1. Endoscopy Matters NICE guidance dyspepsia, New build, National Context & NAEDI Dr Michelle Gallagher Consultant Gastroenterologist

2. Current pathways into diagnostics for upper GI symptoms…. GP TWR to clinic or direct to test GP referral to OP C&B direct access endoscopy Gastroenterology Upper GI surgery Diagnostic Endoscopy

3. NICE guidance Immediate (same day) referral for: – Significant gastrointestinal bleeding Urgent referral (within 2 weeks) is indicated at any age for: – Progressive dysphagia – Unintentional weight loss – Epigastric mass – Suspicious barium meal – Iron deficiency anaemia – Persistent vomitin Recent onset “unexplained and persistant” dyspepsia alone in those over 55

7. Local Performance TWR and C&B open access endoscopy

8. RSCH Upper GI Cancer Diagnoses 2010/2012 377 TWR referrals (18% cancer; national average 14%) Of all Upper GI malignancies – 32% referred as TWR – 23% Non TWR referral – 29% Emergency presentation via A&E – 16% Internal referrals

9. Open access? PROS? Straight to test – Shortened patient pathway No OP consultation ? Cost CONS Reduced opportunity to speak to a specailist Test only Complex patients Unrestricted access – Increased activity!

10. Choose & Book Direct Access Endoscopy RSCH C&B direct access OGD established 2008 4 C&B slots per week – 1 Gallagher – 1 Preston – 1 Soon – 1 Tibbs Audit – 6/12 data analysed

11. Choose & book audit 68% male Age range 25-75 100% pre treated with PPI therapy! All but 3 endoscopies undertaken by Consultant / SPR under supervision 5 OPA appointments generated – 3 Non medical endoscopist – 1 Malignancy – 1 Newly diagnosed portal hypertension

12. Results – Indication within NICE?

13. Results – Endoscopic diagnosis?

14. RSCH Endoscopy 2 rooms > 7000 procedures pa Increased proportion therapeutic endoscopy – Cancer services – Bowel cancer screening – Non invasive tests MRCP (CTC)

15. New Unit Due to open Autumn 2012 – 4 rooms – Compliant with single sex accommodation & infection control standards – Dedicated “quiet room” – 1 room for BCSP!

16. NAEDI National Awareness and Early Diagnosis Initiative Cancer Reform strategy 2007 – DoH – Cancer Research UK – National Cancer Action Team Co-ordinate and provide support – Activities which promote early diagnosis of cancer – Research

17. UK Cancer Statistics Cancer survival – measure of effectiveness of healthcare 10 000 “avoidable deaths” pa UK Diagnostics surrogate marker for effective healthcare 25% new cancer diagnoses following emergency presentation 1 year survival poorer for emergent presentations

18. NAEDI “……..Work stream 1 aims to achieve earlier (and more appropriate) presentation of potential cancer patients with symptoms to primary care. It focuses on interaction with members of the public up to the point of presentation”

19. NAEDI Be clear on cancer campaign 2 pilots – SW & East of England 48% increase in the number of people who visited their GPs with symptoms 32% increase in urgent referrals to hospitals Campaign recognition was high with 75% of the public saying they had seen the advertising Overwhelming support for the campaign – 96% of the public and 89% of GPs believed it was important.

20. Be Clear on Cancer ……………….. National campaign February 2012!