June 2019

June 2019

Project Name: Neuro-Endocrine Tumour (NET) Service Development Joint Working Project 

Joint Working Project Summary:

The Christie NHS Foundation Trust Hospital (The Christie or ‘Trust’) is a tertiary referral centre for neuro-endocrine tumours (NET) covering Manchester’s population of 3.2 million people. In addition it takes referrals from outside of the immediate area including North Staffordshire and West Yorkshire. The service sees 120 new gastroenteropancreatic (GEP) NET patients and a further 20 lung NET patients per year. Currently the NET service is under resourced. There is a demand for support with non-clinical care. This includes assistance with the organisation of information required at clinic and follow-up appointments (e.g. test/scan results) and the logistics of community based therapies following discharge.

The Greater Manchester Health and Social Care Partnership (a Partnership made up of Greater Manchester local authorities, NHS clinical commissioning groups and 13 Trusts within the Greater Manchester area) , aims to be an innovator in the provision of healthcare services and encourage health professionals across the country to pilot new models of care.

The Macmillan Charity has worked with the Department of Health and Social Care and Frontier Health Economics (Frontier Report, 2010) to determine the current gap in the workforce supporting cancer services and a model for the future has been developed. The report shows that 33% of cancer care could be delivered by a trained but unregistered practitioner.

This project gives an opportunity to bring together these different elements to pilot a new way to bring support the clinical team to enhance patient care.

Expected Patient Outcomes for this Project: 

The aim of this joint working project is to provide a Band 4 Clinical Support Worker (CSW) to work in partnership with specialist NET consultants, Clinical Nurse Specialists (CNS), and Nurse Clinicians. This Clinical Support Worker will focus on clinical care of patients by taking the non-clinical elements of the workload away from the CNSs. Responsibilities of the CSW will include: management of homecare delivery systems and the collating of blood test and scan results.

The transfer of these tasks from the CNSs will free up nurse time to enable the set-up of a dedicated NET telephone clinic.

 

Project aims and outcomes:

  1. Provide an improved NET service to provide consistent and holistic care to patients from the first consultation through to after treatment care.
  2. Build data around this new service which can be analysed to understand whether the new service is benefitting patients and is financially sustainable
  3. Show the benefit this new model of care can bring to patients and share this across the wider region; including other teams at the Christie/ Greater Manchester Cancer Alliance and the NETs community. 

Start Date and Duration: June 2019, 26 Months

Project Name: Service improvement for the detection and treatmentof Heart Failure (“HF”) in Community and Secondary care

Joint Working Project Summary:

The Joint Working Project (JWP) will involve the introduction of a new Community and Hospital HF service; a “50:50” Community and Secondary Care Heart Failure Specialist Nurse ("HFSN") to identify and triage HF patients (both at acute medical receiving units, non-Cardiology departments and in the community) so they can be appropriately referred for specialist HF input. Subsequently coordinating the discharge of patients and following up in a timely manner will ensure continuous appropriate care for HF patients after their discharge from hospital.

 

Expected Patient Outcomes for this Project: 

The following measures will be evaluated by the Trust:

  • development of clinical strategy/protocol and implementation procedure of the same to govern the clinical operations of the Integrated Heart Failure Service described in the JWP (the “HF Service”);

 

  • positive increase against the following baseline % measures as stated in the most up to date NICOR HF audit (whether published or not) for the Princess Royal Hospital (Brighton and Sussex University Hospital NHS Trust) – patients receiving/being prescribed:
    • input from specialist
    • received Echo
    • received discharge planning  
    • referral to HF nurse follow up  
    • ACEI on discharge  
    • ACEI/ARB on discharge
    • Beta blocker on discharge
    • MRA on discharge
    • Reduction in re-referrals
    • % patients seen within 2 weeks of discharge

 

  • patient satisfaction linked to the HF Service (PREMS)

Start Date and Duration: 30/06/2019, 24 Months

Project Period: 24 Months

 

Project name: Service improvement for the detection and treatment of Heart Failure in secondary Care.

Joint Working Project Summary:

This Joint Working Project (JWP) will involve the introduction of a hospital-based specialist heart failure (HF) service for patients admitted for the treatment of HF. The service will include the identification and triaging of patients (both at acute medical receiving units and when already admitted via General Medicine/other non-Cardiology departments) so they can be appropriately referred to the relevant Cardiology service and receive specialist HF input, and subsequently coordinating with primary care health services to ensure continuous appropriate care for HF patients after their discharge from hospital.

