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November 2014 Disclaimer We have made every effort to ensure that the information we have provided is accurate and will help you introduce the Treatment Summary into the care and support that you provide. Macmillan Cancer Support cannot accept liability for any inaccuracy in this information or that of third parties, such as the websites to which we link. Thanks This guide, based on work conducted by the National Cancer Survivorship Initiative (NCSI), a collaboration with Department of Health, NHS Improvement and Macmillan Cancer Support, has been revised and edited by Macmillan Cancer Support and its General Practitioner Advisers. We acknowledge and thank them for their work in developing and testing the Treatment Summary, and Tribal Consulting Limited for evaluating the work of the test sites. We also thank the Somerset Cancer Register and InfoFlex CIMS for their work in transforming this concept into an electronic solution and the NCSI who have been key in the development of this work. Contents What is a Treatment Summary? 4 When and how is it used? 4 Why was it developed? 4 Summary of evaluation following testing 5 Style and format 5 Using an electronic solution template 5 Treatment Summary templates and guidance 6 Recommended practice for using the Treatment Summary 6 Tips from health professionals using the Treatment Summary 7 The commissioning process 8 Commissioning intentions 8 Service specifications 8 Quality requirements 9 Quality incentive schemes (CQUINS) 11 Local incentive schemes 12 Local tariffs 12 Reporting requirements 12 Appendix 1: Treatment Summary template Appendix 2: Structured letter template Appendix 3: Example of a Treatment Summary Appendix 4: READ codes to be sent with the Treatment Summary Appendix 5: Screenshot from the Somerset Cancer Register Appendix 6: Rationale for data fields included in the Treatment Summary 14 15 16 17 18 19 Resources available for the Recovery Package 22 3 Treatment Summary: user guide and templates This user guide has been produced following testing and evaluation of the Treatment Summary, to help you implement the Treatment Summary in your local hospital Trust/service. This document outlines what a Treatment Summary is, what its key components are, what templates should be considered for implementation, and what the commissioning process is. What is a Treatment Summary? A Treatment Summary (TS) is a document produced by secondary and tertiary care cancer teams, usually following treatment for cancer or at other subsequent trigger points. It is designed to be shared with the person living with cancer and their General Practitioner (GP). A Treatment Summary describes the treatment that a person has received, its potential side effects, and signs and symptoms of recurrence. It will also help inform the GP Cancer Care Review and enable the GP’s database and records to be kept up to date. The Treatment Summary forms a key part of the Recovery Package¹ – a series of key interventions which, when delivered together, can greatly improve outcomes for people living with and beyond cancer. Treatment Summaries are useful for: • GPs and primary care professionals • people living with a diagnosis of cancer • secondary care clinicians, particularly those in A&E and those dealing with unplanned emergency admissions • hospices, day centres and care homes, and • oncology staff who would benefit from an at-a-glance summary. 4 When and how is it used? A Treatment Summary is designed to be completed by the hospital clinician at the end of an episode of treatment. This may be following surgery, chemotherapy, radiotherapy or adjuvant therapy. It is then shared with the person living with cancer and sent to their GP. A Treatment Summary can be sent with the standard clinic letter or replace it altogether. It may also be used when there is a referral from secondary care to palliative care for symptom control or at other points in the cancer journey, for example, following treatment for recurrence. A Treatment Summary includes details that are relevant to further management and care, for example, endocrine or other maintenance treatment and ongoing surveillance. Treatment Summaries are as much for people living with cancer as they are for health professionals, because these documents can help people understand more about their condition. They can also use them to share the information about their treatment with others, for example, for travel insurance purposes. Why was it developed? The Treatment Summary was developed to improve communication between primary and secondary care professionals working with people living with cancer. It was also conceived to help GPs update their records and databases and provide better support for people living with cancer. Following a scoping exercise in 2010, GPs reported that they were receiving lots of