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Macmillan Primary Care Nursing Project Training Needs Analysis: Cancer as a long term condition for General Practice Nurses. October 2018 We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

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Page 1: Macmillan Primary Care Nursing Project · NICE (20161) outlines best practice for people living with multi-morbidities emphasises the importance of an integrated and holistic approach

Macmillan Primary Care Nursing Project

Training Needs Analysis: Cancer as a long term condition for General Practice Nurses.

October 2018

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

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Contents Executive Summary ................................................................................................................................. 5

Project Overview ..................................................................................................................................... 8

General Practice Nurse TNA Development ............................................................................................. 9

Methodology ......................................................................................................................................... 11

Results ................................................................................................................................................... 13

Limitations ............................................................................................................................................ 26

Conclusions ........................................................................................................................................... 26

Next steps ............................................................................................................................................. 27

Appendix ............................................................................................................................................... 27

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Foreword- A patient’s perspective

As someone who has been affected by cancer both as a carer and through my own diagnosis

and treatment, I’m very aware of how important it is for those living with and beyond cancer to

get the best possible support from primary and community healthcare. This is particularly so,

when their hospital treatment has ended. I’ve been involved as a patient partner for a long

time speaking up for better recognition of the needs of the ever increasing numbers of people

now surviving and who have finished their cancer treatment. This can be a particularly

stressful time and from discussions I have had with many people affected by cancer, whether

they be patients or a family member, it’s often a time of feeling isolated and unsupported. To

identify ways of increasing the support available by looking at the role of the General Practice

Nurse and understanding their training needs to enable them to provide holistic out of hospital

care for those people affected by cancer is to be welcomed and applauded.

That so many practice nurses have indicated support for this development of their role is

fantastic news. I am very pleased to have been involved in this project and look forward to

its further progress.

Bonnie Green

Cancer Patient Partner

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Foreword- a General Practice Nurse and Nurse

Consultant Perspective.

With improved outcomes for people diagnosed with cancer and the increased numbers of

those living with and beyond cancer , there is an increased need for new models of care that

best meets the needs of those who are surviving. Cancer is increasingly seen as a long-term

condition and the role of healthcare services outside of hospital is developing. The numbers

of people living with cancer continues to grow.

Additionally, 70% of people with cancer have another long-term condition. We know that

living with another long-term condition reduces survival rates and adds complexity to care

provision. The numbers of those with one long term condition or more is also expected to

continue to rise. NICE (20161) outlines best practice for people living with multi-morbidities

emphasises the importance of an integrated and holistic approach to care. Initiatives to move

follow up care out of hospital (e.g. for prostate cancer) enable an integrated approach to be

possible.

However patient experience at the end of treatment and those living with cancer is well

documented to need improvement. Patients rate their ‘out of hospital’ experience as poorer

than any other aspect of their cancer care. In addition London patients have worse experience

than those nationally.

The primary care workforce are seeing patients with cancer on a daily basis and in particular

the nursing workforce is well placed to meet the needs of this patient group as we typically

routinely manage their other long term conditions.

Clearly nurses need education and support in order to fulfil this role and I therefore welcome

this report which gives an overview of the current provision in relation to GPNs and education

1 NICE (2016) Multimorbidity: clinical assessment and management. NICE guideline NG56. Available : https://www.nice.org.uk/guidance/ng56

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around cancer as a long term condition. There is much work to be done to improve knowledge

and provide general practice nurses with the knowledge, skills, competence and confidence

in caring for this patient group.

Next steps must include a strategy to work together with CCGs, CPENS, GPs, GPNs and primary

care teams to address the education needs of GPNs on cancer as a long term condition. I look

forward to working with the project team to promote education opportunities for GPNs over

the next year to ensure we have a knowledgeable nursing workforce that can provide great

care to patients after their cancer diagnosis and treatment.

Fiona White

Nurse Consultant- primary care support team

Merton Clinical Commissioning Group

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Macmillan Primary Care Nursing Project:

Report from Training Needs Analysis for General Practice Nurses

“I would value up to date information about cancer treatment as I would like to

better support the patients - I feel lacking at times”

“I think this is a growing and important area practice nurses should receive training

in”

General Practice Nurse respondents

from SW London

Executive Summary This report provides an account of the methodology, results and recommendations of a

training needs analysis conducted with general practice nurses across SW London in August

2018. A survey monkey link was emailed to all general practice nurses in the 6 CCGs across

SW London and paper versions were available at face to face engagement events.

A total of 147 general practice nurses completed the survey. A summary of the results is

below:

Overview:

115 of 147 respondents are currently a registered general practice nurse working in one of our six boroughs

Of these – 55% have been working in general practice for over 10 years. This implies that most nurses will be conducting long term condition reviews.

