Microsoft word - primary care cancer strategy 2007-2010.doc

Merseyside & Cheshire Cancer Network
Primary Care Cancer Strategy
2007 - 2010

The Cancer Plan has achieved impressive results since it was published in 2000. However, demographic trends, new treatments,
increasing survival rates and reforms in the NHS have altered the context in which cancer services operate1.
As the policy environment changes with the introduction to the NHS of Payment by Results, foundation trusts, choice and competition
from private sector providers and a new focus on care outside hospitals, as a result of the White Paper, Our Health, Our Care, Our
(2006), the opportunities for working across organisational boundaries and maintaining clinically led services have never been
The purpose of Merseyside and Cheshire Cancer Network (MCCN) is clear - to deliver improvements in cancer services for patients
in line with national policy in a way that meets the needs of the local population – and it is expected that the development of the
Cancer Reform Strategy, announced by the Secretary of State in November 2006, will present many challenges and opportunities for
Primary Care Cancer Services and the Merseyside and Cheshire Primary Care Clinical Network Group (CNG) is confident that it
will address these appropriately.
It is likely that that there will be a focus on reform rather than spending commitments - giving patients more choice , strengthening
commissioning and shifting care from inpatients to outpatients and from hospital to community.
A big challenge will be how to maximize the opportunities for prevention and early diagnosis: the emphasis being on reducing health
The NHS in England: the operating framework for 2007/08 places the emphasis on continuity and the Public Service Agreement
(PSA), described in detail in National Standards, Local Action (July 2004) aims to substantially reduce mortality rates by 2010 from
cancer by at least 20% in people under 75, with a reduction in the inequalities gap of at least 6% between the fifth of areas with the
worst health and deprivation indicators and the population as a whole.
Indeed, the 2007-08 Framework puts the issue, and the target, at the heart of NHS service planning and performance and the 2006
Department of Health data update2 demonstrates that whilst the life expectancy is increasing for both men and women, it is
increasing more slowly than is required to reduce the gap.
Cancer incidence accounts for around 18% of the life expectancy gap and given that of the five (nine pre 1 October 2006)
Merseyside and Cheshire Cancer Network Spearhead PCTs, only one is measured as being on track to narrow their share of that
1 Future Trends and Challenges for Cancer Services in England Kings Fund (2006) 2 Tackling Health Inequalities:2003-05 data update for the National 2010 PSA Target Department of Health (2006) gap, four are partially on track and one is off track (as indicated in the 2003-05 data update referred to above), considerable emphasis throughout 2007 – 2010 on reducing Health Inequalities will be expected. The first MCCN Primary Care Cancer Strategy was compiled for 2003 – 2006, and provided a framework for measuring progress and performance against some key Cancer Plan targets in the primary care setting. This revised Primary Care Cancer Strategy reviews the current position in relation to progress made and provides strategic direction for 2007 – 2010 and the CNG will encourage Cancer Locality Groups to incorporate it into their individual Strategic Plans. It is proposed that the NHS Northwest undertakes a strategic review of current and future actions required to improve health and health care and inform commissioning in the NW. In particular, it will clarify demographic trends, lifestyle impacts, incidence and survival data, benchmark standards and make recommendations about the specific actions needed to prevent further cases, improve diagnosis and treatment outcomes, support people living with cancer and address inequalities. As MCCN will contribute to its development, it is expected that this work may change its focus over time Chair of Primary Care Clinical Network Group
Purpose of the Strategy
To provide the Merseyside and Cheshire Cancer Network Primary Care Clinical Network Group with a vision for cancer care services within the health economy. To inform the Merseyside and Cheshire Cancer Network Service Delivery Plan. To inform the commissioning processes of Primary Care Cancer Care through Practice Based Commissioning To support primary care to contribute to a whole systems approach to the delivery of National Initiatives
Aims of the Strategy

The main aims of the strategy are to -:
♦ Improve prevention by ensuring that the public are aware of the risk factors associated with cancer; ♦ Ensure that good administration and onward referral mechanisms are in place in primary care to support screening; ♦ Sustain achievement of waiting time targets for all cancers by ensuring assessment and prompt onward referral for those patients with symptoms suspected of cancer; ♦ Improve treatment and care through collaborative working with partner agencies by developing communication mechanisms to promote clinical continuity and coordination; ♦ Ensure that the supportive and palliative care needs of patients and carers are met in a timely fashion at all stages ♦ Improve the skills and develop capacity within primary care by investing in staff through training, development and ♦ Engage stakeholders, professional and non-professionals to improve the patient experience; ♦ Promote multidisciplinary team working to breakdown professional barriers, which will improve communication between patient’s carers and professionals working at all levels; ♦ Ensure that patients and their carers are offered high quality, timely information and support. This should be made available to suit the individual’s needs; ♦ Ensure that good evidence based practice is identified, disseminated and evaluated. Improving Prevention

To improve prevention by ensuring that the public are aware of the risk factors associated with cancer

