Delivering the PCN Directed Enhanced Specification for Prostate Cancer

We welcome the introduction of the Primary Care Network (PCN) Directed Enhanced Service (DES) Specification 4 2022/23 on prostate cancer in England. If you are in a devolved nation, this content can be applied to help develop and support your early diagnosis work. 

This content has been developed to support PCNs to successfully find the 14,000 men that are missing their prostate cancer diagnosis, because of the pandemic. 

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Why this specification will create impact:

  1. Analysis of the Rapid Cancer Registration Data, showed that in prostate cancer stages 1, 2 and 3 diagnoses had all been impacted proportionately – creating a significant fall in the proportion of curable diagnoses in the short term and a cause for concern going forward.
  2. Many cancer awareness campaigns focus on symptoms. However, for prostate cancer, it is important to note that early (curable) prostate cancer does not normally cause symptoms.  

This is why understanding and promoting risk factors with asymptomatic men is a priority for NHS England.  

Awareness of the PSA blood test

We are aware of the many barriers that men experience when accessing health care. This includes low knowledge of what the PSA test is. To clarify this, we will now be referring to the PSA test as the PSA blood test.

We would recommend that this language is adopted by your clinical staff and admin staff, so that patients are aware that it is a blood test.   

Risk Categories and Age Ranges

Our recent COVID19 research has shown that men below 70 are missing their diagnosis and are being diagnosed late. We therefore advocate that the below age ranges are targeted within the DES specified risk groups:   

  • Men aged 50- 70  
  • Black men aged 45-70
  • Men with a recorded family history of prostate or breast cancer aged 45 -70

Data

We recognise that family history and ethnicity records may not always be complete and would urge surgeries to collect this data as gold standard practice, helping to support any local health inequalities work that you decide to initiate.     

If your practice is an iPlato  or accuRx user, it is possible to send patients an ethnicity questionnaire. When this is completed by your patient their response will be automatically coded into their records.  

Planning

There are several activities that we recommend as part of your planning discussions. We outline this below, as well as sharing some useful tips and advice.  We have summarised these interventions as flowcharts which you can download.

Interventions Summary

Straight to Text Pathway with Digital Informed Choice via Text Message

Pathway for Opportunistic Conversations with Patients

Practice plan  

  1. Determine who in your practice will lead on this work.  
  2. When you begin your activity, ensure that your practice/s are aware that asymptomatic men will be contacting the surgery for a PSA blood test or to talk to a GP, depending on what intervention you decide to adopt.  

Audit

To understand what intervention and time commitment is required, audit how many men per practice have risk factors as per the target cohort described above.  

We would recommend that when auditing, that the below patients are excluded. 

Patients that: 

  • Have a diagnosis of prostate cancer 

  • Had a PSA blood test within the last 12 months 

  • Are on the end of life pathway 

 

Appointment Availability 

Discuss within your practice/s the possibility of holding between 10-15 PSA blood test appointments per practice per week. 

Activity

Activity that you may decide to undertake is outlined below. If you would like support in project development then please do get in touch with us, below. 

health-professionals

Proactive assessment via text message

Text messaging patients is an effective communication tool, has been proven to be cost effective whilst also initiating behavior change.   

We have developed a sample text message that you can send to your patients that can include a bespoke link to our risk checker  

This will include a straight to test pathway offering patients informed choice via the digital means of text message.

Please contact us for your bespoke URL to the risk checker which will allow for data monitoring and assessment.

  • The risk checker is a digital tool that allows patients to make an informed decision about whether they want a PSA blood test.

  • Patients will receive a text message that provides brief information about their risk, it will also include a hyperlink to a bespoke risk checker URL associated with your particular PCN. 

  • When they open up the risk checker URL, they will receive detailed, comprehensive and accurate information about their risk - increasing their awareness and knowledge of prostate cancer risk.

  • The risk checker also provides balanced, concise and up to date information about the pros and cons of the PSA blood test as per PCRMP guidance.  

  • The risk checker will incrementally take the patient through the pros and cons of the PSA blood test.

  • When the patient has gone through these steps they can decide if they would like to have a PSA blood test. If they do decide to have a test, your text message will advise them to contact the surgery to make an appointment for a PSA blood test.

  • This intervention eliminates the need for a GP PSA counselling appointment, creating efficiency not only for your surgery, but also for your patient, by going straight to a PSA blood test. 

Risk checker provides patients with informed choice

Our research shows that more than 87% of men who completed the risk checker stated that they felt they had enough information to make an informed decision about whether they wanted to have a PSA blood test.

