Q&A: Record-keeping for cancer patients using a treatment summary
Dr Terry Bowley explains how a new treatment summary can improve Read-coding and record-keeping for GPs’ cancer patients, especially for cancer care reviews in the QOF
What is a treatment summary?
The treatment summary (TS) template was designed by the National Cancer Survivorship Initiative (NCSI) to provide information such as diagnosis/staging, treatment aim (palliative or curative), possible treatment toxicities, side effects and/or late effects of treatment and alert symptoms that require referral back.
It also provides a summary of the information given to the patient, details useful to input onto a care register if appropriate, DS1500 status, referrals made to Allied Health Professionals, as well as contact details for advice or referral back.
The patient can also have a copy to help improve understanding of their condition and share with other professionals (for example, in A&E if they have presented with an acute problem).
There are three TS formats that can be used by secondary care: a structured letter, a template with Read codes, or an electronic template. GPs can then Read code this information on receipt of the summary.
So far the electronic template has only been integrated into the two main cancer information systems used by secondary care (Somerset Cancer Register and InfoFlex Cancer Information Management System). At the moment, this information cannot be transferred electronically to the GP, although there are proposals to try to develop this.
How can the TS improve patient care and my QOF achievement?
Two million people are now surviving cancer and this is set to rise to four million by 2030. A quarter of those continue to live with the consequences of treatment. Primary care is good at managing chronic disease and for many patients cancer can now be regarded as a long-term condition.
Remodelling of secondary care services means increasing numbers of patients will not have long-term follow-up in hospital or with a consultant. Rather, they will be on a supported self-management programme and returned to primary care, so it is essential that GPs have succinct and relevant information to manage cancer in primary care.
Information from secondary care regarding the patient’s treatment varies in quality so in 2010 Macmillan’s GP advisers identified the key information that would be useful at the end of a patient’s initial treatment and at other significant stages of treatment - for instance, after completing chemotherapy. This formed the basis of the TS.
How commonly-used is the TS?
The treatment summary was initially tested by NHS Improvement in 11 NHS sites. Across four groups of patients with tumours, 250 TS were issued. Evaluation found 90% of GPs wanted to keep using it, and over 50% felt it would alter the way they managed patients.
The TS is now being used in 32 acute trusts across the country, although not yet across all pathways for patients with tumours in each trust. Another 16 trusts are in the process of implementing it at the time of writing.
Dr Terry Bowley is a Macmillan GP adviser in London, Anglia and South East England, and a GP in South Woodford. The TS can be viewed at www.ncsi.org.uk (Assessment and Care Planning)