While the causes of many cancers are unknown, there are some actions, which can be taken to reduce the risks associated with
cancer. These actions include:
♦ smoking reduction/cessation; ♦ improving diet and reducing levels of overweight and obesity; ♦ increasing levels of exercise; ♦ cutting down on alcohol consumption; ♦ taking appropriate precautions against exposure to the sun.
How can this be
Desired Outcome
PSA08a: Smoking quitters
PSA08b: Smoking status
their partners, according to reduction in prevalence cessation and should work in partnership with local authorities and others to prepare for the implementation of the legislation PSA10a: Childhood obesity
PSA10b: Broader strategy
co-operatives and easier access to fruit and vegetables; address issues of alcohol abuse in the light of the Government’s Alcohol Harm Reduction Strategy (March 2004). CNG should address equity of access to alcohol support services needs to continue, with the Skin cancer incidence is outdoor shady areas at schools, nurseries and need to take account of the implications for managing patients with pre-cancerous and low risk cancerous lesions in the community as per IOG This prevention strategy will be implemented by making the best use of health promotion resources within the PCTs together with community nurses, health visitors, midwives, pharmacists and other local health workers, and by working in partnership with others, particularly local councils and the voluntary sector. Prevention work depends on the availability of high quality information in a variety of formats and from a wide range of services including the Department of Health, health charities and local authorities. This includes leaflets, campaigns, the media, and the Internet. In particular, people need: ♦ information on how to reduce their chances of getting cancer by adopting a more healthy lifestyle; ♦ advice on how to detect possible cancer as early as possible, with information on signs and symptoms; ♦ information and advice sessions on opportunities available locally for improving nutrition and exercise levels and for encouraging ♦ support and advice for those with a family history of cancer. PCTs and practices should plan local publicity and events in line with national cancer awareness campaigns such as breast, colorectal and prostate cancers, and National No-Smoking Day; PCTs should use the results of health equity audits to target resources on cancer prevention and link to the work of the public health network (ChaMPS) in sharing good practice. MCCN has appointed a Macmillan Cancer Support funded Network Information Manager who will work with the Primary Care and Health Inequalities CNGs in implementing appropriate Health Prevention Information. IMPROVING SCREENING

To ensure that good administration and onward referral mechanisms are in place in primary care to support screening and
to facilitate access to information for patients

Timescale Current Progress
How can this be
Desired Outcome
Cancer Screening Programme on behalf ♦ Consider the implications There are several partner services ♦ GP practices should Clinical genetics Services. Work is in ♦ Network Referral which will act as the first line contact for ♦ Participate in the Cheshire Breast Screening patients into these services are in place Network CNG agreed revised Referral ♦ Network Agreed Patient IMPROVING ACCESS

Improve access to care and treatment by ensuring assessment and prompt onward referral for those patients with
symptoms suspected of cancer

Timescale Current Progress
How can this be achieved?
Desired Outcome
Performance against the ♦ Promote the use of Urgent the number of breaches; ♦ Implementation of Training collaboration during public awareness campaigns to provide information in the community IMPROVING TREATMENT AND CARE

To ensure the provision of high quality cancer care, support and treatment to patients and their families/carers in the
community setting and where possible offer the patient a choice in where to receive treatment
Cancer patients spend the majority of their time at home rather than in hospital. The Primary Health Care Teams provide support and care to patients and their families/carers throughout the cancer experience from presentation and referral, to diagnosis, treatment, palliative and terminal care and bereavement. Although still predominantly administered in secondary care some cancer treatments/care can, and are increasingly, being administered in community settings. Cancer in Primary Care – A Guide to Good Practice (2004) was developed by Macmillan Cancer Relief, Cancer Services Collaborative Improvement Partnership and the National Cancer Action Team as a tool for professional groups to assist them in the implementation of processes to support the delivery of high quality patient care. In terms of the care and treatment of patients it emphasises the co-ordination and continuity of care, ongoing support for cancer patients, the management of patients with advanced disease, including end of life care and support for families and carers. It states good practice guidelines for both Primary Care Trusts and Primary Health Care Teams Since then the requisite levels of good practice have been detailed in Improving Supportive and Palliative Care of Adults Guidance 2004 (NICE). This recommends the assessment of supportive and palliative care needs and highlights the areas of information provision, communication, general and specialist palliative care, terminal care, psychological, social and spiritual support. It also addresses complementary therapies and rehabilitation and covers the needs of carers during the patient’s illness and in bereavement. More recently, both Commissioning a Patient Led NHS and the White Paper, Our Health, Our Care, Our Say (2006), advocates the re-design of patient pathways to provide more services in the community, closer to home and this strategy aims to be the vehicle by which this can be achieved within Local Health Communities. The Primary Care CNG will seek to influence Practice Based Commissioning Decisions in relation to cancer and palliative care. Objective
Timescale Current Progress
How can this be
Desired Outcome
All PCTs within MCCN have a Primary ♦ Primary Care Trusts Primary Care Trust lead A tiered model of (formerly Supportive & Palliative Care responsibility for the implementation of Patient & Carer, in addition to other occur across the Network which need to be formalized and incorporated into the Network Education and Workforce Strategy. Record of Consultation; quality Information and ‘The Transition from Cancer Patient to Survivor: A Guide to Mental Wellness’ ♦ Support the PCTs; Several PCTs make available Cancer Information in Public Libraries to an Network agreed standard WORKFORCE
Improve the skills and develop capacity within primary care by investing in staff through training and development and
workforce reform


Timescale Current Progress
How can this be achieved?
Desired Outcome
linked to KSF to deliver service according to strategic aims; Primary Care workforce can prepare for shift of care as outlined in the White Paper; ♦ Use of KSF to facilitate Personal Sufficient staff available with learning time’ activities; The Education Network Group (ENG) is established CROSS CUTTING ISSUES

Timescale Current Progress
How can this be
Desired Outcome
care implications of a patient undergoing clinical trial involvement & engagement; The Patient and Carer Network Group has Locality based Cancer Partnership Groups involving all Local Healthy Communities



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