CANCER � PRACTICE REPORT

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					                             CANCER – PRACTICE REPORT

                  PCT                                    Shropshire County
             Practice name                        Anon Medical Practice, Shrewsbury
             Practice code                                     Mxxxx


1.1 Introduction

Practice profiles (cancer) were published for GP practices in England in September 2010
(updated in December 2010). This brief report provides an explanation of your profile, and
enables you to compare your practice for certain indicators, with others in Shropshire County
PCT by looking at the charts attached (appendices 2 - 11).

The 2010 profile for your practice is attached as appendix 1. The next edition of the practice
profiles is expected in December 2011.

NB These profiles provide comparative information for benchmarking and reviewing variations at a
General Practice level. They are intended to help primary care think about clinical practice and service
delivery in cancer and, in particular, early detection and diagnosis. They are not for the purpose of
performance management and there are no 'right or wrong' answers. PCT data are based on
aggregated practice data and may not be comparable to other sources - see Metadata document
(which has been sent to practices previously).



1.2 Demographics

        Practice list 2008/9 – total                                                   6620
        Number of patients aged over 65                                               1196*
        Proportion (over 65s as proportion of total list size)                       18.1%*
        PCT mean                                                                      20.2%
        England mean                                                                  15.6%
        Socio-economic deprivation                                                  Quintile 2

Table 1
* indicates that your practice data is significantly different from the PCT mean.
Socio-economic deprivation is divided into 5 quintiles (quintile 1 is the most affluent; quintile 5 is the
least affluent).

       A higher proportion of patients over the age of 65 usually equates to a higher
        incidence of cancer.
       Your practice has a significantly lower elderly population compared with other
        practices in the PCT.
       The socio-economic deprivation indicator value for your practice population is close to
        the PCT mean.




                                                      1
1.3 Cancer Incidence, Cancer Prevalence and Cancer Deaths

                                                                     2007              2009
    Incidence (new cases)                                             39
    New cases – rate per 100,000 population                           589
    Number of patients on cancer register                                              104
    Prevalence (% on practice cancer register as
                                                                                       1.6%
    proportion of total list)
    Deaths – number                                                                     17
    Deaths – rate per 100,000 population                                               257

Table 2

         Your cancer incidence (39 cases, or 589 per 100,000 population in 2007) was higher
          than the PCT mean (478 cases per 100,000 population) and the England mean (412
          cases per 100,000 population), but this wasn’t considered statistically significant.
         Cancer deaths (17, or 257 per 100,000 population in 2009) were lower than the PCT
          mean (289 per 100,000 population), but again this wasn’t statistically significant.


1.4 Cancer Screening

                                                                 Practice       PCT      England
                                                                  uptake       mean       mean
Breast (3 year coverage %)1                                       80.5%*       76.0%      71.8%
Cervix (5.5 year coverage %)2                                    83.8%*        79.3%         75.4%
                                                             3
Bowel (% screened within 6 months of invite)                      62.0%        59.3%         55.1%

Table 3
* indicates that your practice data is significantly different from the PCT mean.

Table 3 shows the screening figures for your practice.
    The breast screening figure of 80.5% represents the percentage of females aged 50
       to 70 who were screened in the previous 36 months.
    The cervical screening figure of 83.8%* represents the percentage of females aged
       25 to 64 who were screened in the previous 3.5 years or 5.5 years, depending on
       their age.
    The bowel screening figure of 62.0% represents the percentage of persons aged 60
       to 69 screened in the previous 2.5 years. NB This indicator is based on less than 12
       months data.




1
  Source – Open Exeter 2007/8- 2009/10
2
  Source – Open Exeter 2004/5 – 2009/10
3
  Source – Open Exeter 2009/10 (not a full year’s figures)

                                                        2
1.5 Referrals

                                                                                     2009
           2 week wait referrals                                                      90
           2 week wait referrals per 100,000                                         1360
           2 week wait referrals (indirectly standardised ratio)                     76.4%*
           Conversion rate                                                           7.8%
           Number of new cancer cases treated                                         16
           % of cancers diagnosed following a 2ww referral                           43.8%

 Table 4
 * indicates that your practice data is significantly different from the PCT mean.

