In October 2015 the Breast Symptomatic Diagnostic Service at James Cook University Hospital (JCUH), Middlesbrough, temporarily moved to University Hospital of North Tees due to an inability to recruit breast radiologists.
Middlesbrough Health Scrutiny Panel were concerned that their constituents were disadvantaged by the breast symptomatic service being located in Stockton-on-Tees and in 2017 requested that South Tees Clinical Commissioning Group (CCG) engage with patients to obtain patients views of the service.
The CCG carried out some patient engagement in August and November 2017 and is now talking to patients who have accessed the service since 1 January 2019 to determine any impact there has been for patients in Middlesbrough and Redcar and Cleveland.
What is the Breast Diagnostic Service?
Women or men with suspected breast cancer following an appointment with their GP (and for the purposes of this engagement - not via the breast screening service) are referred into a specialist breast service (breast diagnostic service - also sometimes known as a breast symptomatic service) and are offered a triple diagnostic assessment in one single hospital visit in accordance with National Institute of Clinical Excellence standards (NICE 2016). Under NHS Standards all breast patients should be offered an appointment within two weeks whether the GP suspects cancer or not. South Tees CCG is responsible for the commissioning of the Breast Symptomatic Service for South Tees patients.
The triple assessment involves:
- Clinical examination
- Breast imaging (mammography and / or ultrasound)
- Taking a sample of breast tissue
This ensures rapid diagnosis whilst reducing anxiety associated with multiple hospital appointments. It was the breast symptomatic diagnostic service outlined above that closed temporarily at James Cook University Hospital in October 2015. Since then, patients in South Tees have attended University Hospital of North Tees hospital for that service.
The CCG is keen to build on previous patient engagement undertaken and understand how patients from the South Tees area are accessing breast symptomatic services, any barriers to service, what ‘good’ looks like to them in order that they can build a more detailed picture of the service and feed this into work ongoing across the region that is looking closely at the way breast symptomatic services are organised.
What does good look like?
NICE referral quality standards  state that commissioners should ensure they commission specialist services that provide a service whereby people with suspected breast cancer are referred to specialist services and offered a triple diagnostic assessment in a single visit. Whilst quality standards are aimed at driving the quality of care, NICE acknowledges this may not be appropriate in practice and that local arrangements can be developed.
The “Gold-Standard” recommendation for a One-Stop Breast Clinic in the diagnosis of symptomatic breast cancer requires provision of a facility staffed by professionals with the combined abilities to perform triple assessment:
- Clinicians [Doctors and/or Nurse Practitioners] with the necessary clinical skills to take histories and perform clinical examination of patients.
- Radiologists and radiographers to perform mammography and ultrasound examination.
- Expertise to undertake biopsy.
The CCG has released a patient survey targeting all patients who have accessed the service at University Hospital of North Tees since 1 January 2019, and are also holding targeted focus groups and engagement with seldom-heard groups, as well as wider public events.
Surveys must be completed April 30 2020.
If you'd like to request a paper copy of the survey, get in touch using the details below: