Cancer Reform Strategy - NHS Cancer Screening Programmes

CHAPTER 7: DELIVERING CARE IN THE MOST APPROPRIATE SETTING 957.13 GPs with a special interest in cancer maywish to develop and offer particular diagnosticservices under practice based commissioning.During the development of this strategystakeholders told us that models which maydevelop and will need to be evaluated include:●Community-based Prostate Health Clinics(see Box 35 below); and● Genetics services (see chapter 2).Specialist diagnostic services7.14 If a GP suspects that a patient has a highchance of cancer, the patient should be referredto a specialist diagnostic unit, linked to an MDTunder the two week wait standard. Whereclinically appropriate, these units should offer allnecessary diagnostic tests in one visit, with sameday results. These units would provide the latesttechnology and be staffed by experts ininterpreting cancer diagnostic information.This would ensure continuity of care andfacilitate multidisciplinary working.7.15 For some cancers highly specialiseddiagnostic facilities are required either fordiagnosis (such as molecular pathology) or fordetermining the extent of disease (such as PET-CT scanning). These services may require highlevels of expertise for accurate investigation andin some cases, expensive technology. It will notbe appropriate for all hospitals to provide theseservices. The Leeds haematological diagnosticservice provides a model for the delivery ofcomplex diagnostic services for a population ofalmost four million people (see box 36 overleaf).7.16 The Leeds haematological service has alsopioneered a patient-centred monitoring servicein response to the increased number of patientsdiagnosed with haematological malignancy notrequiring immediate treatment. The service iscommunity-based using primary carephlebotomy and central haematological reviewof laboratory parameters, with symptomsidentified by a patient self-assessmentquestionnaire. This approach is effective atidentifying patients in need of treatment andresults in improved access and convenience withless travel for patients and significantly reducedwaiting times. Patients are supplied with copiesof all relevant information and have access totelephone advice empowering them to managetheir condition.Box 35: Community-based Prostate Health ClinicsDue to the complexities involved in diagnosing significant prostate cancers, one suggestedmodel is that men should receive advice and support on prostate health issues at dedicatedcommunity-based prostate health clinics. Decision advisers would help men at the followingpoints in the pathway:●●●●Men without symptoms considering having a PSA test or equivalent;Men with urinary or other potential symptoms of prostate cancer;Men considering having a biopsy for prostate cancer following a PSA test; andMen diagnosed with benign prostate disease.Decision advisers could be clinical nurse specialists (CNSs) on a dedicated or outreach basis,GPs with a special interest in prostate cancer, community based specialist urologists or otherappropriately trained practitioners. Access to prostate health clinics would be via GP referral ordirect access for men concerned about their prostate health.Improved support for men in making decisions about further investigation or treatment wouldnot be a form of rationing, but rather a way of ensuring that men have the best possibleinformation and support when making difficult decisions. Improved support for men will ensurethat more appropriate referrals for biopsy or further care will be made, reducing unnecessaryinterventions and complications, saving significant levels of NHS resources.