Living with and beyond cancer: The improvement story so far - NHS ...

34 | Living with and beyond cancer: The improvement story so far
NHS Luton
Increasing primary care skills and knowledge has
reduced length of stay, unnecessary appointments and
admissions to hospital for patients with cancer
Summary
• An education programme for
professionals has been developed to
support the provision of an oncology
service in primary care and improve
the quality of care for patients during
and after treatment for cancer
• The programme offers a range of
learning events for GPs, district
nurses and other health and social
care staff covering a wide range of
topics, and enhances the knowledge
of community practitioners and their
confidence to support cancer patients
following treatment
• The education programme was
established prior to this project and
has enabled the testing of primary
care led services.
The Problem
• NHS Luton identified that patients
were admitted and experienced
extended stays in hospital in order to
receive treatment for their cancer or
the side effects of treatment
• The community based palliative care
team used agreed criteria for referral
to their service however lacked
capacity and skills to manage patients
earlier in their journey as resources
were targeted at those nearing the
end of life
• The district nursing teams felt they
lacked the knowledge and skills to
care for these patients (e.g. with
venous lines, neutropaenia, nausea
and vomiting etc) resulting in delayed
discharges, unnecessary emergency
admissions or GP appointments
• To address the above problems, NHS
Luton seconded one team member to
complete their ENB 237 to act as a
resource in providing knowledge and
advice within the specialist palliative
care team and to other primary care
based health professionals
• It was quickly identified that the new
skills of the individual were not
optimised as she remained part of
the palliative care service
• Access to this new knowledge and
skill was limited to the individuals
availability
• It did not provide a sustainable
solution for an oncology service.
What was done
The service was re-designed to include
the following:
• A primary care oncology service to
provide care for patients with any
tumour type on a curative pathways
supporting all types of treatment
• An agreed operational policy and
referral criteria
• An ongoing training programme
tailored to the needs of primary care
staff to enable more patients to be
cared for at home.
The training programme collaboratively
works with the acute and independent
sector and is open to all health and
social care professionals within the
cancer network. The programme
delivers 14 workshops coordinated by
the Macmillan Lecturer Practitioner
within NHS Luton Community Services.
Training sessions pertaining specifically
to oncology include:
• Introduction to oncology and
treatments – one day course run by
specialist nurses, AHPs and doctors x
two per year. Content includes: ’what
is cancer’, staging treatments and
side-effects the cancer pathway from
awareness to survivorship, ongoing
surveillance, and oncology
emergencies. Each workshop focuses
on a different tumour group with
research and latest management
• Oncology emergencies content
includes – awareness, signs and
symptoms of neutropaenia,
hypercalcaemia, supra vena cava
obstruction, intestinal obstruction
and haemorrhage
• The management of central venous
devices for long term
haematology/oncology treatment
content includes – anatomy and
physiology, position of lines,
management and safe practice.
A variety of delivery mechanisms were
agreed and tested and included
sessions for out of hours teams, ‘lunch
and learn’ sessions for community staff
and evening and Saturday session for
GPs on topics requested by them such
as Neutropaenia, local research trials,
oncology drugs, oncology emergencies.
Training is held mainly in health centres
or other venues as long as they are
free!
All sessions attract CPD points and any
practical skills training is accredited
when competence is reached.
What difference has the education
programme made
Quality
• Central lines are now inserted in
outpatients rather than on the wards
with referral direct to district nurses
for line management etc. which has
saved approximately 550 hospital
visits during ’2008-09 for regular line
flushes and associated travel/parking
costs, and reduced the risk of
hospital acquired infection