The Treatment Record Summary, Cancer Care Review

1. The Treatment Record Summary, Cancer Care Review Cathy Burton Macmillan GP Advisor

2. Treatment summary project • Effective monitoring and management of cancer survivors by improved communication between the specialist cancer team and multi disciplinary primary care team

3. Primary Care Perspective • Increasing number of survivors • Variable letters from hospitals – some examples of good practice e.g. highlighted letters • Summary details vary between hospitals • What follow up is required? Who is responsible? • Possible post treatment long term effects • Aim of treatment, outlook • Likely recurrence and signs/symptoms to watch for

4. Developing and Piloting the TRS • July – August 2009 • Tested out prototype with 4-5 Oncologists as ‘critical friends’ • Feedback from Oncologists and GPs • A standard format for a possible TS was formulated • Formal pilot phase in 11 test sites through NHSI • “ A summary of treatment provided to a patient’s GP by the patient’s consultant

5. Treatment Summary Insert Trust Logo and Address Insert GP Contact Details Address Dear Dr X Re: Add in patient name, address, date of birth and record number Your patient has now completed their initial treatment for cancer and a summary of their diagnosis, treatment and ongoing management plan are outlined below. The patient has a copy of this summary. Completing Doctor: Signature: Date:

6. Each Test Site developed their own way of using it • Electronic version, completed by consultant in clinic • Discharge letter template amended to include TRS headings • Word document completed by consultant (medical info) and CNS (holistic info) jointly • Form completed by CNS, signed off by consultant

7. Challenges and Barriers • Technology • Time • Duplicating present systems to greater or lesser extent • Present systems can’t accommodate (tapes to India) • Too complex • Not appropriate for all types of cancer (haematological) • Agreeing at what stage(s) in journey to send TRS; may depend on tumour type

8. Rating usefulness of each section

9. Has it made a difference to the way you manage your patients?

10. Who is it useful for?

11. Would you like this service to continue?

12. Levers • Feedback from GPs and patients • GP commissioners

13. Influencing G.P. contract arrangements

14. EVALUATION OF TEMPLATE PROJECT • Assess the extent of usage • Introduce to wider number of practices • Patient views • G.P. views

15. Aspects covered in the cancer care review

16. User friendliness

17. Prompts in the template

18. Usefulness of resources

19. Patient satisfaction

20. G.P. INTERVIEWS • . ‘Sometimes when patients are diagnosed, they’re so busy with hospital. They need medical certificates from us but they don’t need other input at that stage’ • ‘(the cancer care review is) to support patients and see how they’re doing’ • looking at it from an holistic point of view in terms of a patient’s physical symptoms but also social and psychological needs’.

21. Benefits • helpful, you don’t forget things. Useful as an aide de memoir’ ‘useful for prompting’‘reminder of topics to cover’ ‘make sure we don’t miss things and offer consistent service’ ‘trigger for us to remember to ask’; • it is easy to miss that aspect which is potentially important because you have not approached it in a structured manner’ • Useful for coding’ and that it is ‘auditable’ I

22. Barriers • It does the basics but you need detail… more patient driven things,’. • If you sit and ask the question and look at the computer and press a button. But that’s not the way we use it’

23. Macmillan Practice Nurse Pilot • Developing training package for practice nurses, to provide skills/knowledge to allow nurses to better support cancer survivors in the community • 2 whole study days plus 7 half days over 2 ‘terms’ • Nurses will be encouraged to identify a patient for a full review, plan the review and then report back, using peer support • Variety of approaches will be used, co-creating health/motivational interviewing plus training resources to provide nurses with wide range knowledge covering late effects, secondary prevention, holistic needs, supported by Macmillan patient information resources • GP in practice agrees to mentor nurse • Practice receives £1000 bursary

24. Practice nurse course Mind Map 1

25. Practice nurse course mind map 2

26. Practice nurse course mind map 3

27. Acknowledgements • Rosie Loftus • Terry Bowley • Lucy Thompson • Charles Campion-Smith • Noeline Young

28. Thank you Any Questions? Calburton@gmail.com