Bristol PCN Pilot

Our pilot working within inner-city Bristol, since July 2022, has shown that:

  • 37% of those who were sent a text message completed the risk checker

  • 30% of those who did the risk checker went on to book a PSA blood test.

The below is a sample text message that has been developed in conjunction with clinicians and patients. These include optimal sentences which instigate action so we recommend that the text is not altered.  

Hello xxx, We know some men are at higher risk of prostate cancer. You can check your risk by using Prostate Cancer UK's risk checker (https://prostatecanceruk.org/gp-risk-DEMO) If after checking, you want to book a PSA blood test, then please call us to make an appointment. Thanks, Dr (NAME)(TELEPHONE NUMBER)

(Please note that the above link is is a demo of our risk checker and not to be used in correspondence with patients, please contact us directly for your bespoke link to use in your messaging.)

  • Identify which cohort of patients you will target first. 
  • Send messages in batches to ensure that services are not overwhelmed. To help you, you may want to consult this "How To" guide from Accurx.
  • Advise admin that they will be getting telephone calls from asymptomatic men requesting a PSA blood test. 

To evaluate the impact of your intervention, we recommend that you either create your own SNOMED code or use the below code. It is important:

  1. To check that it is currently not in use and
  2. That all practices in your PCN/area consistently use this code for future audits and evaluation purposes.

Patient advised about prostate cancer screening (situation)

SCTID: 698470001
698470001 | Patient advised about prostate cancer screening (situation) |

    Advice given about prostate cancer screening
    Patient advised about prostate cancer screening
    Patient advised about prostate cancer screening (situation)

 

Our risk checker is an ideal tool to inform patients about their risk and to have PSA blood test counselling. We can let you know how many patients have accessed the risk checker specific to your PCN, what percentage are of Black ethnicity, have a family history and age, which is useful for evaluation and monitoring purposes.

When you contact us to request your unique URL link to the risk checker, it’s important that you let us know if your PCN has opted for your patients to:  

  • Make a straight to test appointment for a PSA blood test or
  • Make an appointment to see a GP and then to have a PSA blood test.

 

We will then provide the appropriate risk checker URL for your PCN. All requests will be collated by the end of each week, then processed with your URL forwarded onto you the following week.

Print a summary of this content to facilitate discussion within your PCN. 

You can contact us if you would like for our team to present this or any other intervention described here. 

Opportunistic Conversations 

There will be some patients from the cohort which you have identified, who will be coming to your surgery for an appointment for another unrelated reason.  

We recommend having an opportunistic conversation with these patients at the end of their appointment. 

  • Admin staff should identify these patients whilst booking their appointments and create an alert for the GP pre appointment. 
  • GPs can use the below sample to help structure a very brief conversation:  

“We are speaking to men over 45 who are Black / men over 50 , to provide information about their potential prostate cancer risk. Would you like to speak to someone in the surgery about this?” 

  • If the patient would like to be sent some information, check you have their up-to-date mobile number and send the above text that includes our risk checker.  
  • Alternatively order our hard copy resources using the links at the bottom of this webpage.  

We recommend that you either create your own unique SNOMED code to record this activity or us the below . This will help when you come to evaluate the impact of this work. 

Opportunistic patient review (procedure)  

SCTID: 918771000000104 918771000000104 | Opportunistic patient review (procedure)  

You can download this process for having opportunistic conversations with patients to present at meetings and to support staff here.

Contact Us

Projects and Support   

We’re aware that there are several pilot projects happening within PCNs, exploring how to achieve this specification.   

If your PCN/practice has started a project we would be keen to hear about it and it's impact . Alternatively, if you require support, then please do contact us too.  

GP guidance asymptomatic patients

NHS Prostate Cancer Risk Management Programme (PCRMP) provides GPs and primary care professionals information to counsel asymptomatic men aged 50 and over who ask about prostate specific antigen (PSA) blood tests for prostate cancer.   

PCRMP patient infomation sheetInformation for asymptomatic men on the PSA blood test  

GP guide on navigating PCRMP and NICE NG12 guidance on PSA testing

 Education

Understanding Prostate Cancer Risk - a video for all staff

Male Urology Learning Week 2022

Online Learning Platform

 Publications for noticeboards, reception 

Are you at risk poster   

Display box: Know your prostate and PSA blood test 

Display box: Prostate cancer information for Black men 

If you’d like to bulk order any of our publications, please register/ or sign in.  

Other Publications

The Prostate Cancer UK Risk Checker

Explaining Fast-track Referral to your Patients

Raising Awareness of Prostate Cancer with and for Black Men Toolkit 

Active Surveillance 

For our full catalogue of Health Professional Resources click here