Of the 115 SWL nurses:

80% of respondents are asked questions relating to cancer at least once a month – with 58% reporting that they are asked questions on a daily or weekly basis

60% of respondents agreed that they were clear about their role in supporting patients with a cancer diagnosis, however it was noted that many felt this was more of an emotional support role, as an ear to listen and were less confident in their knowledge of cancer, treatments, and consequences of treatments.

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Cancer care reviews:

Only 11% of respondents currently complete cancer care reviews in their roles, however, 73% of respondents noted that GPs in their practice, or other nurse colleagues are completing these. Only 13% were unaware of them.

Looking at understanding of a cancer care review, many respondents seemed to understand that a review took a “holistic approach” – looking at health symptoms but also their wellbeing, financial and social support and signposting where appropriate. Several respondents also mentioned completing a template document. However, responses varied, and some remained unsure.

Over 70% of respondents were not confident completing a cancer care review (13% strongly disagree, 41% disagree, 17% unsure)

Prostate cancer follow-up reviews:

40% of respondents were not aware of prostate cancer follow-up reviews in their GP practices. And of those who were aware, only 8% were completing them with patients as part of their role.

As a result, over 78% of respondents were not confident completing a prostate cancer follow-up review (23% strongly disagree, 40% disagree, 15% unsure)

Supporting patients:

Respondents were most confident in supporting patients in relation to hormonal treatment (60% agree or strongly agree) and surgery (53% agree or strongly agree) and less confident in advising on reasons for delayed/no treatment (42% disagree or strongly disagree) or targeted immunotherapy (44% disagree or strongly disagree)

Looking at managing side effects, respondents were most confident in supporting patients with issues such as fatigue, body image and psychological issues. They were less confident supporting patients with more medical -related side effects i.e. fertility, bone health

In offering lifestyle advice, over 80% of respondents were comfortable offering advice on smoking cessation, physical activity and weight loss – more general topics. In contrast, only 37% were comfortable advising on signs and symptoms of disease recurrence and only 25% on follow up testing. Financial and vocational issues were also matters that they did not feel comfortable advising on.

Training:

Over 70% of respondents had not received any training specific to cancer. Of those who had, the majority related to screening – cervical, breast and bowel – or were mentioning the Macmillan training course they were attending that day.

Less than half of respondents noted that they used any existing nursing competency documents. Of those who did respond, only 13% used the Macmillan competency framework. The most popular was the RCGP competencies for GPNs- not a cancer specific tool.

In terms of delivering training, 94% of respondents were keen to attend face to face training, with shadowing other nurses as their second preference (41%)

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A lack of time generally (66%) and protected learning time (44%) along with training location and timings (both 43%) were the biggest barriers to attending training. However, a large number of respondents commented that they were keen to find out more and attend training where possible.

Recommendations:

The potential role of GPNs in the care and support of people living with and beyond cancer needs to be recognised by commissioners, employers , and educators.

Employers and commissioners should encourage and support GPNs to attend cancer training including the Macmillan Practice Nurse Course. The benefits to general practice and patients should be made explicit.

GPNs who have completed the Macmillan course should be offered ongoing support and education in order to develop their role to best support people living with and beyond cancer.

Cancer as a long term condition needs to be included as core content of post graduate eduction for GPNs.

Limitations:

The sample represents the views of over 20% of the workforce but the results cannot

be assumed to be representative of the entire group

The survey was conducted over the summer in keeping with the project timeline but

this may have impacted on the response rate.

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Macmillan Primary Care Nursing Project. Report from Training Needs Analysis

for General Practice Nurses

Project Overview The Macmillan south west London Primary Care Nursing Project commenced in March 2018

and will complete in March 2020. It covers the south west London STP footprint across all six

CCGS in South West London (SWL) and is funded by Macmillan. The Project team consists of

a Primary Care Lead Nurse, a Specialist Clinician and a Project Manager. The project focus is

on planning education and support to increase capacity and confidence of Primary Care

Nurses to deliver personalised long-term cancer care in their settings. The case for change is

based on increasing cancer survival rates and the growing number of people living longer

following a cancer diagnosis, with unique ongoing care needs (management of physical and

psychosocial consequences of treatment).

The project is aligned to the following national strategies:

Achieving World-Class Cancer Outcomes (Independent Cancer Taskforce 2015-

2020i2), specifically the priority of transforming approach to support people living

with and beyond cancer

Ten-point action plan for General Practice Nursing (NHS England)3, by raising the

profile of general practice nursing and improving access to training

GP Forward View (NHS England)4, by developing the capacity and capability

needed to manage care closer to home and support improved and innovative

approaches in delivering health and wellbeing

The Project will build on the evidence base from previous work to standardise the skills and

knowledge in managing cancer as a long-term condition with the aim to improve the quality

of care, clinical outcomes and patient experience of cancer patients

Outputs

A general practice nursing competency/learning framework to support caring for

cancer as a long-term condition

Training Needs Analysis (TNA) to identify training and learning needs of SWL

general practice nurses

Sustainable education strategy to address identified gaps in skills and knowledge