information from secondary care, but they were lacking a simple summary of their patient’s Treatment summary: user guide and templates cancer diagnosis, treatment and ongoing management plan. Discharge and clinic letters were often missing key information in a format that allowed people to self manage or be fully managed effectively in the community. This resulted in unnecessary delays and referrals back to secondary care. In 2009, a group of Macmillan GP Advisers identified information that would be helpful for primary care following treatment and the Treatment Summary template was designed to capture this information. Summary of evaluation following testing The Treatment Summary was tested in secondary care communities across several tumour groups. It was evaluated through surveys, telephone interviews and face-to-face meetings with more than 50 clinicians. An updated version for wider use was developed based on feedback and subsequently used in test sites in 2011 and 2012. The Treatment Summary has been positively received in both primary and secondary care. Eight out of 10 GPs found it useful or very useful. More than half felt it would make a difference to the way they managed people living with a cancer diagnosis and nine out of 10 wanted to see its use continued. The majority of hospital clinicians recognised the value of summarising what could be months of treatment and holistic care into one concise summary. One clinician said, ‘it made us document and communicate better’, while another reported that it was, ‘excellent to be able to access all the relevant data quickly in a short document’. People living with cancer found the Treatment Summary useful because it kept all the necessary information in one place. Their Treatment Summary allowed them to share their information with family members or carers. They also found it useful if they were admitted to hospital in an emergency, if they found themselves in a different hospital or hospice, or if they were applying for travel insurance. Style and format There are three different formats for the Treatment Summary. Clinicians and administrative staff can choose the template that best suits their local practice. The options are: • a standard Treatment Summary template • a structured letter template, and • electronic solutions. The templates can be adapted to suit local community or IT systems as long as the document follows the rationale in Appendix 6. Using an electronic template An electronic template can be automatically populated from the Cancer Information Systems (CIS) provided by the Somerset Cancer Register and InfoFlex CIMS Ltd. It can then be added to the electronic patient record (EPR), making it quicker and easier for a clinician to complete following treatment. The template can also be built into local systems. For further information, please contact your CIS provider or your local IT provider. 5 Treatment summary: user guide and templates Treatment Summary templates and guidance Recommended practice for using the Treatment Summary • Appendix 1: the standard Treatment Summary template. • • Appendix 2: the same information in a structured letter template. All sections of the Treatment Summary should be completed, with one copy offered to the patient and another sent to the GP. This should happen promptly following any treatment for cancer. • Appendix 3: a completed example template with prompt notes. • • Appendix 4: GP READ codes to be sent with a Treatment Summary. Treatment Summary updates should be generated at key points, eg following recurrence, further treatment or transition to end of life care. • Appendix 5: an example screenshot from the Somerset Cancer Register. • • Appendix 6: a user guide with rationale for why data has been included. This shows which fields are essential and which are desirable (this information is important if the form is going to be redesigned for local use). The Treatment Summary should be used alongside a Holistic Needs Assessment and care plan as it will not capture the same detailed information as the needs assessment. • All members of the multidisciplinary team involved in a person’s care should have the opportunity to contribute to their Treatment Summary. • The GP can enter the details onto the patient’s primary care medical records or their database and use the information to inform the Cancer Care Review. • If recommended, the GP will make sure the person is entered onto an appropriate monitoring or screening programme and review surveillance systems, eg for osteoporosis. The templates were tested in a variety of ways: • The majority used the formatted template provided (Appendix 1). • Some used the structured letter template to make it easier for secretarial staff to complete from dictation (Appendix 2). • Some sent the Treatment Summary electronically to GPs, while others printed and posted it. • One consultant used the electronic Treatment Summary instead of routine clinic letters at all appointments and gave the patient a copy when they left the clinic. 