 

The JWP will focus on timely diagnosis, early initiation of HF treatment, rapid access to specialist care and planning for early supported discharge, post-discharge monitoring and early follow-up.

 

Expected Patient Outcomes for this Project: 

 

The following measures will be evaluated by the Trust:

  1. Development of an in-patient strategy/protocol and implementation procedures of the same to govern the clinical operations of the Service
     
  2. Positive increase against the following baseline percentage (%) measures as stated in the most up to date National Institute for Cardiovascular Outcomes Research HF audit (whether published or not) for Southend University Hospital:
  • Input from Consultant Cardiologist
  • Joint Working Executive Summary
  • ENT19-C035a May 2019
  • Input from specialist
  • ACEI on discharge
  • ACEI/ARB on discharge
  • Beta blocker on discharge
  • MRA on discharge

3. Patient satisfaction linked to the HF Service (PREMS)

Start Date and Duration: 30/06/2019

Project Period: 24 Months

Project Name: North West London Immune Thrombocytopenia (“ITP”) service development Joint Working Project (“JWP”)

Joint Working Project Summary:

Hammersmith Hospital is part of the Imperial College Healthcare NHS Trust (“the Trust”) and is the centre for Immune Thrombocytopenia (“ITP”) treatment and care across North West London (“NWL”). Eight other local partner Hospitals, across a catchment population of 1.5 million, link with Hammersmith Hospital for ITP clinical guidance and advice to form a clinical ITP Network (“the Network”). The Hammersmith ITP clinical team (“the NHS team”) recognise there is a growing demand on the ITP service at Hammersmith Hospital1,2. There is also no formal process to assess or improve the ITP patient pathway service across the Network in line Hammersmith ITP service standards2,3. This is impacting the ability to improve the quality of care and patient satisfaction of the ITP patient pathway service at Hammersmith and across the other NWL Network Hospitals.

The aims of the JWP are to improve the quality of care and patient satisfaction of the ITP patient pathway service at Hammersmith Hospital and across the Network. This will be achieved by a new Clinical Nurse Specialist Pathway Coordinator (“CPC”) working with the NHS team and the other Network Haematology teams to implement and coordinate new dedicated CPC / CNS led ITP clinics for stable ITP patients. These clinics will be for ITP patients deemed suitable by the local Consultant, at Hammersmith and other Network Hospital sites. The clinics will provide consistent and timely access to treatment and clinical reviews along with the provision of tailored patient support and information. Subject to the views of the local Network Hospitals site, the CPC will either run the new ITP clinics or train a local CNS to run the clinics.

The NHS team and Novartis will jointly fund the CPC role, with Novartis providing JWP management to track progress at regular JWP meetings. The NHS team will provide clinical oversight, training and ongoing support for the CPC along with generating service levels reports to review at JWP meetings.

References.

  1. Imperial College Healthcare NHS Trust Annual Report 2015-16. https://www.imperial.nhs.uk/~/media/website/about-us/.../annual-report-2015-16.pdf
  2. Personal communication from Dr Nichola Cooper, ITP lead for Hammersmith Hospital.
  3. Hammersmith ITP service standards. Document provided via email from Dr Nichola Cooper and kept on file.
  4. Definition of Holistic Needs Assessments. https://www.england.nhs.uk/wp-content/uploads/2016/04/cancer-guid-v1.pdf

Novartis ITP Pocket Log / App: www.itpsupport.org.uk

Expected Patient Outcomes for this Project: 

The JWP will improve the quality of ITP patient care and patient satisfaction via the dedicated CPC / CNS led ITP clinics in terms of the following:

  • reduced time waiting in clinic;
  • tailored patient consultation, advice, materials and treatment plans;
  • a poster / letter to advertise the new service;
  • sign-posting to psychological support, benefits advice and Holistic Needs Assessments (“HNAs”)4;
  • regular clinical assessments and blood test reviews;
  • patients able to utilise the benefits of the ITP Pocket Log / App5 to support disease understanding and improve compliance to treatment;
  • support clinic attendance / reduce the need for unplanned calls to the ITP service / Hospital.
  • CPC organised and facilitated meetings for ITP patients to talk about their experiences of the ITP service across the NWL Network and make suggestions for improvements.

Financial Contribution: As detailed in the Joint Working Agreement

Start Date and Duration: Start date by the end of June 2019 with an expected duration to the end of June 2021.

Project Period: 24 Months

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