GP Contract 2023/24

April not only sees the start of spring but also updates for primary care contracts with changes to the PCN DES, Investment and Impact Fund and QOF.

Much of the focus from NHS England this year is around patient access to primary care but the earlier diagnosis of cancer remains a high priority. Cancer is the leading cause of death in adults in the UK with one in two of us been diagnosed with a cancer in our lifetime.

Cancer component of the PCN DES

Many of the DES requirements are similar to last year. There are five service requirements with an expectation that PCNs will build on existing work with a continuing focus on health inequality groups. Broadly the requirements are:

1. To review and improve referral practice for suspected and recurrent cancers

2. Increase the uptake of bowel and cervical cancer screening

3a. Embed the requesting of FIT for suspected colorectal cancer

3b. Where available and appropriate to embed the use of teledermatology to support skin cancer referrals

4. Focusing on proactive and opportunistic assessment for possible prostate cancer in populations where referral rates haven’t recovered post pandemic

5. Review use of the Rapid investigation service for nonspecific symptoms and consider direct access testing

The alliance GPs and other members of the alliance primary care team can help PCNs with all of these requirements. We can help PCNs find and review their data, offer practical advice and support and provide education to all members of the PCN team including GP registrar tutorials, upskilling ARRS workers and working with your admin teams to facilitate practical aspects of suspected cancer referrals. Please do contact the alliance at england.wessexcanceralliance@nhs.net 

Cancer component of the Investment and Impact Fund

CAN-02 Percentage of lower gastrointestinal two week wait cancer referrals accompanied by a Faecal Immunochemical Test (FIT) result with the result recorded in the 21 days leading up to the referral. Lower target 65%, upper target 80%.

This is broadly the same as last year but the criteria has been tightened so that only FIT results received in the 21 days prior to referral will qualify. FIT tests requested at the time of referral will no longer count towards this indicator.

This data should be available to PCNs via the PCN Dashboard. The Alliance can facilitate obtaining data for PCNs.

FIT tests should be requested for patients where colorectal 2WW referral is being considered (except for those with abdominal, rectal, or anal masses or anal ulceration who should be referred as usual). Referral on the 2WW pathway should only be made where FIT ≥10 or where there is a strong clinical concern. Please ensure you are using the new lower GI 2WW form, see here for reference. Patients with new (<12 months) iron deficiency anaemia should be considered for fast track referral using the IDA form regardless of FIT result.

For more information on the use of FIT and the colorectal pathway, see our FIT web page here. For further information and explanation, please see this recent Gateway C webinar.

Cancer component of QOF

This is essentially the same as last year with the requirement to maintain a register of cancer patients (CAN001), perform a structured cancer care review within 12 months of the cancer diagnosis (CAN004) and providing the opportunity for discussion and information about available support within 3 months of the cancer diagnosis (CAN005).

The alliance can provide support to practices and PCNs with training to practice nurses and ARRS staff around delivering holistic cancer care reviews.

Additionally, the Alliance expects to offer a Cancer LIS to PCNs and to provide practical support to PCNs to achieve the goals. 

Teledermatology

As highlighted above, one of the service requirements for this year’s PCN DES is the use of teledermatology to support skin cancer referrals (where available and appropriate).

Teledermatology has been working really well on the Isle of Wight, and in Portsmouth and the South Eastern Hampshire area, for some time. Having seen the positive impact teledermatology has made in these areas, the Alliance are very keen to support both primary and secondary care to rollout teledermatology across Hampshire and Dorset. An information sheet has been developed to provide the background to the pilots currently taking place in Wessex, and to describe the benefits for GPs, patients and secondary care. The information sheet also includes a number of additional resources that you may find useful, including a training package for using dermatoscopes and adaptors. Our thanks to all the GPs who contributed to this information sheet. 

Please contact england.wessexcanceralliance@nhs.net if you have any queries or you would like to take part in one of the pilots.

Bowel Cancer - Screening and prevention

April is Bowel Cancer Awareness Month and so we want to take the opportunity to highlight the importance of screening and prevention for this cancer, which is the third most common cancer for men and women in the UK.