6 Treatment summary: user guide and templates Tips from health professionals using the Treatment Summary • Involve administrative staff early on when changing to the Treatment Summary system and encourage them to suggest the best ways of implementing it locally. • Make sure all members of the medical records department are familiar with the Treatment Summary and know where it should be filed in the medical records. This will prevent any Treatment Summaries from being filed in the wrong place or inappropriately removed from the medical records. • • If the Treatment Summary template is redesigned to fit with other hospital documents, check that data inclusions or fields are not removed as they may be useful to other people (see the rationale for data fields in Appendix 6). Think about providing a prompt list for clinicians to use as they dictate the information for the Treatment Summary in clinic. • Consider creating a template letter with headings to make it easier to fill in. • Get into the habit of completing a Treatment Summary at the end of an episode of treatment. Add a reference in the clinic notes that you have completed it and file a copy in the medical records. • Provide the standard GP READ codes attached to whichever Treatment Summary format has been used or issued to GP practices separately. • Test the system with a few clinicians then review and amend the process if necessary before its full implementation. • Attach the template or prompt list to the front of the case notes before a person is seen in the clinic to help encourage its completion. • Pre-populate the entries wherever possible (either electronically or by hand), eg the common signs and symptoms of recurrence and treatment toxicities. Different tumour groups may require different pre-populated entries. • Consider creating a separate list of signs and symptoms and key contacts for complex tumour groups to cut and paste from. • If the Treatment Summary template is set up on a local electronic database, it may be possible to add common side effects, signs and symptoms of recurrence and medications as drop-down menus or electronic versions. • Use the Treatment Summaries available on InfoFlex CIMS or the Somerset Cancer Register where possible, as these will self-populate much of the detail from the multidisciplinary team meetings. • Share testing and experiences with colleagues in order to encourage more people to use the Treatment Summary. 7 Treatment summary: user guide and templates The commissioning process Service specifications The inclusion of Treatment Summaries in NHS contracts This is where commissioners document the service they expect to commission. The development of this document should involve a collaborative approach between the CCG and the provider to define the expectations of the service. The inclusion of Treatment Summaries in NHS contracts could occur through a number of different levers. The publication Living with and beyond cancer: Taking action to improve outcomes1 promotes the importance of increasing the number of people with a care plan and a Treatment Summary. In terms of the NHS Outcomes Framework 2014/20152, Treatment Summary implementation would form part of Domain 2: Enhancing the quality of life of people with longterm conditions. Commissioning intentions Commissioning intentions represent the means to communicate the intentions of clinical commissioning groups (CCGs) for the following year. They set out how things will be different and what the impact on providers will be. The commissioning intentions process ensures that resources are focused on realising the CCGs’ mission and goals. Service specifications can be developed to describe services in different ways. This may be by care pathway, by individual service or by individual service user. Where agreed pathways (such as use of the Treatment Summary) need to be captured within the contract, a service specification can be used to identify this expectation. A service specification provides a brief description of the services being commissioned and will include information on: • the population’s needs • the scope of the service to be provided • appropriate national and local clinical standards, such as NICE care pathways, and • key service outcomes, eg the expectation that all patients will receive a Treatment Summary. An example of the inclusion of Treatment Summaries in commissioning intentions could be, ‘All newly diagnosed cancer patients will receive a Treatment Summary.’ 1 National Cancer Survivorship Initiative (2013) Living with and beyond cancer: Taking action to improve outcomes. 2 Department of Health (2013) NHS Outcomes Framework 2014/2015. 