Trust Clinical lead Improving services for upper GI (OG) cancer Application template (Version 2) Managerial lead Date completed 14 June 2013 Barnet & Chase Farm Hospitals NHS Trust Dr Marta Carpani Upper GI Cancer Lead Clinician, Consultant Gastroenterologist Mr Fergus Browne, Senior Cancer Business Manager Applying to provide: Local OG Cancer unit Specialist OG Cancer surgical centre Proposed sites Local OG Cancer unit Complete Part I Specialist OG Cancer centre Complete Part II Barnet & Chase Farm Hospitals NHS Trust Application Template Final 10.05.2013 (Version 2)
Vision for future upper GI (OG) cancer services Please outline your organisation s broad vision for the delivery of upper GI (OG) cancer services. BCF is committed to the future development of our Upper GI {OG} cancer service for the local population. We will continue to provide a full range of diagnostic and palliative services via our multidisciplinary, Peer Review compliant, Local Upper GI Cancer MDT, recognising that the majority of this patient group will require palliative treatment at BCF. We will continue to work closely with designated tertiary treatment centres to ensure that all OG cancer patients have access to a full range of surgical and oncological treatment options. The Trust will review the provision of supportive care services to ensure that all OG cancer patients have access to assessment, care planning and intervention from a Clinical Nurse Specialist and Senior Specialist Dietician throughout their treatment and follow up. Business cases for Upper GI CNS and Dietician, and a new Endoscopy Unit are currently in development. The long term strategy for BCF oncology service is to provide in house chemotherapy day care to GI cancer patients in collaboration with in reach oncologists from the tertiary treatment centres. Have you secured trust board-level approval for your application? (please give details) This bid has been discussed and approved by the Trust Cancer Board and has Board level approval. Have you discussed your proposals with other trusts and/or local GPs? (If so please give details) There have been discussions with both specialist surgical centres and oncological centres as part of our current integrated local cancer network. Have you discussed your proposals with any other relevant stakeholders? (If so please give details) Has already been discussed via pathway board and commissioners. 2
Part I: Outline of proposed Local OG cancer unit N.B. The high-level summary in the column below provides an overview of the main features addressed by the service specification at each pathway stage. Please consult the service specification document for a more detailed description of the provision we would expect services operating at this level to offer. Part of pathway High-level summary of specification Proposal Developments necessary Diagnosis of cancer Fast-track referrals for patients with suspected upper GI (OG) cancer BCF will continue to provide a full endoscopic and radiological diagnostic service for fast track referred patients with suspected upper GI {OG} cancer. Clinical nurse specialist present at all cancer diagnoses BCF have reviewed the current Upper GI CNS provision {1 WTE} as inadequate to ensure that all patients have access to CNS support from diagnosis. An additional 0.6 WTE is required. Business case for 0.6 WTE Upper GI Cancer CNS Band 7 currently in development Diagnostic facilities on-site (CT and MRI) BCF will continue to provide on site diagnostic facilities with CT and MRI scanners Robust coordination with other centres in situations in which facilities or resources are not available in-house (e.g. rapid access, PET- CT) BCF will continue to liaise closely with tertiary centres {University College and Mount Vernon Hospitals} that provide rapid access to PET- CT. MDT Clinical workforce trained in advanced communication skills Local MDT with conferencing capability with specialist MDT BCF will ensure that all the Upper GI Clinical Team have attended Advanced Communication Skills training. BCF will continue to provide video conferencing facilities. BCF will provide in house Advanced Communication Skills training for cancer clinical staff. The first of these courses is planned for October 2013. BCF is committed to regular and systematic maintenance and upgrade of VC facilities. Application Template Final 10.05.2013 (Version 2)
Part I: Outline of proposed Local OG cancer unit N.B. The high-level summary in the column below provides an overview of the main features addressed by the service specification at each pathway stage. Please consult the service specification document for a more detailed description of the provision we would expect services operating at this level to offer. Part of pathway High-level summary of specification Proposal Developments necessary Treatment decision Access provided to a key worker for all patients (usually a clinical nurse specialist) Carries out holistic assessment, including palliative care and travel needs Patients are offered all appropriate treatment options and all appropriate types of reconstruction whether or not these are available at that particular provider site BCF have an Upper GI CNS to ensure OG patients have access to a key worker from diagnosis and receive a Holistic Needs Assessment at key points on their cancer pathway. BCF will continue to provide a Holistic Needs Assessment as part of the Electronic Patient Record. BCF will continue to provide in-house endoscopic and palliative treatment and will continue to refer patients to tertiary centres for surgical and oncology treatment. The current establishment for CNS support in not sufficient and a business case for 0.6 WTE Upper GI Cancer CNS Band 7 currently in development. Decision-making process involves rehabilitation and supportive care and palliative care professionals The Upper GI Clinical Lead will ensure that dietetic, CNS and specialist palliative care professionals regularly attend the MDT and contribute to the treatment decision making process. Business case for Senior Specialist Dietician 0.7 WTE Band 7 currently in development. 4
