On 3rd April we launched the changes to two of our cancer pathways: Skin and Lower Gastrointestinal.
During Summer 2023, changes will be made to one further pathway: Breast.
We are continuing to work with clinicians, CMCA and other key stakeholders to ensure a smooth launch of a new breast pain clinic. For further information, please click the “introduction of a breast pain clinic” link below.
The several pathway changes were initially prompted by the development of the Faster Diagnostics Standard, which is mandated to be in place for all cancer pathways by March 2024.
This standard indicates that patients who are referred on an urgent cancer pathway should be advised of a diagnosis of cancer, or that cancer has been ruled out, within 28 days of referral from their primary care practitioner.
Additionally, the NHS England Planning Guidance for 2024 has prioritised the adoption of faecal immunochemical testing (FIT) to be undertaken in primary care as a precondition of referrals for asymptomatic colorectal cancer.
You will find more detail relating to each pathway by following the links below.
Adapting to these changes to these three pathways was made more straightforward for practices in St Helens and Knowsley by the simultaneous introduction of pro-forma templates within the Accenda Gateway system.
The templates automatically populate with relevant data from the patient record, and include appropriate prompts to ensure that the referrals sent on to the hospital are as fully detailed as possible. This will mean that your patients can be triaged more quickly and moved on to appropriate treatment pathways.
Your place teams will provide training and support where needed.
- Lower gastro-intestinal cancer – changes to the pathway relating to the use of FIT
"FIT will support patients to have the right referral, investigation and management at the right time and according to their clinical risk of colorectal cancer”
Dr Debbie Harvey, GP Lead , Cheshire & Mersey Cancer Alliance
From 3rd April 2023, the suspected Lower Bowel or Gastrointestinal (LGI) cancer diagnostic pathway will be changing for St Helens, Knowsley and Halton.
The change to the diagnostic pathway includes more use of FIT (Faecal Immunochemical Test), to match guidance from the British Society of Gastroenterology (BSG) and Association of Coloproctology of Great Britain & Ireland (ACPGBI), which is supported by NHS England and approved by National Institute for Health and Care Excellence (NICE). It is underpinned by lots of evidence to support the use of FIT to improve the detection of cancers and improve patient experience.
This video below from the Cheshire and Mersey Cancer Alliance GP Lead provides more background and details.
‘Guidance for GPs on the faecal immunochemical test (FIT) for patients with bowel symptoms’
Why is it changing?
FIT provides a high level of assurance to patients with negative results (99.7%). It’s easy to complete and is more accurate than a colonoscopy which means you can avoid an intrusive and unnecessary investigation.
How can you help?
Please use FIT in line with the updated guidance, and emphasise to your patients how important it is that they complete and return the FIT as soon as possible, so that you can make a well-informed decision about any further tests or treatment.
The table below is a great tool to help with FIT decision making.
The revised FIT pathway is operating well, with many practices ensuring that FIT is completed prior to referral. We will be looking at referrals to identify any patterns in where FIT was appropriate but has not been completed, and will provide further information to PCNs and Place Teams to provide support where needed.
Need more information?
- Skin cancer - introduction of Teledermatology and improvements in Advice and Guidance
Skin - Teledermatology
The use of teledermatology is one of the priorities in the 2023-24 planning guidance from NHS England.
Mersey and West Lancashire Teaching Hospitals NHS Trust are aiming to deliver better care for our patients by the use of teledermatology and Advice and Guidance, as part of a wider programme of work improving cancer pathways.
From 3rd April 2023 we’ll be encouraging all GPs to make use of Advice and Guidance, including teledermatological images, as a first step in considering a referral for skin cancer.
Skin cancer is one of the most frequently diagnosed cancers in the UK.
The current pathway for skin cancer referrals in St Helens and Knowsley means that many patients are obliged to attend hospital appointments, incurring travels costs and worrying about their condition until a diagnosis is made by a specialist clinician.
However, on average 92% of patients referred to Hospital are not diagnosed with skin cancer, and are subsequently treated for less serious conditions.
One way in which patients can receive a quicker diagnosis and avoid travel costs is by teledermatology and Advice and Guidance, where GPs transmit images of lesions to specialist clinicians for an initial opinion.
Teledermatology involves the gathering of high quality images of the affected areas of the skin using dermatoscopes, which incorporate specialised photographic lenses.
Many local GP practices have been provided with dermatoscopes. If your practice does not yet have a dermatoscope, please talk to your Place Team, who will be happy to help.
High resolution images are captured and shared securely using a smartphone app, and saved to the patients record.
The images can then be attached to Advice and Guidance requests, and to referrals if appropriate.
We want to encourage Advice and Guidance requests, including the use of teledermatology, as a first step where there is benefit to the patient in getting a specialist opinion before a referral into the skin cancer pathway.
Advice and Guidance requests will be responded to within two working days, and most requests are responded to within twenty-four hours. The response may suggest treatment which can be prescribed by the GP, or that the request has been upgraded to a ‘two week wait’ referral.
This means that GPs can quickly reassure many patients that their condition is not cancer and may be helped with treatment prescribed by the GP.
And if after reviewing the images, the specialist clinician has concerns, they will immediately upgrade the Advice and Guidance request to a ‘two week wait’ referral, without any further intervention from GPs.
So GPs can be confident that patients whose condition does require further urgent investigation will quickly be called in to hospital for face-to-face appointments at the Dermatology Outpatients Clinic.
Where GPs are certain that the patient’s clinical symptoms meet the ‘two week wait’ referral guidelines, they should continue to submit a referral to the 2WW skin cancer pathway.
Teledermatology and Advice and Guidance provides secure, rapid, two-way digital communication between GPs and the Hospital Dermatology team.
Continuing to Improve Care for Patients
Thank you for your support in making excellent progress with teledermatology so far. There has been a significant increase in the number of advice and guidance requests coming through to MWL consultants, meaning more patients have been reassured sooner.
MWL and the Place Team will continue to work together to provide individual feedback and support to practices.
Please continue to monitor the MWL website and GP bulletins for further details of the Advice and Guidance pathway and teledermatology.
- Extract from RCGP e-learning: Dermatology toolkit: Clinical resources for practitioners – dermoscopy and teledermatology (rcgp.org.uk)
- NHSE: Teledermatology and e-Referral Service advice and guidance - Dermatology digital playbook - NHS Transformation Directorate (england.nhs.uk)
(links to be provided)
Patient letters and leaflets
These will be available shortly
- Breast cancer – introduction of a breast pain clinic
Breast Pain Pathway
Breast pain is a very common problem which causes a great deal of worry and anxiety. For most people, the pain settles naturally within a few months, but some people have more persistent problems.
People tend to worry about breast pain because they are concerned about whether it could be related to breast cancer. Extensive research into this issue has confirmed that breast pain (without any other breast abnormality) is NOT a sign of breast cancer. There is therefore no need for patients to undergo mammograms or scans for breast pain alone.
Most individuals with breast pain will be successfully managed by their GP. For the minority of people who continue to have problems, GPs will soon be able to access a new breast pain clinic based in the community, at the Millennium Centre in St Helens.
Unfortunately, due to extended time taken on building and refurbishment works at the Millennium Centre, we have had a further delay in the launch.
Please monitor the MWL website and GP bulletins for further information.
Patients must be referred to the breast pain clinic by their GP following clinical review and cannot self-refer. Specific referral guidance will be provided.
People attending the breast pain clinic will be examined by an experienced breast clinician and they will complete a family history questionnaire. This will provide a personal risk assessment for the patient that will be shared with their GP.
Anyone attending the breast pain clinic who is found to have a breast lump, or any other abnormality of their breast tissue, will be directly referred to the Burney Breast Unit at St Helens Hospital for usual triple assessment.
Also, individuals who are found to have a significant family history of breast cancer will be offered an appointment in the Family History clinic for further evaluation and management
However, we believe most people attending the community-based breast pain clinic will be offered examination, clear advice, and reassurance.
Feedback from people attending similar clinics elsewhere in England shows extremely high satisfaction ratings. We will seek feedback from patients attending this clinic and aim to continually improve the care delivered.
Data regarding patient outcomes and patient satisfaction will be collected and evaluated both locally and nationally.
Keep an eye out for further updates during the countdown to the breast pain clinic launch!
BMJ – Case Study – Breast Pain care – Derby :
(links to be provided)
Patient letters and leaflets:
These will be available shortly