8 Treatment summary: user guide and templates Quality requirements Included in the quality requirements will be the: Within the contract document there is a section on quality requirements where commissioners will include quality indicators that would be expected to be achieved. It is best to work this up collaboratively with the provider, and potentially include financial rewards or penalties. • quality indicator • threshold • method of measurement, and • consequences of non-achievement. An example for Treatment Summaries is shown below in Table 1. Quality requirement Implementation of Treatment Summaries by March 2015 Threshold Method of measurement 50% of patients to have Measurement is by the a Treatment Summary number of new patients receiving first treatment within the quarter, as 50% of all new patients reported by the cancer to have a Treatment waiting times, who Summary provided have had a Treatment Summary Consequences of breach Action plan produced by providers with risks and risk mitigation identified 9 Treatment summary: user guide and templates Service development and improvement plans The service development and improvement plan (SDIP) is a mandated plan that is closely aligned to local CCG commissioning plans. These plans may be included in the contract, and the best improvement plans include actions for both the provider and the CCG. In the case of Treatment Summaries, this might include a commitment to educate GPs about the Treatment Summary and the Cancer Care Review, as well as a requirement that the provider implements the Treatment Summary rollout for all tumour sites. SDIPs can be used to support implementation of Treatment Summaries. An example of a SDIP to support Treatment Summary implementation is illustrated below in Table 2. Actions are often divided in the four quarters of the financial year where Quarter 1 (Q1) is April to June, Quarter 2 (Q2) is July to September, Quarter 3 (Q3) is October to December and Quarter 4 (Q4) is January to March. Table 2: An example of a service development and improvement plan for Treatment Summaries Clinical area Actions Timescales Benefits Cancer: Work in collaboration with the CCG and strategic clinical network colleagues to be an early adopter of cancer Treatment Summary initiative Actively contribute to strategic clinical network activity By end of Q1 Create local awareness 10 Work with the CCG By end of Q2 and cancer network leads on developing an implementation plan for commencement in Quarter 3 based on outputs from network events Rollout cancer Treatment Summaries for three tumour types, ie skin, lung and bladder Commencement date Work with commissioners in developing a rollout implementation plan for all cancer specialities. By end of Q4 Enhanced experience of cancer survival for patients Better communication with GPs and primary care Learning through implementation and developing sustainability measures Early implementer status and reputational benefit for Trust Treatment summary: user guide and templates Quality incentive schemes (CQUINS) Table 3: An example of a Treatment Summary CQUIN Milestones Rules for achievement of Date milestones Example milestone milestone including evidence to be reported weighting (% of CQUIN to be supplied to commissioner scheme available) Quarter 1 Develop local project plan for the implementation of Treatment Summaries By mid date 0.45% Quarter 2 25% of eligible patients with colorectal and breast cancer will be supplied with a Treatment Summary, as will their GP By mid date 0.45% Quarter 3 50% of patients with colorectal By mid-date and breast cancer will be supplied with a Treatment Summary, as will their GP 0.45% Quarter 4 75% of patients with colorectal By mid date and breast cancer will be supplied with a Treatment Summary, as will their GP 0.45% 11 Treatment summary: user guide and templates Local incentive schemes There is also a section for local incentive schemes that create additional risk-share agreements for other improvements which don’t fit anywhere else in the contract. They might include all-or-nothing incentives between providers that specify they have to work together on something to gain any financial benefits. Local tariffs This is where you can develop innovative ways of paying for services which do not fit under national definitions. A good example of this would be non-face-to-face consultations where a Holisitic Needs Assessment is completed, eg over the phone. These may be conducted by a Clinical Nurse Specialist or a Band 4 care coordinator, rather than being charged the normal price for a consultant follow up. Reporting requirements This is where the CCG may stipulate that they want specific regular reports from the providers that help inform their commissioning but do not have a specific target attached to them. For cancer, that might mean an activity report around numbers of patients on remote monitoring by CCG or a regular action plan shared off the back of peer review and patient experience surveys. 