Meet the Christie NHS Foundation Trust
The Christie NHS Foundation Trust has set up community based prostate cancer follow up clinics run by a nurse specialist. This aims to meet the patient’s needs away from hospital as much as possible and manage their symptoms in a holistic way. This has resulted in a more individualised and accessible service for men and has freed up 800 outpatient appointments at the hospital.
The big idea
The Christie is a tertiary Specialist Cancer Centre in Greater Manchester serving a local population of 3.2 million, with a quarter of our total referrals coming from other parts of the UK. Approximately 1,200 prostate cancer patients are treated at The Christie each year, with aftercare generating more than 5,000 hospital based follow ups annually.
The follow up these men receive has been mainly traditionally delivered through a medical model involving Consultant or Specialist Nurse out-patient appointments and associated monitoring tests. With no defined follow-up pathways for men who have had prostate cancer treatment, patients often returned for hospital follow-up for many years, despite the NICE guidelines recommending follow-up ‘outside the hospital environment’ two years after treatment.
With increasing diagnosis and survival rates for men with prostate cancer, there is now an increasing pressure on hospital outpatient departments to provide follow-up care. The work of the cancer survivorship initiative has also demonstrated that there is a growing demand for more individualised cancer aftercare services, with feedback from patients telling us that they continue to have unmet needs at the end of their treatment.
Finding out what works
By utilising Clinical Nurse Specialists to work between primary and specialist care we have demonstrated a safe transfer of routine follow-up care for prostate cancer patients into the community much earlier in the patients pathway, with an emphasis on survivorship principles and self-management.
Patients who are routinely followed up at The Christie are now being moved into community based prostate cancer follow-up clinics which are being run by a Nurse Specialist. The Nurse Specialist has expert clinical skills and experience in managing this group of men and is competent at assessing and dealing with symptoms of late effects as well as expertise in understanding when treatments need to be altered and when it is appropriate to refer back to specialist care. The aim being to keep the patient out of hospital for as long as possible and deal with as many of his symptoms in a holistic way in the primary care environment.
The safety of transfer of care has been assessed with the collection of outcome data and positive patient experience. As well as positive outcomes, quality long term follow-up and patient satisfaction, it is also anticipated that there will be a mixture of cash savings and improved productivity. Productivity is improved through the release of outpatient resources in hospitals and the cash saving is from the commissioner’ point of view, due to the reduced number of secondary care follow-up appointments being paid for and the potential for a cheaper ‘community tariff’.
Five community clinics have been set up with plans to expand, which have resulted in over 650 men moving into community based follow-up pathways with care closer to home.
Fast track referral is available back into the hospital if required.
Over 800 hospital appointments have been freed up.
100% of men reported their experience as ‘good’ or ‘very good’.
15% of patients discharged onto a GP supported self-management protocol.