2015/16 - Service Specification. 1. Context Improving our cancer care for our patients in City and Hackney is a priority for the CCG. Every hour, three more Londoners are diagnosed with cancer. On average, one of them will die within 12 months, one will live with their cancer for the rest of their life, and only one will beat it. Despite all the advances in successfully treating the disease, Londoners still have a poorer chance of beating their cancer than elsewhere in the country and we need to close that gap. Tackling the reasons behind late diagnosis of cancer is key to making improvement, as well as addressing the unacceptable variations across in screening rates and access to treatment. The NHS has also recently launched a new independent taskforce to develop a five-year action plan for cancer services and a major new programme to test innovative ways of diagnosing cancer more quickly at over 60 sites in the country, working jointly with Cancer Research UK and Macmillan Cancer Support. During the last year the Planned Care Board has worked with Cancer Research UK (CRUK) to deliver an Early Detection and Diagnosis initiative in Primary Care. This is funded and delivered by CRUK Primary Care Facilitator and is supported by the CCG Cancer Clinical Lead reporting into the Planned Care Board. The project works directly with practices in enabling improvements through the use of reflective audit on the cancer diagnosis cases and implementing best practice processes and procedures. Engaging with the project and its recommendations is currently voluntary and practice participation can be hampered by the competing demands on practices time. The Planned Care Board now wishes to build on this local focus and to drive more quality improvements in patient care and experience. Formal commissioning of primary care to support the CRUK programme is in line with the national agenda and additional time to support a diagnosis of cancer seeks to provide extra capacity in primary care for GPs to have the opportunity to support their patients in a more meaningful way. 2.) Contractual Framework As part of the CCG Long term conditions contract, the CCG wishes to commission the GP Confederation to provide the following: 2.2) Increase uptake of bowel screening through outreach and endorsement All practices will instigate the systems and participate with the promotion of patient participation in national bowel screening programme. All practices to receive electronic results of bowel screening via lablinks Check bowel cancer screening participation opportunistically at consultations with people aged 59 to 75 (pop-up reminder to be included in EMIS); endorse and support screening uptake use CEG search to identify people due for screening invitations (60 th birthday pending) or DNA result in last 4 weeks Practices to write to, telephone and provide standardised GP endorsement and information to o people aged 60 due to be invited (1,600 p.a.) for bowel screening for the first time o people aged 61 74 who were invited and failed to participate in bowel screening (11,500 p.a)
Contact to non-returners of the bowel screening kit to offer an explanation and support complete the test Practices to consider and make additional efforts for patients with difficulties that could include language, literacy, physical disabilities, learning difficulties or who are profoundly deaf Protocol, standardised endorsement letters and health promotion script for calling can be provided to practices by the CCG Cancer Clinical Lead Costs include stationery, postage, list management, telephone costs, calling by advocates Engage through PPI groups to support work to develop patient literature and other communication materials to encourage bowel screening uptake Full payment will be made at year-end based on the proportion of eligible patients spoken to over the phone, or contacted by letter or if not possible Payments based on practice target population size (60 74 year olds) 2.3) Referral safety-netting With continued support from the CCG Cancer Lead and the CRUK Primary Care Engagement Facilitator, the GP Confederation will ensure that all practices will: Have a system to ensure the dispatch of all 2 week wait referrals within 24 hours of the patient consultation; Have a system to make all diagnostic referrals where cancer is suspected within 24 hours of the patient consultation; Ensure that all 2 week wait referrals are routinely coded; Ensure that the practice has a safety net process for follow-up of all 2 week wait referrals Practices will be provided with a template for routine recording of this information Ensure that information on 2 week wait referral pathways, diagnostic testing and local pathways is available to locums and new registrars 2.4) Time to talk for cancer patients via extended practice consultations. This service will be primarily focused on patients diagnosed with cancer, some of which may need more than one consultation because of more complex existing health conditions which have been further complicated by a diagnosis of cancer. Ten minute consultations already exist within QOF therefore the CCG will commission the GP Confederation to ensure that all patients on the QOF Cancer register are offered an additional 20 minutes consultation time. The extended consultation of up to 30 minutes with the patient s GP will Cover issues of multi-morbidity, multiple medications, their interactions and possible side-effects Discuss the cancer diagnosis in context of existing illness both psychological and physical Consultations will be offered to appropriate patients in any of the following circumstances: Once a City and Hackney registered patient has a confirmed diagnosis of cancer notified by secondary care: The practice will identity the named GP for the patient who will provide continuity of care to the patient; The practice will offer the patient an extended consultation to come in to see their named GP on receipt of the diagnosis; Once a City and Hackney registered patient has had one of the following: A planned inpatient episode (e.g. surgery) for management of cancer;