12 To find out more about the Treatment Summary, please email [email protected] Treatment summary: user guide and templates 13 Appendix 1: Treatment Summary template <Insert GP’s contact details> <Insert Trust logo> <Address> Dear Dr <insert GP’s name> Re: <insert patient name, address, date of birth and record number> Your patient has had the following diagnosis and treatment for cancer and received a summary and ongoing management plan as outlined below. They have been offered/received a copy of this summary. Diagnosis: Date of diagnosis: Organ/Staging: Local/Distant: Summary of treatment and relevant dates: Treatment aim: Possible treatment toxicities and/or late effects: Advise entry onto primary care palliative or supportive care register: Yes/No DS 1500 application completed: Yes/No Prescription charge exemption arranged: Yes/No Alert symptoms that require referral back to specialist team: Contacts for re-referrals or queries: In hours: Out of hours: Secondary care ongoing management plan: (tests, appointments etc) Other service referrals made: (delete or add) District nurse AHP Social worker Dietician Clinical Nurse Specialist Psychologist Benefits/Advice service Other Recommended GP actions in addition to GP Cancer Care Review: (e.g. ongoing medication, osteoporosis and cardiac screening) Summary of information given to the patient about their cancer and future progress: Additional information, including issues relating to lifestyle and support needs: Completing clinician: Signature: Date: Please take this document with you to your GP practice appointment where your diagnosis and cancer care will be reviewed with you. 14 Treatment summary: user guide and templates Appendix 2: Suggested structured letter template (refer to rationale in appendix 6) Date: <insert date> Dear Dr <insert GP’s name> Re: <insert patient’s name> Your patient has had the following diagnosis and treatment for cancer and received a summary and ongoing management plan as outlined below. They have been offered/received a copy of this summary. Diagnosis: Date of diagnosis: Staging: Summary of treatment and relevant dates: Treatment aim: Possible treatment toxicities and/or late effects: Alert symptoms that require referral back to specialist team: Secondary care ongoing management plan: (tests, appointments) Recommended GP actions: (e.g. medication, osteoporosis/cardiac screening) Summary of information given to the person living with cancer: Additional information including issues related to lifestyle, physical activity and support: Advise entry onto primary care palliative or supportive care register: (Yes/No) DS1500 application completed: (Yes/No/N/A) Prescription charge exemption arranged: (Yes/No) Contact for re-referral or any queries: In hours: Out of hours: Yours sincerely <insert clinician’s signature> <Insert clinician’s name> CC: <Insert patient name> Please take this document with you to your GP practice appointment where your diagnosis and cancer care will be reviewed with you. 15 Appendix 3: Completed Treatment Summary example Dear Dr Jones Re: John Smith, 3 Park Road, Doncaster DN4 DEF DoB: 10.10.10 NHS No: 123456 Your patient has had the following diagnosis and treatment for cancer and received a summary and ongoing management plan as outlined below. They have been offered/received a copy of this summary. Diagnosis: Date of diagnosis: Organ/Staging: Dukes T2 Colorectal cancer 10.02.10 Local/Distant: No Summary of treatment and relevant dates: Treatment aim: Surgery – Resection (March 10) and reversal of stoma (Sept 10) Radiotherapy – May–June 2010 Curative Possible treatment toxicities and/or late effects: Advise entry onto primary care palliative or supportive care register: No Diarrhoea following pelvic radiotherapy DS 1500 application completed: No Prescription charge exemption arranged: Yes Alert symptoms that require referral back to specialist team: Contacts for re-referrals or queries: • Diarrhoea for more than two weeks not relieved by loperamide/ In hours: 01234 567890 (CNS team) codeine • Blood or mucus per rectum Out of hours: 01234 987654 (oncology ward) • Further change in bowel function • Abdominal pain that persists for longer than four weeks and does not respond to simple analgesia Secondary care ongoing management plan: (tests, appointments etc) • • • • Referrals made to other services: Next OP Review – Jan 2011 CEA next due in Jan 2011 then annually until 2015 CT scan (abdo and chest) next due Sept 2011 Colonoscopy repeat next due Sept 2015 Community dietician Benefits/Advice service Recommended GP actions in addition to GP Cancer Care Review: (e.g. ongoing medication, osteoporosis and cardiac screening) Please review dose of XXXXX in two months if symptoms of XXXX resolved reduce to 4mg daily Summary of information to the patient and/or their carer: John Smith and his wife have been informed