from the TNA and project scoping

2 The Independent Cancer taskforce (2015) Achieving first class cancer outcomes. A strategy for England 2015-2020. Available: https://www.cancerresearchuk.org/sites/default/files/achieving_world-class_cancer_outcomes_-_a_strategy_for_england_2015-2020.pdf 33 NHS England (2017) General Practice- Developing confidence, capability and capacity. A ten point action plan for General Practice Nursing. https://www.england.nhs.uk/wp-content/uploads/2018/01/general-practice-nursing-ten-point-plan-v17.pdf 4 NHS England (2016) General Practice Forward View. https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

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Delivery of the education strategy, including an evaluation of a pilot for a bespoke

module for community nurses to inform the direction of support for this group

Outcomes

Cancer considered, and managed as a long-term condition in a holistic

personalised care model

A more standardised and visible role for primary care nurses in cancer care, raising

the profile and influencing recruitment and retention

Benefits

Improved patient experience, specifically relating to ‘out-of-hospital’ care and

quality of life

Increased number of primary care nurses leading key cancer care activity (e.g.

Holistic cancer care reviews, prostate cancer follow-up reviews)

Increased quality and standardisation of cancer care follow-up (e.g. signposting/

referral protocols for services addressing consequences of treatment)

Project Plan

March 2018 to October 18

Stakeholder engagement, scoping and planning work, pre-intervention data

collection, competences developed, TNA conducted, education plan developed

October 2018 to October 2019 (plan)

Implementation of education plan; learning opportunities, resources, mentorship,

develop sustainability strategy

October 2019 to March 2020 (plan)

Post intervention data collection, evaluation report, implement sustainability

strategy

General Practice Nurse TNA Development An understanding of the education needs of primary care nurses is a key part of the project.

The following informed the approach and content of the Training Needs Analysis tool-

Engagement with GPNs to discuss their perception of their role in relation to cancer

One to one interviews with GPNs who were carrying out CCRs and prostate reviews

Consideration of the data provided by the Transforming Cancer Service’s Team’s TNA

carried out in 2016

Scoping for the project identified that very few nurses were carrying out cancer care reviews

and prostate cancer reviews in south west London currently.

Discussions with GPNs identified that they do not feel equipped currently to carry out cancer

care reviews or prostate cancer reviews, their knowledge of the needs of people living with

and beyond cancer was mostly informed by experience (such as personal or close family/

friend experience) as opposed to having formal education or training.

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With this starting point we reviewed the content of the TCST Pro-Cam LWBC tool5. This tool

is based on a survey produced by University of Cambridge and Oxford Brooks University

designed to assess physicians’ knowledge and attitudes regarding care of patients with

cancer. The tool was adapted for use with GPNs by TCST.

GPN completion of the TCST tool was lower compared to the GP completion rate (48 vs 86

with 13 nurses in SWL-source: ‘TNA for London Highlight Report’ for PCEG Oct 2017). Possible

reasons for this may have been a perceived lack of relevance to this survey to the GPN role –

based on feedback from GPNs about their role in relation to living with and beyond cancer

during our engagement. The survey was fairly lengthy and the required time investment

might not have been prioritised if the subject was perceived as not relevant.

The TCST Pro-cam LWBC tool was comprehensive and included detailed questions about the

consequences of cancer and possible side-effects of specific treatments. The wide range of

skills and levels of practice of SW London GPNs was considered, and given the relative low

level of knowledge and experience around LWBC that was demonstrated both in our

engagement and the TCST Pro-Cam analysis it was agreed that whilst clearly this knowledge

was relevant it was less likely that GPNs would have this level of advanced knowledge in this

disease area. We therefore removed the more complex medically focused questions for the

SW London tool.

With consideration of the above we therefore adapted the Pro-cam tool to reflect our

understanding of the GPN role in SW London and their current involvement in cancer care.

The team acknowledge that the adapted tool is not validated, however the Pro-Cam for

nurses is an adaptation of tool validated for physicians and not nurses .The adapted tool was

sense checked and tested with nurses before use.

The content of the adapted tool also reflected the content of the competencies that we had

developed for GPNs. This process included in depth discussions with members of the project

steering group and other clinical experts as to what knowledge would be essential for nurses

to have in order to support patients living with and beyond cancer. The content of the

framework therefore was a key informer of the content of the developed TNA.

5 Transforming Cancer services Team for London ( 2017) living with and beyond cancer – nurse responses https://www.england.nhs.uk/wp-content/uploads/2016/04/gpfv.pdf

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Methodology Workforce data indicated that there are currently 471 registered nurses working in general practice

or 320 WTE in south west London (NHS digital August 2018). We aimed to get a response from 20% of

nurses in order to have a generalizable sample.

