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

6 | Living with and beyond cancer: The improvement story so far
NHS Birmingham East and North Health Economy
The impact of a community Macmillan
nurse in curative care
Summary
Pan Birmingham Cancer Network and
NHS Birmingham East and North
(NHSBEN) have worked together
throughout the testing process to
develop five projects within the NCSI
programme of work, targeting breast
cancer patients within the PCT treated
at Good Hope Hospital. A focus group
was held to test out the ideas that
came from some gap analysis which
gave valuable feedback to each of the
individual services which were involved
within the Cancer Awareness and
Recovery Enhancement (CARE) project
and what became clear was that
further definition of services was
required to prevent overlap of the five
work streams involved in the project.
The five projects taken forward were:
• Bridges Care - Testing the use of a
charity organisation offering
individual needs assessment
facilitating a bridge between health,
social and community organisations
• Own Health Care – A partnership
with Pfizer Health Solutions, testing a
telecare model to provide support,
assessment, signposting and referrals
• Hospital Care - Ensuring
consistency of access to post
treatment services irrespective of
treatment aim
• Specialist Nurse Care – Testing a
primary care based cancer nurse case
management model for those
patients within Macmillan level
3 and 4
• Self Management Care – testing a
six week post treatment self
management course entitled HOPE
(helping overcome problems
effectively).
Improvement stories about progress in
each of the five projects are available
online.
The following story focuses on
specialist nurse care, testing the
Macmillan Primary Care Cancer Nurse
(MPCCN) service, a unique service
within NHSBEN and Macmillan. The
role steps away from the traditional role
of the community Macmillan nurse in
end of life care. It is an innovative role
which aims to provide complex, expert
assessment to identify and address the
problems faced by patients living with
breast cancer. It also helps deal with the
complexities and adverse effects of
acute oncological treatment whilst
maintaining (where possible) the
patient in the community setting.
What was the problem
Patients with breast cancer face not
only the dramatic impact of their
cancer diagnosis but also prolonged
multiple modalities of treatment which
can have a profound impact on them,
physically, psychologically, sexually,
spiritually and financially. If complex
needs of breast cancer patients are not
addressed early this can affect how
they cope with their breast cancer
treatment but also how they cope with
their transition from cancer patient to
cancer survivor.
What was done
For the purpose of this project the role
of the MPCCN was re-designed to
provide support in primary care for
patients undergoing their cancer
treatment for breast cancer.
In response to the need for clear
definition of services the MPCCN
devised clinical outcomes, measures
and a patient evaluation questionnaire.
The measures are captured on the
patient administration system (PAS)
database including the number of
contacts and interventions with each
patient.
The MPCCN was integrated into the
breast cancer multidisciplinary team at
GHH (MDT) and she attends the weekly
meetings.
To raise the profile and develop an
understanding of the role, the MPCCN
presented the service to the breast MDT
and oncology nursing team. Patient
information leaflets were also devised
which would be made available to the
breast care team and oncology team to
be given to appropriate complex
patients at time of referral. Clinical
letters are sent to individual GPs
following the initial and any
subsequent holistic needs assessments
including information on each patients
individual care plan.
What difference has the testing
work made
Since testing began the MPCCN has a
caseload of 35 complex patients who
require Macmillan level 3 and 4
intervention. Every patient who is
assessed by the MPCCN is given an
individualised care plan which is
reviewed at each subsequent visit;
The MPCCN has prevented 11 accident
and emergency admissions and over
100 outpatient attendances.