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

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

Remote monitoring PROS  Promotes individualised, risk stratified approach to care  Care closer to home  Potential reduction in cost to commissioners  Releases capacity in secondary care CONS  Disease knowledge base in primary care / interpretation of results  Less immediate access to specialist team for advice  Viability of scheme for individual practices  ‘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 Treatment summary Robust call/recall systems + link worker Varied level scheme Locally agreed protocols and referral processes Educational support Resources Transitional support Health and well-being LCS for primary care

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

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 Outcomes & Benefits of Change

2/52 OPA + CEA Consultant led 3/12 OPA + CEA Nurse led 6/12 CEA + U+E pre CT 9/12 CT scan OPA with Result + CEA 12/12 CEA 15/12 OPA + CEA 18/12 CEA 21/12 CEA + U+E pre CT 24/12 CT scan OPA with Result + CEA 30/12 CEA 36/12 OPA + CEA rectal Supported Self management Shared care Complex Case management CEA 6/12 Until 5 years Secondary care Primary Care 12/12 Colonoscopy 5 yrly Colonoscopy Until 75 yrs. Sheffield Colorectal Cancer - Follow up basic clinical pathway

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

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