Bring care closer to home in rural areas

Meet Northumbria Healthcare NHS Foundation Trust

Northumbria Healthcare NHS Foundation Trust provides care to around half a million people. It covers one of the largest geographical areas in England, stretching from the Scottish border down to North Tyneside, and from the North Sea coast to the Pennines. The Trust has three District General (DG) hospitals, and six community hospitals and the area is characterised by remote, rural communities, many with high levels of deprivation following post-industrial decline.

The big idea

Diagnostic services, treatment and follow-up care are all provided only at the DG hospitals, which can be more than 100 mile round trip for men living in some rural communities. Furthermore, specialist treatments, including all surgery, some oncological treatments and clinical trials are carried out in Newcastle. This leaves many men with long travel times for care, and significant inequities in access to follow up and supportive services.

Reflecting this, a survey undertaken in 2007 showed that rural patients with long travel times were the least satisfied with their care, therefore the aim of the project was to ensure that men in rural areas have equal access to care and support, from the CNS, GP, and local voluntary sector services. This would be done primarily by offering CNS-led clinics in community hospitals in Berwick and Alnwick, as well as by working with the voluntary sector and GPs in local areas to improve community-based follow up care and access to support services.

Finding out what works

The project aimed to achieve:

For patients:

• Reduced travel times for men in rural areas, and ensure that they have equal access to care and support services;
• Increase satisfaction with care, and patient experience of care;
• Ensure more men can (and do) access Voluntary & Community services (VCS) in their local area;
• Improve the outcomes for prostate cancer survivors.

For HCPs:

• Ensure that GPs are more confident and able to follow up patients in the community, and to re-refer where necessary. They are also more aware of how to link in with secondary and voluntary sector services.

For the healthcare system:

• Increase consultant capacity, by allowing more patients to be followed up in nurse-led clinics;
• Help to better integrate VCS, primary, secondary and tertiary care

Lessons learnt

Better integration between secondary care and local VCS has resulted in a partnership and good working relations with Macmillan Northumberland to provide Living With Cancer Courses (LWWC) for men living in Northumberland, but there is a limited pool of professionals to help present on the LWWC courses. We are competing for resources with Macmillan’s usual programme of LWWC courses.

An agreement was reached to run a course solely for men with prostate cancer on condition that at least 10 men attended.

Due to enquiries from other disease sites who want to adopt this model, resources are at risk of being stretched even further e.g. psychologists who work with all disease sites.

We have tried to overcome this challenge of limited availability of professionals by using professionals based locally, who work with men with prostate cancer e.g. physiotherapists who deliver pelvic floor assessment and training and running the course once a year where there is a smaller pool of patients, to ensure that a minimum number attend.

Outcomes

Using previously tested Prostate Cancer UK models to invite patients to attend survivorship courses, all men living within North and West Northumberland diagnosed within the last 12 months were invited to attend a LWWC event.

The first course was held in November 2015 and so far 68 men have been invited and 22 have attended (32.3%). 8 from West Northumberland (36.36%), and 14 (63.63%) from North Northumberland. This compares with only 3 men with prostate cancer attending the Macmillan LWWC in the whole of 2015.

Find out more

This project has been funded through our Health and Social Care Professionals Programme, thanks to support from The Movember Foundation.

If you would like to learn more about this project, please contact us.