The Recovery Package

Hayley Williams Macmillan Survivorship Programme Manager South Yorkshire Bassetlaw and North Derbyshire Dr Anthony Gore GP Cancer Lead & Primary Care Champion Sheffield CCG Northern England SCN November 10 th 2014

Drivers for change

• Evidence base re value of traditional ‘medical models’ • Patient • Care Closer to Home agenda • NCSI – March 2013 • CCG Revised Clinical Pathways

Remote monitoring

PROS CONS  Promotes individualised, risk stratified approach to care  Disease knowledge base in primary care / interpretation of results  Care closer to home  Less immediate access to specialist team for advice  Potential reduction in cost to commissioners  Viability of scheme for individual practices  Releases capacity in secondary care  ‘Loss of patient’ in system

Revised pathway ( NTCN 2011 )

Old

 ‘One size fits all approach’  5 years secondary care led  CEA 3/12 (2yrs) 6/12 (3yrs)  CT 9 and 24 months  OPA 3/12 (2yrs) 6/12 (3 yrs.)  Colonoscopy as per need/protocol

New

 ‘Stratified pathway’ (not post treatment)  2 yrs. (colon) 3yrs (rectal) secondary care  Clinical components same  OPA frequency reduced  Transfer of care to PC under LCS

Components of effective remote monitoring

Managing patient expectations/ Information and knowledge HNA and care planning Educational support Resources Treatment summary Locally agreed protocols and referral processes Robust call/recall systems + link worker Transitional support Health and well-being LCS for primary care Varied level scheme

Sheffield experience

 Patient expectations – revised pathway as at 2011  2 level LCS developed – implementation = 12 months  Locally relevant CEA protocol and agreed referral mechanism  The Recovery Package  Resource tools  Education (PLI/ PN)  Enhanced Cancer Care review template (colorectal specific content)  PRESS signposting tool

Overcoming Challenges

• Engagement • Clarity • Manage expectations • Impact of patient – anxiety and uncertainty – can not rely solely on them to make sure CEA protocol gets followed • Education key

Outcomes & Benefits of Change

• Promote patient self-management • Provide more effective yet efficient support to cancer survivors • Support which reduces an individual’s reliance on traditional health care • Transformational change • Culture change

Outcomes & Benefits of Change

• Effective engagement and collaboration • Services ‘shaped’ by the patient voice • Assurance of equitability • Foster integrated approach • Skill sharing/role development • Use of data to drive commissioning

Sheffield Colorectal Cancer

- Follow up basic clinical pathway 5 yrly Colonoscopy Until 75 yrs.

Supported Self management 12/12 Colonoscopy 2/52 OPA + CEA Consultant led 3/12 OPA + CEA Nurse led 9/12 CT scan OPA with Result + CEA 15/12 OPA + CEA 24/12 CT scan OPA with Result + CEA 36/12 OPA + CEA rectal Shared care Complex Case management 6/12 CEA + U+E pre CT 12/12 CEA 18/12 CEA 21/12 CEA + U+E pre CT 30/12 CEA CEA 6/12 Until 5 years

New Colorectal Pathway 2011

Treatment Summary Health and well-being event HNA colon HNA review

CT 6/52 OPA + CEA 3 m OPA + CEA 6 m CEA 9m OPA CT result CEA 12m CEA 15m OPA + CEA 18m CEA CT 21m CEA 24m OPA CT result CEA 6m OPA for 1 yr.

CEA

HNA rectal

Level 1 CEA 6 m Level 2 CEA 6 m + Review

Cancer Care Review

Thank you