The first of a planned programme of radiotherapy or chemotherapy; An unplanned emergency hospital admission; Completed a course of radiotherapy/chemotherapy; Been discharged from hospital care (including patients discharged in line with risk stratified pathways breast pathway will be the initial patient group) The GP will keep an overview of each patient s care and referrals and, where clinically appropriate, proactively organise a consultation to review or discuss the care plan. The extended consultations could cover: Reviewing the patient s condition, current health status and recent history; Reviewing the patient s care plan and ensuring that this reflects their wishes; Discussing the diagnosis, tests and treatment options that have been suggested including potential side effects and what the NHS will provide; Ensuring that the patient and their carers have access to emotional support and other local voluntary sector support groups, access to patient information and information about local resources; Reviewing any lifestyle issues as appropriate Arranging annual immunisations and the relevance of involvement in future screening programme activity (and where necessary making arrangements for the patient to be excluded); Undertaking a medication review; Assessment of the carer and their needs; For patients finishing treatment and moving onto self-management: Ensuring they have been offered an individualised Health and Wellbeing event by their cancer care provider as part of the Recovery Package Ensuring they understand warning signs which necessitate representation to secondary care For patients in the palliative phase of their illness: Discussing end of life issues and facilitating advanced directives where appropriate, including development of a Coordinate My Care plan; Ensuring both patient and carer are clear about any alarm signs and know when and who to contact if a crisis occurs. 3. Key performance indicators and outcomes Bowel screening quarterly reports % of men and women contacted around their 60th birthday by telephone and offered health promotion to encourage uptake of bowel screening % of men and women in the above group sent endorsement letter by practice if not reached by telephone % of men and women aged 61 70 who have not participated in bowel screening in the last 3 months contacted by telephone and offered health promotion to encourage uptake of bowel screening % of men and women in the above group sent endorsement letter by practice if not reached by telephone Increase in bowel screening uptake across City and Hackney practices 2 week waits quarterly reports Numbers made by practice
Numbers of DNAs/delays where the practice took action Time to talk quarterly reports % of appointments offered by practice % of appointments taken up by practice Annual patient experience survey/questionnaire 5. Pricing Bowel Screening 11,500 patients @ 5 per patient Improvement payment (payable six months in arrears) 5% improvement in C&H average (deducted if not achieved) 10% improvement in C&H average (deducted if not achieved) 57,500 6250 6250 Two week wait referral processes One clinical session per practice per quarter 51,600 Time to Talk Extended session of 20 minutes per patient on QOF register (440 patients) @ 35 per patient 15,400 Total 137,000
6.) Contractual Framework - Part two As part of the CCG Clinical Commissioning and Engagement contract the CCG will commission directly with practices to undertake the following activities. RCGP/SEA audit will be commissioned as one of the pan Hackney audits within the CCG Clinical Commissioning and Engagement contract. Attendance at two education events will also be included in this contract within the education domain. These are therefore already funded and included in the global sum for the contract. 6.1) Engagement with two educational events All practices to send a representative of clinical/non-clinical staff to relevant educational events Participation in Training/education on the use of cancer Risk Assessment Tools/Macmillan electronic Clinical Decision Support tool or Qcancer within consultations to assess patients in whom there is a possibility of a cancer diagnosis 6.2) Reflection on referrals Supported by the Cancer Lead and CRUK Primary Care Engagement Facilitator as above: included in the Clinical Commissioning contract as the pan Hackney audit Each practice to undertake RCGP audit of new cancer diagnoses Each practice to meet to discuss Significant Event Analysis on any delayed diagnosis Participate in an annual meeting of the practice with the CRUK Primary Care Engagement Facilitator or CCG Cancer Lead to discuss and share ideas on: practice profiles; audit results and reflection on patient management; referral dilemmas; quality of referrals and improving referral practice; cancer significant event analysis; comparative practice referral rates for diagnostics & screening formulate a practice action plan Participate in an annual feedback meeting at consortium level to share results of audits and SEAs and examples of good practice 7). Key performance indicators and outcomes Evidence in the tracker of attending relevant education events and audits complete assessed as part of mid-year review and in line with payment protocol for this contract. Cancer Clinical Lead and CRUK facilitator will be circulated with copies of the RCGP/SEA audits by all practices. Report to include actions taken by practices as result of the audit.