The transforming cancer care in the community (TCCC) programme was set up with the aim of establishing whether an out-of-hospital care model is scalable and sustainable; better for patients; reduces the existing over-reliance on hospital-based care; and can be more cost-effective to develop services, where clinically appropriate, outside the acute setting.
It comprises seven pilot sites, and currently has 16 primary care cancer nurses and 10 support workers providing community-based support to approx. 1,000 patients. The seven teams work in excess of 86 GP practices to support cancer patients within the primary care setting.
The east of England region has 5.8 million people, just under 180,000 of them living with a cancer diagnosis. In 2012 cancer was responsible for £0.5 billion spend on healthcare in the region. This is set to rise. It is also predicted that there will be a £20-30bn NHS deficit gap by 2022. Improved services will therefore have to be provided at less cost.
Other challenges include: outcomes that are still comparatively poor nationally; a failure to deliver integrated care at-scale, outdated delivery systems, an ageing population, increasing incidence of other long-term conditions, rising ‘stakeholder’ expectation, and a wide variation in quality.
There is an urgent need for a transformational approach towards cancer care, both in provision and commissioning.
The programme’s overarching aim was to develop a community-based model of cancer patient integrated care meeting four key objectives. Firstly, it would provide improved quality of care and achieve better coverage by, for example, offering a more responsive service and providing care closer to home.
Secondly, it should be scalable and sustainable, being designed to free-up secondary care service capacity and GP appointments, develop an integrated care pathway, and maximise the number of community-based interventions.
Thirdly, it should have a greater focus on patient and carer need, going beyond traditional treatments. Key to this was embedding the NCSI Survivorship Recovery Pack in the community setting.
Finally, the programme should prove that its model could be cost-effective over time.
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