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Challenges to primary care and the community Peninsula Survivorship Conference

Challenges to primary care and the community Peninsula Survivorship Conference. Dr Peter Rose University Lecturer and GP. GP role in cancer. Then…. Prevention and screening Diagnosis and referral End of life. GP role in cancer. Now.. Cancer care review Agenda Does it happen?

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Challenges to primary care and the community Peninsula Survivorship Conference

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  1. Challenges to primary care and the communityPeninsula Survivorship Conference Dr Peter Rose University Lecturer and GP

  2. GP role in cancer • Then…. • Prevention and screening • Diagnosis and referral • End of life Peninsula cancer survivors

  3. GP role in cancer • Now.. • Cancer care review • Agenda • Does it happen? • Earlier discharge • Longer survival • Psycho-social • Long term and late effects • Co-morbidity Peninsula cancer survivors

  4. Reasons for follow up • Detecting recurrence…but evidence for benefits of pre-symptomatic detection • Monitoring treatment and side effects • Support of patients and relatives • Psychological • Social • Employment • Signposting • Addressing information needs Peninsula cancer survivors

  5. Reasons for follow up • BUT… • Different health professionals focus on different bits • Contact with GP variable • The first stage is still hospital focussed Peninsula cancer survivors

  6. The follow up pathway • Hospital alone +/- GP • Discharge • Patient alone +/- GP Peninsula cancer survivors

  7. A new care model

  8. Aims of new model • Level 1 70% (now 10%) • Level 2 20% (now 90%) • Level 3 10% (Now <1%) Peninsula cancer survivors

  9. Patient views • Who is a cancer survivor? • What is important to patients? • Varies a lot….do we offer flexible approach • E.g.Prostate cancer and treatment effects • Patient views on GP role • Not an expert • Lack knowledge • Do not want to bother the doctor Peninsula cancer survivors

  10. Peninsula cancer survivors

  11. Peninsula cancer survivors

  12. Peninsula cancer survivors

  13. Peninsula cancer survivors

  14. What information do patients get? • About the reasons for follow up • Especially related to detection of recurrence • About the role of health professionals • About the choices they have • About where to get information Peninsula cancer survivors

  15. Partners’ views • Become carers and health workers • Concerns about providing emotional support • Recognising needs of patient while having their own fears to cope with • Concerns about own health • Concerns about the future • Looking out for signs of recurrence Peninsula cancer survivors

  16. Partners’ views • Role of GP • Would have like help but did not ask for it • Issues of confidentiality E Adams et al. Brookes University Peninsula cancer survivors

  17. New inititatives • Earlier discharge means greater GP role • Unless new model excludes GP • But GP role not defined or formalised • Survivorship care plan • Risk stratification leading to new models of care • Risk stratification v needs Peninsula cancer survivors

  18. What can primary care offer? • Care for physical, psychological and (some) social aspects of care • Care for co-morbidities, prevention and screening • Continuous longitudinal care • Co-ordination of care between patient and other agencies • Care for families Peninsula cancer survivors

  19. What are the challenges? • In general……. • Specification of roles and responsibilities throughout follow up but acknowledge patient choice • Dedicated recall systems for follow up • Education and training • Knowing what help we need and where to get it……… Peninsula cancer survivors

  20. Peninsula cancer survivors

  21. What are the challenges? • In particular…. • Contact in the initial stages • Better use of the cancer care review • Contact at time of discharge • Flexibility • Follow up those with ongoing needs or those who choose continued contact • Better contact with families Peninsula cancer survivors

  22. It is a big task! Peninsula cancer survivors

  23. Thank you and questions • Acknowledgements • All the colleagues who have worked on these projects with me but especially Eila Watson, Nada Khan, Sian Harrison and Eike Adams Peninsula cancer survivors

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