Practice Audit of Upper GI Patients

Primary Care

London Cancer Reference number / Age of Patient
Country of Birth / Ethnicity
Housebound / Yes No / Employment status / Working
Unemployed
Retired
Any problems communicating? / Yes No
If yes, please specify:
Does patient use social services? / Yes No Not known
Does the patient have cognitive impairment? / Yes No
If yes, please specify:
  1. DEMOGRAPHIC PROFILE
  1. GP DETAILS

Name and address of GP Practice
Date patient registered with practice
Number of attendances/nonattendance in the last 2 years:
Home Visit
Practice Appointments
Telephone Consultations
Total number of attendances within the last 2 years
Total number of cancelled or DNA appointments within the last 2 years (if available)

London Cancer Reference Number: London Cancer Primary Care Audit

  1. MAJOR MEDICAL AND PSYCHOLOGICAL DIAGNOSES

Details / Date diagnosed
  1. CANCER DIAGNOSIS

SITE OF CANCER:
Appointments of any kind in primary care in the 2 years prior to diagnosis
Date / Reason / Outcome (ie refer, investigate)

4. CANCER DIAGNOSIS cont’d

Did your patient have any of the following symptoms in the last 2 years previous to diagnosis?
Dyspepsia<6weeks / Yes No
Dyspepsia> 6weeks / Yes No
Dysphagia / Yes No
Chronic GI Bleeding / Yes No
Progressive weight Loss / Yes No
Persistent Vomiting / Yes No
Iron Deficiency Anaemia / Yes No
Epigastric mass / Yes No
Suspicious Barium Meal / Yes No
Upper abdominal Mass / Yes No
Unexplained upper abdominal pain / Yes No
Obstructive jaundice / Yes No
Previous peptic ulcer >20yrs before / Yes No
Known Barretts oesophagus / Yes No
Known dysplasia atrophic gastritis / Yes No
Known intestinal metaplasia / Yes No
Do you have any further comments about the patient’s interaction in primary care?
  1. INVESTIGATIONS AND TESTS ORDERED BY THE GP

Were any tests ordered in the last 2 years?
If yes, please list the investigations ordered below: / Yes No
Date ordered / Investigation / Result/outcome
Are there any tests you would have liked to order that were not available?
Yes No
If yes, please list the investigations you would have liked below:
  1. HOSPITAL APPOINTMENTS (including A&E)

Total number of outpatient or emergency attendances in 2 years prior to diagnosis
Details of hospital / A&E attendances in the last 2 years
Date / Hospital / Emergency / Planned / 2ww? / Reason (symptoms) / Follow-up (admitted, outpatient appt, referred back to GP, discharged home, no follow-up)
Do you have any further comments about the patient’s interaction in secondary care?
  1. OUTCOMES

Were there any delays informing the GP Practice of the diagnosis? Yes No
If yes, please comment:
Were you informed about the stage of disease at diagnosis? Yes No
If yes, please specify the stage:
Were there any avoidable delays to the patient’s journey? Please comment:
If the patient is deceased, please enter date of death (dd/mm/year):

THANK YOU FOR COMPLETING THIS QUESTIONNAIRE

When you submit the data, you will need the following for reimbursement:

1)NAME of bank account (if different from practice name provided above)

2)Bank sort code and account number

3)Email address for remittance advice to be sent

REIMBURSEMENT RATES

  • £50 for completion with no missing data (can report “not known”)
  • £25 if London Cancer come to GP practice to access records and complete

1