• Supporting quality improvement within the practices in your area is an opportunity to localise or update and promote cancer screening and prevention (e.g. smoking cessation) in HealthPathways. When considering your work plan, allow time to update HealthPathways so they are ready to promote on the launch of your cancer screening and prevention quality improvement activities.
   
• Providing your HealthPathways team with a link to this toolkit may help them to consider inclusions for cancer screening and prevention HealthPathways.

• It is important that your practice support and cancer screening/population health staff are confident in supporting primary care providers within your PHN area to use this toolkit.
  
  Cancer Institute NSW are available to provide training for PHN representatives who can then provide training and guidance to practices within their PHN regions.
  
  Contact CINSW Primary care team for more information CINSW-PrimaryCare@health.nsw.gov.au
   
• When undertaking annual planning, PHNs may like to consider factoring in staff training activities to ensure your team has the confidence and skills they need to promote and support engagement with the Toolkit modules and resources.

PHNs are encouraged to embed the cancer control toolkit within existing approaches to quality improvement and practice engagement. You may wish to consider how cancer screening and prevention quality improvement can be integrated and cross-promoted with:

Existing quality improvement processes and activities including:

• The Practice Incentive Program Quality Improvement Incentive. 
• Methods used by your organisations for presenting quality improvement data to practices in an interesting and accessible way (eg. data ‘dashboards’).

Existing cancer screening and prevention initiatives and activities within your region

• If your PHN has tailored tools and methods that it uses to present and support quality improvement activities, you may wish to implement the toolkit using your own templates, data collection and reporting approaches. Think about how you will present and support quality improvement so that it can be a sustainable activity within your organisation.

It is suggested that PHNs consider seeking continuous professional development (CPD) points for education associated with the toolkit modules and encourage clinicians in general practices to do so.

• PHNs may wish to consider developing a graphic representation of cancer screening participation or lifestyle risk factors in their region from their Reporting for Better Cancer Outcomes data. 
   
• Refer to the Cancer Institute NSW's cancer statistics in NSW.
   
• PHNs may wish to develop graphic representation of rates of people who smoke, consume alcohol or other lifestyle risk factors (speak to your Health Planning/Data team). 
   
• Making cancer control indicators in their area available and providing a comparison with surrounding areas can be engaging and motivating for practices.

Benchmarking is a very important part of quality improvement in the primary care setting. It provides motivation and direction for practice teams and allows teams to track progress over time.

Prior to launching the toolkit, PHNs should consider:

• how and when they will request participating practices to submit cancer screening and prevention participation data 
• how they will present data back to practices in a way that allows them to track their performance over time and against other practices.

Some PHNs use data audit tools to regularly extract and present benchmark data to their practices in ‘dashboard’ formats.

Consider how your PHN can support practices to develop and implement tools for gathering, analysing and implementing patient feedback.

Consider how your PHN can identify and share the experience of practices who have implemented:

• recall and reminder systems 
• systematic family history taking
• prevention based quality improvement activities 
• health assessment and GPMP templates that integrate cancer screening and prevention
• software to strengthen point-of-care reminders.

The National Framework for Continuous Quality Improvement in Primary Health Care for Aboriginal and Torres Strait Islander People 2018–2023 provides useful guidance on the actions PHNs can take to support cancer screening quality improvement activities.

The Australian Health and Safety Commission’s National statement on health literacy (PDF) provides guidance on what support organisations, such as PHNs, can offer to improve health literacy.

• PHNs may wish to consider what research, data extraction, analysis and dissemination they can undertake to build practices’ insight into under-screened populations. 
   
• PHNs can request BreastScreen NSW participation rates, by location and language group, using the BreastScreen NSW data request form (PDF). 
   
• Working with primary care providers, relevant stakeholders and the community to undertake consumer research with under-screened populations can support practices to better understand barriers and enablers to screening in the local context. Read an example of this type of research, undertaken by North Coast Primary Health Network.

Mapping and strengthening the cancer screening neighbourhood is an important support function that PHNs can undertake. This can improve collaboration and coordination between: 

• Practices.
• BreastScreen NSW.
• Local Health Districts.
• Aboriginal Community Controlled Health Organisations (ACCHOs) and other relevant community organisations and services (eg. multicultural groups, disable peoples organisations, community transport providers, cancer advocacy groups, breast care nurses, etc.).

View more information on GPs role in BreastScreen NSW (PDF).