho.org.uk/default.aspx?QN=HP_FINDSEARCH2012] http://www.apho.org.uk/default.aspx?QN=HP_FINDSEARCH2012 By 2020, almost half of those who die in that year will have had a cancer diagnosis during their lifetime. The number of people living with cancer in the UK will go up by 30% between 2013 and 2020. INSERT EARLY DEATHS FROM CANCER GRAPH Available from your local Health Profile. Access at http://www.apho.org.uk/default.aspx?QN=HP_FINDS EARCH2012 http://www.apho.org.uk/default.aspx?QN=HP_FINDS EARCH2012

6. UK outcomes lag behind

7. Early Diagnosis Stats CCG NAMENational Average Emergency Presentations 2013 (%) X23.7 % NON-2WW 2014/15 Q1 X51 6 weeks for diagnostics 2015 (%) X98.3 6 weeks for diagnostics bowel cancer 2015 (%) X95.6 Stage 1 or 2 at diagnosis 2015 (%) X54.5 Conversion 2ww Rate 2014/15 Q1 (CR %) X8.4

8. Colorectal cancer – survival rate plotted against stage of diagnosis If diagnosed at stage A, colorectal cancer has a 93% survival rate Source: National Cancer Data Repository, 2009

9. Overview of learning event Regional Cancer Stats Cancer SEA  Quality Themes Quality Improvement Tools Workshop Plenary Toolkit and Resources

10. Cancer SEAs Quality Improvement Tool Case selection, Reflection, Quality, Action and Impact Identify learnings points and share good practice Make recommendations for quality improvement Not about blame or judgement Supported by NHSE, RCGP and Macmillan Cancer Support

11. Your experiences Established method of learning Good and unexpected outcomes can be used for learning Insight, transparency, non-judgemental Sharing = learning

12. Why do a Cancer SEA? Evidence of reflection Appraisal Revalidation CQC inspections Achieving world-class cancer outcomes-a strategy for England 2015- 2020 Recommendation 25: All GPs should be required to undertake a Significant Event Analysis for any patient diagnosed with cancer as a result of an emergency admission.

13. Why do a Cancer SEA? Done well is worth the effort Benefits it can bring for clinicians, patients, the practice as a whole and the primary-secondary care interface. It would generate the ‘nudge’ across the board towards reflective thinking and quality improvement. Enhances the reflective process Deconstruct the journey to diagnosis Unpick themes Lead to a range of improvements better communication modifying practice systems improving documentation proactive safety netting.

14. Case selection Choice of case is important Emergency presentation Late stage diagnosis Avoidable delay RCGP cancer diagnosis audit tool to track activity in a practice

15. Practice activity Practice meeting Inclusive of all staff – clinical and admin Involve hospital where relevant Liaise with CCG cancer lead if needed ‘Actions the actions’ agreed in the discussion

16. What is a Cancer SEA? An account of an SEA should not allow patients to be identified and should comprise: Title and date of the event Date the event was discussed and the roles of those present A description of the event involving the GP(s) and other colleagues What went well? What could have been done differently?

17. What is a Cancer SEA? Reflections on the event in terms of: knowledge, skills and performance safety and quality communication, partnership and teamwork maintaining trust What changes have been agreed: for me personally for the team Changes carried out and their IMPACT

18. Practice process

19. What happened?

20. Why did it happen?

21. What has been learned?

22. What has been changed?

23. Impact

24. Was it effective?

25. Cancer SEA instructional video

26. Themes Checklist (1) Avoidable or unavoidable delays Clinical Presentation Communication Co-morbid long term conditions Complexity of the case Consultation activity Continuity Documentation quality Education and guidelines

27. Themes Checklist (2) History of a previous cancer In-practice systems Investigations and access to diagnostics Patient education and awareness Patient safety Practice staff issues Practitioner issues Primary-secondary care interface

28. Themes Checklist (3) Read coding Referrals management Risk assessment tools Routes to diagnosis Safety netting Screening Teamwork Training

29. Actions & Impact Communication protocols Continuity approach Documentation improved Identify learning needs within the team In-practice systems modified Investigations protocols Guidelines refresh and team education Patient education and awareness Primary care team involvement Quality improvement tools Read coding Referrals read coding and tracking Risk assessment tools or clinical decision support tools Safety netting Screening protocols Training

30. Feedback Instrument

31. Workshop Use the workshop brief as a guide Reflect on three Cancer SEAs of differing quality and impact Patient A Patient B Patient C Review the differences Discuss themes identified Explore actions taken as a result of the SEA

32. Plenary Thoughts? Concerns? Questions? Motivated to do Cancer SEAs? Access the toolkit at www.#######

33. Use the toolkit Access the toolkit here: #######

34. Thank you Please complete the evaluation form, so we can send you your CPD certificate