We anticipated that obtaining a 20% response was going to be challenging given that the similar

intervention by Transforming Cancer services Team for London had received only 13 replies from SW

London GPNS, and the current pressures facing primary care and competing priorities for GPNs. In

addition, the data from the TCST indicated that cancer was not currently a priority education area for

GPNs.

In consideration of this the project team developed a communications strategy using a number of

routes to engage with GPNs and inform them of the project and the rationale for collecting the data.

In addition, we made the decision to offer each respondent the chance to win a £50 gift voucher as

an incentive to complete the survey. The money was obtained from a Macmillan grant.

A large cancer event was scheduled before the release of the survey monkey. The project team tested

the draft TNA tool with nurses at this event. We did this partly to test the tool and also to ensure that

we did not miss the opportunity to gather data from a large number of nurses. The draft tool had been

seen by the steering group and the project team were awaiting final comments from the steering

group and TCST colleagues at this time. A small number of changes were made to the TNA after the

event- the ordering of questions in order to group themes together, and an additional question was

added to capture nurse’s use of competencies. The data captured at the event was included in the

final survey in order maximise the response rate, with the limitations of this approach acknowledged

by the project team

We attended a number of face to face education and networking events in Wandsworth and Merton.

The selection of these two CCG areas was based on the availability of events /meetings that were

being held during the pre-survey and survey period. The survey Monkey link was sent out to all GPNs

with an accompanying email via the CPEN/CCG GPN leads. In addition the south west London

Communications team also tweeted a series of tweets to inform GPNs in SW London about the survey

and encourage their participation. This intervention was repeated a number of times using differing

written and visual content. An example is shown in below.

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In addition the RCN general practice face book forum was contacted to seek permission to post the

survey link. The forum currently has 4360 members – these are RCN members working in general

practice across the United Kingdom. There was a risk of receiving replies to the survey from nurses

across the country but this was mitigated by the survey design as non-SW London nurse’s replies could

be filtered out or analysed separately. The post below was posted on 6th August.

We also worked collaboratively with Cancer Research UK facilitators and Macmillan GPs so that they

could encourage GPNs to participate in the survey when carrying out practice visits.

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Results There was a total of 147 respondents, of which 12 were excluded after question one as they did not

meet the criteria for the survey; being a registered general practice nurse.

When excluding those not registered as general practice nurses, and those who identified as working

outside of SWL, the response rate for SWL GPNs was 24.4% (calculated against the latest total GPN

headcount number for SWL, from NHS Digital March 2018).

Q1. Are you currently a registered general practice nurse?

This was asked to ensure all applicants were a registered nurse and currently working in a general

practice setting.

12 respondents did not meet this criteria and were therefore not able to proceed with the survey

Q2 How long have you been a general practice nurse

The majority had been working in general practice for over 3 years with 56% having worked there for

over 10 years.

This suggests a high level of experience as a GPN and indicates that the majority of the respondents

would currently be seeing patients with long term conditions to manage their condition. Nurses new

to general practice would generally develop skills in immunisation, wound care, and cervical screening

etc. before developing their skills in long term condition management.

Q3. Which CCG area do you work in?

8 respondents were from outside of SWL. The survey was promoted on social media, and at a west

London practice nurse course. It was decided that we would include respondents from outside SW

London- the answers of which could be disregarded or analysed separately for each question if

needed.

Richmond’s response rate was the lowest across SW London. Richmond currently do not have a

Macmillan GP or Cancer Clinical Lead in post which may have an impact on the visibility of cancer work

within the CCG area.

Q4. How often do you get asked questions related to cancer by your patients?

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Just over 40% of respondents (52) reported they faced questions about cancer on a weekly basis

compared to 15% (18) who answered “daily”. The remaining respondents were split evenly between

“monthly” and “a few times a year”.

This biggest proportion of nurses are therefore required to support people with concerns about cancer

every week however the wide range of responses shows there is variation across the region. For those

that replied “monthly” it is possible that nurses are not proactively asking patients about cancer as

part of a holistic assessment, given that the majority of the nurse surveyed will be completing

long term conditions reviews and are likely to be seeing patients with a cancer history.

Q5. I am clear about my role as a nurse in supporting patients with a cancer diagnosis

60% of nurses either agreed or strongly agreed with this statement and only one strongly

disagreed. The diagram above provides a further breakdown of the responses from the nurses

who answered positively indicating that for the majority their knowledge regarding cancer is

60.2% (n74)

are clear about their role in supporting patients

When descibing a CCR none mentioned the Macmillan Recovery Package

12.2% (n9) had incorrect understanding of what a CCR is

31.1% (n23) had low/poor understanding

56.8% (n42) had appropriate understanding of what a CCR is

(Qst7)

16.2% (n12) are completing CCRs with patients

5.4% (n4) haven't heard of a CCR

(Qst 6)

41.9% (n31) have had some training specific to cancer

10.8% (n8) have completed or currently on the Macmillan Cancer

for Practice Nurses course

Of the 8 familiar with Macmillan GPNcourse;

- All 8 had appropriate understanding of a CCR (Qst7)

- 6 are confident in completing CCRs (Qst8)

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likely to be limited. For example, of the 74 nurses who stated they were clear about their role

related to cancer, 35 of those had never had any training on cancer, suggesting they do not

see cancer care as part of their role. In addition, 4 of the nurses who felt confident about their

role had never heard of a CCR, and 32 defined a CCR incorrectly or with a poor understanding.

