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Ensuring Better Treatment

Chemotherapy

Chemotherapy - Ensuring Quality and Safety

The provision of safe and high quality drug treatments is a key strand of the Cancer Reform Strategy's 'Ensuring Better Treatment'. This section sets out the workstreams and progress to deliver improvements in the commissioning and delivery of chemotherapy. This web site has been designed for use by Healthcare Professionals to provide an update on progress and developments in chemotherapy.

Note to non-health professionals

This site may be of limited use to non-clinical personnel; service users or carers seeking advice on chemotherapy or cancer care. If you are a patient or service user; you may find the following site of more help. For information on cancer; chemotherapy and other treatments visit: www.cancerbackup.co.uk

The Cancer Reform Strategy was published in December 2007. Since then the National Chemotherapy Advisory group has produced a report Chemotherapy Services in England: Ensuring quality and safety.

This report emphasises the need for teamwork and for teams to work together within hospitals and across Networks. The careful provision of care by teams who communicate well is central to this. The National Chemotherapy Advisory Group believes that the implementation of the recommendations made in this report will ensure that these ‘3 Cs’ are ever present in cancer chemotherapy so that the patient remains the true focus of all our efforts. Additionally; the cancer reform strategy understood that effective development needs to be underpinned by robust commissioning.

The National Cancer Action Team are leading a number of work streams to ensure that the recommendations of the NCAG report and the Cancer Reform Strategy are met, and that services are developed in a sustainable way for the future.

This is co-ordinated by the National Chemotherapy Implementation Group (NCIG). Broadly these work streams are focused on:

  • Contracting Framework and Specification
  • Development of a skilled workforce
  • HRGs and Tariff
  • Data and Information
  • Capacity Planning and CPORT
  • Acute Oncology Service
  • New Service Models including community chemotherapy and nurse led clinics
  • Clinical Governance work e.g. National Consent form for chemotherapy
  • Support for revision of Peer review measures

As work on these topics develops, updates will be provided through this website.

Forthcoming Events

Chemotherapy - Governance

Governance

Ensuring quality and safety in chemotherapy services is vital wherever the treatment setting is. This section will be expanded once all the new work streams are established.

Peer Review

The current measures for chemotherapy are being reviewed.

The 2004 peer review measures will be replaced by measures that reflect the changes in chemotherapy since peer review began. The revised measures which will cover Chemotherapy and Intrathecal Chemotherapy and Acute Oncology Services will be included here when available.

Safety

Cancer Networks are now developing their local responses to the NCAG report. The patient pathway (Chapter 2) covers the areas on patient safety.

Patient Pathway

Clarity about patient pathways is vital.

A model patient pathway has been developed.

Whilst some local customisation may be required; it maps the essential steps in the patient’s journey. It should be seen in conjunction with the commissioning framework and service specification (see commissioning section).

Chemotherapy - Commissioning

Currently commissioning for chemotherapy is limited in its scope and structure across Networks. The tools to support commissioning are not yet well developed.

Implementing an effective commissioning model requires clarity in expectation of delivery and care pathways. Supporting this is a nationally developed service specification that clarifies the key elements required within the service along with a generic patient pathway that sets out the expected stages of a patient journey. Commissioners and Trusts also have access to the Cancer Commissioning Tool Kit.

Networks and SHA Cancer leads have been asked to consider their plans for commissioning chemotherapy as part of their response to the NCAG report. A number of commissioning exemplars around chemotherapy services have been funded and are due to report later this year.

To support the commissioning of high quality chemotherapy a draft nationally agreed chemotherapy clinical data set has been developed. It is aimed at collecting national data for chemotherapy to emulate the HES data already collected by Trusts. It is currently out for testing before a final submission to the Information Standards Board. The aim is to make collection mandatory by April 2012.

Nationally work is continuing to improve coding and costing guidance. A Simple Guide has been produced nationally which offers you an overview of PbR in Chemotherapy. A sub-group of the NCIG has also been formed with a terms of reference which seeks to enhance reference cost guidance and validate the principles underpinning the current HRG4 tariff structure for chemotherapy. Further information will be published on this site as it becomes available. 

Systemic Anti-Cancer Therapy Dataset (Chemotherapy)

Some cancers are treated primarily by a range of anti-cancer drugs and many cancers are managed by a combination of surgery, radiotherapy and drug treatments.  Whereas information on surgery and radiotherapy is collected nationally, there has been, up to now, no national collection of data recording the management of patients receiving cancer drug treatment.

In September 2011, the NHS Information Standards Board has now granted Full Stage approval to the Systemic Anti-Cancer Therapy (SACT) Information Standard (Standard Number ISB 1533). An Information Standard Notice has been circulated to the NHS. All relevant documents can be found on the ISB website.

The standard covers all patients receiving cancer chemotherapy in or funded by the NHS in England.  The data standard relates to all cancer patients, both adult and paediatric, in acute inpatient, daycase, outpatient settings and delivery in the community.  It covers chemotherapy treatment for all solid tumour and haematological malignancies, including those in clinical trials. 

