The increasing case for the role of primary care in supporting people living with cancer

There is sufficient evidence to make a compelling case for why primary care is best placed to support people living with cancer, especially after treatment has ended:

• Increased incidence and survival mean the population living with cancer is growing.
• People with cancer spend the majority of time in the community and not in hospital.
• In 2019 the NHS Long Term Plan introduced personalised care for those living with long-term conditions, including cancer.
• Comorbidity in those diagnosed with cancer is common with 70% having at least one other long-term condition and 29% having three or more (Macmillan Cancer Support, 2021).
• General Practice Nurses (GPNs) have expertise in long-term condition management, such as asthma, diabetes, high blood pressure.
• National Cancer Patient Experience Surveys consistently show that people’s experience of care ‘out of hospital’ is poorer than their experience of hospital-based care, especially during and after treatment.

The new Quality Outcomes Framework for Cancer 2023/24 came into force from 1st April 2023 and funds primary care to deliver three outcomes:

1. Maintain a register of people diagnosed with cancer (CAN001)
2. Record the percentage of people on register who have had a Cancer Care Review using a structured template recorded as occurring within 12 months of the date of diagnosis. Target 50-90% (CAN004)  
3. Record the percentage of people on register who have been offered the opportunity for a discussion and informed of the support available from primary care, within 3 months of diagnosis. Target 70-90% (CAN005)

Knowledge and skills in cancer are not typically regarded as core training for GPNs and despite already providing personalised care and support planning for other long-term conditions, few complete a Cancer Care Review.

However, the Macmillan Practice Nurse Course is enabling GPNs to increase their knowledge and confidence to apply their skills to cancer. Also, there are other useful resources on the Macmillan Primary Care Hub.

As a result, there is a small but growing group of GPNs developing their expertise in the management of people living with cancer as those with other long-term conditions.

We share best practice and ideas through the National Primary Care Discussion Group (Personalised Cancer Care), facilitated by the Transforming Cancer Services Team for London. 

I became a GPN having worked in cancer for over 22 years. Having identified people newly diagnosed with cancer, I offer support by text, with links to our website, and offer a phone call within three months of a cancer diagnosis. Those people are then offered a further review as a conversation, usually following treatment (between six and 12 months of a cancer diagnosis), to support them to self-manage moving forward.

To do this efficiently and effectively, I have implemented the Macmillan e-HNA and My Care Plan platform, which send a personalised link to the person living with cancer to complete in advance of the conversation the holistic needs assessment. During the conversation we develop the Care Plan together, which is then sent as a personalised link for them to access.

I have just audited the experience of the 56 people who completed a Cancer Care Review in 2022. 17 people completed the questionnaire, a 30% return rate. This is a very small sample of people and therefore it’s hard to make any real conclusions. The free text comments were overwhelmingly positive:

“Invaluable service, Jackie has extensive knowledge and experience and was able to answer my questions. It was reassuring that I can contact Jackie at any time and when I do see her, I don’t feel rushed for time and that I am listened to.”

“I have filled out the (HNA) questionnaire for Churchill and Medical Practice and feel the one to one (with Jacqui) was the most beneficial."

As a GPN, I also complete Asthma Reviews, as another long-term condition, as well as act as Infection Prevention Control Lead for the Practice and am Occupational Health Lead for Staff immunisations.