Specialist Clinical oncology (where this service will be provided locally) Radiotherapy offered to all appropriate patients Oncologists with some sessions devoted to OG oncology BCF will continue to provide access to radiotherapy via referral to oncology centres with weekly in reach clinics with OG oncologist sessions on both sites. Access to a Specialist Dietitian with expertise in dealing with Upper GI BCF will ensure that OG patients referred to oncology have been assessed by a Senior Specialist Dietician. Takes full part in all relevant clinical trials BCF will ensure that OG patients have access to clinical trials via the oncology centres. Specialist Oncology: Chemotherapy Clear referral pathway with chemotherapy units if not delivered locally BCF will continue to provide access to chemotherapy via referral to oncology centres including weekly in reach clinics with OG oncologist sessions on both sites. The long term strategy for BCF oncology service is to provide OG chemotherapy day care on site. Neoadjuvant chemotherapy to be offered to all OG cancer patients who meet the criteria Adjuvant chemotherapy or chemoradiotherapy to be offered if appropriate BCF will continue to provide access for OG patients to Neo adjuvant and chemoradiotherapy via discussion with the SMDT and referral to tertiary oncology centres. Senior Specialist Upper GI Dietician available to see all nutritionally at risk patients. BCF will ensure that OG patients referred to oncology have been assessed by a Senior Specialist Dietician. Acute oncology Full acute oncology service that meets Peer Review standards BCF will continue to provide an Acute Oncology Service that meets Peer Review standards. 5
Post treatment Clear procedures governing the receipt of patients who have been discharged from care of the specialist treatment centres BCF has agreed procedures for receiving patients discharged from tertiary centres. Key worker/cns handover, and timely discharge summary communication, has proven to be critical for seamless care. BCF will continue to review the existing pathways and discharge procedures from oncology and surgical centres with our tertiary centre partners to ensure safe and timely transfer of patients back to local care. The BCF lead Clinician will review and agree discharge procedures with the successful Specialist Surgical Provider. Follow-up clinics for post-treatment patients (involving surgeon, oncologist, CNS, rehabilitation services) BCF will continue to provide post treatment follow up clinics for oncology and endoscopic treatments. Additional CNS and dietician will be required for rehabilitation in post treatment follow up clinics. BCF will work with the successful Specialist Surgical Provider to agree local surgical follow up arrangements. Palliative care Process in place to enable a patient s rapid readmission, if necessary Clear referral pathways for patients with palliative and specialist palliative care needs BCF will continue to provide patient rapid readmission via A&E, CNS liaison and Acute Oncology. BCF will continue to provide in house Specialist Palliative Care services and will continue to refer to community Specialist Palliative Care providers locally. Research and innovation Access to multidisciplinary oncology service including clinical trial research and research nursing BCF will continue to provide patient access to a multidisciplinary OG service that includes access to Clinical Trials in the tertiary centres and in house, as and when suitable clinical trials become available. The MDT Lead Clinician will review the OG Cancer CLRN Clinical Trials Portfolio. Patient travel Informs patients of support available for travel to specialist centre and radiotherapy units BCF will continue to inform OG patients of available travel support via the in house Macmillan Cancer Information Service and via close liaison with tertiary centres. 6
Part 2: Outline of proposed Specialist OG cancer centre N.B. The high-level summary in the column below provides an overview of the main features addressed by the service specification at each pathway stage. Please consult the service specification document for a more detailed description of the provision we would expect services operating at this level to offer. Part of pathway Summary of specification Proposal Developments necessary MDT Treatment decision Surgery Hosts a specialist MDT (specialist surgical centres only) Or video-conferences with specialist MDT (specialist chemo-radiotherapy providers) Patients are offered all appropriate treatment options and all appropriate types of reconstruction whether or not these are available at that particular provider site Decision-making process involves rehabilitation and supportive care professionals and palliative care professionals Close working relationship between both specialist surgical centres (prior to consolidation into a single surgical centre), with unified treatment protocols and sharing of skills, data, etc. Rigorous approach to surgical clinical trial participation Systematic data collection, including capture of outcomes Integration with local services and oncology 7
Part 2: Outline of proposed Specialist OG cancer centre N.B. The high-level summary in the column below provides an overview of the main features addressed by the service specification at each pathway stage. Please consult the service specification document for a more detailed description of the provision we would expect services operating at this level to offer. Part of pathway Summary of specification Proposal Developments necessary Post treatment Acute oncology Palliative care Research and innovation Patient travel services to provide a seamless experience for patients Provision for timely discharge and liaison with local units, primary care and local rehabilitation services Prompt provision of comprehensive discharge information following completion of treatment in line with national standards Process in place to enable a patient s rapid readmission, if necessary Full acute oncology service that meets Peer Review standards Clear referral pathways for patients with palliative and specialist palliative care needs Access to multidisciplinary oncology service including: tissue banking, clinical trial research, and research nursing Informs patients of support available for travel to specialist centre and radiotherapy units 8