University Hospitals Coventry and Warwickshire("UHCW") NHS Trust
Project Name: Cardiac Rehabilitation and Treatment Optimisation for Heart Failure Patients
Joint Working Project Summary:
Implementation of nurse-led Heart Failure clinics, including a comprehensive Cardiac Rehabilitation programme for patients who fulfil defined referral criteria with the aim of delivering a patient-centred service, which optimises the patients’ health and well-being, enhances their quality of life and minimises the risk of recurrent cardiac events.
The nurse led clinics will consist of: (i) initial clinic assessments; (ii) group education; (iii) mid-way clinics and (iv) exit clinics in readiness for discharge back to the GP.
Expected Patient Outcomes for this Project: The following measures will be evaluated by the Trust:
patient numbers seen by the Cardiac Rehabilitation programme with concurrent nurse-led Heart Failure clinics: target of up to 200-220 per year;
patients discharged from the Cardiac Rehabilitation programme with concurrent nurse-led Heart Failure clinics: target of up to 130 per year;
patient satisfaction linked to the Cardiac Rehabilitation programme with concurrent nurse-led Heart Failure clinics (PREMS): target of up to 96% of patients surveyed;
increased proportion of patients with LVSD receiving guideline-directed pharmacological therapies at 30 and 90 days post-discharge (measured against the NICOR 2016 report);
submission of business case for the future funding of the Cardiac Rehabilitation programme with concurrent nurse-led HF clinics to the relevant NHS authorities.
Start Date & Duration: 10/04/2018, 24 Months
Project Period: 24 months
University Hospitals Bristol NHS Foundation Trust
Project Name: The Bristol Royal Infirmary Endocrine Service Improvement Joint Working Project (“JWP”).
Joint Working Project Summary The Bristol Royal Infirmary (“BRI”) is part of the University Hospitals Bristol NHS Foundation Trust. The BRI clinical endocrine team (“the NHS team”) provides a local endocrine service and also operates as a tertiary regional hub. There is a growing demand on endocrine services with a significant proportion of Clinical Nurse Specialists (“CNSs”) time triaging, scheduling and undertaking the endocrine patients for Dynamic Function Tests (“DFT”). These DFT’s are an important, albeit time-consuming, aspect of diagnosis and tailoring a treatment plan for endocrine patients. The DFTs are run over a number of hours, for each patient, with a series of blood samples taken and the checking of fluctuating hormone levels.
Aims A JWP between the NHS team and Novartis to improve the BRI endocrine services and the quality and consistency of endocrine patient care. A new band 5 full-time endocrine nurse will triage, schedule and undertake the DFTs for endocrine patients. This will benefit the NHS team by increasing the capacity of the CNSs to concentrate on more effectively undertaking, implementing and coordinating a series of service activities, such as CNS led clinics. It will also improve the timely access to service activities and improve the efficiency and flow of endocrine patients along the endocrine patient pathway. This will free-up Consultant and endocrine CNS time for complex clinical case management and reduce inappropriate administrative tasks for clinical staff.
Novartis will benefit from an improved reputation and stronger partnership with the NHS team, along with a better understanding of the endocrine patient pathway standards which the NHS teams work to. This will enrich Novartis discussions with other NHS sites when developing other JWP’s.
The NHS team and Novartis will form a project steering group (“PSG”) to initiate, review and measure the progress of this JWP. Aggregated and anonymised service level and patient satisfaction reports of the endocrine service will be generated by the NHS team and viewed at PSG meetings. Novartis will not have access to any patient specific treatment or clinical outcomes data. The results of the JWP will be included in a JWP summary report to provide evidence for the long-term financial sustainability of the service, solely funded by the NHS, after completion of the JWP.
Expected Patient Outcomes for this Project Improved access and quality of care across the endocrine patient pathway in terms of the following: • treatment delivered within 18 weeks; • diagnostic tests completed 6 weeks from general patient referral; • injectable endocrine therapies would be initiated within 4 weeks of the clinical need being identified; • DFTs to be completed within 2 weeks for urgently referred patients.
