Personalised Care and Support Planning will help you to:
Facilitate conversations with healthcare professionals along your cancer pathway
Identify your needs (with Holistic Needs Assessments)
Develop a Personalised Care and Support Plan
Share the right information, at the right times
Signpost you to local support services.
We are committed to supporting the NHS Long Term Plan to deliver PCSP for people living with cancer.
What are the interventions of PCSP?
Personalised Care and Support Plans (based on Holistic Needs Assessments)
End of Treatment Summaries
Primary Care Cancer Care Reviews
Health and Well-being Information and Support.
eHNA
A Holistic Needs Assessment (eHNA) is offered to see if you have any concerns or issues and to then plan what additional care, information and support may help you.
This can be at any time from your diagnosis but can be particularly helpful when treatment is completed. A HNA may be offered as an online assessment, by telephone, or in person and will be a supportive conversation focussing on your needs.
Ask your nurse specialist or health care professional involved in your care if you would like a Holistic Needs Assessment.
Alternatively you can telephone the centre to arrange an appointment to have a HNA with one of the Macmillan Information and Support Centre staff.
The you tube video below provides more information on the holistic needs assessment process (filmed by Macmillan Cancer Support)
Treatment Summary
The treatment Summary is a document produced by secondary cancer care professionals (hospital team) at the end of a phase of treatment and is given to you and sent to your GP. It provides important information, including possible
treatment toxicities, information about side effects and/or consequences of treatment, signs and symptoms of a recurrence and any actions for the GP. It aims to inform GPs and other primary care professionals of any actions they need to take and who to contact with any questions or concerns. Hopefully this will improve understanding of your condition and aims to provide a summary to share with other professionals and those of your choice, eg for travel insurance purposes. A copy of the Treatment Summary in your medical notes is also useful for medical staff if you get admitted in an emergency after primary treatment is complete.
If you have not be offered one after finishing a phase of treatment and you require more information please contact your treatment team/CNS team at the hospital.
For more information about treatment summaries please click on the below link:
What does my follow up look like?
Personalised Follow up in the form of PIFU and PSFU describes all interventions which make the outpatient follow-up experience more personalised for you following cancer treatment. All personalised follow-up interventions seek to:
• reduce unnecessary outpatient appointments
• personalise care
• improve your experience
As such, both interventions have the same aims and are delivered in the same way. Both are
designed to empower you to take more control over your condition and to reduce the stress
and cost to you attending appointments that you do not need.
PIFU and PSFU are both recognised models of personalised follow-up, some of which are set
out below. These can be used on their own, or in combination depending on the individual
needs and preferences of your needs:
Patient initiated follow-up (PIFU) – You initiate an appointment when you need one, based on your individual circumstances. PIFU is widely used across multiple specialties and may also be called ‘see on symptom’, ‘open appointments’, ‘open access’, ‘patient triggered’ or ‘supported self-managed pathway’.
Personalised stratified follow-up (PSFU) – refers to the use of PIFU in cancer services,
where you continue to have all the cancer surveillance scans and tests you need, but a
proportion follow a PIFU (or ‘self-managed’) pathway.
Please ask your cancer team for more information about follow up and how you can make it more personalised to suit your needs.
For more information about personalised follow up please click on the link below:
Cancer Care Review
A Cancer Care Review (CCR) is a conversation between a patient and their GP or Practice Nurse about their cancer journey. It is essential to personalised care and helps patients to:
- talk about their cancer experience and concerns
- understand what support is available in their community
- receive the information they need to begin supported self-management.
Please ask your GP practice if this will be of benefit to you and you have not been offered one yet. Here is a video giving you more information about cancer care reviews:
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