With the advent of electronic systems, particularly electronic prescribing, it is possible to record complex information on patient management in a standardised way. The reporting data set will be used at both local and national levels to generate reports consistent with the requirements of the Cancer Reform Strategy and Improving Outcomes: A Strategy for Cancer. It will provide high quality data to support service development and commissioning. 

The Chemotherapy Intelligence Unit (CIU) has been established, which will receive the returns, hold the data repository and provide analysis and reporting functions. The CIU is managed jointly by the National Cancer Action Team (NCAT) and the National Cancer Intelligence Network (NCIN). 

The CIU is in the process of finalising the website.  The website will become operational by the 31st October 2011 and will provide access to the upload portal for the SACT data submissions.  Testing of the portal will begin in October. The website will also contain information and corresponding resources on the SACT data set, requirements for submission of data, data submission guidance, schedules for submission and FAQs. 

Current timetable

  • Information Standards Notice (ISN) circulated to NHS September 2011.
  • October 2011 to March 2012 - Trusts need to review their capabilities in relation to the ISN and develop individual action plans.
  • 1st April 2012 – Start of mandatory collection from trusts with e-prescribing systems. September 2012 - trusts without e-prescribing systems commence partial downloads.
  • By April 2014, all trusts submitting full data.

 

For details of the dataset and guidance on its implementation, please refer to the linked documents.

Contact details:

Chemotherapy Intelligence Unit CIU@sph.nhs.uk – for issues in relation to extracting and submitting data

or

Dr Ken Lloyd and Sue Forsey sue.forsey@ngh.nhs.uk – for clinical issues

For details of the dataset and guidance on its implementation, please refer to the linked documents.

Downloads

SACT dataset v.15

Definitions for the dataset

User Guidance

Chemotherapy - Capacity Planning & C-PORT

CPORT Brochure attached

Why do we need to capacity plan?

The Incidence of Cancer in the UK is reported to have grown by 25% in the thirty years between 1977 and 2006 (Cancer Research UK). This growth appears to have stabilised in the last decade with approximately 300,000 new cancers diagnosed each year. A significant number of these patients will need chemotherapy at some point in their cancer pathway. Improved survival rates and new drug technology coupled with an increase of around 60% in the amount of chemotherapy delivered is putting cancer chemotherapy services under increasing pressure to provide a safe and effective service with limited resources.

In addition to the increase in demand and the complexity of chemotherapy delivery, the Cancer Reform Strategy (2006) and the National Chemotherapy Advisory Group Report (2009) have both challenged the service to rethink how and where they deliver the service. It is therefore important that chemotherapy services appropriately plan to ensure a safe and effective service.

To meet these challenges Chemotherapy services have successfully developed a web based capacity planning tool C-PORT which is being rolled out in cancer networks across the United Kingdom.

How was C-PORT developed?

C‑PORT was initially developed by a partnership between NCAT and 12 pharmaceutical industry companies from the Pharmaceutical Oncology Initiative Partnership. NCAT has worked with chemotherapy services and IT developers to release Version 5 released in August 2010

Version 5 includes many new features that have been developed as a consequence of feedback from clinical teams. In particular the data entry has been much improved with the first link the Varian e prescribing system (ARIA™)Work to link the tool with other  e prescribing providers are in progress.

What is C-PORT?

 C-PORT offers a practical solution to help plan for the challenge of increasing demand upon chemotherapy services

The main uses of C‑PORT, as a chemotherapy planning tool, are:

  • To survey the current position in chemotherapy services
  • To model the effects of changing demand and changing capacity
  • To plan for new services and “new builds” in order to meet demand

The tool is accessed online and is backed up by a training programme coupled with comprehensive documentation. A team of C‑PORT facilitators provides implementation and ongoing support to users and there is also a dedicated “helpdesk” to resolve any IT issues.

For more information about C-PORT go to www.cport.co.uk

CPORT Case Studies

Case Study 1 - Norfolk & Norwich (Learn how the team used C‑PORT to support the introduction of a Saturday morning service)

Case Study 2 - Barking, Havering, Redbridge (Learn how the team used CPORT to balance the wokload and redut patient delays)

Case Study 3 - QEH South East London (Learn how the team used CPORT to reduce nurse utilisation by 13%)

Case Study 4 - Wrightington, Wigan, Leigh (Learn how the team used CPORT to improve staffing levels within the chemotherapy unit)

Case Study 5 - Heatherwood and Wexham Park (Learn how the team used CPORT to assess the impact of merging two units)

Case Study 6 -Barnet and Chase Farm (Learn how the team used CPORT to support the management decision to employ an extra member of staff to cope with the projected increase in patient numbers)

Case Study 7 - Darent Valley Hospital (Learn how the team in Kent used CPORT to reduce patient delays)

Case Study 8 - South East London (Read how the team in South East London used CPORT to assess the relocation of GI, breast & lung patients

Case Study 9 - Lancashire & South Cumbria (Read how Trusts in Lancashire & South Cumbria have used CPORT to model the impact of the rapid infusion of rituximab)

Case Study 10 - Darent Valley Hospital (Read how staff in Kent used CPORT to support repatriation of urology patients

Case Study 11 - Darent Valley Hospital (Read how the team used CPORT to model the impact of clinical trials)

 

National Chemotherapy Implementation Group (NCIG)

The National Chemotherapy Implementation Group (NCIG) was formed following the publication of the National Chemotherapy Advisory Group (NCAG) report in 2009. This multidisciplinary group, chaired by Dr Peter Clark is leading on a number of key works streams to support teams to deliver a safe and sustainable service. The full terms of reference and group membership can be found in the NCAT documents list.