Improved patient satisfaction of the young person in transition from paediatric to adult endocrine services in terms of the following: • introduce the young person to one of the adult endocrine CNSs during transition period; • awareness of how to access the adult endocrine CNSs by telephone or email; • knowledge of condition and its long term management at time of transition from paediatric to adult endocrine services; • the opportunity for holistic assessments through the joint paediatric and adult endocrine CNS; • signposting to relevant support groups; • patient awareness of when the first appointment in adult endocrine services should be; • CNS present for extra endocrine patient support at first appointment in adult endocrine consultant clinics.
Financial Contribution: As detailed in the Joint Working Agreement Start Date and Duration: Start date by the end of April 2018 with an expected duration to the end of July 2019 Project Period: 15 months
The Christie NHS Foundation Trust
Project Name: Christie Hospital NHS Trust Breast Service Development Joint Working Project
Joint Working Project Summary The Christie Hospital NHS Foundation covers the Greater Manchester region, serving a catchment population of 3,200,000. The Christie is a centre of excellence for the treatment of breast cancer with over 300 people referred annually with metastatic breast cancer (MBC) and a population of over 600 currently receiving treatment for MBC at The Christie site alone. In addition there are more patients referred in for clinical trials. Currently metastatic breast cancer patients are seen in clinics at the Christie after being reviewed at an MDT, however these clinics are extremely over-subscribed.
There are also challenges with regard to patients who are referred from Wrightington, Wigan and Leigh (WWL) NHS Foundation Trust which serves a local catchment population of 300,000 people. The Christie @ Wigan is the largest chemotherapy delivery unit outside of The Christie’s main site in Withington, delivering more than 5000 chemotherapy episodes per year. The medical oncology breast cancer clinics at Wigan are becoming increasingly stretched with increasing number of patients being treated here.
This joint working project between Novartis and the Christie Hospital would provide a trained pharmacist to run an ‘Oral Therapy Breast Clinic’ at both Christie and Wigan Hospitals to run alongside the current clinic set up. This Specialist Breast Cancer Pharmacist could provide treatment review and ensure that patients receive their prescriptions in a timely manner. The pharmacist would also set up a dedicated ‘Oral Therapy Breast Telephone Clinic’, which would reduce the patients’ requirement to travel for non-urgent consultations. The telephone clinic would handle routine monitoring and ad-hoc queries. In addition this pharmacist would be able to screen and identify patients who would benefit from multi-disciplinary team (‘MDT’) discussion at the cancer centre to provide consensus approach for their MBC management and to identify those who may be eligible for clinical trials.
Expected Patient Outcomes for this Project The JWP aims at setting up breast service redesign at the Christie and Wigan Hospitals by setting up new clinics to be run by a Specialist Breast Care Pharmacist. In addition the pharmacist will identify metastatic breast cancer patients who require timely review in an MDT. The dedicated pharmacist will provide specialist breast cancer care during treatment and provide consistent support to the patient population. Patients that are more complex will have more time with the consultant. This will be made possible by increasing capacity in the clinic by stratifying patients for the new Oral Therapy Breast Clinics and The Oral Therapy Breast Telephone Clinic which will free up Consultant time to see the more complex MBC patients. The project will specifically:
Allow equal access to the breast cancer service due to earlier identification of patients and MDT review;
Set-up 2 pharmacy-led Oral Therapy Breast Clinics and an Oral Therapy Breast Telephone Clinic in order to provide patients with access to oral treatment in a timely manner and closer to home;
Improve patient experience of the breast cancer service and improve on-treatment support; and
Prepare a business case to ensure the project is sustainable beyond the initial 2 year phase.
Start Date & Duration: April 2018 – June 2020 Project Period: 26 months