1. Developing the GP Cancer Lead Community Dr P Sawyer Herts Valleys Macmillan Cancer Lead

2. CCG Clinical lead CCG role – Monitoring – Engaging – Challenging and Changing – Advising and representing Clinical lead – Using your knowledge – Influencing

3. Cancer Action Group Local focus Commissioner perspective Invite providers Detailed analysis of data/information Action plan Reports to commissioning executive/board

4. CCG Clinical lead CCG role – Monitoring – CCG Cancer Action group – Engaging – with local trust (cancer committee) – Challenging and Changing – Advising – CCG board and sub-committees Clinical lead – Using your knowledge – clinical, organisational… – Influencing – clinicians, managers, commissioners

5. Change Can be a difficult process People don’t like it Barriers to overcome Must have clear reasons & benefits Will have consequences (foreseen & unforeseen) May take a long time Requires leadership and a plan…

6. Transforming Prostate Cancer Follow-up in West Herts Dr Phil Sawyer HVCCG Macmillan Cancer Lead

7. Why? Care closer to home –Convenient –Responsive –Team working –Using IT –Systems & protocols –Time for patient –Empowering and enabling patients

8. More reasons… Modernisation Pressures within secondary care Expected rise in new cases Efficiency – avoid duplication Recommendations of NHS Improvement, Macmillan, NICE… Health & Well-being clinics May reduce costs

9. The current service All patients given similar routine follow up Little choice of appointment times/dates Sometimes rescheduled by hospital Clinics over-stretched, busy & over-run If well & stable very brief consultations, receive PSA result & next follow-up date May not have time to cover patient’s concerns Re-referred onto other services if problems

10. A vision of a different way Risk stratified once stable post treatment Discharged to community team (GP practice) follow up End of treatment summary with bespoke follow-up plan Cancer Rehab programme (delivered by H&W-B clinics) Access back into secondary care services if/when necessary Education & training for PC teams Ongoing support for patients

11. Stakeholders (small group role play) – Patients – GPs – Secondary care consultants – CNSs – CCG commissioners – Practice managers

12. Stakeholder views Comments Questions What have we missed out/forgotten? What blocks/hurdles exist? Can you/your organisation support us? Next steps…

13. Requirements for success Support from stakeholders Agreed risk stratification & follow-up protocols Expectation & acceptance by patients End of treatment summaries ‘Cancer rehab’ programme Engagement from primary care teams : including training & support Follow-up clinic protocol Clear sign-posting & pathways Monitoring & outcomes

14. Key actions and learning points Metrics and outcomes. Baseline questionnaire Agree End of Treatment Summary & follow-up protocols with secondary care Agreed follow-up clinic template Get project officer support to organise meetings and get paperwork through organisation structures Develop some GP and practice nurse education alongside to up-skill and reassure clinicians Commissioning a new service: Business case. Service spec. Timetable. Costings. Presentations… Unable to establish exact numbers & costs because cancer follow ups are not coded differently from any other urology OP appointment. The best source of Prostate cancer prevalence I found was via http://lci.cancertoolkit.co.uk/ http://lci.cancertoolkit.co.uk/ other stats available from http://www.cancerresearchuk.org/cancer- info/cancerstats/types/prostate/ http://www.cancerresearchuk.org/cancer- info/cancerstats/types/prostate/

15. More learning… Difficult to find suitable Read codes A simple monitoring/claim process is recommended, particularly as numbers (and value of work) per practice are quite small. The process of claiming should not be disproportionate. – This was why we decided to pay practices something (a reduced rate 50% of current OPA tariff) for all the Prostate cancer patients with the ultimate expectation of 50% follow up in the community. Secondary care offered to help audit discharged cases

16. risks Practices won’t engage Secondary care won’t discharge patients Primary care clinicians will lack necessary skills/confidence Primary care will start searching out ‘extra’ prostate cancer cases by screening ?

17. Next steps Macmillan Practice Nurse training course GP education programme Next tumour site? Other work – CCG Cancer Action group – Engaging with local Trust Cancer committee and their action plan – Actions re new NICE guidelines…

18. Summary CCG Clinical Lead role has many facets and functions – Differences probably exist between CCGs depending on organisations, personalities and local issues Clinical leadership offers the potential to challenge and change existing systems Need to identify where change is possible and beneficial Clinical knowledge and input is valuable Understanding and influencing stakeholders is crucial to success