Guidance for referring patients for suspected prostate cancer
Please refer to the updated NCL Cancer Alliance guidance (11 June 2020, see Downloads, right) for referring patients for suspected prostate cancer.
- GPs should continue to refer men with suspected prostate cancer on the current 2WW form
- GPs should undertake prostate-specific antigen (PSA) testing in symptomatic patients in line with NICE guidelines (new lower urinary tract symptoms, visible haematuria, unexplained non-visible haematuria WITH dysuria or raised WCC on blood test)
- GPs should continue to undertake PSA testing in asymptomatic patients following Public Health England’s Prostate Cancer Risk Management Guidelines on the risks and benefits
- GPs should take the opportunity to discuss the need for men to attend secondary care for their investigations and address or reassure them regarding any concerns they have.
- We are aware that there are pressures on phlebotomy across NCL at this time but that efforts are being made to restore capacity as quickly as possible.
Primary Care Prostate Cancer Locally Commissioned Service
The aim of the Prostate Cancer Locally Commissioned Service (LCS) is to provide enhanced support for stable prostate cancer patients in primary care. The service includes an annual holistic needs assessment (HNA) and PSA monitoring. This service supports NCL CCG’s strategic objective of moving care closer to home. It will also ensure primary care is funded for work being moved from secondary to primary care.
GPs who have signed up for the LCS will be required to provide this service as set out in section 3 of the service specification (see Prostate Cancer LCS page).
Patients will be transferred following secondary care assessment for suitability and accompanied by Treatment Summaries that include patient-specific protocol for PSA monitoring, any consequences of treatment (medical, physical and psychosocial) and instructions for ongoing management.
Practices can also search via EMIS for stable prostate cancer patients who meet the eligiblity requirements and invite them for a HNA and a PSA test as per the LCS, in order to receive payment. Practices can download the clinical template and import into EMIS.
Another cohort of patients eligible for this LCS are all the patients who have already been discharged by secondary care to general practice who have prostate cancer and need an annual follow-up. These patients would also qualify for a £50 payment once they’ve had their PSA and holistic needs assessment completed. In order to do this your practice would have to do a computer search for all the patients who have a diagnosis of prostate cancer, then each individual set of records has to be looked at to identify if the patient has been discharged by urology. Typical yield for a practice of 10,000 patients would be approximately 20 patients, potentially earning a practice £1,000 if all the patients concerned get their PSA test and holistic needs assessment completed during the financial year.
Helpful hint: practices who have FY2 doctors or GP registrars may wish to potentially discuss the logistics of this exercise with them, as a possible QIP, or audit project.
Personalised Care & Support Plan (PCSP) code addition (July 2021)
The NCL Prostate Cancer Stratified Follow-Up LCS template has been updated to ‘v16 June 2021’ (see Downloads, right).
The sole change is that in order to receive the annual year of care payment of £50 per patient three SNOMED codes need to be ticked instead of two (see below). The PCSP SNOMED Code 1187911000000105 has been added in order to ensure that all activity that supports holistic personalised conversations are recorded and monitored.
The search/report template for this has been updated in EMIS for Barnet, Enfield, Haringey and Islington [Camden to follow}.
Description and SNOMED code
- Holistic Needs Assessment completed 787261000000106
- Discharged from secondary care prostate cancer service 1034421000000103
- Personalised Care & Support Plan agreed 1187911000000105
If you have any queries please contact a member of the NCL Cancer Team