In September 2020 I started a secondment to Transforming Cancer Services Team (TCST) for London as Primary Care Lead Nurse.
TCST is part of the Healthy London Partnership and supports London’s CCGs and the NHS England regional team to deliver the NHS’s Long Term Plan for cancer. In addition to the CCGs and NHS England, we work in collaboration with London’s five integrated care systems, four cancer alliances, several major cancer charities and Health Education England (London).
I was previously the Macmillan Primary Care Lead Nurse for South West London Health and Care Partnership .This was a new role, funded by Macmillan Cancer Support for two years, leading a project that developed the role of primary care nurses in relation to cancer as a long-term condition. I have extensive experience in the care of patients with long term conditions having worked in many community/primary care settings and remain in clinical practice as an Advanced Nurse Practitioner in primary care.
A growing number of people are living with cancer in the UK and this is predicted to grow substantially in the next 20 years. With improvements in earlier diagnosis and improved treatments, cancer has transitioned in the most part to become a long term condition. That people are living longer after a cancer diagnosis is fantastic, but people living with cancer often experience long lasting consequences from the cancer and its treatments. These long-lasting consequences can be physical, psychological, and social.
70% of people diagnosed with cancer also have another long term condition (LTC) and often they have multiple other LTCs (29%). This adds complexity to care provision and health and care needs. 2016 NICE multi morbidity guidelines outline the importance of an integrated and holistic approach to care.
Initiatives to move follow up care out of hospital seem logical, given that most other long-term conditions are largely managed in primary care. Primary care is well placed to provide a holistic approach to cancer follow up. The National Cancer Patient Experience Survey (2019) however showed that only 52.1% of patients feel well supported by primary, community and social care teams during their cancer treatment and after treatment this decreased to 45%. These findings have changed very little in the last 5 years. There is much work to do improve patient experience of their out of hospital care.
I believe that primary care nurses are really well placed to support people living with cancer. General Practice Nurses lead on long term condition care, but generally have not included cancer within their scope of practice. Nurse education – undergraduate and generalist postgraduate – has historically viewed cancer as a secondary specialist area. A survey of general practice nurses in SW London in 2018 showed 70% hadn’t had any training on cancer at all, of those that did this was mostly focused on cervical screening. It’s no wonder nurses told us they didn’t feel confident to talk about cancer with their patients, let alone take on interventions such as cancer care reviews.
The Macmillan-funded project I led set out to lead change in this area. We identified that system changes were essential (to recognise that change was needed), education was required, and clinical leadership was crucial to success. You can find out more about the project here.
Over the coming six months I have an ambitious work programme that aims to build on the successes of the SW London project. It includes:
- Leading the existing pan London Cancer Community of Practice for GPNs, with an aim to develop a sustainable self-sustaining forum .
- Influencing Universities to include cancer as a long-term condition as core to their under graduate and primary care post graduate education offer for nurses
- Deliver ‘Cancer as a Long-term condition’ taster sessions across London to GPNs – to make the case for change so that supporting patients living with cancer is seen as relevant to their role.
- Developing a menu of education resources on cancer for primary care nurses for this website
- Scoping the development of a rotational programme for primary care nurses to develop their knowledge and expertise in cancer
For further information I can be contacted on Sandra.Dyer1@nhs.net.
Primary Care Lead Nurse
Transforming Cancer Services Team for London
Healthy London Partnership