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1. Harrogate, Leeds and York Screening Centre
2. Bowel Cancer Diagnosis and Treatment The Current Picture
3. Presentation (Currently) Change in bowel habit – looser
Rectal bleeding
Anaemia
Abdominal mass
Rectal mass
4. Colorectal Cancer - Diagnosis
5. Colorectal Cancer - Diagnosis
7. Obstruction
8. Obstruction
9. Ileostomy
10. Colostomy
11. Complications from fashioning stomas
12. Complications - Separation
13. Complications - Necrosis
14. Complications - Prolapse
15. Complications – Parastomal Hernia
16. How Do We Improve Outcomes?
17. Service Model for Bowel Cancer Screening
18. Faecal Occult Blood test (FOBt) + Colonoscopy Two large screening studies from Nottingham and Odense, Funen (Denmark) published in 1996 showed significant reductions in bowel cancer mortality
Shown to be logistically feasible in two NHS pilots in the West Midlands and Scotland
First two waves of Bowel Cancer Screening Centres have started screening
19. Population Benefits 16 -18% reduction in colorectal cancer mortality
Prevention of cancer in the people cleared of polyps
Lower incidence of emergency presentation with bowel cancer
Lower proportion of people in the community living with a permanent stoma
22. Faecal Occult Blood test + Colonoscopy
Call and recall of FOBt by GP practice
The positive tests (around 2%) are given Specialist Screening Practitioner (SSP) “Nurse Positive” Clinic appointments in Harrogate, Leeds or York
SSP has a 45 minute consultation with the participant and books colonoscopy with the local screening colonoscopy unit
23. Faecal Occult Blood test + Colonoscopy SSP accompanies person to the colonoscopy
Patients diagnosed with cancer are referred to the local MDT
Patients with polyps are kept under surveillance according to BSG Guidelines
People with a normal colonoscopy are referred back to the screening programme
24. Expected Numbers…
25. Rollout Timetable
26. JAG Visits Harrogate July 2008 – Accredited
York November 2008 - Visited
Leeds January 2009 – Visit in January 2009
27. Rollout Full FOB rollout in Harrogate and York
Advice from Hub for optimal staged Leeds rollout
First two SSPs and Screening Centre Administrator to be appointed shortly
GP and pharmacist engagement started November 2008
28. Rollout Harrogate and York Screening commences – February 2009
Leeds Screening Commences – April 2009 when GRS compliant
29. SSP Clinics – Harrogate and York
Harrogate & District NHS Foundation Trust
York District NHS Foundation Trust
30. SSP Clinics – Leeds Armley Moor Health Centre
Parkside Health Centre on Dewsbury Road
East Leeds LIFT (due to open June/July 08)
It is envisaged that these sites will be reviewed via patient survey/number of DNA’s to ascertain whether they are sited appropriately. Estates are able to be flexible about the SSP clinic sites in different parts of the city
31. Colonoscopy Centres / Colorectal MDTs Harrogate & District NHS Foundation Trust
Leeds General Infirmary
York District NHS Foundation Trust
The SSPs will develop links with the colorectal CNSs and the each of the MDTs to present screening patients diagnosed with cancer and hand over to the symptomatic service
32. Health Promotion
33. Health Promotion Strategy In conjunction with Harrogate and District NHS Foundation Trust and North Yorkshire and York PCT joint strategy plan
Leeds will need to target specific socially excluded and vulnerable groups
Influences from other areas:
Bradford found that uptake was not necessarily poor in Black and Minority Ethnic groups (although 29% in some parts of Bradford)
34. Key Tasks Provide information to ensure clear understanding
Make the programme relevant to the individual
Identify and overcome barriers to participation in screening
Ensure consistency of message
Monitor outcomes and reduce possible inequalities
35. Health Promotion Strategy Leeds will work closely with community, voluntary and faith sector. Conducting a review of current posters, leaflets and literature with these groups to form opinion to design a local leaflet/resource (with approval from National Screening Programme)
Use lessons learned from other screening programmes including a social marketing approach, videos within GP surgeries (Life Channel) and initiatives such as the pharmacy campaign
All approaches will be evaluated and continuing analysis of uptake undertaken when data is available