Download Update on The Treatment Summary TS

The Treatment Summary
A Survivorship Tool in Primary Care
Terry Bowley
Macmillan GP Advisor North Central, North East
London & Sussex, GP in Redbridge
GP Advisers (GPA)
• Based across the UK
• Work closely with Macmillan to enhance care
for those affected by cancer in the primary care
area
• Provide strategic leadership for primary care to
Macmillan
• Help support the development of the primary
care workforce as regards delivery of Macmillan
strategies
The cancer story
is changing
Cancer as a long term condition
Macmillan’s Priorities
By 2030, the 4 million people living with
cancer in the UK will say:
I was diagnosed early
I understand, so I
make good decisions
I get the treatment and
care which are best for
my cancer, and my life
Those around me are
well supported to help
me, and themselves
I am treated with
dignity and respect
I know what I can do
to help myself and
who else can help me
I can enjoy life
I feel part of a
community and I’m
inspired to give
something back
I want to die well
What do patients need after Primary treatment?
• A long term supportive professional
relationship.
• Help with symptoms and side effects of
disease and its treatments.
• Information to enable self management
• Rapid referral back to specialists as needed.
• Signposting to others who can help.
Cancer “survivors”.
•
•
•
•
•
•
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Over 40% may have long term effects from the cancer and treatments1
Many have unreported emotional and physical problems1
Will have poorer health outcomes in the presence of co-morbidities
Will use GP appointments more than age matched controls2
This increased demand varies between cancers but prostate cancer patients
may consult three extra times per year for >15 years.3
May not identify primary care as best placed to deliver long term cancer care,
due to three barriers. GPs being perceived as “non-expert”, as “too busy” and
the lack of “continuity of care” in general practice making discussion of long
term issues difficult.4
Many are going to find themselves followed up within Primary care soon.
1-Macmillan Health and Wellbeing of Cancer Survivors Study 2008
2-Armes et al J Clin Oncol. 2009 Dec 20;27(36):6172-9. Epub 2009 Nov 2.Patients' supportive care needs beyond the end of cancer treatment: a
prospective, longitudinal survey.
3-Khan et al Br J Gen Pract. 2011 March 1; 61(584): 197–199
4- Khan et al Br J Cancer. 2011 Nov 8;105 Suppl 1:S46-51. doi: 10.1038/bjc.2011.422
What is a Treatment Summary?

Produced by Secondary Cancer Care Professionals

At the end of initial treatment for cancer and other
subsequent trigger points

Shared with patient and their General Practitioner

Outlines treatment that has been received, side effects, signs
and symptoms of recurrence

Enables GP database to be kept up to date including cancer
care review (CCR)
Why was it developed?
 Increasing numbers of survivors, summary details varied
between hospitals (what follow up is required? who is
responsible, possible post treatment long term effects)
 2009 – Macmillan GP Advisors identified information
that would be helpful at the end of initial treatment
 TS Template was designed to capture this information
 2010–2012 – TS tested in 11 NHS test sites across several
tumour groups
Who it is aimed at?
 GPs and Primary Care professionals
 Patients - record for visits to
GP/hospital (travel insurance)
 Secondary Care Clinicians, particularly
for A & E and any unplanned
emergency admissions
 Hospices & Care Homes
Summary of evaluation findings
• Positively received in both primary and secondary
care
• 80% of GPs found summary useful or very useful
• Over 50% felt that it would make a difference to the
way they manage patients
• 90% wanted its use to continue
• The majority of hospital clinicians recognised the
value of summarising what could be months of
treatment/care in to a concise summary
Style and Format
 3 different formats – a template (GP read
attached) a structured letter, electronic
template www.ncsi.org.uk
codes
 Electronic template can be automatically
populated from the Cancer Information Systems
(CIS) provided by Somerset Cancer Register &
Infoflex. This can be added to the patient’s
electronic record – quicker and easier to complete
The Treatment Summary
London Cancer
• Made the decision to implement the
Macmillan template locally
• Aim is to embed it in the Urology pathway
initially
• Aim to roll out to other pathways next year
National Cancer Survivorship
Initiative Website www.ncsi.org.uk
(Assessment & Care Planning)
Acknowledgements:
Noeline Young Project Manager NCSI
Anne Wilkinson National Improvement Lead – Cancer
GPA Group
Nicola Harker
MacGP Weston Super Mare
David Plume
GPA (Anglia)
Helen Rickard
Healthcare Project Officer, Primary & Community
Care Macmillan