Old New Revised pathway (NTCN 2011) ‘One size fits all approach’ CEA 3/12 (2yrs) 6/12 (3yrs) CT 9 and 24 months Colonoscopy OPA 3/12 (2yrs) 6/12 (3 yrs.) 5 years secondary care led Clinical components same OPA frequency reduced Transfer of care to PC
Diagnosis & Treatment Recovery Early monitoring End of life care Progressive illness Later monitoring What happens here?
Cancer survivorWider population Use of the NHS past 12 months: Primary Care Specialist doctor A+E 90% 45% 20% 68% 15% 11% Impact on work and relationships Prevented by health from working in preferred occupation Health interferes in relationship with partner 25% 29% 9% Difficulty/ inability in undertaking different activities: Vigorous activities (running/ sports) Housework, shopping, cooking Going out Social activities Personal care 59% 16% 18% 16% 13% 27% 2% 4% 2% Macmillan Health and Well Being Survey 2008
Where we think people are…. Is not necessarily the case…
New Colorectal Pathway 2011 HNA + Care Plan Colonoscopy 6/52 OPA + CEA 9m OPA CT result CEA CT 12m CEA 15m OPA + CEA 18m CEA 21m CEA 24m OPA CT result CEA HNA colon CT 6m OPA for 1 yr. CEA HNA rectal Risk Stratification Level 1 CEA 6 m HNA review 3 m OPA + CEA 6 m CEA Cancer Care Review Level 2 CEA 6 m + Review Treatment Summary Colonoscopy Colonoscopy 5 yrly Health and well-being event
NCSI ‘immediate benefit to patient experience and quality of care along the pathway’
HNA and Care Planning Treatment Summaries Health and Well-being programme Cancer Care Review 1-2-1 support pilot Risk stratified pathways Remote Monitoring Workforce Education and development Rehabilitation > Working through cancer > Let’s get moving pathway Project work-streams
A complete picture Revised follow up pathway The Recovery Package Locally commissioned scheme Self-management Clinical effectiveness
Forecast No. of potential eligible patients per year = 450 Old pathway (visit) > 2 x OPA per yr. @ £72 each = £64,800 70% Level 1 = 315 > 2 x CEA per yr. @ £18 each = £11,340 25% Level 2 =112.5 > 2 x CEA per yr. @ £18 each = £4,050 + 1 x review per yr. @ 41 each = £4,612 Total under scheme = £20,002 Saving per year = £44,798 Cost benefit analysis - colorectal
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