challenges to primary care and the community peninsula survivorship conference

DEPARTMENT OF PRIMARY HEALTH CARE

July 21, 2011

Challenges to primary care and the community

Peninsula Survivorship Conference

Dr Peter Rose

University Lecturer and GP

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GP role in cancer

Then….

Prevention and screening

Diagnosis and referral

End of life

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GP role in cancer

Now..

Cancer care review Agenda Does it happen?

Earlier discharge

Longer survival Psycho-social Long term and late effects Co-morbidity

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Reasons for follow up

Detecting recurrence…but evidence for benefits of pre-symptomatic detection

Monitoring treatment and side effects

Support of patients and relatives Psychological Social Employment Signposting

Addressing information needs

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Reasons for follow up

BUT…

Different health professionals focus on different bits

Contact with GP variable The first stage is still hospital focussed

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The follow up pathway

Hospital alone +/- GP

Discharge

Patient alone +/- GP

A new care model

Aims of new model

Level 1 70% (now 10%)

Level 2 20% (now 90%)

Level 3 10% (Now <1%)

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Patient views

Who is a cancer survivor?

What is important to patients? Varies a lot….do we offer flexible approach E.g.Prostate cancer and treatment effects

Patient views on GP role Not an expert Lack knowledge Do not want to bother the doctor

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What information do patients get?

About the reasons for follow up Especially related to detection of recurrence

About the role of health professionals

About the choices they have

About where to get information

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Partners’ views

Become carers and health workers

Concerns about providing emotional support Recognising needs of patient while having their own

fears to cope with

Concerns about own health

Concerns about the future Looking out for signs of recurrence

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Partners’ views

Role of GP Would have like help but did not ask for it Issues of confidentiality

E Adams et al. Brookes University

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New inititatives

Earlier discharge means greater GP role Unless new model excludes GP But GP role not defined or formalised

Survivorship care plan

Risk stratification leading to new models of care

Risk stratification v needs

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What can primary care offer?

Care for physical, psychological and (some) social aspects of care

Care for co-morbidities, prevention and screening

Continuous longitudinal care

Co-ordination of care between patient and other agencies

Care for families

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What are the challenges?

In general…….

Specification of roles and responsibilities throughout follow up but acknowledge patient choice

Dedicated recall systems for follow up

Education and training Knowing what help we need and where to get

it………

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What are the challenges?

In particular….

Contact in the initial stages

Better use of the cancer care review

Contact at time of discharge

Flexibility Follow up those with ongoing needs or those who

choose continued contact

Better contact with families

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It is a big task!

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Thank you and questions

Acknowledgements

All the colleagues who have worked on these

projects with me but especially Eila Watson,

Nada Khan, Sian Harrison and Eike Adams