Work for the group is focused on the following key areas:

-          Contracting Framework and Specification

-          Development of a skilled workforce

-          HRGs and Tariff

-          Data and Information

-          Capacity Planning and CPORT

-          Acute Oncology Service

-          New Service Models e.g. community chemotherapy and nurse led clinics

-          Clinical Governance work e.g. National Consent form for chemotherapy

The group meet three times a year and an update will be available after the next meeting in January 2012.

National Chemotherapy Advisory Group - Report

The final report produced by an independent group of experts looking at chemotherapy provision and to advise on planning future chemotherapy is now complete.

This report offers advice on delivering high quality and safe chemotherapy services. The report highlights improvements in three key areas:

  • The provision of elective chemotherapy services based around the care pathway approach
  • The provision of emergency care not only for cancer patients who develop complications following chemotherapy but also for patients suffering from the consequences of their cancer
  • The leadership, information systems, governance, monitoring and commissioning of chemotherapy services

Download NCAG Report here

CONTRACTING WITH HEALTH RESOURCE GROUPS (HRGs)

NB: Chemotherapy also known as Systemic anti Cancer therapy (SACT)

National currencies have been designed for chemotherapy based on an HRG framework; details of which can be found on the NHSIC web site at:

http://www.ic.nhs.uk/casemix/downloads

The Department of Health Payment by Results (PbR) team with NCAT has been working with the National Casemix Office at the Health and Social Care Information Centre (HSCIC)) and NHS Connecting for Health (NHSCFH) to ensure that coding and costing guidance is regularly updated and fit to support the implementation of PbR in Chemothearpy.

The DH has mandated the delivery currencies for use in chemotherapy contracts from April 2012 and along with this published a non mandated tariff see: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132654
The following sections provide an overview of the guidance available to support the implementation of these currencies.
 
RECORDING THE ACTIVITY
The first building block for these currencies is the record of events that take place in treating people with chemotherapy.  Guidance has been published which defines the key components of activity measures for contracting based on national outpatient and admitted patient care commissioning data sets.
This activity is then subject to coding and classification using OPCS-4 procedural codes for both the attendance (Delivery) and the procurement and preparation of the drugs (Procurement).
 
CODING & CLASSIFICATION

Aligning Guidance

The DH PbR team lead an Oncology Regimen Steering Group (ORSG) which maintains an over sight of regimen list and reviews coding guidance making sure that they continue to reflect clinical practice.  Detailed guidance for clinical coders can be downloaded from TRUD and a link can be found on the NHSCFH data standards and classification web site at: http://www.connectingforhealth.nhs.uk/systemsandservices/data/clinicalcoding/codingstandards/opcs4/chemoregimens

The guidance is based on the national allocation of OPCS codes to each regimen. The regimen list is updated regularly nationally and each treatment is allocated both procurement and a delivery code.  For more details please go to the DH web site http://www.dh.gov.uk/en/Managingyourorganisation/NHSFinancialReforms/DH_109534

To provide Trusts with the opportunity to hear from organisations already experienced in coding chemotherapy, NCAT ran two road shows in 2010. The presentations and reports from these events can be found at: (documents)
 
COSTING ACTIVITY

Further analysis of reference costs has given a whole range of high level benchmarks with which Trusts and commissioners can compare their organisation with others of similar size. This work was completed for 0809, 0910 and 1011 reference cost submissions and can be found in this report (Moore and Bailey report). This report also provides Trusts with further guidance on what to consider when costing each HRG.

 

CONTRACTING FRAMEWORK

The 2012/13 PbR Guidance mandated HRG4 as a currency for chemotherapy delivery and following consultation with a range of stakeholders a non mandated tariff was also published.  During 2012/13 the PbR team with the help of NCAT sought feedback on the impact of the currencies and non mandated tariff with the intention of publishing a mandated tariff for the financial year 2013/14. 

The results of questionnaires sent to providers and commissioner is attached (paper)

The DH PbR team, alongside the National Casemix Office at the HSCIC are currently reviewing the design and use of procurement codes. Further guidance is expected later in the year.  

SUMMARY      
Although contact will be made with those Trusts already part of the NCAT network the NCAT team are happy to provide support and advice to any other Trusts – contact Susan Gibbin sgibbin@supanet.com