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National Cancer Survivorship Initiative

Cancer Care Review

What is a General Practitioner (GP) Cancer Care Review (CCR)?

The Quality and Outcomes Framework (QOF) requires all patients diagnosed with cancer to receive a CCR by their GP  within three months (from April 2014 this will change to six months) of the GP practice being notified that the person has a cancer diagnosis.

The QOF lacked clarity surrounding what the CCR should consist of and what is helpful and necessary to include. As a result the patient experience is variable.

The Macmillan primary care community has been proactive in supporting and developing an IT template for the CCR.

How did we develop the Cancer Care Review?

The Macmillan primary care community has worked with the main GP IT system providers, INPS and EMIS, to develop cancer care templates similar to those for other chronic disease templates to ensure consistency and quality.

During 2010 Macmillan Cancer Support tested and evaulated the use of the new CCR template, looking specifically at how the template was used by GPs, how it could be used more effectively and also how helpful the review was for patients. 

Brief summary of the results

Most GPs understand that a CCR is about a conversation with the patient to get a sense of their understanding, answer any queries and assess support needs. Some GPs take an opportunistic approach and rely on the patient coming in for other purposes although many had a more structured approach.

In many cases, the CCR is seen as quite different to reviews of other long term conditions:

“Much more tricky diagnosis, the emotional content is higher”

“Patients’ knowledge and acceptance of diagnosis is variable…. the twists and turns can be dramatic and upsetting. It is challenging to support patients through cancer”

“Bit more depth for the CCR as it has more impact on the patient… feels like time is short often”

Many GPs had experienced challenges with completing CCRs.  These challenges generally focused on the review itself rather than the template. The main challenge appeared to be patients who do not wish or feel able to discuss their condition, either emotionally or because they were busy with, other hospital appointments. There were 109 GP survey responses and total of 24 GPs. The vast majority (79%) found the templates to be user friendly. They found prompts about reviewing medication and noting details of carers to be most useful. 

88% found it useful to have easy access to Macmillan information resources during a CCR

In the discussion with their GPs, 22 out of 28 patients responding to the survey discussed their cancer diagnosis, 21 out of 27 discussed the treatment they received; 20 out of 28 discussed the medication they were taking or might need to take; 14 out of 28 discussed the different types of information they might need; 7 out of 26 had discussed how and/or where to get support or advice about financial issues; 15 out of 25 had discussed support from family/friends/neighbours. All of these were found to be very useful.

Patients spoke about the ‘open, frank and caring’ nature of the CCR, and that the doctor was ‘friendly and understanding’.  15 out of 21 respondents to the survey were very satisfied with their CCR and only one was not at all satisfied. None of the patients had someone with them when they had their review. Some stated that it was not necessary even though they might want someone with them when they go to the hospital.

For more details the full evaluation report is available here.

What the GPs said:

  •  The template is straightforward to use and can give a good guidance as to the contents of CCRs.
  •  Excellent aide memoire.
  •  These issues are all really important and anything which increases GPs asking appropriate questions to cancer patients and signposting beneficial help and support can only be a good thing.

What the patients said:

  •  It was open, frank and caring.
  •  It gave me information how to deal with the cancer and how to go forward.
  •  I was given a broad understanding of my condition which has proven very helpful and allows me to live confidently.

An EMIS Guide is available to enable you to upload to your system.

Please contact Helen Rickard for further information and support.

 

 

 

Last updated on December 5, 2013