that the cancer in his colon was non-invasive and that he has received surgery and radiotherapy with curative intent. He is aware however that it may recur in the future and we have briefly discussed the further treatment available should this be required. He is fully aware of the symptoms of recurrence and what to do should any occur. Additional information relating to lifestyle and support needs: I have advised him to quit smoking and referred to smoking cessation clinic. He is keen to join local colorectal support group and plans to attend next session in November. Completing clinician: Charles Goodenough Signature: Date: 30.10.10 Please take this document with you to your GP practice appointment where your diagnosis and cancer care will be reviewed with you. 16 Appendix 4: GP read codes for common cancers (For GP use only) Please include with the Treatment Summary to the GP. Note: This is an aide memoir for common cancer related codes, not all will apply to this patient. Other GP READ codes are available if required. (Note: the codes are case and symbol sensitive so always ensure codes are transcribed exactly as below) Systmone (5 digit codes) Treatment All other systems Version 3 five byte codes Treatment Palliative radiotherapy 5149. Radiotherapy tumour palliation 5149. Curative radiotherapy XalpH Radiotherapy 7M371 Chemotherapy x71bL Chemotherapy 8BAD. Radiotherapy Xa8S1 Treatment aim Treatment aim Curative procedure Xallm Curative treatment 8BJ0. Palliative procedure XaiL3 Palliative treatment 8BJ1. Actions recommended to the GP: Actions recommended to the GP Tumour marker monitoring Xalqg Tumour marker monitoring 8A9.. PSA Xalqh PSA 43Z2. Osteoporosis monitoring XalSd Osteoporosis monitoring 66a.. Referral for specialist opinion Xalst Advised to apply for free prescriptions 9D05 Entitled to free prescription 6616. Cancer Care Review Xalyc Cancer Care Review 8BAV. Palliative Care Review XalG1 Palliative Care Plan Review 8CM3. Information to patient: Information to patient: DS1500 form claim XaCDx DS1500 completed 9EB5. Benefits counselling 6743. Benefits counselling 6743. Cancer information offered XalmL Cancer information offered 677H. Cancer diagnosis discussed XalpL Cancer diagnosis discussed 8CL0. Aware of diagnosis XaQly Unaware of prognosis XaVzE Carer aware of diagnosis XaVzA Miscellaneous: On GSF Palliative Care Framework XaJv2 On GSF Palliative Care Framework 8CM1. GP OOH service notified Xaltp GP OOH service notified 9e0.. Carers details 9180. Carers details 9180. 17 Appendix 5: Screenshot from Somerset Cancer Register 18 Appendix 6: Rationale for data fields included in the Treatment Summary Field Why include this? Essential (E) or Desirable (D) Diagnosis • Important for the GP and patient to know the type and location of cancer and the likely source of secondary recurrence. E Organ staging/local or distant spread (grade) • Information about staging and spread provides insight into prognosis and risk of recurrence. D Date of diagnosis • Shows how long the person has known their diagnosis. • Shows the time period between referral from primary care and diagnosis – helps identify where delays can be minimised in future. • Important data for monitoring treatment outcomes in relation to survivorship. • Helps plan the date of a GP Cancer Care Review. E Summary of treatment and relevant dates • To understand the range and order of treatment/s and the likely sequence of treatment effects. • Essential to inform future treatment choice if further disease occurs. • Important information for people wishing to take out insurance or a mortgage. E Treatment aim • Shows whether treatment intended is curative, palliative or for symptom relief – helping the GP understand the aims of treatment and to refer back to secondary care or other services appropriately. • Supports the GP to anticipate future care needs. E Possible treatment toxicities and/or late effects of treatment • People undergoing some cancer treatments may be more prone to toxicity and late effects of treatment such as osteoporosis or heart disease. Including risks here will help ensure the patient is entered onto appropriate ongoing surveillance programmes by the GP practice (see Quality Outcome Framework (QOF). • Signs and symptoms addressed earlier may improve quality of life and treatment outcomes from side effects or late consequences of treatment. • Suggested or preferred treatment associated with toxicities and late effects can be initiated without the patient needing to be referred back to the specialist. • Raises awareness of common late effects and reduces delays to further investigation and treatment. This may also impact on survival rates as symptoms are picked up sooner. E Advise entry onto palliative or supportive care register • Including the patient on the palliative care register ensures that the out of hours (OOH) teams are made aware that a