Personalised Stratified Follow Up (PSFU) comprises:
• Patient Initiated Follow-Up (PIFU) pathways (essentially the ‘supported self-managed pathway’ within PSFU)
• Personalised care and support planning
• Support for self-management and wellbeing.
The evidence from PSFU in cancer is directly supporting roll out of PIFU into non-cancer specialties, which will contribute to achievement of the LTP target to reduce NHS outpatient attendances by 30 million by 2023.
The guidance for implementing phase 3 of the NHS response to the COVID19 pandemic highlights the benefits of PIFU and provides practical information about how to implement in secondary care.
Benefits of PSFU
- A treatment plan tailored to the patient's priorities and requirements
- Increased skills to self-care
- Reduced expenses associated with attending outpatient appointments (including loss of income)
- Better safety netting compared to the traditional system as the patient retains direct access to care team
- Timely access to their results and care team
- Single point of access via the CSW
- Promotes deploying personalised care as per the NHS cancer strategy
- Advances the 'digital first' and PSFU agenda as per the Long Term Plan
- Enhanced ability to audit and monitor the quality of care
- A decrease in variation of care through the use of protocols
- Efficiencies gained through a decrease in face to face out-patient appointments
- High satisfaction rates reported by the teams and in particular the CSW's
- A large proportion of the consultant and CNS administrative workload such a follow- up calls and patient queries are attended to by the CSW
- The new role of CSW is a valuable addition to the team with core skills to increase patient empowerment and activation which can be applied to other care pathways
- Clinical capacity released through PSFU can be redistributed to improve quality of care and higher value clinical activities
- Clinical time can be redeployed to activities such as diagnosing more new patients and reducing waiting times; supporting more complex patients; and more clinics for elective care and procedures
Key factors influencing PSFU implementation include:
Whole Pathway approach: Where PSFU is viewed as integral to the whole cancer pathway, greater priority is given to implementing PSFU and benefits are seen within systems. An example of this is providing increased capacity to support the achievement of Cancer Waiting Time standards.
Digital: All Cancer Alliances reported digital challenges, which have delayed the delivery of digital Remote Monitoring (patient-tracking) Systems (RMS). Funding, interoperability and procurement for remote monitoring, present significant barriers to implementation. Cancer Alliances adopting an Alliance-wide approach, working with digital suppliers and digital leads in Trusts and STP/ICS (where available) have made the most progress. Patient portals appear to increase the benefit of PSFU pathways, with 24-hour access to information and support allowing patients to make real-time informed health and lifestyle decisions.
Workforce: Effective PSFU requires a properly resourced and appropriately skilled workforce. Implementation of PSFU has resulted in workforce development across cancer clinical and programme management teams. The cancer support worker (or similar) role has been a positive addition for patients and the wider workforce, delivering personalised care interventions and supporting PSFU. This has freed up specialist clinical staff to focus on delivering complex clinical interventions. However, many of these new roles are not substantively funded, posing a significant risk to achieving sustainable service changes.
Health Inequalities: In line with the recent Marmot report on health equity in England, it is essential that health inequalities are reduced through implementation of PSFU. The evaluation study highlighted the opportunities to consider in depth the health inequality challenges around health literacy, digital accessibility and service accessibility in relation to personalised care, PSFU and managing the impact of cancer.
Moving to Business as Usual (BAU)
Cancer Alliances are transitioning from transformation projects to sustainably commissioned services for breast, colorectal and prostate PSFU. Most either have, or are close to having, agreed protocols in place for these cancer sites. Having a model approach to commissioning and contracting arrangements will support PSFU becoming BAU for all cancer sites in the long term
Impact of COVID19
The COVID19 pandemic has resulted in a different approach to the delivery of all cancer care.
Virtual consultations are increasing, which is a potential enabler for implementation of PSFU. Accelerating remote monitoring systems will provide a safety net to safeguard patients. COVID19 also offers the opportunity to increase the number of patients using supported self-managed pathways, to release capacity and achieve effective self-management.