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NAEDI Primary care Audit Results 2010

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					NAEDI Primary Care Audit

Avon Somerset & Wiltshire Cancer
           Network



  Dr Alison Wint. GP & Associate Medical Director
NAEDI


   Advanced stage at diagnosis is thought to account
    for 50 – 70% avoidable cancer deaths.

   Equivalent to 6,000 avoidable cancer deaths
    between 1995-99.

   1 year survival figures for England lag behind those
    for similar European countries.

   Advanced stage at diagnosis does impact on
    quality of life because of more toxic treatments
    and psychological distress.
NCAT-RCGP Primary Care Audit

   Retrospective Audit of new cancer
    diagnoses Aug 2008-Aug 2009.
   Excluding screen detected cancer and BCCs
   Practices asked to under take two
    Significant Event Analyses & hold practice
    team meeting.
   ASW one of several Cancer Networks to
    participate and submitted data for national
    analysis.
   These results represent the ASW data.
Avon Somerset & Wiltshire Audit 2010

   BANES -8 Practices 30%
   62% taught medical students
   62% training practices
   25% Urban, 75% > 5,000 patients
   Types of cancers, age, sex & ethnicity
    matched ASW & national data.
   In total 56 practices from all 6 PCTs20% of
    Network (277)
   1,550 new cases of cancer analysed
Number of visits to GP before referral

                                      Number of Visits to GP before Referral
                                                   (N = 1550)
                      900
                                  773
                      800
 Number of Patients




                      700
                      600
                      500
                      400                   325
                      300
                      200   137                      126
                      100                                        42       37            47             63
                        0




                                                                                                    d
                            0



                                  1



                                           2



                                                    3



                                                             4



                                                                      5



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                                                                                                 fie
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                                                                                         ot
                                                   Number of Visits




                                                                                        N
Number of GP visits by stage at diagnosis

                           Number of Visits to GP Before Referral by Stage at Diagnosis
                                                    (N = 1550)
                     500
                     450
                                                                             Distant metastases
                     400
                                                                             Local spread
Number of Patients




                     350
                                                                             Not known
                     300
                                                                             Organ
                     250
                     200
                     150
                     100
                      50
                       0
                            0        1        2        3         4       5     > 5 Visits     Not
                                                                                            Specified
                               Median Time (Days) Q1 - Q3
         S




                               10
                                    20
                                         30
                                              40
                                                   50
                                                        60
                                                             70
                                                                  80
                                                                       90




                           0
             ar
               co
                 m
                      a
               Lu
                   ng
       U
H         nk
               no
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    m              w
       at            n
          ol
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   O             ic
     th             al
       er
            (N
                 O
                   S
      U               )
        ro
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                   ca
        U              l
          pp
                er
     B              G
       ra             I
H          in
 ea           /C
    d             N
       an            S
           d
                                                                                             (N = 1161)




               N
                 ec
                     k
        Lo
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                    G
      A               I
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G           C
  yn           as
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                                                                            Time from First Presentation to Referral Sent




                  ca
      Te              l
           st
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                 ul
                    ar
            B
               re
                                                                                                                            Time to referral by cancer type




                 as
                     t
                S
                    ki
                       n
Type of Referral

                           Referral Type (N = 1550)
                         Routine
               Private    12%
                3%

               Other
                1%

   Not referred by
      Practice
         8%

        Not known
           3%

                                                      2 Week
                                                       61%
            Emergency
              12%
TWW by Speciality
                  Two Week Waits by Speciality (N = 934)

                       Upper GI
                Lung               Gynaecological

                                          Skin

   Lower GI                                                Haematological



                                                 Other     Other (NOS)

                                                           Head and Neck
                                                            Testicular
       Breast
                                                            Unknown
                                                            Sarcoma
                                  Urological
                                                            Brain/CNS
Time to be seen, by route of referral

                                     Time Interval from Referral to Specialist Investigation by
                                                          Referral Type
                                                            (N = 1431)

                        70
Median Days (Q1 - Q3)




                        60
                        50
                        40
                        30
                        20
                        10
                         0




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                                                                                                          A
                                                    by




                                                                                               N
                                     E



                                                   ed
                                                 rr
                                               fe
                                             re
                                          ot
                                         N
Stage of cancer by time to referral

                                                  Time From Presentation to Referral Sent

                                50
                                45
Median with Quartiles 1 and 3




                                40
                                35
                                30

                                25
                                20
                                15
                                10
                                5
                                0
                                      Distant          Not known     All Cases   Local spread   Organ
                                     metastases
Access to Care for four main tumours

          Access to Secondary Care by Main Tumour Site (N = 816)

   2 Week    Emergency        Not known   Not referred by Practice   Other    Private   Routine


All (Main) Cases


 Prostate (31%)


     Lung (16%)


Colorectal (25%)


   Breast (28%)


                   0%   10%     20%   30%    40%     50%    60%      70%     80%   90%    100%
                                                % of Patients
Stage of Cancer at diagnosis by PCT

                   Stage at Diagnosis for Main Cancer Sites by PCT (N = 816 (53%))
                         Distant metastases         Local spread         Organ    Not known


      ASW



  Wiltshire



S Glouces



 Somerset



N Somerset



    Bristol



    Banes


              0%             20%              40%                  60%           80%          100%
Summary:

   Patients referred swiftly. Mean time to
    referral 5 days.

   TWW referrals the fastest route to being
    seen in secondary care.

   BANES results vary from Network average
    with low TWW referral and high
    TWW/Emergency ratio
Network Recommendations

   Develop Network LAEDI Strategy with
    Steering Group
   Revisit patient pathways particularly for
    lung, but also for Upper & Lower GI
   Disseminate the learning from audit
   Adopt Practice Profiles
   Develop CUP Pathway
   Review Community Services
Any Questions


Alison.wint@nhs.net

				
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