Cascade Programme Workshop Summary

Cascade Programme workshop summary

The Studio, Glasgow, 1 December 2016

Cascade workshops are an initiative supported by the Royal College of General Practitioners (RCGP) and Cancer Research UK (CRUK).
They provide a forum for information sharing, networking and generation of practical ideas about how to implement cancer quality improvement activities within primary care settings.

WORKSHOP OVERVIEW

The 9th Cancer Cascade workshop, held in Glasgow on 1 December 2016, focused on cancer as a quality improvement topic, and the challenges of diagnosing cancer in specific populations. The aim of the workshop was for attendees to:

ü  gain more insight into the national cancer agenda and GP cluster working

ü  learn about practical ways to drive improvements in cancer control

ü  hear from and meet academics and national leaders in cancer control

ü  network with other cancer champions from other areas

ü  discuss and share ideas for local improvement activities

The workshop agenda (see Appendix I) included:

·  A presentation on the work of the Scottish Primary Care Cancer Group by Dr Hugh Brown.[1]

·  An interactive session on cancer as a quality improvement topic.

·  Presentations from Dr Peter Murchie[2] and Dr Sara MacDonald[3] on the challenge of diagnosing cancer in rural and older populations, and group work focusing on these challenges.

·  An update on latest developments in cancer control from Dr Richard Roope.[4]

Presentations will be shared with workshop participants – please see attached

objectives and expectations

At the beginning of the day, delegates were asked to provide their expectations and objectives for attending the Cascade event. These included:

·  How to support a team approach to QI focused on cancer

·  Take back cancer learning to clusters

·  Share the learning of TLAT

·  Share NW improvement team work in deprivation and education to support

·  Understanding how cancer and the ageing population can be supported

·  Better understand the CRUK offer and explore support in Scotland

·  Understand cancer as a high priority within the context of capacity issues to investigate/ diagnose

·  How to square QI - now QOF has gone

·  How to address waiting times and what is the right level of referral for GPs

·  Realistic medicine and the importance to targeting QI at high impact interventions

·  Cluster group offers opportunities but need to consider secondary care

·  GP workforce issues and wider primary care teams roles

PRESENTATIONs

1.  The work of the Scottish Primary Care Group (Dr Hugh Brown)

Dr Hugh Brown gave an overview of the work of the Scottish Primary Care Cancer Group, including membership, meeting schedule and other groups that the SPCCG feed in to. Dr Brown also gave examples of some of the topics discussed by the SPCCG:

·  Detect Cancer Early

·  Macmillan modules

·  The National Cancer Diagnosis Audit (NCDA)

·  Transforming Care After Treatment (TCAT)

He also discussed how primary care can contribute to the Detect Cancer Early Programme, for example:

·  Bowel screening programme

-  Reducing non-attendance for screening appointments.

-  How do we keep the return rate high?

·  Direct access to certain diagnostics

·  Reviewing the referral guidelines

-  The SPCCG was involved in the Scottish Referral Guidelines for Suspected Cancer

-  This is available in hard copy, and also now as a mobile app.

2.  Cancer as a Quality Improvement Topic

The interactive session on cancer as a quality improvement topic was led by Dr Richard Roope and Michael McGrath. At the start of the session, they asked for everyone’s thoughts on the changes to QOF in Scotland. Below are some of the thoughts and concerns that were raised on the day:

·  There is a real need for a ‘buffer’ between what the Health Board deem to be a priority, and what practices think is a priority.

·  The change was supposed to be driven from the bottom up rather than the top down – but it is still early days.

·  Clusters are taking GPs out of the practice and they are being asked to do things that they don’t have time for. Cluster work means that there is not enough time to do patient work, and it’s very difficult to do this without the resources.

·  The guidance issued so far has been very vague – it is not clear what the next steps will be.

Overview of the new contract arrangements (Marion O’Neill)

Marion O’Neill (Facilitator Regional Manager, CRUK) gave an overview of the changes to QOF in Scotland. This included criticisms of the previous QOF, the internal and external roles of GP clusters, and timelines for the transitional year.

Why cancer? (Dr Richard Roope)

Dr Richard Roope presented on the scale and burden of cancer for primary care, and outlined why it would be a good option for clusters to adopt as a quality improvement topic. For example we know that:

·  1 in 2 will be diagnosed with cancer in their lifetime

·  Incidence of cancer is increasing

·  Cancer survival in the UK still lags behind comparable health economies

Dr Roope focused on where primary care could make a difference here – earlier diagnosis leading to stage shift.

