Dr Winnie Kwan

Lead for Cancer

My journey

I have been working as a GP in Bexley since 1989 and as the GP Clinical Lead for Cancer since 2008. My role is to support the PCNs to deliver the initiatives/ services which help with Cancer Prevention, Early Diagnosis, Personalised care and End of Life Care in order to improve the experience and outcomes for cancer patients. One in two of us born after 1960 will develop some form of cancer in our life time, according to Cancer Research UK.

Over the years of my experience in this role, I have worked closely with my colleagues in primary, secondary, community care, the Cancer Improvement team within the Integrated Care Board (ICB), my Cancer lead counterparts in the rest of the South East London boroughs, the South East London Cancer Alliance (SELCA), the third sector such as Cancer Research UK, and the Bexley Local Care Partnership. I am a Macmillan GP.

I have organised and chaired by March 2023 sixty quarterly interactive Bexley Clinical Roundtable for Palliative Care and Cancer meetings.  I introduce stakeholders such as cancer specialists, patients, allied health professionals etc to the Bexley Primary Care communities to highlight issues/ services and generate discussion that would impact service delivery and outcome improvement for the Bexley Primary Care Networks (PCN) and their practice populations. This is a part of a local incentive scheme for quality improvement, well supported by the PCNs and the ICB. This provided the means to inform, involve and engage with representatives from each practice. One example being, through this mechanism, Bexley was successful in 2020 in the application for Transformation Funding to pilot for 18 months the use of CtheSigns, an interactive cancer Decision Support Tool.

One of the NHS Long Term Plan ambition is to increase the proportion of cancer diagnosis in the early stages of I & II from the current 50% to 75% by 2028. The COVID-19 Pandemic since 2020 has set back previous progress. I was involved in communicating with the PCNs via webinars and bulletins when certain major cancer pathways had to change due to the restrictions and the pressure on the NHS at the beginning of the pandemic.  I supported the Primary Care Networks by providing guidance and involvement at a workshop organized by the South East London Cancer Alliance to support the PCNs in the service delivery of the Cancer Early Diagnosis Direct Enhanced Service.

Bexley practices have continued to achieve high coverage in Bowel and Cervical screening compared to London and England levels. Due to a change of access mode for patients and workforce pressure in mammographers, the previous high level of breast screening coverage has fallen in line with the national picture. An update of Cancer Screening was presented at the Local Care Partnership Forum and that generated support from the other stakeholders and the Comms team to promote screening especially in the minority and seldom seen groups.

I continue to deliver the quarterly Bexley Clinical Round table for Palliative Care & Cancer meetings. I am liaising with the Primary Care Service Deliver Manager to work towards a hybrid meeting model for the local incentive scheme to enable a wider inclusion of participants.

I am the go-to person for cancer related issues faced by the PCNs where I escalate the issues to the South East London ICB and the South East London Cancer Alliance to achieve a resolution. I represent the Bexley GP perspective at the fortnightly SEL ICB GP Cancer Leads meeting and the bimonthly SELCA Board meetings.

I help to support the introduction and delivery of new cancer services to Bexley, the latest being the Rapid Diagnostic Clinic (RDC) at Queen Elizabeth Hospital, launched in 2022. I am a member of the RDC Board and involved in the RDC GP Education programme.

I liaise with the SELCA Systems Development Facilitator for Bexley, Greenwich and Lewisham who reach out to the PCNs with their cancer performance data.

I liaise with the Primary Care Interface Project Manager Cancer Services at Lewisham & Greenwich Trust ( LGT). I am involved in joint audits with the cancer specialists to review the quality of 2ww referrals and improve patient pathways. I contribute from the Primary Care perspective at the LGT Cancer Board Meetings.

I am a co-convenor for the Lung Cancer Early Diagnosis Community of Practice. This is a voluntary group of cross boundary professionals and interested stakeholders including patients who want to make a difference to achieving early diagnosis for patients with lung cancer. Our goals are to raise awareness of lung cancer symptoms, to connect stakeholders, and to improve equity. Lung cancer is the biggest cancer killer in the UK.

I regularly attend the Lung Tumour Group meeting. There appears to be an increasing incidence of Lung Cancer in Never Smokers (LCINS), never smokers being people who smoked fewer than 100 cigarettes in their lifetime. Younger unsuspecting patients, especially women, who were previously fit and well present in late stage to unsuspecting clinicians.

The British Thoracic Oncology Group (BTOG) organised a LCINS update education event in 2022 where I presented a primary care perspective. I am in the process of liaising with an oncologist at Guy’s who is conducting research in this subject to better understand the demographics and presenting patterns of LCINS.  More knowledge of LCINS will support an awareness raising campaign for primary care and the public.