A total of 42 sites initially signed up to our CCR pilots across our six ICS/STP, where over the duration of the pilot only six sites withdrew due to limited administration resources. Anglia Ruskin University (ARU) were commissioned to carry out the evaluation to provide the opportunity to share successes. Being involved at the start of the programme ensured the evaluation by ARU was designed in-line and ran concurrently with the project.
Evaluation of the training sessions offered to healthcare professionals was key, as well as pre and post training self-assessments to capture the perceived confidence of staff to deliver a CCR. In addition, patient surveys were held after their CCR, staff surveys were held at the end of the pilot and an audit of the CCR process were included as part of the data collection process.
The pilot enabled 258 patients across the region to receive a CCR at the end of their cancer treatment. The success of the pilots varied partly due to the difficulty of being able to measure whether the CCRs occurred within the six-month pilot time-frame. Approximately one third occurred within the time-frame, however data was missing for another third, therefore it could not be determined whether they occurred between October 2019 to March 2020.
Health professional training to deliver a CCR was considered a success and the rating was generally high. Clinician confidence and abilities to carry out a CCR increased following attending the one-day training session. Feedback from training facilitators suggested extending the training to two days, as per other CCRs training they deliver to further improve overall learning and reduce the risk of attendee fatigue.
For the CCRs that did take place the quality overall was deemed high by staff and patients alike. Survey data highlighted the CCR content covered was found to be appropriate, as was the timing and length of the CCR appointment.
Patients identified they were happy with the length of time of their CCR appointment demonstrating flexibility of the timings can be considered. The pilot criteria stated a minimum of 30 minutes per CCR appointments however many of the CCR’s carried out were between 20-30 minutes.
Some barriers were flagged in relation to time and staff resource issues where recommendations are discussed to try and overcome this. For example, issues of identifying eligible patients and receiving notifications of end of treatment from secondary care were highlighted. End of treatment notification was identified as an issue within the setup phase of the pilot, and unfortunately not all sites were able to resolve this issue.
Recommendations are made in the report for improved IT integration and access to admin support to help identify patients, along with establishing better systems with secondary care to improve communication around the end of treatment. Furthermore, sharing of best practice between Primary Care Networks (PCNs) could help establish solutions to some of these barriers.
It is important to note the impact of COVID-19 which affected the number of audit returns received at the end of the pilot along with a lack of resource to be able to clarify data queries and discrepancies. Originally the evaluation aimed to include interviews with staff involved in the CCR pilots for qualitative feedback and to cover issues the survey may not have included to provide a richer data analysis.
Overall, the quality of the CCRs that were delivered were deemed high and seen as a success. If this pilot were to be rolled out into a larger programme, further work needs to be carried out to support sites in identifying eligible patients and putting tighter end of treatment notification systems in place to deliver this.
The CCR pilots aimed to contribute to building the evidence base for managing Cancer as a Long-Term Condition with the overall aim to provide commissioners of cancer a business case to support cancer patients as part of long-term conditions – please access our CCR Business Case and Local Incentive Scheme on Cancer Alliance website as supporting documentation.
Following the pilot evaluation there will be the opportunities for commissioners to further develop their primary care services to include Annual Reviews as Point four of TCST’s model within local initiatives such as the Year of Care model or integrated care frameworks as outlined in the Five Year Forward View (NHS England, 2014).
Furthermore, the NICE consultation proposes the holistic CCR is offered within 12 months of diagnosis using a structured template to tailor individual treatment plans which may include a treatment summary where available.