Improving outcomes for people with skin tumours including melanoma

A3
Improving Outcomes for
People with Skin Tumours
including Melanoma
Appendix 3
Clinicians working in the community
The guidance states that some patients with precancerous or low-risk
BCCs may be diagnosed, treated and followed up by clinicians
working in the community under the direction of an MDT. The need
for community skin cancer clinics will vary according to the expertise
available and ease of access to local hospital departments. Some
cancer networks already have such services in place and it will be for
local commissioners to decide whether to establish them where there
is currently no such provision.
In the absence of cost-effectiveness evidence, a survey was
conducted to inform the resource implications of the guidance. The
costs include sessional rates paid to general practitioners with a
special interest (GPwSI) in dermatology in the community and a more
comprehensive service cost that includes GPwSI, nurse and
administrator time and consumables. In addition, hospital practitioner
sessional rates have been included (Table A1). The costs at a cancer
network level for the service inclusive of GPwSI time, nursing time,
administration and consumables is around £625,727 per network (±
25% range, £469,296 to £782,159). For a cancer network to deliver 30
sessions a week for 52 weeks of the year, the annual cost of those
sessions, with a GP locum payment, would be around £329,373 (±
25% range, £247,030 to £411,716); at hospital practitioner rates the
payment would be £196,773 (±25% range £147,580 to £245,966).
Thirty sessions in a network equates to 3.4 sessions per PCT or LHB.
These cost scenarios have a high degree of uncertainty because they
include an element of costs for patients that have conditions other
than non-melanoma skin cancer (NMSC). It also needs emphasising
that the costs have been presented for information purposes and it is
for local commissioners to investigate whether a GPwSI service would
enhance their existing services.
Multidisciplinary teams
The guidance recommends that cancer networks should establish two
levels of multidisciplinary team – LSMDTs and SSMDTs. Skin cancer
teams are currently established in some but not all cancer networks.
It is estimated that 36% of all networks require at least one SSMDT.
Fifty percent of networks require between three and six LSMDTs with
a further 23% requiring a further two to four LSMDTs.
All costs in this section are based on the MDT meeting every 2
weeks. For those cancer networks currently without any skin cancer
MDTs in place, the estimated annual opportunity costs for attending
MDT meetings is estimated to be between £129,134 (± 25%, £96,851
to £161,418) and £258,268 (± 25%, £193,701 to £322,835).
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National Institute for Health and Clinical Excellence