Cancer as a quality improvement topic: group work (Facilitated by Michael McGrath)

Delegates were asked to work in small groups (2 tables of GPs and 3 tables of other health professionals) to answer the following questions:

GPs

·  Why should you elect cancer as a QI topic? What are the pros and cons?

·  You have selected cancer as a QI focus:

-  What would you do first?

-  What would success look like?

·  What do you need from whom to make the QI focus work for you?

Outcome of this session:

ü  Delegates were confident about the pros of choosing cancer as a quality improvement topic; for example cancer has a high prevalence and mortality rate, and there are lots of opportunities for improvement work that can be tracked.

ü  Some of the concerns were that as cancer is such a large area, it could be hard to decide where to focus and where to start, and could raise expectations that primary care can pick up cancers.

ü  In order to do something meaningful, it is important to look at what data is available, and what is doable and demonstrable.

ü  Ideas for potential QI work included: screening uptake and comparison with local practices; appropriateness of referrals; access to diagnostics.

ü  Success would include sharing experiences with peers; understanding the reasons for differences; working in partnership; targeting hard to reach groups.

ü  Support and resources could include tools such as the NCDA; liaison with and support from secondary care; sharing learning from SEAs; increased diagnostic capacity and support to understand guidelines.

Non-GPs

·  What would be the benefit of a QI focus for you?

·  What impact will a cancer QI focus have on your area? What are the opportunities and fears?

·  What do you need to do when you get back to the ranch in preparation for a lot of cancer QI focus decisions coming your way?

Outcome of this session:

ü  The benefits of clusters choosing cancer as a QI focus would be a potential impact on addressing health inequalities; get more GPs interested in screening; align with other agendas such as older populations; potential for teachable moments; improve data and increase primary care influence on secondary care.

ü  Fears included the lack of staffing and capacity in services to cope with increased demand; a fear that other areas may be neglected; lack of useful data; and an expectation on supporting services.

ü  Opportunities identified were the chance to tackle inequalities; an ability to be flexible to local needs; prevention and lifestyle focus would impact across many diseases not just cancer; the opportunity to work with the most motivated practices and linking with community and 3rd sector.

ü  In order to support clusters choosing cancer as a QI topic, it would be necessary to have effective communication between strategic groups and local influencers; cascade the message that the QI topic is a choice for GPs; have a more informed conversation with GP practices; make more contacts and talk more about how can capitalise in this opportunity.

What’s New? (Dr Richard Roope)

Dr Richard Roope gave an update on some of the latest developments in cancer control, including:

·  Breast cancer presentation: 1 in 6 cases of breast cancer begin with non-lump symptoms

·  Very brief intervention: Very brief advice from GPs can have an impact on weight loss

·  Colorectal cancer: routes to diagnosis, increasing incidence and key symptoms.

·  E-cigarettes: concerns, effectiveness, increased usage and an update on the CRUK-RCGP position statement which can be seen here.

·  Dismantling Scottish QOF and formation of GP clusters: RCGP publication Setting the Strategy for Quality in Scotland’s General Practices

·  New CRUK stats and infographics: New infographics on screening, obesity, alcohol and inactivity are all available now online.

Updates from CRUK and RCGP

Patricia Barnett (Cancer Intelligence Relationship Manager at CRUK) outlined CRUK’s strategic priorities within policy and information for the next two years. This includes:

·  Optimising the wider CRUK environment

·  Optimising the pathway across prevention, early diagnosis and treatment

·  Building our profile as an authoritative health and science brand

·  Ensuring that we follow our key principles:

-  We are evidence-based

-  We are audience-focussed

-  We tackle inequalities in all of our work

Marion O’Neill then gave an overview of the CRUK Facilitator Programme in Scotland and the work that they do with primary care.

Recently this has included the National Cancer Diagnosis Audit (NCDA), which uses primary and secondary care data relating to patients diagnosed with cancer, and will start this year looking at cases diagnosed in 2014. This is to help us to understand patterns of diagnosis for all cancer types, and will give a benchmark against we can eventually measure the impact of the new referral guidelines. This will have numerous benefits to patients, GPs and clinical practice.

To register your interest in the audit, please visit the link above or email .

