80 Making In-Reach Work: A Collaborative Model for Oesophago-Gastric Cancer Surgery Across Regional Centres

Abstract Aim In-reach models involve surgeons from hospitals without dedicated Oesophago-Gastric (OG) cancer services regularly attending a centralised OG cancer unit to perform resectional operations. They are often unsuccessful due to challenges with integration and continuity of care. In our region, an in-reach model for OG resections has been successfully implemented. This study explored why the model works. Method We evaluated the in-reach service of OG resections performed at a centralised unit by surgeons from non-OG cancer centres. Semi-structured interviews were conducted with surgeons to identify success factors using the Consolidated Framework for Implementation Research (CFIR). Results Success factors were identified:Long-standing professional relationships between surgeons; built through regional MDTs, training networks, and shared respectIntegrated MDT; allowing referring consultants to remain involved throughout the decision-making processConsultant cross-cover when needed, allowing for daily consultant review of post operative patientsRegular Morbidity and Mortality assessments; supporting transparency and fostering a culture of open discussion to maintain high standards of careShared peri-operative protocols; ensuring consistent standards regardless of operating consultantCultural buy-in across clinical teams; including anaesthetics, ITU, nursing staff, and surgical traineesUpper GI emergency on call rota in which all surgeons participate It was noted that patients value continuity with their local surgeon, and opportunities for surgical trainees were preserved. Conclusions With appropriate infrastructure and culture, in-reach models can deliver high-quality cancer care. Our experience provides a framework for similar regions aiming to balance centralisation with continuity.