Qualitative analysis of the comments provided by 29 of the respondents below also adds to

the picture of ambiguity despite the response.

8 nurses replied favourably, one identified their role as being supportive and signposting,

and the rest mentioned previous training or experience which made them feel clear about

how cancer fitted into their role. For example:

“I undertook the 5 day Macmillan GPN course at the Royal Marsden, it was really

informative”

Six nurses reported they were aware their role in relation to cancer was evolving, for

example:

“I understand as practice nurses we are to become more involved in cancer care

reviews”

“I feel my role is evolving – I need to improve my knowledge base to improve my

care for oncology patients as this is increasing – it would also make these

encounters more satisfying”

Other nurses replied less favourably, for 5 nurses they felt their role was limited to providing

support, for example:

“I can only give emotional support”

“It’s not a formal role more an ear to listen…other than specific needs from the treating

team”

4 nurses highlighted how they had some knowledge but also identified gaps, for example:

“my early nursing career was mostly surgical so can discuss what to expect with surgery so

feel able with that but would benefit from specific training especially in what to expect

with chemotherapy”

10 nurses felt their lack of training on cancer prevented them from understanding their role,

for example:

“Knowledge could be increased to raise confidence in supporting patients”

“Unsure what information/support should be given”

“No formal training, very diverse needs”

“Do not feel knowledgeable enough”

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Q6. Have you heard about cancer care reviews taking place in GP surgeries?

Out of 123 respondents to this question 14 nurses reported that they complete cancer care

reviews (CCRs) as part of their role which is contrary to our scoping work which found only

one nurse undertaking CCRs. 4 respondents reported that CCRs do not currently happen in

their practice and 16 nurses were not aware of them at all.

As expected the majority of nurses 63% (77) reported that the GPs in their practice completed

them.

Q7. Please briefly outline what you understand by the term ‘cancer care review’

This free text question resulted in significant variance of response. Approximately 40% of

responses showed good or appropriate understanding, 35% showed little or no knowledge

and 25% provided inaccurate descriptions.

Qualitative analysis showed that no-one mentioned a cancer care review was part of the

recovery package or that it was a routine part of patient care.

The Word Cloud below illustrates words and phrases that were included in answers. They

range from appropriate descriptions highlighted in ‘greens’ around the themes of assessment,

provision of information and holistic support, to poorer answers (‘unsure what it entails’,

‘regular follow-up’) highlighted in ‘yellows’, to incorrect descriptions around end-of-life (EOL)

highlighted in ‘reds’.

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Thematic analysis of the free text responses was completed. A range of terms to describe a cancer

care review was analysed and four themes were derived from the literature:

1. Assessment

“Check how patient is doing”, “review”, “completing a template”, check patient’s understanding”,

“how they’re feeling”, “save information in notes”, “risk of recurrence”

2. Provide information

“Answer questions”, “make referrals”, “liaise with secondary care or support services”, “signpost if

needed”, “provide practical advice”

3. Support

“Spend time”, “issues/concerns”, “ask open questions”, “face to face”, “ensure patient is supported”,

“discuss support network”

4. Holistic

“Psychological wellbeing”, “financial”, “social”, “physical health”, “treatment side effects”, “support

needs”, “carers’/families’ needs”, “symptoms review”, “enable them to live their lives as normally as

possible”

Q8. I feel confident in completing a cancer care review even if I don’t currently complete

them as part of my role

Over 50% of respondents disagreed or strongly disagreed with this statement which is in keeping with

the response to question 7 which showed that the majority of respondents did not have a clear or

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accurate understanding of what a cancer care review is. Interestingly although 39 nurses felt confident

to complete a cancer care review this does not correlate with the answer to question 6 which showed

only 14 nurses actually complete them in practice, suggesting there are additional barriers other than

skills and confidence.

Q9. Have you heard about prostate cancer follow-up reviews taking place in GP surgeries?

A greater proportion (40% v 13%) of nurses were unaware of prostate cancer follow ups

compared to cancer care reviews despite them being routine practice in two out of the six

CCGs. Clearly nurses are not taking a leading role in prostate cancer follow ups although there

are examples in practice where this is happening very effectively.

