Paul Twomey
In 1999 national cancer guidance was circulated to primary care organisations and looked to build on the work undertaken through the Calman Hine programme. More recently, we have received NICE guidance on primary care referrals for patients with suspected cancer. Within NE Lincolnshire locality our approach has been to utilise the ational cancer guidance as an opportunity to ‘localise’ or practically integrate the current evidence to developlocality guidelines within care pathways. The localisation of national cancer guidance has been implemented by a three stepped process by which we have looked to engage the local health community.Within the establishment of the care pathways we have looked to utilise a number of key characteristics for the various areas of cancer onsidered. The guidelines were developed over 3–4 year period and we focused on the areas for which the development of referral guidelines would be most appropriate. What has been the value of the work to date? –fromaudits, as well as anecdotal feedback, there is a high level of awareness and utilisation of locality guidelines. One practical reflection of this is the high level of utilisation of referral proformas where they have been developed. The work to date has also led to significant sharing of experiences and outcomes across practices within the primary care trust,facilitated by the PrimaryHealthCareTeamstructure. The above were desirable as we looked to reflect on the value of the implementation of locality guidelines. However, the most important factor is what positive impact there is on service delivery. A potential independent indicator is that of conversion rates of urgent two week wait (2WW) referrals to cancer. The paper considers the potential impact of localisation on conversion rates. It then highlights the potential quality assurance framework for the development of effective care pathways.
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