Remote Monitoring in Prostate Cancer
Interviewee: Mike Henley, Consultant Urologist & Medical Director
The requirement to see new cancer patients and provide follow up appointments has been a struggle during COVID-19. Focus has been on seeing as many patients as possible, but the issue going forward revolves around the capacity of consultant staff & specialist nurses, particularly in secondary care.
There was a realisation that if a review was completed on how patients suffering with prostate cancer are followed up, it would be possible to make changes. This would free up time for consultants and specialist nurses to do higher level jobs, whilst managing to maintain patient safety.
A need was identified to find new people who currently did not have the skills required but who could be upskilled to look after a patient group with moderately complex care needs who are mainly classed as ‘safe’ with an element of things that could go wrong. It was felt that the use of an expert system would be a way to achieve this and this was tackled in two different ways.
In Hull, there was interest in this being run as a hub approach, with a couple of centres looking after the patient group. In East Riding, the preference was that GP’s wanted to take care of own patients. The two different groups were run in parallel, one being a hub that had expertise and looked after people across practices, and the other as an individual practice basis.
An expert system was used, built on expert standards of care. This was tested on real patients (it had been started in 2012 in south Derbyshire so there was a degree of knowledge that this worked when it came to Hull and East Riding).
Patients have regular appointments once every 6 months consisting of a blood test followed up by a nurse, over the telephone, asking a few clinical questions and completing an online form with the blood test result added in too. The system knows about the patient (treatments received and pathway they are on) and it can work out whether the patient is still well or is in need of intervention i.e. whether they have recurrent cancer or if they are still safe. This is facilitated by a discharge nurse at the hospital, the patient is then discharged into the community. There is a further update to this which is patient led and they manage their own care, completing all info on their device where the data is married up.
The innovation has freed up consultant time to see patients (equivalent of 2 consultants doing a new patient clinic per week). This has had a significant impact on the number of patients who can now be seen, 20 new patients a week or 44 observations a week, which is a big impact in ongoing care.
Both models have worked well in the community, practices are happy, and the support calls are similar from the two, there is preference for the hub as looking after 4 centres is much easier than looking after 37 individual GP practices
Once business cases were passed, an initial round of location training was completed and investment made into lead local trainer’s, for both East Riding and Hull to enable a cascade of further training, this has worked well. Training has been a mixture of virtual and face-to-face, due to Covid -19.
Ideally, there is a desire to continue virtual appointments. Currently 1600 appointments are completed per year over both sites, the cost to see all of these as a hospital service would be £100k per year. Using new methods a 60-70k saving would be seen , potentially enabling 2 new single consultants to see new patients.
Post COVID-19, there is a desire to use this more broadly across the network as it is a proven system so there is a need to prove its worth as more of the same would be of benefit.
The direct patient module has been built and would benefit from a trial, for which places are being identified to carry this out. The system has been written in a modular way so other conditions could be slotted in e.g. some of the blood disorders which have similarities to prostate cancer, as well as for breast cancer etc, leading to bigger savings across the system.
Key Learning Points
Remote monitoring is excellent; however, there is a need to look to the future. If the same staff are utilised and it is taking the same duration, then transport costs/parking fees have been saved, but perhaps things have not changed as much as anticipated. This system is remote but also changes the grade of the staff who are able to look after the patient. The hybrid of remote monitoring including some AI is optimal and will result in the most savings, alongside freeing up consultants and specialist nurses to fulfil that role.
- Ensure there is clinical buy-in and able managers to introduce this plus financial support to start with.
- There is an appetite for change and support with this will provide relief for staff and patients. Stable cancers require some change and support is critical.
- Empowerment of people to get on with things is needed and to just say ‘yes’.