patient is nearing end of life, and they and their carers may need more support. • The register is shared with all relevant OOH doctors, as well as staff from the ambulance service, community district nursing teams, Macmillan support team, social care and hospice, as appropriate. Patients can then receive the support, information and benefits they need. E Key contact in hours for advice and re-access • To ensure the person living with a cancer diagnosis, GPs and primary care team know who and when to contact should they have queries or concerns. • The contact should be able to triage enquiries and initiate action. E 19 Treatment summary: user guide and templates DS 1500 status (benefit that a patient can claim at the last six months of life) • If a DS 1500 hasn’t already been completed, this will prompt the GP to arrange this. Prescription exemption • If a prescription exemption hasn’t been completed, this will prompt the GP to arrange one. All cancer patients are entitled to have their prescription charges waived for any cancer treatment or drug they need. E Alert symptoms that require referral back to specialist team • This should only include the symptoms where immediate re-referral to a secondary care specialist is required (e.g. acute breathlessness requiring a pleural tap) not the expected side effects of treatment that can be managed by the GP or community team. • People living with cancer will have a better understanding of the symptoms that they should be concerned about and that should prompt them to contact the specialist team. E Contact for re-referrals or queries in and out of hours • Confirms contact details for the patient or GP for advice on care or treatment or to arrange an urgent review. The OOH contact could be a ward, the acute oncology team or the relevant on call team. E Secondary care ongoing management plan • Include any planned outpatient reviews and surveillance tests dates (or approximate timescales) – this provides a framework for GPs. If indicated here, further tests can be scheduled before the outpatient visits. • People living with cancer will be better informed about follow up plans and what to expect. • It is reassuring for people living with cancer to see the planned care, surveillance and support – then they know what to expect and when. E Referrals to other services • Helps avoid duplication of referral if the patient visits the GP between appointments and is unsure of who is involved in their care. • Particularly useful with social care referrals and when the person is known to other agencies. • Can help to reinforce the importance of attending appointments with other agencies. • Useful to also include details related to third sector support and centres such as a Maggie’s Cancer Caring Centre, if available. D Recommended GP actions including medication etc E 20 • To provide clarity about expectations in terms of the person’s ongoing care and how they can support them. • Provides prompts, e.g. to add the patient to routine screening programmes to help mitigate late effects of treatment. • The person living with cancer will be more empowered to approach the GP if they need further advice and support. • A specific request can be given to the GP to ensure continuity of care and avoid ambiguity. • Provides the GP with guidance and advice on which drugs, if any, need stopping and when. Also whether any adjustment is needed between follow up appointments or following discharge. • May avoid inappropriate prescriptions, overdose or misuse. Particularly important if the GP is going to continue to prescribe long term, ie endocrine manipulation. • People living with cancer will also know what to expect from their GP. Treatment summary: user guide and templates Cancer Care Register • This reminder helps ensure the patient is entered onto the register and that they are formally reviewed by the GP within six months of diagnosis. This is a requirement for the QOF for all general practices. D Summary of information provided to patient on diagnosis and prognosis • Sharing information on what has been discussed with the patient and their carer, and any written information provided, improves the quality and openness of the discussion that the GP can have with people living with cancer. E Additional information to people living with cancer • Confirms which lifestyle information and advice has been given or signposted to, including details of local support groups and psychosocial support, complementary therapies, returning to work advice etc. D READ Codes • It is the GP’s responsibility to assign the appropriate codes and enter them on their systems. GP READ codes are similar to hospital HRG codes and are used to identify diagnosis, tests and treatments. Both are complex systems and must be input manually. • Including the READ codes in the TS prompts and encourages GPs to accurately code patients. This helps improve