Bowel cancer screening has recently been extended to 54-year-olds in the South East. For more information about bowel screening and the age extension plans, click here.

Information on prevention measures and what clinicians can do to make a difference can be found here. Our thanks to Dr Richard Roope, for providing this information sheet.

Further resources:

GatewayC Colorectal Course: A 1-hour CPD accredited course that follows the real-life story of a patient whose early symptoms of colorectal cancer were unfortunately missed. Access here

Bowel Cancer UK – GP Guidance sheet: Access here

Secondary breast cancer

There was an announcement last week from Dame Cally Palmer, national cancer director for NHS England, about audits being carried out to understand the experiences of patients with secondary breast cancer to improve access and treatment outcomes.

Patients who have received treatment for breast cancer will receive tailored follow ups to meet individual needs. Cancer teams will ensure that information about the possibility and signs of cancer recurrence or spread is provided sensitively and that patients understand the importance of reporting any symptoms.

As you are aware the signs of secondary breast cancer can include frequent headaches, bone pain, breathlessness, swelling or lumps elsewhere in the body, bloating and weight loss.

The statement included a call to action from individuals so you may find an increase in people asking for consultations:

“If anyone is worried they might have symptoms, please do get them checked with your GP or local hospital team as soon as possible – it might not be cancer, but it’s better to get it ruled out quickly.”

As per NICE guidelines, patients who have received treatment for early or locally advanced breast cancer, will also receive an annual mammogram until they enter the NHS Breast Screening Programme, or an annual mammogram for 5 years for those who are already eligible for breast screening. Recommendations | Early and locally advanced breast cancer: diagnosis and management | Guidance | NICE

Genomics in primary care

The NHS North Thames Genomic Medicine Service Alliance is running a series of online workshops exploring the application of genomics in primary care.

Across three modules, the workshops cover an introduction to genomics and the National Genomic Test Directory, familial cancer and risk assessment tools, pharmacogenomics and direct-to-consumer testing.

Module 1 is taking place 1pm - 2pm on Tuesday 2, May. You can find out more and register here.

These workshops are aimed at all primary care staff interested in learning more about genomics.

Please click here to watch the recording of this month's Wessex Cancer Alliance Primary Care Lunch and Learn webinar which focused on genomics.   

National informal discussion group for primary care: Personalised Care and Cancer

Mary Edwards, Project Lead for the Additional Roles Reimbursement Scheme at the Wessex Cancer Alliance, was a guest speaker at last month's National informal discussion group for primary care: Personalised Care and Cancer meeting. Please click here to see the recording. 

Further information on the discussion group and how to join the mailing/invite list can be found here. 

Nursing Times Awards 2023

The Nursing Times Awards have introduced a new category for this year: the 'Nursing in Primary Care' award.

This award is specifically for primary care nursing, which also encompasses the scope of their previous award for the management of long-term conditions.

The deadline for entries is the 12th May 2023. Further information can be found here.

Please contact Jemma Jones, Communications Lead for the Alliance, if you would like some assistance with completing an entry form.  

GatewayC study day links – On demand

In February 2023, Wessex Cancer Alliance teamed up with Gateway C to run two virtual study days, with each session tailored to support different clinicians within primary care. The study days were split into short, accessible sessions, each covering several cancer-related topics. These have now been made available to us for a further 12 months and if you register your viewings, CPD points are also available. Click on this link to find the sessions and please continue to share the details of this education across your PCNs https://wessexcanceralliance.nhs.uk/primarycaretoolkit/education-and-training/

Wessex Cancer Alliance Nutrition Study Day

This study day is aimed at the supportive workforce*, and focuses on the nutritional and emotional impact on people with a cancer diagnosis.

The day will consist of various presentations, an opportunity to meet the local cancer information and support service providers, as well as a Q&A session.

Date: Thursday 18, May 2023

Time: 9.30am-4pm

Location: The Axis Centre, Southampton Science Park

Please email to register for this event.

*We welcome all members of the cancer supportive workforce including Cancer Support Workers, AHP Support Workers, Cancer Care Coordinators, Social Prescribers, Fitness Instructors etc, to this event.