The Wessex Rapid Investigation Service (RIS) for suspected cancer
Service Specification
The Wessex RIS is a single point of access service for the Wessex geography, covering Hampshire, the Isle of Wight and Dorset, via a central virtual Hub which is supported by a small clinical team.
The RIS provides a new urgent suspected cancer referral pathway for adult patients who exhibit symptoms which might be explained by an underlying diagnosis of cancer, but without cancer site-specific symptoms, in order to make or exclude a cancer diagnosis more quickly.
The RIS Hub is responsible for the integrated co-ordination, triage and onward referral of patients with non-specific symptoms and those with a suspected pancreatic cancer who are not currently served by existing NG12 pathways.
The RIS clinical hub team will be able to access local diagnostics and continued care, as appropriate.
As part of the RIS specification, an Equalities and Health Inequalities Analysis (EHIA) had to be completed and submitted to the national NHSEI team for review before being uploaded. We are pleased to say that the comprehensive submission has been approved at first submission and is available on the NHSEI portal.
Programme Management
Development of the RIS in the early stages, was carried out via the work of task and finish groups, chaired and led by local systems experts with responsibility to design aspects of the service, relevant to their area of expertise.
These groups were;
- Finance and Commissioning – Chaired by Cindy Shaw-Fletcher,
- Digital – Chaired by Georgie Cole
- Referral and Triage – Chaired by Dr Sarnia Ward and Dr Jane McLeod
- Pancreatic Cancer – Chaired by Dr Zaed Hamady
As the service roll out is complete, these groups have now stood down however the chairs continue to provide clinical support and expertise to the Clinical Reference Group (CRG) established to provide clinical governance and oversight for the live RIS.
The Chairs of these groups also attend a monthly RIS Steering Group meeting for updates and monitoring of the service.
Hub Implementation and PCN roll out across Wessex
Hosting of the the virtual Hub aspect of the RIS is managed by a partnership between South Central Ambulance Service NHS Foundation Trust (SCAS) and University Hospital Southampton NHS Foundation Trust (UHS).
A phased roll out of the RIS took place throughout 2020 with all PCN’s across Dorset, Hampshire and the Isle of Wight going live in a planned approach, as per the timetable set out below:
| PHASE | LOCATION/PCNS | TRUST GOING LIVE | DATES (2020) |
| 1a | 1 Dorset PCN | Poole | 22nd June – 19th July |
| 1 b & c | 2 Dorset PCNs | 20th July – 16th August | |
| 1 d & e | 2 Hampshire PCNS | Bournemouth
Southampton Portsmouth |
17th August – 11th October |
| 2 | All of IOW
Rest of Dorset |
St Marys
Dorset County |
12th October – 29th November |
| 3 | Rest of Hampshire | Hampshire Hospitals | 30th November through to January (2021) |
Covid 19 Pandemic Impact
The original plan had been for the RIS Hub to be hosted at the SCAS offices in Otterbourne but due to Covid -19 restrictions, the Hub was initially set up at UHS instead and in early 2021, when wave three of the national lockdown was announced, a decision was taken to move the Hub to Aldermoor Surgery for at least the next 12 months. Patients referred to the Hub will not notice any change to the service they receive from the RIS team, since a lot of the work will continue to be delivered virtually regardless of where the hub is hosted. It has been this virtual aspect of the service that has proven to be one of its’ biggest benefits during the pandemic.
The RIS remains fully operational, is accepting referrals and continues to work to the 28FDS.
Referral and Triage through the RIS
An RIS referral form developed by the Referral and Triage group and other aspects of the RIS pathway were validated at a workshop in early 2020.
Based on consensus and current national trends in rapid diagnosis, it has been decided that the pancreatic cancer pathway will be embedded into the generic RIS referral pathway with the RIS clinician identifying patients at risk of a suspected pancreatic cancer at the point of triage.
Due to the non-specific symptom nature of the RIS pathway, the mandatory filter tests must have been completed and results received by the GP prior to referral.
Patients need to be available at the point of referral to RIS, to prevent any delays to the patient from the point of referral into the pathway and ensure that the RIS is compliant with the 28-day Faster Diagnosis Standard (28FDS).
Appropriate investigations will be requested at this point by the RIS clinical team and an audit will be undertaken to identify the impact of non-specific symptoms on pancreatic cancer diagnosis.
The RIS team works closely with secondary care providers and has an ongoing engagement with the teams at each of the seven Trusts, to support the patients and build relationships as well as agreed processes for each onward pathway.
RIS Progress
The RIS roll out is now complete and all PCNs in Wessex can refer to the RIS.
Shared learning and feedback from the pilot as well as the patients who have now been through the RIS referral pathway, continues to inform next step planning and engagement. It was due to this patient feedback that the name “Rapid Diagnosis Service” was changed to Rapid Investigation Service. Patients told us that “diagnosis” was a misleading title since it suggested a diagnosis would be made, regardless of whether that was cancer or not. The service was officially re-named to Rapid Investigation Service, on January 4, 2021.
We have welcomed the evident enthusiasm and support from GPs and stakeholders who have contributed to the success we have seen of this service so far. We recognise the amount of work that has gone in to enabling this to happen and want to thank all colleagues who have been involved.
Communication, Patient Engagement and Evaluation
Communication and Engagement strategies for the RIS were developed to support the RIS roll out and ongoing patient engagement requirements.
Wessex Voices supported the programme by; collating and sharing patient engagement from other pilots as well as interviewing the patients who were referred to the RIS during 2020 and early 2021.
Wessex Voices carried out some patient and public engagement just before the first lockdown in March 2020, asking specifically about the virtual aspect of this service. A report was shared with the RIS Steering Group and has also been used to assist with the design and content the patient information leaflets which describes the RIS and acts as an aide memoire for staff who may come into contact with patients on the RIS pathway.
A copy of this leaflet is available on this page and also via the Cancer Matters Wessex website along with other information on the RIS including FAQs.
Future plans include Wessex Voices gaining further input from the public to ensure the service can meet the needs of people in the Deaf community and those who may have limited access to digital technology.
During the first year of the service, each patient referred was offered the opportunity to be contacted by Wessex Voices who have carried out the structured telephone interviews on behalf of the RIS, asking about their experience.
These telephone interviews formed stage one of the comprehensive patient engagement strategy, which has now been replaced by an online survey. All feedback will be reviewed and incorporated as part of the ongoing evaluation of the service.
National Interest
The Wessex RIS model has attracted a lot of interest from Rapid Diagnostic Centre peers, who have been particularly interested in the virtual triage and digital infrastructure which is core to the Wessex specification.
National evaluation is being co-ordinated by a partnership led by Ipsos Mori on behalf of the national delivery team. This will include performance and the minimum data set (MDS) and patient engagement. Each Alliance has an identified Ipsos relationship manager and expressions of interest requested to join two national working groups for patient experience and evaluation dashboard.
Wessex Cancer Alliance will be represented in the patient experience group and has also presented its’ experience at the national RDC collaboration event which took place in September 2020.
