The purpose of this locally commissioned service (LCS) is to provide enhanced support for prostate cancer patients in the community including annual holistic needs assessments (HNAs) and prostate specific antigen (PSA) monitoring, which will also encourage and facilitate the transition of care of prostate cancer patients stable on treatment out of the acute hospital setting and into primary care. This supports the strategic objectives of improving patient experience, moving care closer to home and delivery of productivity savings.
Following recommendations by the North Central London (NCL) Cancer Commissioning Board, the five NCL clinical commissioning groups (CCGs) have worked collaboratively with the NHS England Transforming Cancer Services Team to develop this LCS specification. The service is designed to help reduce the outpatient burden on local acute trusts and improve patient care by providing follow up reviews within primary care.
Increasing incidence of cancer (currently 3 per cent per year) alongside increased survival rates are putting huge pressure on outpatient resources and impacting on the quality and efficiency of services provided. The ten year survival for prostate cancer is 83.8 per cent and recurrence is usually detected through PSA monitoring which can be conducted in either a secondary or a primary care setting. Both patients and professionals have identified that many appointments are unnecessary, add no value and incur unnecessary costs for patients and the NHS.
In the UK, the numbers of men living with a diagnosis of prostate cancer will continue to increase as the population ages. The traditional follow up model follows a standard regime of hospital outpatient appointments and surveillance tests over several years. The National Institute of Clinical Excellence recommends that patients stable at two years after radical treatment and patients who are undergoing “watchful waiting” should be offered follow-up outside of hospital in an appropriate setting.
As 70 per cent of cancer patients have at least one other long-term condition, there are other potential advantages in establishing a primary-care-led model of care that is fully integrated with the care of other long-term conditions. The challenge of providing effective aftercare for this increasing number of men is a driver to redesign care pathways away from traditional consultant led models of follow up.
The primary care stratified pathway has been tested in Croydon CCG. The evaluation of the pathway showed that patients were in favour of primary care follow-up with feedback outlining confidence in primary care to manage effectively and appropriately their holistic needs. The evaluation also showed that clinicians felt assured by the process of receiving specialist advice when needed. Finally, clinical safety was achieved through the maintenance of a prostate register which mitigated patients being “lost” within the system.
The aims and outcomes of this LCS are to:
- Provide care closer to patient’s homes. This is particularly beneficial for patients who are frail or who have dementia
- Release capacity within the acute sector and free up appointments enabling shorter waiting times and faster treatment of patients newly on a cancer pathway, supporting the 14 and 62 day targets
- Reduce acute costs and ensure a more cost effective approach to follow up
- Upskill GPs in primary care and enable a shifting of resources from the acute setting into primary care
- Be more locally cost effective
Lists of patients who are suitable for continued follow-up in the community will be sent to GP practices with recommendations for the number of PSA test required to ensure adequate monitoring over the course of a year. GPs will then be expected to maintain a register of these patients and to provide holistic wellbeing reviews and review test results throughout the course of the year.