For more information on the Facilitator Programme, see here.

The challenge of diagnosing cancer in specific populations (Dr Peter Murchie and Dr Sara MacDonald)

Dr Sara MacDonald (Senior Lecturer in Primary Care) presented on the challenge of diagnosing cancer in older populations, and her research in this area.

Dr Peter Murchie (Senior Lecturer in Academic Primary Care) then presented on rurality and cancer in Scotland – focussing in particular on two important pieces of research, the CRUX studies (2002-2016) and the NASCAR study (2014-ongoing).

Delegates then worked in small groups to provide their thoughts on the following questions:

·  Can you perceive challenges to diagnosing cancer in your practices or area in patients living further away? What are they, and what could you do about them?

·  Based on your experience do patients from further away receive less input following cancer treatment? If no, why not? If so why, and what could we do about it?

·  Can you perceive challenges to diagnosing older and or comorbid patients in your practice or area? What are they, and what could you do about them?

·  Based on knowledge of your own practice or area, what is your own experience of referring frequent attenders? More or less likely to be referred?

·  Based on your experience can you think about cancers diagnosed via emergency presentation? Could something else have happened?

takeaway ACTIONS

At the end of the workshop attendees were invited to identify one action or area worthy of further consideration that they would take away from the day. Below is a list of just some of the key actions highlighted by participants:

·  When next in practice, raise the issue of cancer as a quality work priority for practice and cluster [GP]

·  Email primary care cancer lead in Forth Valley to express interest [GP]

·  Try to set up more robust practice policy to ensure that bloods/investigations are recorded, results looked for and acted upon in a timely manner [GP]

·  Try to improve prevention of cancer by smoking cessation/weight loss/ alcohol reduction encouragement in patients and encouraging other practice members to do the same [GP]

·  Suggest to the Cluster group to consider a cancer topic as a QI

·  Aim for consistency between GP Practices across my HSCP and joined up working

·  Keep the profile of cancer high on the agenda at locality/cluster meetings

·  Decide what we can do differently across Lanarkshire

·  Share my learning and information gathered with colleagues and partners. Also, within my geographical area I will aim to provide any support I can offer to cluster groups [Health Improvement]

Actions for CRUK

We will do the following:

·  Feedback to CRUK what health professionals are saying locally

·  Share the learnings from the event with colleagues and externally

·  Follow up requests from delegates for an A4 summary sheet for cancer QI topics

·  Take the feedback on board from the Glasgow event for our 2017 Cascade event in Aberdeen.

APPENDIX: 1

Cancer cascade workshop

Thursday 1 December 2016

The Studio, Glasgow, G2 6AE

AGENDA

10:00 – 10:35 / Arrival and registration
Marketplace: Tools to help Primary Care diagnose cancer earlier
10:35 – 10:40 / Welcome
Dr Richard Roope – CRUK / RCGP Clinical Lead for Cancer
10:40 – 11:00 / Your expectations/ objectives for the day
Michael McGrath – Cascade Advisor
11:00 – 11:20 / The work of the Scottish Primary Care Cancer Group
Presentation by Dr Hugh Brown – Chair of the Scottish Primary Care Cancer Group
11:20 – 12:30 / Cancer as a Quality Improvement Topic – interactive session
Group work facilitated by Dr Richard Roope and Michael McGrath
12:30 – 13:30 / Lunch and networking
Marketplace: Tools to help Primary Care diagnose cancer earlier
13:30 – 14:00 / What’s new?
Dr Richard Roope – CRUK / RCGP Clinical Lead for Cancer
14:00 – 14:20 / Updates from Cancer Research UK and the Royal College of General Practitioners
14:20 – 15:30 / The challenge of diagnosing cancer in specific populations – interactive session
Dr Peter Murchie - Senior Clinical Lecturer in Academic Primary Care, University of Aberdeen: The rural challenge
Dr Sara MacDonald - Senior Lecturer in Primary Care, University of Glasgow: Cancer and the older population
15:30 – 16:00 / Action planning and wrap up
Michael McGrath – Cascade Advisor
16:00 / Close
Dr Richard Roope – CRUK / RCGP Clinical Lead for Cancer
16:00 – 16:30 / Tea and networking
Marketplace: Tools to help Primary Care diagnose cancer earlier

Cascade Glasgow Dec 2016: summary report Page 7 of 7