Royal Marsden surgeon leads national review to restore safe and efficient care for thousands of breast patients

Fiona MacNeill, a consultant oncoplastic breast surgeon at The Royal Marsden NHS Foundation Trust, and National Clinical Lead for Breast Surgery has co-authored a national report into breast surgery services which aims to improve care and outcomes for thousands of patients across England.

Fiona MacNeill, consultant oncoplastic breast surgeon at The Royal Marsden
Fiona MacNeill, Consultant Oncoplastic Breast Surgeon at The Royal Marsden

The recently published Getting It Right First Time (GIRFT) national report into breast surgery makes a series of national, regional and trust-level recommendations for improving breast diagnostic and surgery services across England.

The GIRFT report summarizes findings from over 125 face-to-face breast unit visits and is consequently the most complete picture of breast diagnostic and surgery activity to date, as it is the first time that information about every breast operation that has taken place in England has been brought together. It focuses on surgery related to breast cancer (which accounts for the majority of surgery on the breast), but also looks at surgery for non-cancer reasons.

The report makes clear that the requirement to see all patients referred by a GP for a breast symptom within 14 calendar days is the biggest challenge for breast diagnostic teams and this can reduce their ability to counsel and operate on cancer patients in a timely manner.

There are more than 500,000 new breast referrals every year in England and the number is increasing, but cancer detection rates have stayed the same. This is because referrals are rising for younger women, especially those under 40 who are least likely to have cancer, with a smaller increase in referrals among the over-60s, who are more at risk.

It is important that public health messages are reframed to provide more information about normal breast health, empowering individuals to better understand what is normal

Miss Fiona MacNeill, Consultant Oncoplastic Breast Surgeon at The Royal Marsden

One of GIRFT’s core recommendations is to make referrals pathway more flexible, giving patients more control and choice over when they are seen but ensuring diagnosis remain readily available to all in a timely manner.

Miss MacNeill said: “It is important that public health messages are reframed to provide more information about normal breast health, such as breast pain and menstrual lumpiness, empowering individuals to better understand what is normal. In parallel, risk-adapted referral and standardised assessment pathways are required to ensure that access and capacity for early, rapid breast diagnosis remains readily available, and – crucially, post-COVID – is sustainable.

In response to the GIRFT findings, Royal Marsden Partners have already developed innovative referral pathways, with new patient and GP information videos and leaflets with a focus on understanding breast health, so women and men can feel empowered to take control and manage their own breast health. Further innovations are planned, such as open access breast tests.

Post-pandemic, with new patient referrals rising since the easing of restrictions and a backlog of operations for those with lower risk cancer or requiring reconstructive surgery, the GIRFT report recommendations will help the NHS to restore and maintain safe and efficient breast diagnostics and surgery, protecting vital patient care through encouraging teams to focus on those with the greatest clinical need. In particular, the report encourages innovation and adoption of evidenced based best practice to minimse unnecessary hospital visits and interventions.

Miss MacNeill further noted that “importantly, these innovations should also enable clinicians to spend more time treating cancer patients.”

Further recommendations in the GIRFT breast surgery report also include having full access to the latest oncoplastic and reconstruction surgery techniques, which support safe cancer surgery and breast appearance after breast conservation or mastectomy. Careful selection of oncoplastic techniques help to ensure patients do not undergo more surgery than they need and reduce planned and unplanned readmissions, making more effective use of resources for essential care.

In April 2020, to mitigate the impact of COVID 19 on delivery of timely cancer surgery services, Cancer Hubs were set up across London, including The Royal Marsden Partners Cancer Hub. Miss MacNeill and Mr Kelvin Ramsey, Consultant Plastic and Reconstructive Surgeon at The Royal Marsden, led the Pan London breast oncoplastic/ breast reconstruction Group that planned the careful and safe reintroduction of breast oncoplastic and reconstruction surgery as soon as was possible.

The Breast unit at The Royal Marsden is one of the largest in the UK, with over 9,000 new referrals per year mostly from the south east of England, but also across the UK as well as from all over the world. Rapid Diagnostic Clinics, run by our experienced specialist teams, with access to full triple assessment and same-day results for the majority, are held daily at Sutton and three times a week at Chelsea, as well as at our new Private Care facility in Cavendish Square.

Breast cancer patients at The Royal Marsden have access to a comprehensive range of services provided by a multidisciplinary team, many of whom are national and international experts/specialists. We aim to deliver the latest high-quality treatment for all stages of breast cancer, and to be at the forefront of international research into the development of new treatments, in the identification of women at high risk, and in breast cancer prevention.

GIRFT is a national programme designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change. It is part of an aligned set of programmes within NHS England and NHS Improvement.

The GIRFT breast surgery report is available for everyone working in the specialty to download here.