Transforming the cancer journey The cancer plan and what it means for primary care

Why do we need a plan? Performance

Why do we need a plan? Demography Ageing population -47% can expect to get a cancer Earlier diagnosis/better treatment half will survive at least 10 years. By 2030 4 million patients living with and beyond cancer Success story… but 1/3 have long term consequences of diagnosis/treatment

‘World class outcomes’

Cancer transformation plan National Board- strategic- originator of plan Cancer Alliances (regional) (cf previous networks) Seeking funding and will choose projects and monitor (via diagnostic and other boards)󠇄 Cancer Steering group CCG, secondary, primary care Working group- focussing on role of primary care and resources

Priorities PREVENTION, SCREENING,EARLY DIAGNOSIS Recovery Package Re stratification of follow up breast/bowel/prostate ALSO patient experience metrics Notion that money will be saved by transformation to further improve services

Early Diagnosis Primary care to become more proactive in Promotion of healthier lifestyle as primary prevention. Awareness of screening uptake and promotion of national programmes Symptom awareness campaigns NICE guidance and the 2 week wait Reducing late presentation ? Direct access to diagnostics Management of vague symptoms 4 weeks to treatment target by 2020

How can we help? Resource packs distributed to practices in South and Central Birmingham and Solihull Macmillan/CRUK practice visits ( part of this year’s incentive scheme in Solihull) Review practice cancer profile on PHE Fingertips Look at easy, sustainable ways to promote preventive strategies and screening programmes Look at resources to support early diagnosis of cancer Raise awareness of developments in cancer rehabilitation

4 cancers in 10 are preventable Reduce alcohol Keep a healthy weight Eat fruit and veg Stop smoking High fibre diet Sunscreen Exercise Reduce intake processed meat Healthy lifestyle message- but public not so aware of cancer prevention, Same factors aid recovery! Diet ,exercise no smoking modest alcohol use avoid excessive sunlight Family history, occupational risk,lifestyle choices

Screening Bowel, breast, cervix (and soon some targeted screening?) Variations in uptake relating to deprivation ethnicity learning difficulty first language mental illness On the horizon- bowelscope/fit test

Earlier diagnosis Symptom awareness ( publicity campaigns) Willingness to present Access to appointment Continuity 2ww criteria Atypical/vague sx and repeated consultation

Late Diagnosis: CRUK study 278 lung or colorectal cancers (emergency presentation) CRUK study Emergency presentation of 278 lung colorectal cancer Most at risk: elderly, carers, ‘philosophical’ (? Mental illness, learning difficulty) Beware vague sx, persistent new sx, atypical sx, symptom noise. Care with safety netting, communication investigations (false reassurance/lost reports)

The Recovery Package Begins at diagnosis Holistic Individual Care Plan, patient centred Operates across hospital and primary care Approaches cancer as a long-term condition, like diabetes Aims to enable patient to live a full life with and beyond cancer

The Cancer Journey (present model) Diagnosis Treatment Discharge..Then? cancer care review in primary care Intense contact with hospital team during diagnosis and Rx Single cancer care review in primary care within 6 months of diagnosis. Mainly unstructured. Sometimes a tick box exercise

At discharge from treatment... Patients report initial elation... Then, often Anxiety/ fear (especially of recurrence) Fatigue, low mood Isolation and a sense of abandonment Difficulty getting back to ‘normal’ Problems with relationships and work Need for information

The Recovery Package Earlier diagnosis & referral Secondary Care: At diagnosis: a holistic assessment/care plan Treatment Discharge holistic needs assessment/summary care plan/health and well being event More care shared with primary care

Holistic Needs Assessment Patient-led Leads to individual care plan Aim is to assess at diagnosis and discharge and between if needed Mainly hospital based so far. Use of ipads to collect data Feedback- focuses consultations without opening ‘can of worms’

Which Clinician? In hospital, multidisciplinary. (and ipads!) GPs can quickly learn process.... but Mac trained nurses are starting to carry out cancer care reviews in primary care using the holistic needs assessment/care plan This format is also suitable for annual review required on the stable prostate pathway.

Restratified follow up For breast, bowel, prostate cancers Earlier discharge of low risk patients Rehabilitation, then…. ‘supported self management’ as with other long term illnesses. Careful pathway redesign (safety-netting) Resistance to change?

Transformation Resources Willingness to change Willingness to work across existing boundaries Better communication/sharing of care Skill mix …..huge potential gain for patients!

Family and Friends... What journey would we choose for them?