Should every suspected cancer referral be assessed in a Rapid Diagnostic Centre?
Dr Sarah Taylor, Sue Sykes, Campbell McNeil
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NHSE: The RDC Service Model
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NHSE Planning for 2019/20
Sep 2019 Jan 2020 Aug 2019 Jul 2019 Oct 2019
Publication: RDC Vision and Specification
Web-Ex: Q&A on publication of specification
Web-Ex: Top tips for RDC planning
Submission: Alliances submit 2019/20 plans to regions
Assurance: Regions assure 2019/20 plans, then to NHSE
Approval: 2019/20 plans Live service: RDCs
accept referrals for agreed cohorts
NHSE will use the same template and sign-off approach as 2019/20
Cancer Alliance Delivery Plans
Approval: NHSE approve 2019/20 plans
How the Multidisciplinary
Diagnostic Centre (MDC)
informed the
development of a Rapid
Diagnostic Centre (RDC)
in Greater Manchester
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Multidisciplinary Diagnostic Centres
• Appointments offered within 14 days
• Navigator key to co-ordination
• One-stop clinic model
• Diagnostic tests CT and gastroscopy
• Hot reporting
• Most patients will receive the results on the same day
• If cancer is confirmed, patients
supported in the clinic by a Clinical Nurse
Specialist and referred on to the
appropriate MDT for further investigations
and management.
• If cancer is excluded, patients will
receive appropriate safety netting advice
and be offered strategies to reduce their
primary cancer risk.
• If cancer cannot be excluded in a
single appointment, patients will be
booked for further investigations until a
cancer diagnosis is either confirmed or
ruled out.
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Referral Criteria: Non site-specific referral criteria
• Some symptoms point towards a specific cancer. These should be investigated or referred in accordance
with the NICE NG12 guidelines and not considered for non-site specific pathway
Exclusion Criteria: Possible site-specific referral criteria
Example symptoms to investigate through this route (non-exhaustive list)
Decreased appetite Non-specific abdominal pain Persistent pain
Nausea Lymphadenopathy Unexplained DVT
Non-specific iron deficiency
anaemia
Hepatomegaly Continued patient or family
concern
Fatigue Splenomegaly GP Concern
Weight loss Bloating
Example symptoms to not investigate through this route
Post-menopausal bleeding Melaena Shortness of breath
Abnormal vaginal bleeding Dysphagia Cough
Rectal bleeding Haematemesis Haemoptysis
Altered Bowel habits Haematuria
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Primary Care Urgent Investigations
In addition to a full clinical assessment and examination, the GP is asked to
arrange the following mandatory tests and review their results before
referring the patient:
• Urgent CXR: within 1 working day of the GP appointment.
• Urinalysis: same-day.
• Urgent blood test: including FBC, U&E, LFT, Bone profile, TFT, LDH,
PV/CRP, Ferritin, Glucose, HbA1c, Mononucleosis test, Coeliac screen.
Also PSA (male only), beta-HCG (male only), CA125 (female only).
Sending a referral without these mandatory tests is likely to result in
unnecessary delay.
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Presenting Symptoms
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MDC Summary – Cancer Groups up to 31st January 2019
Tumour Group (ICD 10 Codes) Royal Oldham Wythenshawe GM Total
Brain / CNS (C47, C69-C72) 0 0 0
Breast (C50, D05) 1 1 2
Gynaecological (C51-C58) 0 0 0
Haematology (C81-86, C88, C90-C96) 4 1 5
Head and Neck (C00-C14, C30-C32, C73, C77) 0 1 1
Lower GI (C17-C21, C26) 3 0 3
Lung (C33-C34, C37-C39, C45) 6 4 10
Other (C74-C76, C78-C80, C97) 1 2 3
Sarcoma (C40-C41, C79, C48-C49) 0 0 0
Skin (C43-C44) 1 0 1
Upper GI (C15-C49, C22-C25) 8 2 10
Urological (C60-C68) 4 2 6
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Results
Wythenshawe Oldham
Total number of patients seen in MDC 250 260
Number of cancers diagnosed 13 29
Cancer conversion rates 5.2% 11.2%
Median wait from referral to first appointment (14 days) 10 days 9 days
Median wait from referral to diagnosis of cancer communicated
(28 days)
11 days 10 days
Number of patients with cancer diagnosis communicated within
28 days
91.9% 94.9%
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Conclusion of MDC Pilot
In summary an MDC approach for patients with non specific but concerning
symptoms:
• Provides a clear pathway for this group of patients.
• Has demonstrated that over 90% of patients receive a Yes / No to cancer on
the same day.
• Onward referral / appropriate treatment for patients where cancer is excluded.
• Provides high rates of patient and staff satisfaction.
PROOF OF CONCEPT
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Should every suspected cancer referral be
assessed in a Rapid Diagnostic Centre?
Is the RDC a concept {Rapid Diagnostic Service) or a physical centre?
Are some services (eg breast) already offering a Rapid Diagnostic Service?
Which patients should be seen in the RDC?
• Vague Symptoms
• Simple red flag
• Complex red flag
• Co-morbidities
Do all patients want to be assessed in an RDC?
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How should the RDC be organised?
• Should there be one suspected cancer referral form?
• Who can refer to the RDC? GPs? Acute physicians? ED doctors? Patients?
• Who should triage the patient to the correct appointment / investigation
• Who should assess the patient in the RDC?
• How many RDCs are needed in Greater Manchester?
• How often should they run?
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How does the Multi-disciplinary Diagnostic Centre
(MDC)
inform the development of a
Rapid Diagnostic Centre (RDC)?
Q1 2019 – Consultation Framework
developed with PPV forum
Q3 2019 – Coproduction
events at 4 ACE Wave 2 sites
plus other events
Q3 2019 – Thematic
Analysis of the conversations
completed with PPV forum
Q3/4 2020 – QMs generated and tested with
the Cancer Alliances
Q4 - 2020 – QM document published
• What does a good experience look like at the point of referral from a GP
to an RDC?
• What does a good experience look like at the RDC? (physical and virtual
process)
• What does a good experience look like at the point of discharge from
the RDC process?
Rapid Diagnosis Centres – Quality Marker Creation
Q&A
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