LUNG CANCER PATIENT PATHWAY PRIMARY CARE VISION

LUNG CANCER PATIENT PATHWAY PRIMARY CARE VISION DR PETER JONES GP ;CANCER/CLINICAL GOVERNANCE LEAD NEWARK & SHERWOOD PCT NATIONAL CLINICAL LEAD PRIMARY CARE CSCIP 1 INTRODUCTION • • • • • • • New GP contract Cancer & the GP Primary Care Cancer Epidemiology Patients at RISK of Cancer Patients with POSSIBLE Cancer Patients DIAGNOSED with Cancer Discussion/Action Points 2 NEW GP GMS CONTRACT • QUALITY--PRACTICE ---OPT in/out • 1050 quality points @ £75--£120 by 05/06 • 12 Cancer • 45 • COPD 121CHD 105 BP 72 ASTHMA 99 DIABETES 3 New GP GMS Contract • The practice has undertaken a minimum of 12 SER in the past 3years to include : • • • • • • Any death occurring in the practice premises TWO new cancer diagnoses TWO deaths where terminal care has taken place at home One patient complaint One suicide One section under the Mental Health Act 4 CANCER & a GP • 8--9 total New Diagnoses each year • 100-180 patients having experienced cancer • 9-10 new MI’s • 3-4 CVAs • 4-6 new DIABETICS 5 PRIMARY CARE EPIDEMIOLOGY (population) Individual Group PCT GP Practice 1,800 10,000 167,000 8-9 40-50 5 1 50 250 25 6 750 3500 420 100 6 New cases p.a. Patients with Ca diagnosis Deaths from Cancer p.a. Home death from cancer Patients at RISK of Cancer • PREVENTION SMOKING • AWARENESS OF SYMPTOMS • ASSESSMENT OF RISK 7 PRIMARY CARE : SMOKING STATISTICS Population Adult Smokers Smoking related deaths Total deaths p.a. Individual Group PCT GP Practice 1800 10,000 167,000 400 4 19 2,200 35 200 37,000 400 1,700 8 Patients with Possible Cancer • The Problem: • Large numbers of patients present to primary care with • -chest symptoms • -bowel symptoms • -upper GI symptoms • - urological symptoms • -moles • Only a small number have cancer • How best to identify those who need investigation/referral? 9 Patients with Possible Cancer • Current Referral guidelines for suspected cancer focus on patients who need urgent referral • Future model : improved assessment of risk of significant illness in primary care • appropriate investigation for all who fulfill 10 defined criteria without delay How best to define a Lung Assessment Pathway • • • • • • • Age >50 Smoking History Haemoptysis Airflow obstruction Weight loss Shoulder pain Cough altered or unrelieved by antibiotics Symptoms altered or not responding as expected 11 ASSESSMENT PATHWAY • • • Patient centred journey CXR CT BRONCHOSCOPY MRI 12 Patients with DIAGNOSED Cancer • COMMUNICATION- 6 KEY trigger points • INFORMATION • SUPPORT---Palliative Care /Key Worker 13 COMMUNICATION PATHWAY 6 TRIGGER POINTS • Trigger 1 Referral • Trigger 3 MDT • Trigger 5 Palliative • Trigger 2 Diagnosis • Trigger 4 Treatment • Trigger 6 Death • D O C •T O R 14 Support/Key Worker • • • • • • Care Co-ordinator Multi-disciplinary Multi-agency Holistic Anticipatory care Focus on Support,Psychological & Social Aims to prevent crises 15 DISCUSSION • SMOKING CESSATION • 2WW FEEDBACK • NATIONAL e referral proforma • COMMUNICATION 16