Health Service Focus

16.12.16

Boosting education to deliver better cancer outcomes

Source: NHE Nov/Dec 16

New data suggests that cancer services in more than 85% of CCGs are failing to provide adequate care for patients. But NHS Gloucestershire CCG talks to NHE's David Stevenson about how it has improved services through a county-wide improvement project.

In October, NHS England published the first set of CCG Improvement and Assessment Framework ratings for cancer, which provided a snapshot of how well different areas of the country are diagnosing, treating and supporting patients. 

Of the 209 CCGs in England, 156 were rated as ‘needs improvement’ and 24 were labelled as ‘greatest need of improvement’, but it was noted that the majority of this assessment is relative. 

The overall rating for cancer is based on four indicators or metrics: early diagnosis; one-year survival; 62-day waits after referral; and overall patient experience. However, CCGs with even one metric rated as ‘below average’ have received an overall rating ‘requires improvement’. 

But NHS Gloucestershire CCG, which received a ‘needs improvement’ rating, was recently recognised by the All Parliamentary Group for Cancer after making improvements in early diagnosis and one-year survival rates. 

Over the past two years, the CCG has worked hard to improve how GPs across the county recognise and act on the signs and symptoms of cancer, as the UK has been lagging behind other countries in terms of diagnosis and outcomes. 

This work, carried out in partnership with Macmillan Cancer Support, included a large-scale education programme across GP services.

A series of 17 masterclasses were held, which covered specific cancer sites and focused on refreshing awareness of red flag symptoms. Following this, a range of online resources, such as ‘top tips’ and videos, have also been developed to support GPs. 

Dr Sadaf Haque a Macmillan GP cancer facilitator working with the CCG said: “Feedback from our GPs indicates that these initiatives have helped them feel more confident in understanding what to look for, assessing clinical risk and communicating effectively with patients.”    

She added that a quality improvement project, in which all the county’s GP practices participated, was carried out. 

“This included 600 Significant Event Audits, which we used to look for improvements in clinical care around diagnosis, including picking up on signs early,” explained Dr Haque. 

“These initiatives are part of a wider clinical cancer programme in Gloucestershire, which is also looking at improving support in the community, and with thanks to funding from Macmillan Cancer Support, we have set up a new Macmillan Next Steps service in two of our localities. 

“This service comprises a team of clinical cancer specialists, who are helping people affected by breast, prostate and colorectal cancer to manage their condition through one-to-one clinics and/or group programmes.”

The team is made up of NHS professionals, including specialists in physiotherapy, radiotherapy and cancer nursing, working in the community. They provide patients with practical support and advice which can help reduce the risk of a cancer recurring and minimise the effects of fatigue, pain, fear, anxiety and depression. 

“We are really pleased that our progress in diagnosis has been recognised nationally, and we’re committed to continuing to make improvements through our clinical education programme, by streamlining hospital processes and by expanding our community support service more widely across the county over the coming months,” said Dr Haque. 

Discussing the CCG’s rating, Kathryn Hall, its associate director of clinical programmes and cancer commissioner, told NHE that while some services have struggled to meet the framework indicators, there is a lot of good practice being done nationally. 

While not disputing the need to make improvements in some areas, Hall said: “We have got to get all of the factors higher. We have a little way to go in where we want to be. But the education work is key to that.”

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