Q10. I feel confident in completing a prostate cancer follow-up review, even if I don't

currently complete them as part of my role

Only 25% of respondents agreed or strongly agreed with this statement in keeping with the

question above showing nurses generally have a limited awareness of prostate cancer follow

ups taking place in GP surgeries.

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Q11. I feel confident supporting cancer patients in relation to the following issues

Nurses felt most confident supporting patients in relation to surgery and hormone treatments

and least confident with chemotherapy and targeted immunotherapy. Overall answers were

skewed towards feeling less confident.

15

11

11

12

5

8

52

34

39

64

17

30

25

26

23

17

35

33

20

41

39

25

45

35

10

10

10

5

20

16

S U R G E R Y

C H E M O T H E R A P Y

R A D I O T H E R A P Y

H O R M O N A L T X

T A R G E T T E D I M M U N O T H E R A P Y

R E A S O N S F O R D E L A Y E D / N O T X

I FEEL CONFIDENT SUPPORTING CANCER PATIENTS IN RELATION TO THE FOLLOWING

ISSUES:

Strongly Agree Agree Not sure Disagree Strongly disagree

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Q12. I am confident managing treatment of related side effects with:

These results were as expected and show general practice nurses are more confident supporting

patients with symptoms which they encounter in other patient populations such as fatigue and

psychological issues. More specific medical symptoms related to people’s cancer of its treatment such

as fertility, sexual dysfunction and lymphedema were met with less confidence. This is unsurprising

given the lack of cancer specific education that the majority of respondents reported.

11

12

8

7

11

10

11

3

11

8

8

42

40

30

34

54

52

43

22

33

34

42

20

24

33

29

19

22

29

33

30

30

27

35

33

36

39

25

27

28

44

36

37

32

14

13

13

14

13

11

11

18

12

13

12

U R I N A R Y P R O B L E M S

B O W E L P R O B L E M S

L Y M P H E D E M A

S E X U A L D Y S F U N C T I O N

F A T I G U E

B O D Y I M A G E

P S Y C H O L O G I C A L I S S U E S

F E R T I L I T Y

C A R D I O V A S C U L A R R I S K S

B O N E H E A L T H

P A I N

I AM CONFIDENT MANAGING TREATMENT OF RELATED SIDE EFFECTS WITH:

Strongly agree Agree Not sure Disagree Strongly disagree

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Q13. I am confident giving lifestyle advice around:

These findings are similar to the results of question 12 in that they indicate nurses are

confident providing lifestyle advice around physical activity, smoking cessation and weight

loss, three areas which are common to other long term conditions. However whether or not

they feel confident on the specific guidance on physical activity and cancer for example

cannot be ascertained from these results but is unlikely given the lack of training they have

received.

These results suggest training would need to include cancer specific advice around vocational

and financial support, sign posting and recurrence risks.

40

51

38

6

19

13

15

14

66

57

62

23

53

36

19

62

9

7

11

40

28

36

44

25

5

5

7

43

14

30

36

17

2

2

3

10

8

8

8

4

P H Y S I C A L A C T I V I T Y

S M O K I N G C E S S A T I O N

W E I G H T L O S S

V O C A T I O N A L O R F I N A N C I A L S U P P O R T

S I G N P O S T I N G P A T I E N T S A N D C A R E R S T O O T H E R S E R V I C E S

S I G N S A N D S Y M P T O M S O F D I S E A S E R E C U R R E N C E

R E C O M M E N D E D F O L L O W U P T E S T I N G

S T R E S S / A N X I E T Y M A N A G E M E N T

I AM CONFIDENT GIVING LIFESTYLE ADVICE AROUND:

Strongly agree Agree Not Sure Disagree Strongly Disagree

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Q14. Have you received any training specific to cancer?

Overall very few respondents had received any appropriate training specific to their role as a

GPN. 72% of respondents had not received any training at any point in their career.

One nurse had a BSc in Cancer Nursing and 8 nurses had previously had a role within an

oncology setting at varying levels, for example:

”Worked in outpatients at the Royal Marsden for 6 years”

“I did 6 months on oncology ward as part of my nursing diploma”

12 nurses had completed some form of brief oncology update training in the past, for

example:

“One day course – many years ago”

“Protected learning time update”

6 nurses stated they had completed screening training and 5 had completed a palliative care

course.

13 nurses had either completed or were undertaking the Macmillan GPN course, the only

relevant training practice nurses are completing but this represents a very small percentage

of nurses surveyed. One nurse added:

“I think every GPN needs to do the Macmillan cancer care course”

Another nurse added an additional comment which echoed the sentiment that nurses were

willing to expand their role in relation to cancer but only with the appropriate support:

“I totally agree that GPN's need to be more knowledgeable but we need the support,

protected time & funding for courses”

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Q15. Do you use any existing nursing competency documents?

