What does the Cancer Team do at the CCG?
We work with our stakeholders and providers and improve the cancer services in Somerset; working closely with the Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Alliance who bring together local clinical and managerial leaders who represent the whole cancer pathway. Together, we provide the opportunity for a different way of working, to improve and transform cancer services. We act on national directives in cancer care and adapt these specifically for our rural population. We work to support our service providers (GPs, Hospitals etc) achieve the highest possible patient standards across Somerset – always trying to improve the care we give to people with a cancer diagnosis and link services together.
There are a number of standards against which our cancer performance is measured; among these are the 2 Week Wait standard for all cancers. A ‘Two Week Wait’ referral is a request from your General Practitioner (GP) to ask the hospital for an urgent appointment for you because you have symptoms that might indicate that you have cancer. The operational standard states that 93% of patients should be seen within 14 days of the referral. The average year to date performance for Somerset (to December 2019) is 86.7%, (data sourced from Strategic Data Collection Service (SDCS), NHS Digital)
There is also the 62 day wait for first treatment following an urgent GP referral: this standard covers patients starting a first definitive treatment for a new primary cancer following an urgent GP referral for suspected cancer. The operational standard states that 85% of patients should receive a first definitive anti-cancer treatment within 62 days of the urgent referral date. The average year to date performance for Somerset (to December 2019) is 80.6%, (data sourced from Strategic Data Collection Service (SDCS), NHS Digital)
The work that we have been leading on and involved with, to support the improvement of patient care in Somerset includes:
Referrals from GPs to Hospitals
We have supported our Somerset primary care (GP) teams to make major changes to improve, in particular, the referral process. Previously, patients were referred to the hospital who then ordered and carried out the necessary tests. The patient would need to return to hospital for a second appointment to receive the results of the tests. The process now is that the GP orders all necessary tests and scans to be carried out first and then reviews the results before referring a patient to the hospital. This saves at least one hospital appointment per patient and also means that when a patient sees the consultant, the consultant has all the information and test results and is able to make a much quicker treatment plan as necessary. It also means that should tests return an unexpected result, the GP can look at other possible causes of illness; again, this saves unnecessary hospital appointments and frustration for patients.
FIT 10 Testing (Faecal Immunochemical Test) across the South West
The FIT 10 test has become available for patients as part of the Bowel Screening Programme: https://www.gov.uk/government/publications/bowel-cancer-screening-benefits-and-risks/nhs-bowel-cancer-screening-helping-you-decide The test has been developed and refined; it is much more accurate and happily, the test is also much easier and simpler to perform than the previous one. Only one stool (poo) sample is required and no dietary changes are needed prior to doing the test. An abnormal result showing the presence of blood in the sample, suggests that further investigation may be needed in order to obtain the correct care. All Somerset GP practices are now using FIT10.
If you would like to read more about this test, please see websites below:
Rapid Diagnostic Service
This is a pilot project which will run for 2020 in various parts of Somerset. Some cancers are harder to detect than others as the symptoms can be non-specific, multiple or broad and can be shared with many other common conditions. The idea of this new way to deliver care is to provide a place for appropriate patients to be referred to so that a broader range of tests and assessments can be carried out as quickly as possible. This saves the time consuming process and frustrations of being referred to multiple hospital departments.
Personalised Care & Support for Cancer Patients (formerly known as Living With & Beyond Cancer)
The NHS Long Term Plan mandates that by 2021, where appropriate, every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support. This will empower people to manage their care, the impact of their cancer, and maximise the potential of digital and community-based support. Every patient with cancer will get a full assessment of their needs, an individual care plan and information and support for their wider health and wellbeing. All patients, including those with secondary cancers, will have access to the right expertise and support, including a Clinical Nurse Specialist or other support workers. Somerset Trusts have developed personalised care and support for specific patient cohorts since 2010.
This new model of care serves to improve the care of patients after their cancer treatment has finished; we learned from patient feedback that more support was needed at this time so we have made a number of changes and are working on others. Cancer Support Workers are now in place in hospitals to work alongside clinical teams and provide extra support for patients and staff. They contact patients following a diagnosis of cancer and work with patients identifying where assistance is needed; they are available 5 days a week and have extensive knowledge of the wider support for patients. In addition to this, they run regular half-day Health & Wellbeing Events in the community which provide a huge amount of information and support for patients recovering from treatment. These cover subjects such as psychological support, fatigue, nutrition, exercise and adjusting to what is often referred to as “a new normal”.
Another vital part of care for patients after treatment is the rehabilitation exercise programmes available at both Musgrove Park and Yeovil Hospitals. Spring at Yeovil and Vitality at Musgrove Park support patients through a 12-week exercise programme to help build strength, fitness and confidence again after surgery or treatment. Both groups are relaxed, sociable and enjoyable, focussing on building a healthy and active lifestyle.
We have also recently supported work on a swimming programme (The Beacon Plungers) to help with the rehabilitation of patients living with the late effects of their cancer treatment. Working jointly with colleagues from Musgrove Park and supported by a Macmillan grant, we were able to trial the benefits of targeted swimming exercises taught by our physiotherapist. This proved to be extremely successful not only in terms of physical improvement but also in terms of general wellbeing as participants supported each other in many ways. We are now aiming to establish this as part of normal rehabilitation for those patients who are affected by lymphoedema and the late effects of their cancer treatment.
This pilot project was funded by a grant obtained to help improve the health and wellbeing of women. Working in conjunction with We Hear You, a number of Nordic Walking sessions were made available for patients recovering from treatment. This form of exercise is particularly good for patients suffering from lymphoedema but was thoroughly enjoyed by all who participated as they walked and talked together; several went on to buy their own poles and join local walking groups.
Treatment Summaries and Cancer Care Reviews
In order to make sure patients are best supported once they leave hospital and have a smooth transition back home, these services and processes will link GP and hospital care in a much better way. Treatment Summaries will provide all the necessary information from the clinical team at the hospital and provide the basis from which GPs can review the care and needs of the patient. This will ensure continuity of care for the patient and provide all the information required ensuring smooth follow up, monitoring and that any necessary repeat testing is carried out at the right time. Copies of treatment summaries will also be given to patients so that they are fully aware of their diagnosis, treatment, possible treatment side effects, future care plans and the signs of recurrence they might need to look out for.
Remote Monitoring and enabling cancer patients to self-manage their condition
We have been working with our medical professional colleagues and IT teams to enable patients for whom it is medically appropriate to be monitored without having to come into hospital for an unnecessary appointment. This will save time and free up out-patient appointments; this time can then be used more effectively to reduce waiting times. The ‘Patient Portal’ will allow low-risk patients to better self-manage their condition and dramatically reduce the need for continual out-patient visits to hospital. Additionally, there will be links to information pages to increase understanding of their diagnosis, treatment processes and support available. This is currently in development and should be available from mid-2020.