PERSPECTIVE 2020 2 Alastair McLellan Editor HSJ Cancer Care Initiative of the Year Implementation of Symptomatic Faecal Immunochemical Testing in the South West South West Cancer Alliances FINALIST Success in the South West – Congratulations for Cancer Care Initiatives In 2018, the South West Cancer Alliances (SWCA) began a pilot for the use of faecal immunochemical testing (FIT) in primary care. The programme was led by the SWCA (Peninsula and Somerset, Wiltshire, Avon and Gloucestershire Clinical Advisory Groups -SWAG) working in partnership with 7 Clinical Commissioning Groups (CCGs), 14 Trusts, GP Cancer Leads, Cancer Research-UK (CR-UK), Exeter Pathology Service, Severn Pathology Service and the DISCOVERY Team at the University of Exeter. The aim was to provide access to FIT for over 600 General Practices, serving a population of approximately 4.5 million across the South West. Following the successful pilot, the full service was implemented the following year. FIT has proven a valuable resource, not just for colorectal cancer (CRC) referral pathways in primary care, but also for triaging in secondary care. With changes to endoscopy services due to the COVID-19 pandemic, FIT has been instrumental in supporting these pathways, and getting patients access to the right services. Another exciting development for the team, was the announcement of their selection as finalists in the HSJ (Health Services Journal) Value Awards 2020. The Value Awards focus on the NHS, and public sector groups who have made exceptional progress on cancer care and prevention. The South West Cancer Alliances were listed, among only seven others, as finalists in the “Cancer Care Initiative of the Year” category! This is a fantastic achievement, showcasing the hard work of all involved, and provides a brilliant model for successful FIT implementation. We would like to congratulate all those involved with the project. The Peninsula Cancer Alliance team produced a video about FIT and its implementation in the South West. You can view this at: youtu.be/zb1o8ykvS6U As the global coronavirus pandemic persists, adjustments are being made across gastroenterology services to ensure the best patient care can be delivered under the cicumstances. The impact and challenges have been huge. In June 2020 the British Society of Gastroenterology reported on the redeployment of Gastroenterologists to other duties, the reduction in the volume of endoscopy, with 21% doing 2 week waits, 11% urgent cases and 5% routine cases. Only 47% had access to trained endoscopy nursing staff for emergency/essential endoscopies. Of those still doing clinics, on average they were doing 57% of their normal number. The majority were doing telephone or video clinics, although only 11% had access to video consultations. 56% of referrals not seen were being collated by the administration team to be seen postCOVID, implying that a significant proportion are at risk of being potentially missed or triaged using different criteria. There is a large backlog of clinic and endoscopy cases and concern that a proportion of patients will have a delayed diagnosis of cancer and poor outcomes for benign disease. This issue of Leading Edge explores how evolutions in gastroenterology diagnostics are helping to support the response to these problems, by offering methods for remote patient testing and non-invasive triage. The benefits of faecal immunochemical testing expanding into secondary care is explored and case studies from Basildon and Glasgow share real life examples of rapid implementation of calprotectin home testing, accelerated by demands of the pandemic.
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