Implementation of the EMBPP

The pilot carried out in Derbyshire, with a catchment population of ~ 1 million, was commissioned by Joined Up Care Derbyshire (JUCD) and implemented by a project team including clinicians and managers from both primary and secondary care. Patients were referred via the NHS electronic referral service (e-RS), available only to the Derbyshire catchment population. Referrals to the breast pain clinic were vetted by an experienced breast clinician and any indicating additional symptoms were rejected and moved to a 2WW clinic. 2WW referrals received for breast pain alone were also triaged into the CBPC after discussion with the referring primary care practitioner.

Three clinic sessions were run weekly throughout the Derbyshire area: two sessions at the Florence Nightingale Community Hospital (Derby) in South Derbyshire and one session at Ashgate Medical Practice (Chesterfield) in North Derbyshire, to match the relevant catchment populations. The clinic was staffed by an experienced breast clinician (an advanced nurse practitioner) and a clinic coordinator. On arrival at the clinic the FH Questionnaire was inputted into the FaHRAS risk assessment tool by the coordinator. A printout of this assessment was provided to the clinician. The patient had a clinical assessment and management in line with the EMBPP.

Results

1036 patients were seen at CBPCs between June 2021 and February 2023.  The median patient age was 49 (range 16-88) years. 993 patients (95.8%) were discharged from the clinic with breast pain management advice. 43 (4.2%) patients were referred for further assessment at a 2WW breast diagnostic clinic. Objective family history risk assessment identified 124 patients (12.3%) above population risk of breast cancer, who were offered referral to Familial Cancer Services for ongoing management.

Seven patients were diagnosed with breast cancer at or within 12 months of CBPC attendance. Five patients were diagnosed through attending the CBPC, one patient was subsequently referred to 2WW clinic with a new symptom and had a mammographically occult tumour and one was diagnosed following a subsequent routine breast screening invitation. Two of the five patients had a personal history of breast cancer which was a stated exclusion criterion for the CBPC. Breast cancer incidence in women with breast pain only and fulfilling CBPC referral criteria was 4.8/1,000, confirming that this population is at low risk of developing breast cancer.

Patient service satisfaction was high with 99% (n=1022) “extremely likely or likely” to recommend the service.

Outcome

• Patients with breast pain only were successfully managed in a primary care setting.
• Patients attending the clinic reported high levels of satisfaction.
• Most patients did not require a breast diagnostic clinic assessment.
• Familial breast cancer risk assessment helped identify unmet need in the community.
• No safety issues were raised.

The Derbyshire pilot confirmed that CBPCs are feasible and acceptable to patients, and in addition they are scalable and raised no safety issues. The service has been in place for 3 years demonstrating that it is sustainable.

ABS Annual Meeting Presentation 17.05.22

ABS presentation 13.05.24

BMJ OQ 2024 CBPCs Derbyshire

RCGP Derbyshire Poster Presentation 03.02.24