5 Year Forward Report - NHS England Key points on Diagnosis

 NHS England today 23^rd October 2014 has published its 5 Year Forward Report which shows the NHS is at a cross road and needs to change and improve as it moves forward. The report is a collaboration between the six leading NHS groups including:

Monitor

Health Education England

The NHS Trust Development Authority

Public Health England

The Care Quality Commission

NHS England

As well as these leadership groups the report has been developed in partnership with patient groups, Clinicians, the voluntary sector and think tanks.

With regards to diagnosis and the NHS the report covers the following areas:

• “Technology is transforming the ability to predict, diagnoses and treat disease.” 

• “70,000 people in England are estimated to have dementia and many are undiagnosed.  The NHS is making a national effort to increase the proportion of people with dementia who are able to get a formal diagnosis from under half, to two thirds of the people who are affected.  Early diagnosis can prevent crises and treatments available may slow down the progression of the disease.

• “Five year ambitions for Cancer.  One in three of us will be diagnoses with cancer in our lifetime.  Fortunately half of those with cancer will now live for at least ten years, whereas forty years ago the average survival was only one year.  But cancer survival is below the European average, especially for people over 75, and especially when measured at one year after diagnosis compared with five years.  This suggests that late diagnosis and variation in subsequent access to some treatments are key reasons for the gap.  So improvements in outcomes will require action on three fronts: better prevention, swifter access to diagnosis, and better treatment and care for all those diagnoses with cancer.  Faster diagnoses.  We need to take early action to reduce patients currently diagnoses through   A&E   – currently about 25% of all diagnoses.  These patients are less likely to survive a year than those who present at their GP practice.  Currently, the average GP will see fewer than eight new patients with cancer each year, and may see a rare cancer once in their career. They will need support to spot suspicious combinations of symptoms. If we are able to deliver the vision set out in this.  Forward view at sufficient pace and scale, we believe that over the next five years, the NHS can deliver a 10% increase in those patients diagnoses early, equivalent to about 8,000 more patients living longer than five years after a diagnosis.”

• “Medicine is becoming more tailored to the individual; we are moving from one-size-fits-all to personalised care offering higher cure rates and fewer side effects…..developing a ground-breaking new intiative….to decode 100,000 whole genomes within the NHS.  Clinical teams will support this applied research to help improve diagnosis and treatment of rare diseases and cancers” 

• Health services redesign research to understand how patients access services and how to improve them.  “An example of the sort of question that might be tested: how best to evolve GP out of hours and NHS 111 services so as to improve patient understanding of where and when to seek care, while improving clinical outcomes and ensuring the most appropriate use of ambulance and A&E services”.

 How can Clinical Decision Support Tools help the NHS meet these 5 year targets?

• The NHS has recognised technology is enhancing and transforming healthcare in the UK.  With an aging healthcare population in the UK due to people living longer they acknowledge they need to tackle early diagnosis of dementia, cancers and other rare genetic and metabolic diseases.  As with many medical conditions (but especially dementia and cancer) by detecting them early and treating them the outcomes are much more favourable especially as there are many good treatments available if diagnosis is made in a timely fashion.  The NHS has investigated and found that 25% of cancers are diagnosed in Accident and Emergency rather than being detected by GPs earlier in previous consultations.  By this time the cancers may be more difficult to treat as they are further advanced.  The key to offering support to GP’s and other primary health care workers is to implement clinical decision support tools.  Isabel PRO  covers over 6,000 diagnoses and when you consider out of this figure 4,000 are classified as rare diseases then the importance of having a tool where a medical practitioner can enter patient’s clinical symptoms and findings from their physical examination to search through a potential list of causative diseases cannot be underestimated.  As the report highlights a GP in their whole career may only see one case of a very rare cancer and how can they be expected to remember the key differentiating symptoms of that cancer when it could be numerous other more benign clinical conditions.  By not expanding their differential and considering the rare diseases they could be at risk of premature diagnosis closure and miss the diagnosis.  Isabel PRO offers a reminder of the rare and also the more common clinical conditions that should be considered and worked up to arrive at a final diagnosis. By detecting dementia, cancer and rare diseases early and therefore offering treatment early this will enable the NHS to meet their five year aims to improve on early diagnosis rates and hopefully exceed the European average for early detection.

• Engaging patients and involving them in Health service access is key to enabling patients to work as a partnership with their health care providers.  A patient is often unsure in the ever changing NHS how to access the correct health care services available to them and work out where they should go based on the symptoms they are experiencing.  Many patients research their symptoms online or look up health information trying to find out where they should go to access healthcare.  This allows the patient to think through their symptoms and formulate the story of how their symptoms have presented.  This ensures the patient has done their research and can then make best use of the appointment time they have been given with their GP or health care provider.  This will allow the health care provider to expand on more directed questions with the patient on their symptoms and more time to perform a physical examination in the limited time they are given for their appointment.  This will allow a more informative discussion between the health care provider and patient and they will work as a team to work through the next steps to be taken and arrive at a final diagnosis quicker. 

The Isabel Symptom Checker enables patients to research their symptoms by entering what they are experiencing in non-medical terminology and then take a copy of the symptoms they have entered to their health care provider and facilitate an active discussion with their provider. A new feature of the Isabel Symptom Checker currently being beta-tested it to provide some information via a Where to now? application. Based on the symptoms entered and questions answered a suggestion is offered for the patient to examine and decide where they may want to go for further help which includes:

Pharmacy / Walk In Centre

GP/Primary Care Physician

Accident & Emergency

This feature could help the NHS assist patients in accessing their healthcare services.

Technology and support tools for Physicians/Patients are readily available and could help the NHS reach their five year targets on early diagnosis and patient engagement mentioned in this report if they are adopted more widely.