The iQudos Stable Prostate Cancer medical service provides the expert diagnostics and management advice providing uniform excellence in care at hugely reduced staffing and training costs
Stable Prostate Cancer Monitoring Module
Background
Prostate cancer is the commonest cancer of men in the UK. The prevalence being 350 men per 100,000 population. Most of these men will remain well with the disease, the 10 year survival is however currently 68%. This means that all men with prostate cancer should be followed up for life, producing a burden for both the men and healthcare providers. In the UK the majority of men are followed up in the hospital setting, twice per year. Approximately 10-20% are followed up in specialist nurse led clinics, the rest under consultant care in urology or oncology outpatients. Clearly the tariff cost of this is significant. In the East Midlands alone for example there are the equivalent of 40 outpatient clinics per week. Some patients are discharged back to GP follow up. There is little research on this, but two unpublished audits showed that only 10% of patients are followed up in line with the advice given by the hospital on the patient’s discharge. This matches research in other disease areas.
Current Costs
Stable prostate cancer is an area of care which is suitable for pathway redesign. When the basic costs are assessed the largest factor is the expertise or staff cost. Regardless of the cost written down on the business case per patient, the bottom line is the cost or opportunity cost of providing the care. Rough costs per hour for GP or consultant are £90 per hour once on costs such as annual leave, study leave and pensions etc. are taken in to account. Specialist nurses are £40-50 per hour. A band 5 nurse providing the same clinic would cost £20 per hour. This represents the opportunity of saving for the NHS if it was possible to run the clinic with a band 5 nurse. Until now however a band 5 nurse would not have the expertise needed to run a stable prostate cancer clinic.
iQudos Stable Prostate Cancer System
iQudos have developed over the course of 3 years a robust expert system for looking after men with stable prostate cancer. Most men would be suitable to enter the follow up at one year post definitive intervention such as radiotherapy or surgery or immediately if treated with hormones or on ‘watchful waiting’. The software is operated by a band 5 nurse and produces a letter written in medical English for the GP outlining patient progress and any action needed. It advises on common problems after prostate cancer treatment. It is able to review the patients history and find subtle patterns which may indicate recurrence. Thereby avoiding delayed diagnosis and unnecessary referral. Because the system is database driven, outcome measures and clinical governance are hardwired from the start. Reporting for local clinicians and commissioners is push button rather than waiting for annual reports. Pathways can be moulded to local needs with the majority of the criteria being flexible according to local need. As only a days training is needed for a band 5 nurse to use the system, huge flexibility in terms of increasing or decreasing clinics is provided.
How does it work in Practice?
Patients are identified from existing prostate cancer databases in secondary care, extracts or relevant blood tests are made and the new databases transferred to the iQudos system. Pathways and suitability can be decided in combination by commissioner and secondary care clinicians. Patients are sent an appointment for the iQudos clinic and may either attend in person or elect to be telephoned. Most patients will remain in the community, those that need re-referral are referred to the urologist/oncologist who was previously in charge of their care.
How is the service Commissioned?
The service can be commissioned in a number of ways. As a joint venture with an existing community services provider, as a new third party provider or as a joint venture with the existing NHS Trust caring for the patients. Each of these has a number of advantages and each will suit different areas.
Where do the guidelines come from?
The pathway is based on the NICE guidelines. Variation is possible based on local requirements.
What is the cost?
There is no new cost associated with the service but a split of savings produced.
Is it safe?
The stable prostate cancer software is a registered medical device. iQudos is the first company in Europe to register expert system software for medical management. All medical expert system software needs to be registered with the MHRA like any other medical device or drug. It has been tested in pre-clinical trials and has a full post market surveillance program in place. The software guidelines are overseen by a panel of urologists who supervise and take part in testing to ensure safety.
How do we implement this?
A simple email with contact details will start the ball rolling. Our team has a number of business cases for various situations. We have employees who have many years of experience running healthcare organisations and expertise in NHS technology adoption. We aim to do everything we can to take all of the strain out of redesigning services.