 Table 4 shows the referral figures for your practice in 2009 (calendar year).

          90 was the actual number of 2 week wait referrals made by the practice that year.
          This converts to 1360 per 100,000 population (crude figure).
          When compared as an age-standardised ratio with the England mean of 100%, your
           practice is significantly lower than expected at 76.4%, i.e. taking into account the age
           of your practice, a higher referral rate would be expected.
          The conversion rate of 7.8% represents the percentage of your 2 week wait referrals
           that turned out to have cancer (7 out of 90). This compares to a PCT mean of 10.4%
           and an England mean of 11.2%.
          The bottom two rows in Table 4 show the % of the total cancers treated (16 or 43.8%)
           following a 2 week wait referral in 2009. The PCT mean was 38.5% and the England
           mean was 42.9%. Your new cancers figure of 16 (non-validated) for 2009 seems low
           compared with the 2007 (validated) number.
          Your practice profile (Appendix 1) details the referral figures for suspected breast
           cancer, suspected colorectal cancer, suspected lung cancer and suspected skin
           cancer. All these figures were in the expected range apart from referrals for
           suspected colorectal cancer which were considered low statistically.


 1.6 Routes to Diagnosis

                                                                           2007
                                                               Number             Percentage
            Emergency presentations                                9                 23.7%
            Managed referral presentations                         17                44.7%
            Other presentations                                    12                31.6%

 Table 5

 The National Cancer Intelligence Network analysed the routes to diagnosis for your new
 cancer diagnoses in 2007.

          39 cancers were diagnosed in your practice in 2007 (see Table 2).
          Table 5 shows the route to diagnosis of 38 of those patients – the other 1 could not
           be matched to your practice.
          9 (23.7%) of your patients were diagnosed following an emergency presentation
           (admitted to hospital on the day of presentation either from A&E or directly from your
           surgery). The lower this percentage is the better, as emergency presentation tends to

                                                     3
          be equated with later stage of the disease process and consequently a poorer
          prognosis. The PCT mean was 20.9% and the England mean was 23.7%.
         17 (44.7%) of your patients were diagnosed following a managed referral. Managed
          referrals include both 2 week wait referrals and routine referrals. These are likely to
          be separated out in future versions of the profiles. The PCT mean was 42.9% and the
          England mean was 48.6%.
         12 (31.6%) of your patients were diagnosed following other presentations (screening,
          death certificate only, in-patient elective, other out-patients and not known). The PCT
          mean was 36.2% and the England mean was 27.7%.




1.7 Emergency Admissions

                                                                             2009
           Emergency admissions (number)                                       35
           Admissions per 100,000 population                                  529

Table 6

         Table 6 shows the number of your patients admitted to hospital as an inpatient or
          day-case via an emergency admission, with a diagnostic code that includes cancer.
         All emergency admissions with an invasive cancer code (ICD-10 C00-C97, excluding
          C44) present in any diagnostic field were extracted from the national HES database.
         The PCT mean was 674 cases per 100,000 and the England mean was 691 cases
          per 100,000.


1.8 Appendices

Appendix 1 (page 6) is a copy of your practice profile (December 2010).

For each of the remaining charts your practice is highlighted in green. Practices highlighted
in orange are statistically different from the PCT mean; practices highlighted in blue are not
statistically different from the PCT mean.

