Practical Implementation Guide for Cancer Care Reviews

• What size is the practice population?
• What is the incidence of cancer within the practice population?
• What percentage of the practice population are coded as cancer?
• How does that compare to local primary care network (PCN), integrated care board (ICB), and national incidence of cancer?

There are over 250 types of cancer. There will be common cancers that you will see most of the time. If there are gaps in your knowledge about the most common cancer types you are likely to support then you should plan how you will improve your knowledge.

The Macmillan Learning Hub has learning and development courses for healthcare professionals to help like our Practice Nurse Course: Supporting Cancer Care Programme and the Cancer Care Review module.

• Is there a local Macmillan Information and Support Centre or a Maggie's Centre?
• Do you have a local Boots with a Boots Macmillan Information Pharmacist or Boots Macmillan Beauty Advisor?
• Is there a Level 4 Exercise Professional at the local gym or fitness centre that can give guided access to increasing physical activity?
• What other services are available? (weight management, stop smoking, mental health, talking therapies, or psycho-sexual health)
• You might want to look at what cancer charities have to offer? There are many cancer-related charities, so take time to find out more. We have included a list of charities at the end of this guide.
• Who is your designated Social Prescriber and how do you contact them? What support do they offer?

It may be important to review what cancer content is available on your Practice's website. You should ask yourself:

• What cancer content is on your practice website?
• Do you have dedicated cancer pages?
• Does the content need refreshing?
• What other links can you add to empower people to self-manage?
• Can you add other local links for information and support?

You could add signposting to the following local links:

• Maggie's Centres
• Macmillan Cancer Information and Support Centres
• Boots Macmillan Information Pharmacist
• Boots Macmillan Beauty Advisor.

You can let patients know about CCRs and their purpose by using the waiting room TV screens. Download our example TV screen announcement.

You may also want to write a section for the Patient Partnership Group Newsletter or social media.

It is important that you are familiar with your IT system when completing CCRs. You will need to understand how to complete searches, perform data cleansing, and code correctly.

It may be helpful to speak to your IT manager, recall team, or designated person for QOF searches.

Create 2 separate spreadsheets to capture newly diagnosed patients (CAN005), who are within the 3-month period and for those within the 12-month period (CAN004), so that you can keep everything on track. For examples, see our 3-month period spreadsheet and 12-month spreadsheet.

Macmillan has worked with Ardens to align their CCR template with our national standardised template.

If your practice is on Resource Publisher, the Ardens CCR template titled 'Cancer (v15.1)', is located in: Shared folders/Ardens Main/Ardens LIVE Toolset/Chronic Disease Templates.

If your practice is on Template Manager, it is located in: Ardens (vX.X)/Chronic disease templates. This template can be accessed from the template picker by searching.

The EMIS template is located in: EMIS Library > EMIS Protocols > Third Sector Partnerships > Macmillan/Cancer Support > Macmillan Cancer templates.

This template can be accessed from the template picker by searching.

To access the CCR template in INPS Vision: In the Vision+ Consultation Manager, select the arrow on the right-hand side of the + icon and select ‘clinical templates’.

There are 3 parts to a meaningful CCR.

A simple questionnaire

You should provide a questionnaire to gather information from the person living with cancer to determine what they know, understand and need. This questionnaire is called a holistic needs assessment (HNA).

With a HNA, people rate their concerns by giving them a score out of 10, with 10 being the highest concern.

It groups questions under physical, emotional, practical, financial, or spiritual needs. People living with cancer only need to score the concerns that matter to them.

HNA comes in various formats. There is no right or wrong version to use. Below are some examples of HNAs:

• Macmillan Concerns Checklist
• Medlink Florey or AccuRx Florey Survey questionnaires of Concerns Checklist / HNA
• Macmillan electronic-HNA (e-HNA)

You may also want to incorporate the Six Personalised Care Questions:

• Who are the most important people in your life?
• What does a good day look like for you?
• When you’re having a bad day what helps?
• What things do you enjoy doing?
• What matters most to you?
• What would you never leave home without?

If using the Macmillan e-HNA portal, then you can choose the questionnaire that incorporates both these sets of questions.

Conversation to discuss the answers

A professional should discuss with the patient the answers to the questionnaire. The patient can invite a carer, family member, or friend to the discussion. The conversation could be by telephone, video or face to face, based on the person's personal preferences.

A written Personalised Care and Support Plan

A plan should be put in place to help address the person's concerns. Essentially this is a summary of the conversation you've had. This can include information to help people self-manage, along with contact details of any helpful organisations or services. Or you may refer directly to other services.

The following example can be used to send to the patient following booking their appointment.

After our discussion on the telephone, an appointment has been booked for your cancer care review on [date and time]. You are welcome to bring someone with you.

A cancer care review is a conversation between yourself and [name] about your cancer, which can help you to:

• talk about your cancer experiences and concerns
• understand what further support is available
• receive information you need to start to self-manage.

Please complete the form on the following link ahead of your appointment to ensure the appointment is as personalised as possible.

This can be completed face-to-face, by video call or over the phone.

A Personalised Care and Support Plan ensures physical, practical, emotional, and social needs are identified and addressed at the earliest opportunity.

A Personalised Care and Support Plan will help to:

• keep a record of conversations, decisions and agreed outcomes
• understand a patient's care and support needs, their life and family situation and what matters to them
• know what is required to make the plan achievable and effective.

You can download a Personalised Care and Support Plan template, so that patients have a record of the discussions they’ve had, agreed actions and advice from their care team.

Once completed download the Care Plan and attach it to their Primary Care record or send to GP via Docman and send a copy of the Care Plan to the patient by their preferred media. If beneficial, share a copy with the patients CNS/MDT within secondary care.