Summary

Nurse-led clinics have been set up in primary care centres/GP practices at 6 locations across Greater Manchester, Lancashire and Cheshire. Patients who have received treatment for prostate cancer at The Christie Hospital are transferred out to the community-based service at the appropriate time point for their continued follow-up. For radiotherapy patients this happens immediately following completion of treatment and their entire post treatment follow-up and discharge happens in the community. Patients are stratified according to risk and discharged to self-manage with GP support at the appropriate time point.

Challenge

Prostate cancer is the most common cancer in men in the UK. It is estimated that by 2030, it will be the most common cancer of all. Encouragingly, 84% of prostate cancer patients survive 10 years or more, but many men experience long term physical and psychological consequences of treatment, such as bladder and bowel problems, deteriorating sexual function, psychological co-morbidity and hormonal side effects. This may make it more difficult for men to get their lives back on track after they have completed cancer therapy, which makes it so important that the care for these patients provides ongoing support well beyond the initial treatment phase. Traditionally, prostate cancer after-care is delivered by oncologists, urologists or specialist nurses in hospital-based clinics using a very medical model of assessing for recurrence with the use of associated monitoring tests. Hospital-based care is often costly to the patient and studies show there is a failure to address the ongoing needs relating to prostate cancer and its treatment. These factors led us to consider alternatives to the traditional hospital outpatient appointment.

Objectives

The main aim was to set up and pilot a new model of follow-up for prostate cancer patients which would meet our patients’ expectations and wishes while maintaining safety and quality. A further aim was to reduce the number of routine long-term follow-up appointments in the secondary care setting, which in turn would create more appropriate appointments for patients who need hospital supervision. It was also anticipated that there would be a mixture of cash savings and improved productivity.  

Solution

A steering group drove the initiative and selected a suitable community venue from which to run clinics. We developed patient information leaflets and maps and identified a suitable individual/team in administration based at the Christie to manage the appointments, telephone calls and type the consultation letters. The specialist nurse identified suitable patients from hospital outpatient lists and liaised with the radiography and surgical and oncology team to encourage referrals. The community clinics were then populated with appropriate patients transferred from hospital. Patients were given a choice to ‘opt out’. A database was created to record outcomes which linked in with individual electronic patient records and a patient satisfaction audit tool was developed to use on both hospital and community-based patients.

Results

More than 1,000 patients have been moved into community-based follow-up clinics to date and clinics have been set up in 6 locations around Greater Manchester, Lancashire and Cheshire, with more planned. This has freed up over 1,500 hospital-based appointments. A reduced community tariff is being developed in dialogue with commissioners and 15% of patients have been discharged to GP supported self-management in the first 12 months of the initiative. We collected data over the first 12 months on the types of issues that troubled patients at various points in their pathways. We found that 12% of men reported emotional problems, 30% reported bowel issues and 34% told us about urinary symptoms. In addition 48% of men had bothersome erectile/sexual problems and 40% ‘other’ symptoms mainly related to hormone therapy. Some of these individuals required further specialist input but the majority of men were able to self-manage when supported with the right advice, education, information and signposting which the specialist nurse teams are able to provide in the community clinics.

Learnings

Evaluation

Salford Royal NHS Foundation Trust has been fully supportive of the innovation from the start and became an early adopter of the model. We helped facilitate engagement between the Trust and commissioner who awarded innovation money for a 12-month pilot. So far there has been positive feedback, with 97% of patients attending describing their experience as ‘very good’. The initiative has been incorporated into the Trust’s 5-year strategic framework and as part of survivorship initiatives in developing community-based cancer services. Salford and Manchester CCGs have endorsed this as a modern model of cancer care and it has been recognised by Prostate Cancer UK as a national exemplar.