The majority (44) of respondents used the RGCP – GPN competencies with 16 nurses

reporting they use the cancer specific Macmillan tool. This provides a clear indication that

nurses are using competency documents to support their practice and so improving the

relevance and usability of a cancer specific tool is likely to be valuable.

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Q16. If you were to attend any training on cancer in the future, what would be your preferred

format?

We were unsurprised to learn that face to face learning remains the most popular format for

training. We recognise that practice nurses can be quite isolated in their roles and with

competing work pressures, time away from practice not only protects the learning but allows

for networking and peer support too.

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Q17. Can you identify any barriers which would make it difficult to participate in cancer

education?

Unsurprisingly the biggest identified barrier was time, followed by a lack of protected learning

time and the location of the training. It is reassuring to see that very few people reported

cancer education was not a clinical or professional priority suggesting that efforts should

concentrate on developing flexible training that can be fitted around pressurised workloads.

Despite face to face being identified as the most favourable training format in question 16, a

blended approach is likely to be most accessible for nurses given the constraints of protected

time and location they have identified above. Incorporating a practical element such as

shadowing or working with a mentor appealed to many and might be one way of addressing

the lack of protected time.

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Additional Comments

11 respondents added additional comments at the end of the survey. These were all positive

in nature and demonstrated nurses’ enthusiastic attitude towards developing their skills and

knowledge in cancer care and being able to provide more support for their patients. However

several also made the point that protected training is essential:

I am passionate about any cancer care especially looking forward to new role in community as GPN

I totally agree that GPN's need to be more knowledgeable but we need the support, protected time & funding for courses

Definitely a good plan for practice nurses as these are patients whom have usually no follow up after treatment finishes so they can feel isolated I would be very interested in learning more about this area so that I could be more involved at the surgery

Limitations Due to the project schedule the survey went lives on July 16th and ended on 31st August. This

unfortunately meant that the majority of the time coincided with school holidays and nurse’s

annual leave. The length of time that the survey was open and the gift voucher incentive

helped mitigate against this risk.

Because we were keen to maximise engagement, in addition to the survey monkey nurses

were encouraged to complete questionnaires at a couple of events where we were providing

education. Responses might have been more favourably informed as a result, so if anything,

we can assume less knowledge than the survey results indicate.

Conclusions General practice nurses currently receive very little cancer training but there is

recognition that their role is changing and that training will be necessary to meet the

needs of cancer patients

Very few nurses currently undertake cancer care reviews or prostate follow ups

There was generally a willingness to consider taking on a greater role in supporting

patients to live well with and beyond their diagnosis

Time is the biggest limitation to attending future training

Nurse prefer face to face learning and would value practical support and mentoring

The results from this local TNA exercise adds to the existing evidence pan London

(TCST) and countrywide (Macmillan) around the education and support needs of

General Practice Nurses in relation to cancer.

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Next steps Development of a sustainable education and influencing plan that will include the following:

Influence across SWL CCGs and CPENs to ensure the education needs of GPNs in relation to cancer are prioritised and promoted at every opportunity

Work with Macmillan to help shape the support to GPNs through the new Macmillan Affiliate offer, and the revised Macmillan Practice Nurse course

Coordinate and deliver local smaller scale cancer education events to GPNs to ensure a wider reach than the Macmillan GPN course can achieve at the current time

Develop a cancer community of practice for GPNs in SWL offering peer mentorship and support in practice

Work with indidivual GPNs who have previously completed the Macmillan Practice Nurse course to support their translation of learning into practice as their role within cancer care develops; utilise this process to develop case studies for larger scale roll out

Work with GP practices where nurses are leading on prostate follow ups to create case studies and practical resources to simplify and enable replication at other practices as stratfied follow up is rolled out across SW London

Continue to test the GPN cancer competency framework locally and nationally

Produce video and podcast resources to support education and engagement events

Scope the potential value and the specialised training required that could support a GPN with a special interest role in cancer to develop higher level knowledge and skills

Work with SW London Prostate Cancer working group to help map opportunities for education and ongoing cpd opportunities for nurses completing prostate cancer follow ups

Engage with all higher education providers across SW London to influence inclusion of cancer as a longterm condition on post graduate primary care nursing training and the developing pre-registration Roehampton masters programme

Appendix Hard copy of the Training Needs Assessment on following page; version used throughout face

to face testing and collection.

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A survey for general practice

nurses to investigate follow-up

care for people living with and

beyond cancer

Thank you for taking the time to take part in this short survey which aims to

understand your experience as a general practice nurse regarding follow-up care for

people living with and beyond cancer.

Your participation will contribute to the Macmillan Primary Care Nursing Project by

helping to identify support and education needs for general practice nurses relating to

the provision of care for people living with and beyond cancer.

Completion of the survey may also be useful to identify knowledge gaps as part of your

continual professional development planning and or reflective practice as part of NMC

re-validation.

The survey will take approximately 5 minutes to complete.