safety in terms of surveillance, disease tracking and audit. • Please note: Codes may differ depending on the GP IT system used. D Include a copy of the READ codes with the TS. You may chose to send local GP practices a laminated copy of the READ Codes in advance to save sending each time. 21 Useful resources for the Recovery Package Treatment Summary – Mac Voice sharing good practice A tool to improve communication between cancer services and primary care. This guide to the Treatment Summary outlines why it is important and how it improves care. be.macmillan.org.uk (Order code: MAC14582) The Recovery Package – Mac Voice sharing good practice The Recovery Package is a series of key interventions which, when delivered together, can greatly improve outcomes for people living with and beyond cancer. This document outlines the interventions, the evidence and how it improves care. be.macmillan.org.uk (Order code: MAC5772_0614_SGP) Assessment and care planning for people with cancer This booklet for patients outlines the process of assessment and care planning, what to expect and what they can prepare for. be.macmillan.org.uk (Order code: MAC12957) Assessment and care planning folder This pack contains two triplicate pads for the assessment and the care plan, sufficient for 100 assessments. This enables the user to give a copy to the patient, a copy to the GP or audit, and place a copy in the medical records. Replacement pads are also available. be.macmillan.org.uk (Order code: MAC13689) 22 The Macmillan Organiser The Macmillan Organiser is designed for the patient to help them keep track of their treatment, make notes, and find the information and support they may need. It enables people to record useful information to help them self manage and contains useful assessment tools such as the concerns checklist and mood and food diaries. be.macmillan.org.uk (Order code: MAC13281) What to do after cancer treatment ends: 10 top tips This leaflet helps patients get the support they need to lead as healthy and active a life as possible following cancer treatment. be.macmillan.org.uk (Order code: MAC13615) After cancer treatment: a guide for professionals This short guide is intended to accompany the Macmillan booklet What to do after cancer treatments ends: 10 top tips. It explains why each of the 10 patient tips is important and provides practical ideas and suggestions for how healthcare professionals can support patients in their recovery from cancer. be.macmillan.org.uk (Order code: MAC14302) Physical activity and cancer treatment This booklet is written for people living with or after cancer who want to know more about the benefits of being physically active. It includes practical advice and useful organisations. be.macmillan.org.uk (Order code: MAC12515) Treatment summary: user guide and templates Get active, feel good exercise DVD In this exercise to music DVD, cancer and fitness expert Dr Anna Campbell, guides you through three exercise plans to complete at home. A booklet comes complete with the DVD. be.macmillan.org.uk (Order code: MAC14016) To find out more about the Recovery Package, please visit macmillan.org.uk/recoverypackage or email the team at [email protected] Health and Wellbeing clinics This booklet provides a guide to Health and Wellbeing clinics for health professionals and includes case studies from pilot sites. be.macmillan.org.uk (Order code: MAC13349) Work Support Route Guide English Version A signposting resource for health and social care professionals. It supports them in guiding people living with cancer who are in employment, on long-term sick leave, self-employed or out of work and want to discuss work options. be.macmillan.org.uk (Order code: MAC13538_ENG. Celtic nation versions also available.) Video content We have produced a selection of videos about the Recovery Package, all of which you can find on our YouTube channel. These cover the following subjects: • The Treatment Summary • Electronic Holistic Needs Assessment • Holistic Needs Assessment and Care Planning • Training for Holistic Needs Assessment and Care Planning 23 When someone has cancer, they don’t just worry about what will happen to their body, they worry about what will happen to their life. At Macmillan, we know how a cancer diagnosis can affect everything and we’re here to support people through. From help with money worries and advice about work, to someone who’ll listen if someone just wants to talk, we’ll be there. We’ll help people make the choices they need to take back control, so they can start to feel like themselves again. No one should face cancer alone. For support, information or a chat, call us free on 0808 808 00 00 (Monday to Friday, 9am–8pm) or visit macmillan.org.uk Macmillan Cancer Support, registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). MAC13894_1014 Printed using sustainable material. Please recycle.