A pilot of fast-track access to a one stop assessment clinic for patients presenting to primary care with a breast lump: evaluation of impact on primary and secondary care workload and patient experience

Background There are well established clinical pathways for primary care to refer suspected breast cancers into secondary care.

People presenting with breast lumps in primary care will be referred as urgent suspected cancer (USC) into secondary care. In NHS Forth Valley this accounts for around 4,000 patients each year.

Offering fast-track access to these patients would potentially reduce primary care attendances and enable faster, person-centred access to one-stop breast diagnostic services.

Aims The aim of this project is to introduce, evaluate and assess the scalability of a change in pathway in NHS Forth Valley to allow fast-track access to assessment clinics for symptomatic patients with a breast lump to support earlier breast cancer diagnosis. Methods Phase 1 (months 1-3), intervention design and preparation.

We will establish a stakeholder group and a PPI group who will develop/refine an intervention and implementation plan. The evaluation framework, and research methodology, approach and methods will be finalised, and ethics approval sought.

Through close working with the stakeholders, we will explore the contextual factors and expected facilitators and barriers to implementation. Phase 2 (months 3-15), implementation, evaluation and adaptation. The intervention will be implemented in line with the plan, adapted as necessary based on evaluation feedback.

Evaluation activities will include the gathering of data related to outcomes and process of implementation. Methods will include the use of routine health services data, surveys to patients, and interviews with staff involved.

Analyses will include: statistical analyses of quantitative data (including before/after comparisons across 3 time points) and economic analyses; descriptive analyses of demographic data; thematic analyses of qualitative data. Phase 3 (months 1-18), scalability and evaluability assessment. This work will begin at project initiation, with evidence synthesised in months 15-18.

The project group will conduct a combined scalability [1] and evaluability [2] assessment, with the research team gathering further data as required (e.g. via qualitative interviews with healthcare professionals) to fill in any missing gaps.

Value This project will result in: a tried and tested improvement, with evidence of how and why it ‘worked’ as it did; a detailed assessment of its scalability, along with information required to develop a comprehensive scale up plan; an assessment of the anticipated long-term impact of the improvement, particularly in terms of reducing inequalities in health; and an assessment of its evaluability on a larger scale.