The Plastic Surgery
“See and Treat” Skin Cancer Clinic
(SATSKIN)
Miss Michelle Gibson BMedSc MRCS MSc
Specialty Doctor in Plastic Surgery
South Eastern Health and Social Care Trust
Based at the Ulster hospital, Dundonald ◦ 7 Consultant Plastic Surgeons
◦ 3 SAS doctors
2 Specialty Doctors
1 Trust grade doctor
◦ 10 registrars
◦ 4 core trainees
◦ FT Equivalent 3 Consultant Plastic and Burns Surgeons at Burns Unit, Royal Victoria hospital
◦ Skin oncology
◦ Hand surgery
◦ Breast reconstruction
◦ Burns
◦ Head and neck cancer
◦ Craniofacial and cleft surgery
◦ Trauma
1 Consultant Plastic Surgeon specialising in skin oncology and head and neck skin oncology
Remaining 9
FTE Consultant Plastic Surgeons ◦ Subspecialty and skin oncology
The 2015/16 Ministerial Target for cancer waiting times states that from April 2015 ◦ At least 95% patients should begin their first
treatment for cancer within 62 days following an urgent GP referral for suspect cancer
◦ At least 98% patients diagnosed with cancer should receive their first definitive treatment within 31 days of a decision to treat.
Suspected Cancer: recognition and referral (NG12) published 23 June 2015 ◦ 1.7 Skin Cancers
Referral using a suspected cancer (red flag) referral pathway (for an appointment within 2 weeks)
Guidance on the referral of suspected or confirmed malignant melanoma, Squamous cell carcinoma and basal cell carcinoma
The Northern Ireland Cancer Network ◦ NICaN skin cancer guidelines – May 2015
◦ Importance of clear accurate clinical information allows patients to be triaged appropriately and therefore seen in a timely manner.
◦ Patients should be referred into secondary care as a ‘Red Flag’ and seen within 2 weeks.
◦ Skin cancer is on the increase
◦ Around 10, 400 cases melanoma are diagnosed in the UK each year
◦ Melanoma is the fastest rising cancer in the Uk, causing 1800 deaths per year
◦ Early detection of melanoma greatly improves survival rates
◦ In Northern Ireland in 2012 there were 346 new cases of melanoma and 43 cancer deaths due to melanoma
Over last decade the registered incidence of Non Melanoma Skin Cancer (NMSC) has increased by over 30% within the UK and Ireland
In 2012, 3738 cases of NMSC were recorded by the NICR
NMSC is the commonest type of cancer now diagnosed in Northern Ireland and accounts for 41% of all new cancer cases
This is an underestimate of the true incidence as only the first NMSC of each histological type is recorded per person and many of these patients will have multiple tumours
The under registration of NMSC means that it is difficult to accurately assess the true burden of the rising incidence of skin cancer on healthcare resources
April 2015 – 12 weeks
April 2016 – longest waiter 6 weeks
GP Dermatologist
GP
Other
Plastic Surgeon
Plastic Surgery Unit
Ulster Hospital
OPD
SATSKIN
Theatre
Clinical Information
Previous biopsy and histology result
Photos
Patient invited to attend SATSKIN at a given time and date
Information pack sent to prepare patient of what to expect
Advised to expect to spend most of day at the hospital
Advised to phone if this option not suitable
Consultant – Mr Derek Gordon
Specialty Doctor – Miss Michelle Gibson
and Mr Andrew Moorehead (newly appointed)
Nursing staff (1 designated DPU nurse)
Theatre staff (3-4)
Admin and secretarial staff
First date 16/4/15
Based at Lagan Valley Hospital (SETRUST)
Day Procedure Unit
179 patients through SATSKIN in 1 year ◦ 5 of which did not undergo surgery
Did not require
Onward referral to Hand Surgeons
Did not want to wait
Did not read information pack
Undecided about surgery, just wanted a consultation
The latter 2 did have their surgery at a later date
5 DNAs
17 unfilled slots due to last minute cancellations
Aim to see and treat 4 patients per clinic
Initially 1 SATSKIN per week
Since January 2 SATSKIN per week
31 GP referrals
136 Dermatology Referrals
3 General Surgery referrals
1 Oncology referral
3 Other
63 SCC
58 Melanoma
4 Lentigo Maligna
8 BCC
8 Pre-malignant
42 Benign Lesions
Average time for ‘RED FLAG’ appointment in Plastic Surgery during last 12 months was 7.7 weeks (SATSKIN) ◦ Patient has definitive surgery same day
Inadvertent impact on ‘RED FLAG’ appointment at Plastic Surgery OPD ◦ Patient put on a ‘RED FLAG’ waiting list to have
surgery
Consultant list
SAS list
Aim to reduce time to ‘RED FLAG’ appointment in Plastic Surgery
Aim to reduce time to definitive surgery
Streamline treatment for skin cancer patients
With new appointment of second specialty doctor, scope for further SATSKIN clinics
Thank you very much, the experience was
fabulous WB
Great to have it all in one day rather than
going home and dwell on waiting for my
surgery MB
Excellent set up and excellent service, thank
you. RD
Re-audit
Patient satisfaction survey
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