Templates for detailed referral letters were revised by the Gastroenterologist cancer team to be filled in by GPs to ensure that all the information required to decide whether or not a patient is suitable for an endoscopy is made available quickly to the hospital. This has speeded-up the system, so that tests are carried out more rapidly.
The government’s 2000 NHS Cancer Plan highlighted concerns about patient access to cancer services. The cancer plan demanded that all patients with suspected cancer must be seen within 2 weeks of referral by their GP. This put a huge service delivery challenge on most NHS trusts in the UK, as many outpatient services were already stretched.
At Milton Keynes Hospital all patients referred by their GPs for suspected upper gastrointestinal cancer assessment were seen in the outpatient clinics within 2 weeks of referral. Patients were then referred for endoscopy to exclude a cancer and this was carried out within 2 weeks of the request. Patients diagnosed with UGI cancer following an endoscopy were further referred for staging CT scan, which took another 2 weeks. Patients were then discussed in multi-disciplinary team meetings and those with potential cancers were referred to the surgical team at John Radcliffe Hospital at Oxford.
The upper gastrointestinal team at Milton Keynes Hospital recognised the need to improve patient access and reduce the timescales for the completion of diagnostic tests. In turn, the patient pathway and the UGI cancer referral proforma were revised. The referral proforma now required additional information to help triage patient directly for an endoscopy without a clinical consultation. It was agreed that when indicated by their GP, patients with normal gastroscopy would be discharged back.
The role of the UGI nurse was developed to include the review and triage of all referrals with the help of the UGI service’s lead clinician. The UGI nurse was also given responsibility for following the patient journey of all those diagnosed with cancer and arranging further investigations.
Since launched in April 2006 over 240 patients have used the “Straight to Test” service delivery, which was initiated to meet the challenge of achieving cancer targets and reduce patient waiting and assessment times.
An audit carried out 12 months later showed that the “Straight to Test” model of service delivery was efficient and safe. This service efficiently achieved the 2 week wait standard for a hospital appointment and the 31day target for completing the diagnostics, and planning further management of care. The service reduced the need for clinic appointments for all referrals. In addition, cost savings were achieved as many patients were discharged back to their GP after cancer is excluded following an endoscopy.
All patients had their endoscopy or ultrasound within 2 weeks. There were no missed cancers at 6 months follow up after endoscopy. The review of the service also demonstrated that the STT service saved 107 new hospital appointments and reduced 134 follow up appointments.
A patient satisfaction survey revealed a high level of satisfaction amongst patient for improved access and early diagnosis. A GP survey is currently underway and initial results are very good.
The model developed at Milton Keynes Hospital has attracted widespread international attention because of its potential for widespread use in cancer and non-cancer clinical services throughout the NHS. The hospital’s cancer performance is exemplary, and over 99% of patients are seen within the target timescales.
by Dr Ravi Madhotra MD, FRCP, FACG