Transcript CCR Presentation June 2016

Cancer Care Reviews
Dr Annetta Monaco
Macmillan GP Surrey Downs CCG
Annie Twidell, Macmillan Primary Care
Nurse Facilitator, Surrey Downs CCG
Macmillan Cancer Course For
Practice Nurses.
June 2016
The following acknowledgments need to be made with
regard to this presentation.
• Dr Annetta Monaco, Macmillan GP Surrey Downs CCG
• Annie Twidell, Macmillan Primary Care Nurse Facilitator, Surrey Downs
CCG
• Macmillan Cancer Support
• Dr. Karen Jones and Dr. Martin Brunet who designed their own CCR
template.
• [Slide 5] Macmillan extracted from a presentation on the Recovery Package
at Surrey Downs CCG Living with and beyond cancer educational event
(Nov 2015) by Dr. Natalie Doyle, Nurse Consultant - Living With & Beyond
Cancer, The Royal Marsden NHS Foundation Trust
• [Slide 14] HNA University of Surrey extracted from a presentation by Jackie
McBride, Teaching fellow, UNIS : ‘holistic assessment of the cancer patient’
on the Practice nurse course 2015
Cancer is Changing
•More people Living with
and beyond cancer
•People living with the
consequences of the
disease and its treatment
The Recovery Package
Why is it not being implemented ?
The what?
Don’t have
the time…
Don’t have
the
resources…
Not
convinced
of the value
of it…
Don’t have the
support…
Cancer survivors often have on-going needs following
active treatment and need greater access to health
care services
(Armes et al, 2009)
In a 12 month period:
Figure 4 from Macmillan outlines the proportion and number of people with
cancer living with other long-term health conditions.
This further supports the notion of cancer
as a long term condition
Why was it developed?
•Forms a key part of the Recovery Package and is integral to
enabling people affected by cancer to engage in supported
self management.
• ‘Achieving World-Class Cancer Outcomes A Strategy For
England 2015 - 2020’ publication that recommends the
introduction of the following metric.
•‘A cancer care review to discuss on going needs and
completed by the patient’s GP or practice nurse’
So
Who is a Cancer Care Review is useful for ?
•
•
•
•
People affected by cancer and their carers
GPs and Primary Care Professionals
Secondary Care Professionals
Local service providers
So
What is a Cancer Care Review?
•Discussion about patients cancer journey
•Can be with GP or Practice Nurse
•Initial discussions - open up about their experience, gain
reassurance, information and support in their local area,
supported self-management as part of the Recovery Package.
• Done alone or accompanied by their carer i.e. a relative or
friend who is looking after/supporting them. With permission
from the patient
So when and how is a CCR used?
•Designed to be delivered by the GP practice within six
months of a cancer diagnosis
•The discussion is tailored to support the persons need
and can include themes such as, information,
treatment, consequences of treatment and actions
Cancer Care Review discussion points:
Discussion of Diagnosis
Open questions about the cancer journey
Needs assessment
The patient may have received an initial Holistic Needs Assessment
and Care Plan from secondary care but further assessment of need
is essential
Information needs
Treatment
A Treatment Summary may have been received from secondary
care: This can aid the completion of the Treatment section of the
Cancer Care Review
HNA Components
Physical
Psychological
Social
Background Information
Spiritual
So what is a Treatment Summary?
•A Treatment Summary is an essential component of the
Recovery Package and a tool that supports effective patient
centred care. This may be a letter, a template, or a print out from
an electronic system
•The Treatment Summary should detail all aspects of treatment
that are important to note in patient consultation
e.g. Diagnosis
Staging
Treatment aim
Possible toxicities and/or late effects
Recommended GP actions
Safety netting
If you haven’t received a Treatment
Summary from secondary care
It is worth contacting the secondary care unit that provided
treatment to understand the treatment that has been
administered
It is worth checking with the patient if they remember having
a Treatment Summary
QOF INDICATOR CANCER 3
Examples of Read-Coded templates that Macmillan Cancer Support has developed together with IT Providers to
support implementation of the above QOF indicator.
These templates encourage good clinical practice as well as providing triggers that will support implementing of
national strategy and policy, e.g. National Cancer Survivorship Initiative, Information Prescriptions and Pathways and
exemption from prescription charges for cancer patients and those with late effects of cancer treatment. Examples
of these triggers include:
A. Discussion of post-treatment GP assessment and care planning
B. Raising awareness of the financial impact of cancer, including patient awareness of prescription exemptions
C. Recording treatment given so that patients with possible late effects can be identified and made aware of
prescription charges exemptions
D. Discussion of information needs in primary care
D
A
B
C
One example of an EMIS CCR template developed by
Dr. Martin Brunet and Dr. Karen Jones,
G.P’s Binscombe Medical Centre
Karen also Macmillan G.P , Guildford and Waverley CCG
Ten top tips for conducting a CCR
1.Ensure a flexible patient centred approach
2.Allow adequate time for a face-to-face consultation
3.Invite patients to bring others including carers, family and
friends
4.Help patients prepare
5. Let patients tell their story / Ask open-ended questions /
Provide reassurance
Ten top tips for conducting a CCR
6. Use as an opportunity for health promotion
7.Deliver tailored information and signpost to find out more
8.Offer on going support
9. Complete an electronic version of the Cancer CCR
10.Capture and share with patient, carer and the cancer care
team
• Worry, fear or anxiety
(breast, ovarian, head & neck, endometrial, melanoma)
• Tired/exhausted or fatigued
(breast, kidney, non-hodgkin lymphoma, ovarian, head &
neck)
• Sleep problems/nightmares
(breast, head & neck, lung, melanoma, ovarian
• Pain
(breast, ovarian, head & neck, kidney, melanoma
What next?
Secondary care follow up ?
Investigations ?
Other clinical input?
Cancer screening?
Unplanned admissions?
Understanding the symptoms of recurrence
Consequences of Treatment
Possible actions ?
•How and where to get more information
•Resources
•Referral/Signposting
•Contact details
•When will the next Cancer Care Review/appointment be
•It is important to be clear on what the
patient will action and what the GP or PN
will action.
Summary Care Record
Any information that is recorded from a Cancer Care
Review could be usefully used to enrich the patients
Summary Care Record.
It is worth checking if the patient has given permission
for their Cancer Care Review information to be
included
Any questions ?