Using a template to support cancer care reviews
This is a template that is widely available in all primary care IT systems, so is available for any GP in England to use as it has been nationally implemented by all of the core IT systems for primary care.
Every person with a cancer diagnosis is entitled to a review in primary care called a cancer care review (CCR). This should be a holistic personalised review tailored to the needs of the person with cancer.
In general, people with cancer are not aware that they have received a cancer care review and so are not receiving the personalised review that the practice is funded to provide. The template was created to try to ensure that each patient with cancer receives a quality holistic review that addresses their needs. This extends beyond the clinical to also cover practical, emotional and financial elements.
Using a template for this review has been found to be helpful as an aide-memoire or reminder for the physician carrying out the review. It also enables easy coding of concerns into the patient file and sharing of relevant information as embedded within the template.
The 2021/22 new GP contract QoF indicators requires primary care teams to carry out two conversations based around a cancer care review discussion in the first year post-diagnosis, the second one of which should be to a structured template.
The aspiration was to encourage primary care physicians to provide everyone diagnosed with cancer a good quality, robust and personalised review to identify and address their needs and for this review to consider emotional, practical and financial concerns they may have. This facilitates the achievement of personalised care for people living with cancer as outlined in the personalised care agenda and the achievement of the 21/22 QoF indicators for cancer.
Solution and impact
The Macmillan Cancer Care Review template is already developed and fully integrated into the core primary care IT systems, including EMIS Web, TPP SystmOne and INPS Vision. The template was designed by primary care physicians with an interest in cancer to improve personalised care for people with cancer in primary care. The template provides a standardised format to support CCR conversations and ensures that all relevant fields that are discussed are then coded back to the patient file to enable continuity of care. The template also has relevant one-page information sheets for the patient integrated into it, which can then be printed off and given to the patient or shared with them electronically during the conversation. This is designed to empower them to access further information and support alongside any services that the physician may refer them on to.
In addition, searches have been developed and integrated into each of the core IT systems to enable practices to carry out searches on CCR-related activity to support quality improvement outcomes. For example, searches exist that allow practices to look at how many CCR conversations are happening and how many of those cover finance or have information shared. This supports the implementation of quality improvement activity to improve the quality and holistic nature of these conversations.
The template is integrated into the core primary care IT systems and available for any GP or general practice nurse (GPN) to use. It can be accessed using the template library and enables SNOMED codes for all relevant fields that are discussed with the patient to be coded back to the patient file. It provides a structure and acts as an aide-memoire to primary care physicians to encourage a holistic, personalised cancer care review to be carried out.
- Can act as an aide-memoire and structure to guide a holistic CCR conversation
- Can code completed fields back to the patient file using SNOMED codes
- Can facilitate search returns to allow practices to look at what is being discussed in their CCR conversations
- Includes patient information which can be printed off and given to the patient or shared electronically during or after the conversation
- Can be opened by users on EMIS Web, TPP SystmOne and INPS Vision
To be used by a primary care physician (face-to-face or as part of a virtual appointment) as part of a review in line with Quality and Outcomes Framework (QOF) timelines and requirements. Includes information that the patient may want to read at home if printed by their physician or shared electronically. To be used in a clinical setting.
Key learning points
Integration into the main GP IT systems encourages consistency in the quality and content of CCR conversations across primary care. It also enables ease of access by primary care physicians by not requiring them to download or access tools outside of the system they use every day. Similarly, building patient information into the template itself allows ease of access to resources that can be helpfully shared with the patient following this conversation. Ensuring any activity completed within the template is coded back to the patient file is also key to ensure consistency and quality of information captured through this conversation.
The Macmillan Cancer Care in Primary Care: A Quality Toolkit for General Practice was offered to GP practices in 2018/19 as part of a pilot programme in England, with the intention of maintaining or stimulating a focus on the care that GP practices provide for people affected by cancer. Module 3 of the toolkit has a section dedicated to the implementation of CCRs. This module was completed by 95% of the 300 GPs who took part, spread over 6 CCGs.
- After completing the toolkit, the number of GPs who reported using the Macmillan CCR template increased from 11.3% to 65.7%
- After using the toolkit, more practice nurses routinely carried out CCRs
- Data indicated that the use of the primary care toolkit increased the quality of the conversations between people living with cancer and healthcare professionals
- The increased quality of the conversation is also cited by many GPs in their qualitative feedback
- GPs often reported that the Macmillan CCR template was one of the most valuable things about the primary care toolkit
- A significant proportion of GPs stated that the template was the element of the toolkit that they would take forward into the future
- A significant proportion of GPs reported that the template has led to different ways of working in their practice
Quality of the cancer care review before and after completion of the toolkit, a summary of this evaluation can be found here:
Find out more
Dr Anthony Cunliffe, Joint National Lead, Macmillan GP Adviser and Joint Clinical Chair, South East London Cancer Alliance
Sophia Nicola, Primary Care Advisor, Macmillan Cancer Support
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