NICE is redrafting its guidelines on suspected cancer. http://www.nice.org.uk/guidance/indevelopment/gid-cgwave0618/consultation. Sarcoma is on pages 272-281 of the Full version. Here are some of the sarcoma guidelines.

See result of consultation: Suspected cancer: recognition and referral

Bone sarcoma

Around 500 new bone sarcomas are diagnosed each year in the UK, meaning that a full time GP is unlikely to diagnose more than one bone sarcoma during their career. It is seen in both sexes, and is one of the commoner cancers in children, teenagers and young people.

Pain and loss of function of the affected limb are thought to be the main presenting 6 symptoms of bone sarcoma. However the rarity of this cancer means there are few studies of its clinical features.

Because of the rarity of bone sarcoma, there is no standard diagnostic pathway for primary care. Plain X-ray may show abnormalities suggestive of the sarcoma.

Clinical questions

• What is the risk of bone sarcoma in patients presenting in primary care with symptom(s)?
• Which investigations of symptoms of suspected bone sarcoma should be done with clinical responsibility retained by primary care?

Recommendation

Consider an urgent direct access X-ray (within 2 weeks) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain. [new 2015]

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people if an X-ray suggests the possibility of bone sarcoma. [new 2015]

Soft tissue sarcoma

Just over 3,000 new soft tissue sarcomas are diagnosed each year in the UK. A full time GP is likely to diagnose approximately 1 person with soft tissue sarcoma during their career. They occur in connective tissue, so can occur in many parts of the body. Five year survival is highly dependent on the specific site.

The rarity of this cancer means there are few studies of its clinical features. It is believed that most present with a mass, which may be painless, and may become quite large. The main method of diagnosis is by biopsy, which is performed in secondary care.

Clinical questions

• What is the risk of soft tissue sarcoma in patients presenting in primary care with symptom(s)?
• Which investigations of symptoms of suspected soft tissue sarcoma should be done with clinical responsibility retained by primary care?

Recommendation

Consider an urgent direct access ultrasound scan (within 2 weeks) to assess for soft tissue sarcoma in people with an unexplained lump that is increasing in size. [new 2015]

Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists. [new 2015]

RNOH Stanmore is a fascinating place. First impression is shock at the age of the buildings but that soon disappears when you meet the wonderful staff and get the best treatment in the world. The place has a charm of its own that is irresistible. The corporate video at https://www.rnoh.nhs.uk/about-us is not just the puff you expect and is worth watching.Even more fascinating is the 48-minute interview on Radio Brockley with the CEO Rob Hurd, discussing a range of topics from the disappointing CQC report to talking about the shuttle bus, via future plans for new buildings and the academic centre in conjunction with University College Hospital. You can listen to it at https://www.youtube.com/watch?v=dJCDNKuJksQ.

I went to an event “Supporting Stronger Voices” and event organised by the Dorset Clinical Commissioning Group at AFC Bournemouth.

Event aim. Six monthly forum for patient, carer and lay representatives to provide:

• Information on how the views of local people are informing the CCG’s work
• The opportunity to provide our views on an area of review or change
• Information on view seeking methods and opportunities
• The chance to meet other representatives, share ideas and network.

Event objectives.

• Inform on patient/carer/lay representative feedback on first Supporting Stronger Voices event and CCG Communications and Engagement team response
• Support  patient/carer/lay representative to have a Stronger Voice by exploring training needs
• Inform on development of Patient Participation Groups
• Provide some detail of  Dorset’s Clinical Services Review (CSR) and opportunity for patient/carer/lay representative involvement.

Presentation by Frances Aviss summarising patient/carer/lay representative feedback  followed by short video illustrating areas where service improvements have been made to reflect patient engagement feedback. Some interesting areas of service improvement, but little said about Cancer and End of Life.

Workshop session to try and tease out skills attendees (grouped 5-6 per table on 8 tables) would like but currently lack.

Presentation by Keith Harrison (Patient Public Involvement Development Worker & a PPG Chair) on developing Patient Participation Groups. Interesting; KH facilitates in the North Dorset Locality and currently 7 out of 10 GP practice groups in north Dorset have Patient Participation Groups. His role is to try and encourage the development of new groups for which he has clearly had some success in the last year or so despite various difficulties along the way. Ian Gall ( PPG Chair of GP practice of 9,000 patients  in Sturminster Newton area) gave details of his PPG group’s organisation and the way it operates. Probably most important factor, in his view, is to establish a high level of confidence and trust between the GP practice manager and the PPG Chair.

Presentation by Phil Richardson, Programme Director (Transformation) for Dorset’s Clinical Services Review. He described the need for the review  and the programme stages.

NHS Dorset CCG is to review the way NHS care is provided in Dorset in order to sustain a high quality of care for people living in the county: it is the first to be done in the country and follows research showing the NHS is facing significant challenges. In Dorset, these challenges include changing population, clinical standards and financial pressures. Dorset CCG is the third largest with a budget of nearly £1bn. There are approx. 100 GP practices involved and a quarter of the population has a long term condition. Dorset scores highly across all benchmarks; the net immigration to Dorset predicted to be 50,000 people by 2012. GPs have had a 20% increase in consultations over the last 2 years (and this is an ongoing trend).

The review is to be undertaken in partnership with GPs, hospitals, local authorities, and the public, and will go through 3 stages:

Stage 1: Design- a review of current services and the creation of a blueprint for future services that will clearly state what changes are proposed.

Stage 2: Consult- a public consultation so people can have their say on any changes proposed.

Stage 3- Implement-delivery of any agreed changes.

Stage 1 (of which this meeting is the pre-amble) will run from October 2014-spring 2015.

He touched upon the role of the consultancy firms appointed for the review: McKinsey would be handling the analysis of a vast amount of public and health professional feedback already in the system as well as new data; Price Waterhouse would be handling the overall project management of the review. PR is anxious to involve/engage the patient /carer/lay representative community, a point reinforced by Frances Aviss who stated that a patient/carer/lay representative engagement team of about 20 people is to be set up to participate in the programme. The team will be chaired/led by Anya de longh who works with the CCG Engagement team. Frances requested that attendees put their names forward if they felt able and willing to contribute to the team. PR, in response to questions/comments from the floor, acknowledged that the programme timescale was very tight and the general election next May could adversely affect the programme.

I would suggest that joining our own GPs Patient Participation Groups is an important way to try to influence the Clinical Commissioning Group and to keep cancer on the agenda.

From the Health Service Journal’s Best Places to Work:

Royal National Orthopaedic Hospital Trust

• Full time permanent staff: 1,298 WTE
• Voluntary staff turnover: 14 per cent
• Exec team male/female ratio: 70 per cent male/ 30 per cent female
• Programme to recruit ethnic diverse staff: No

As its name suggests the trust specialises  in neuro-musculoskeletal care. It delivers  well on the training of its staff with 87 per  cent having received health and safety training, 77 per cent having equality and  diversity training and 88 per cent having been appraised in last 12 months. As the largest orthopaedic hospital in the UK, it plays an important role in teaching and training with over 20 per cent of orthopaedic  surgeons in the UK receiving their education at the trust.

The Royal Marsden Foundation Trust

• Full time permanent staff: 2,377
• Voluntary staff turnover: 12 per cent
• Exec team male/female ratio: 40 per cent male/60 per cent female
• Programme to recruit ethnic diverse staff: No

The Royal Marsden offers a free travel clinic and immunisation service to its staff and promotes a cycle to work scheme. Open meetings with the chief executive are held regularly and the trust runs a local employee of the month scheme.