-   Appendix 2 (page 6) is a comparative chart showing cancer incidence (2007).
-   Appendix 3 (page 7) shows cancer deaths (2009).
-   Appendix 4 (page 8) shows breast screening coverage.
-   Appendix 5 (page 9) shows cervical screening coverage.
-   Appendix 6 (page 10) is a comparative chart showing the 2 week wait ratio (indirectly
    age-standardised).
-   Appendix 7 (page 11) shows the conversion rate (i.e. the % of 2 week wait referrals that
    turned out to have cancer).
-   Appendix 8 (page 12) shows the percentage of cancers diagnosed following a managed
    referral (2ww plus routine out-patient referrals).
-   Appendix 9 (page 13) shows the percentage of cancers diagnosed following an
    emergency presentation.
-   Appendix 10 (page 14) shows the percentage of cancers following an “other”
    presentation (see 1.6 above for definition of “other”).
-   Appendix 11 (page 15) combines appendices 9-11.




                                                 4
Points to consider

      Your cancer screening results are very good - breast and cervical coverage being
       statistically better than the PCT mean.
      Your referral rate is lower than expected (statistically significant), as is your
       conversion rate (but this is not statistically significant).
      Your referral rate for suspected lower GI cancer was considered to be statistically
       low.
      A recent audit of 2ww referrals to SATH showed that xxxxx only used the 2ww
       referral pro-formas for 1 out of 9 referrals.
      Would the use of the pro-formas raise awareness of the NICE referral criteria?
      You may wish to consider auditing your 2 ww referrals and/or the patient journey to
       diagnosis using the NCAT/RCGP audit template. These would be useful for QOF and
       revalidation.




                                            5
           Appendix 1


Practice profile would appear here




                6
                                              Appendix 2

                               Shropshire County PCT Cancer Incidence
                                 Cases per 100,000 population (2007)
                        1200




                        1000




                         800
Cases per 100,000 pop




                         600




                         400




                         200




                           0

                                   Cases per 100,000 population   PCT   England



                                                    7
                            Appendix 3

                     Shropshire County PCT
               Deaths per 100,000 population (2009)
         600




         500




         400
Number




         300




         200




         100




           0

                Deaths per 100,000 population   PCT   England




                                  8
                       Appendix 4

                Shropshire County PCT
         Breast screening coverage (2007-2010)
90.00%




80.00%




70.00%




60.00%




50.00%




40.00%




30.00%




20.00%




10.00%




0.00%

                 Breast screening   PCT      England


                            9
                        Appendix 5

                  Shropshire County PCT
         Cervical screening coverage (2004-2010)
90.00%




85.00%




80.00%




75.00%




70.00%




65.00%

               Cervical screening    PCT           England


                             10
                              Appendix 6

                       Shropshire County PCT
          2 Week Wait Ratio (indirectly age-standardised) 2009
180.00%



160.00%



140.00%



120.00%



100.00%



80.00%



60.00%



40.00%



20.00%



 0.00%

                               2ww ratio    England



                                  11
             Appendix 7

      Shropshire County PCT
30%
       Conversion Rate 2009




25%




20%




15%




10%




5%




0%

      Conversion rate     PCT   England


                  12
                      Appendix 8

               Shropshire County PCT
      Diagnosis source - managed referrals 2007
80%




70%




60%




50%




40%




30%




20%




10%




0%

             Managed referrals     PCT    England


                           13
                            Appendix 9

                     Shropshire County PCT
         Diagnosis source - emergency presentations 2007
40.00%




35.00%




30.00%




25.00%




20.00%




15.00%




10.00%




5.00%




0.00%

                 Emergency presentations   PCT     England


                                 14
                          Appendix 10

                   Shropshire County PCT
80.00%
         Diagnosis source - other presentations (2007)



70.00%




60.00%




50.00%




40.00%




30.00%




20.00%




10.00%




0.00%

                 Other presentations    PCT     England


                               15
                           Appendix 11

                   Shropshire County PCT
            Proportion of Diagnosis Source (2007)
100%



90%



80%



70%



60%



50%



40%



30%



20%



10%



 0%

       Managed referrals   Emergency presentations   Other presentations


                                16

				
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