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

2. Why do we need a plan? Performance

3. 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 million patients living with and beyond cancer
Success story… but
1/3 have long term consequences of diagnosis/treatment

4. ‘World class outcomes’

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. 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)

13. 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

14. 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

15. 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

16. 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

17. 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’

18. 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.

19. 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?

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

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