1. Increasing awareness and early diagnosis of cancer An update from Primary Care Jo Preston Service Improvement Facilitator NECN Dr Bill Hall Primary Care Cancer Lead South Tyneside

2. The Challenge Increasing public awareness of signs and symptoms – Campaign overview – National Lung Cancer Awareness Campaign Supporting Primary Care – Background – Practice Profiles and visits – Next steps Content

3. Supporting drive to save 1,000 lives High levels of early death from cancer Low levels of awareness among public of signs and symptoms Call from clinicians for sustained public information campaign The challenge

4. All based upon insights gained from Cancer Awareness Measures (CAM) surveys (five across the North of England) Key message: Finding cancer early enough makes it more treatable and saves lives Call to action: Tell your GP Consistent across all the campaign activity The campaign messages

5. Phase 1 & Phase 5 - The Race for Life partnership February to July 2011 & 2012 Phase 2 - Shopping centre, sports sponsorship and patient recruitment September to November 2011 Several distinct campaign phases

6. Phase 3 – National bowel campaign January to March 2012 Phase 4 – Pilot Department of Health oesophago-gastric campaign April to June 2012 Phase 6 – National lung campaign May to June 2012 Phase 7 – National refresh of bowel campaign September to October - tbc Anne Maguire Bowel cancer survivor Newcastle Val Armstrong Breast cancer survivor Carlisle Several distinct campaigns continued

7. National Lung Cancer Awareness Campaign The campaign starts on the 8 th May and will run for 8 weeks with a high level of media saturation The key message will be to encourage people who have had a cough for at least 3 weeks to see their GP The target audience is people over the age of 50.

8. National Lung Cancer Awareness Campaign

9. Anticipated Impact Based on 2 pilots carried out in East & West Midlands networks There was a 23% increase in the number of people who visited their GP with relevant symptoms over the period of the pilot campaigns and GPs are expected to see 2 or 3 more patients with relevant symptoms each week.

10. Anticipated Impact 29% increase in the number of 2 week wait referrals a 15.8% increase in CT scans with the majority (80%) of tests carried out in the target age group and a 16.4% increase in chest X-rays with the majority (60%) of tests carried out in the target age group.

11. NAEDI 2011 – 12 Cancer Networks Supporting Primary Care

12. Cancer Networks Supporting Primary Care Current programme of work with primary care – Practice profile visits – Use risk assessment approaches to support GPs in assessing patients with potential cancer diagnosis – Primary care education programme – Wider use of safety netting practices to help GPs review patients with potentially serious illnesses if the symptoms do not resolve – Encourage wider use of audit tools – Working with Macmillan to support Primary Care Cancer Leads – Increased working between primary and secondary care – Roll out of Tees NAEDI Project – NHS Health Check

13. Practice Profiles Produced by National Cancer Intelligence Network (NCIN and National Cancer Action Team (NCAT) Available to view on Cancer Commissioning Toolkit (CCT) First released in December 2010 and updated in December 2011 Comparative information for benchmarking and reviewing variations at Practice level. GP Leads within the NECN have been visiting selected practices who vary from the PCT mean on certain indicators. – Top and bottom 15% for deprivation and age of population. – Number of 2ww referrals, Conversion rate and emergency presentation.

14. Practice Profiles continued Practice demographics Cancer screening rates Cancer Waiting times data – Number of 2ww referrals – 2ww conversion rates Presentation and diagnostics – Number of colonoscopy procedures – Number of emergency presentations – Number of other presentations

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18. Profile visits An opportunity for practices to understand their profiles and recognise any areas in which they may be able improve. In South Tyneside because of the small number of Practices involved I am in the process of visiting every practice. In other areas GP leads are visiting practices with profiles which differ greatest from the mean..

19. Willie Hamilton RAT Lung Cancer Assessment Tool for Non –Smokers Male  Female  Cough Fatigue Dyspnoea Chest pain Loss of weight Loss of appetite Thrombocyt osis Abnormal spirometry Haemoptysi s 0.4 0.70.81.10.91.6 2.4PPV alone 0.6 0.8 1.81.62.01.22.0Cough 0.5 6 0.90.81.01.21.84.03.3Fatigue 0.91.22.0 2.34.9Dyspnoea 0.91.8 2.01.45.0Chest pain 1.22.36.11.59.2Loss of weight 1.70.92.7>1 0 Loss of appetite 3.6>1 0 Thrombocyt osis >1 0 Abn. spirometry 17Haemoptysi s B Lung Cancer Assessment Tool for Smokers Male  Female  Cough Fatigue Dyspnoea Chest pain Loss of weight Loss of appetite Thrombocytosis Abnormal spirometry Haemoptysis 0.90.81.21.32.11.84.24.04.5 PPV alone 1.31.01.40.92.32.86.53.63.9 Cough 1.21.41.32.02.32.4>1 0 6.1 Fatigue 1.52.23.15.52.4>1 0 6.9 Dyspnoea 1.44.47.6>1 0 4.1 Chest pain 1.75.0>1 0 Loss of weight 2.7 Loss of appetite 12Haemoptys is

20. Cancer Diagnostic Pathway Audit and Significant Event Audit Practices have been given the opportunity to participate in several audits to date: RCGP/ NCAT Cancer Diagnostic Pathway Audit. This looks at all cancer diagnoses over a 9 month period to identify any delays in pathways. The practices then agreed actions to improve and re-audited following interventions. Results of this are currently being analysed. Significant Event Audit. GP’s have been invited to analyse any diagnosis of cancer within the last 12 months where they think there may have been a delay. Results of this are currently being analysed.

21. Ideas for future programme of work – Review current direct access to diagnostics and also GP access to secondary care opinion – Evaluation of Risk Assessment Tools - oesophago-gastric cancer – Link cancer awareness to NHS healthy heart check (modelled on Tees NAEDI project) – Further work on referral pathways (particularly lung) – Set up a regional Practice Manager group – develop a tool to identify patients most at risk of cancer – develop surveillance tool for higher risk patients – Timely staging data Going forward with the health community

22. Contact: Jo Preston Jo.Preston@necn.nhs.uk Bill Hall Hall717@btinternet.com Any Questions?