The information you provide will be handled in a manner that ensures confidentiality.

No identifying information will be released in any publications resulting from the

study. Participation in this survey is voluntary.

Thank you very much for your involvement.

Macmillan Primary Care Nursing Project

Background

As cancer treatments improve, the number of people living with and beyond

cancer is increasing. Late onset and long-term side effects of cancer and its

treatment have been defined as ‘consequences of treatment’. They can be

functional, physical or psychosocial problems and can occur months or years after

completion of treatment. As many as 500,000 cancer survivors in the UK are

considered to be experiencing consequences attributable to cancer treatment

(Macmillan Cancer Support, 2013).

Complete for your

chance to win a £50

M&S gift voucher

Simply add your contact

details on the last page of

the survey to be eligible to

win

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Start well, live well, age well v7 20180718

Understanding the primary care nurse role with cancer patients

1) Are you currently a general practice nurse (registered)?

Yes

No

2) How long have you been working as a general practice nurse?

3) Which CCG area do you work in?

4) How often do you get asked questions related to cancer by your patients?

Daily

Weekly

Monthly

A few times a year

Never

5) Please select the number that best represents how you feel:

I am clear about my role as a nurse in supporting patients living with and beyond cancer.

6) Have you heard about cancer care reviews taking place in GP surgeries?

Yes, I complete them with patients as part of my role

Yes, GPs in my practice complete them

Yes, GPs and other nurse colleagues in my practice complete them

Yes, but they don’t currently happen at my practice

No, I am not aware of them

Comments:

Comments:

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7) Have you heard about prostate cancer follow-up reviews taking place in GP surgeries?

Yes, I complete them with patients as part of my role

Yes, GPs in my practice complete them

Yes, GPs and other nurse colleagues in my practice complete them

Yes, but they don’t currently happen at my practice

No, I am not aware of them

8) Please briefly outline what you understand by the term ‘cancer care review’:

Comments:

Comments:

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Confidence

9) Please select the number that best represents how you feel:

I feel confident in completing a cancer care review or nurse led prostate cancer review, even if I

don’t currently complete them as part of my role.

Cancer Care Review:

Nurse-led Prostate Cancer:

10) Please select the option that best represents how you feel:

I feel confident in supporting cancer patients in relation to the following issues:

Common cancer treatments Strongly Agree

Agree Neither Disagree Strongly Disagree

Surgery

Chemotherapy

Radiotherapy

Hormonal treatment

Target immunotherapy

Reasons for no treatment or delayed treatment

Comments:

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I feel confident in supporting cancer patients in relation to the following issues:

Management of treatment related side effects

Strongly Agree

Agree Neither Disagree Strongly Disagree

Urinary problems

Bowel problems

Lymphedema

Sexual dysfunction

Fatigue

Body image

Psychological issues

Fertility

Cardiovascular risks

Bone health

Pain

Giving lifestyle advice Strongly Agree

Agree Neither Disagree Strongly Disagree

Physical activity

Smoking cessation

Weight loss

Vocational or financial support

Signposting patients and carers to other services

Signs and symptoms of disease recurrence

Recommended follow up testing

Stress / anxiety management

Comments:

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Training

11) Have you received any training specific to cancer?

Yes – please specify

No

12) Do you use any existing nursing competency documents (tick as many as apply)

(Macmillan) A Competence Framework for Nurses: Caring for Patients Living with and Beyond

Cancer

(UKONS & RCN) Career and Education Framework for Cancer Nursing

(HEE) District Nursing and General Practice Nursing Service Education and Career Framework

(QNI/QNIS) Voluntary Standards for General Practice Nursing Education and Practice

(RCGP) General Practice Nurse Competencies

Any other: please specify___________

Comments:

Any comments of these documents or use:

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13) If you were to attend any training on cancer in the future, what would be your preferred

format? (tick up to 3 that apply)

Face to face

Online

Video

Webinar

Written

Shadowing other nurses

Working with a mentor

Other: please specify____________

14) Can you identify the main barriers which would make it difficult for you to participate in cancer

education? (tick up to 3 that apply)

Lack of time generally

Lack of protected learning time

Not a clinical priority at my practice

Not a professional/personal interest

Financial

Arranging cover

Support from line manager

Location of training

Day of the week/Time

Lack of accreditation

Would you like to add any further information?

Thank you very much for completing this questionnaire which will make a significant difference to the

future of training and support available to primary care nurses and services offered to people living with

and beyond cancer.

For the chance to be eligible to win a £50 M&S gift voucher please provide your name and email address

below. A winner will be selected at random and contacted by October 2018.

Name:

Email:

If you would like to find out more about our project or ways that you can be

further involved, please tick this box giving us permission to share with you

results of the training needs assessment, finalised nursing competencies for

general practice nurses and the final project report. Alternatively, you can

contact us by emailing: [email protected]

Comments: