1. 62 day performance John Wayman North Cumbria

2. 62 Day performance 2012 (Upper GI)

3. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTLocal MDTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy

4. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTLocal MDTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days

5. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTLocal MDTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days

6. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTLocal MDTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days

7. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTLocal MDTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days 7 days

8. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days 7 days

9. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days 7 days

10. Upper GI Cancer pathway Triage of referral EndoscopyHistologyCTSpecialist MDT Further Investigation Neo-adjuvant chemotherapy 14 days 7 days

11. “Further Investigations” EUS (Newcastle)MDT PET CT (Preston)MDT Neck USS (NCUH)MDT CPEX fitness assessment (Newcastle) MDT Laparoscopy (Newcastle/NCUH) MDT

12. “Further Investigations” EUS (Newcastle)MDT PET CT (Preston)MDT Neck USS (NCUH)MDT CPEX fitness assessment (Newcastle) MDT Laparoscopy (Newcastle/NCUH) MDT <20days?

13. Why are we missing 62 day target? Nationally Long, multi-step pathway Diminishing performance of steps: “Step”“Pathway” 195%95% 295%90% 395%85% 495%80% Locally Limited capacity – CT – USS – MRI – Bronchoscopy – Endoscopy Reliance on other providers – EUS – C-PEX – PET CT – EMR

14. Saving time Solutions – >95% OGD within 7 days – >95% CT within 7 days – Investigate in parallel – Provide EUS and PET in house – Staging Admission – Remove MDT re-visits from pathway (Investigated to Protocol) Risks – Capacity? – Over investigation – Cost of equipment and expertise – Capacity? – Exclude specialist interpretation of results and insufficient CNS support to co-ordinate

15. Suggestions? Agree protocols for local MDT’s for – PET/Bone scan – EUS – Neck USS – Bronchoscopy – C-PEX Discuss at specialist MDT only after all investigation complete (or a result which “stops” the curative pathway) Combine investigations – EUS + Neck USS + C-PEX/Anaesthetic assessment Other Suggestion??