National Acute Oncology Conference 2017 - New Services top tips

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New Services workshop feedback
Many thanks for taking such an active part in our workshop, we do hope
you got as much out of it as we did! As we discussed, we have put
together some ‘top tips’ for managing service set up or service expansion;
these are a combination of the discussions had during all 4 workshops, as
well as some thoughts that Lisa, Cathy and Rosie have had. We have also
included at the end the emails of those of you who had ideas/services
that are of interest to everyone and who kindly agreed to share their
contact details.
We do wish you success in the set up/expansion of your services, and we
are very happy to be contacted if you feel we can be of assistance.
- Lisa Barrott (Cancer Matron BSUH NHS Trust):
lisa.barrott@bsuh.nhs.uk
- Rosie Roberts (Velindre/SWCN chemotherapy specialist
nurse/Macmillan AO project manager): Rosie.Roberts3@wales.nhs.uk
- Cathy Hutchison (Cancer Consultant Nurse, Beatson West of Scotland
Cancer Centre/NHS Greater Glasgow & Clyde):
Cathy.Hutchison@ggc.scot.nhs.uk

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Top Tips
Starting out
• Ensure you collect baseline data to measure against and prove you are making a
difference. Include both quantitative and qualitative data eg door to needle time for
sepsis. Length of stay for CUP patients, numbers of complaints and patient
experience.
• Have an awareness of the ‘big picture’ ie what are the Trust /Health board /hospital
priorities- build your business case for funding using the right emphasis that reflect
these priorities to give better chance of success.
• Don’t reinvent the wheel – find out what others have done and learn from their
successes and their mistakes. Useful group: UKONS Acute Oncology Forum.
• Don’t be afraid of trying a new model if what others have done will not fit with your
local situation.
Engaging with others
• For a sustainable service – need to negotiate cross-cover for absence.
• Importance of gaining support from colleagues who may feel threatened when
services first set up – ensure they know how you can help them and engage them
with supporting you with OOH services.
• Establish close links with key people in the emergency admission departments and
acute medical departments, palliative care, haematology, site specific CNS, triage
services. Networking is time consuming and can be slow to show benefits, but you
will reap real rewards from putting the effort in.
• As early as possible establish a visible presence in clinical areas, communicating with
and engaging with teams in Emergency Departments, Medical & Surgical Assessment
Units, & Palliative care.
• Manage expectations of what the service is able to offer.
AOS team /human resources
• Identify skill mix needed for your service eg balance of medical /nursing roles
/administrative support.
• If possible your team should have a mixture of skills and experience eg oncology /
chemotherapy/acute care /palliative.
• Ensure budget and time built in for professional development to help motivate and
retain staff.
• Admin time to support service is essential.
• Need to have clearly agreed roles with agreed boundaries & guidelines. Acute
Oncology is by nature a grey area; however, it is important to have clear priorities at
the start of the service, and then negotiate role expansion as you go forward.
• Need to include developmental posts and equip staff with education, knowledge and
skills for the role. Macmillan are keen to support developmental posts so speak to

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your local link. Search what courses are offered through your local university as it is
best to work with them to create programmes of study that fit your needs. If none
currently available, look at what is available nationally.
Practical resources
• Ideally have 1 contact number / email for AOS team for clarity.
• Make friends with IT – set up a database to capture activity and outcomes. Ensure
whatever database you go for is supported by your IT department, so if things go
wrong with it, they are there to help fix it! consider the Somerset Cancer Register
(well recognised, national system with new AO & MSCC pages).
• Establish a website or pages on existing hospital/cancer network sites with details of
your service, protocols and pathways.
• Cancer flag – start by looking at what other ‘flags’ are already established in your
organisation as it’s much easier for IT to model the cancer flag on an already
established system.
• Don’t forget to identify office space, desk, chairs, computers, printers, phones etc.
• Consider what referral system will work best for you, for example an email referral
system.
• Develop clear referral criteria for the service, whether this is for an AO review or if
you are developing an Acute Oncology Assessment Unit, to manage expectations and
ensure you are not overloaded with inappropriate patients.
• Consider attendance at acute medical meetings if they exist in your hospital (good
for networking/visibility and picking up referrals).
• Find out what access you have to inpatient beds within oncology/haematology: this
may sound obvious, but understanding the pressures on beds and how the system
works is vital. Can you access an area for an assessment unit or will patients be
directed in via A&E/ chemo unit etc? consider what is your ideal and then look at
ways of achieving it (this is likely to be a long process, your data will be key to
supporting any business case for a separate unit).
______________________________________________________________________
Education
• Education is vital and must be prioritised Use every opportunity – often one to one
ad hoc or planned, may need to be OOH, meet staff where they are, understand
their pressures and the reality that acute staff rarely have time to take out for
training /education.
• Target your education to the key staff –focus on the front line staff dealing with
acute admissions.
• Use baseline audit /questionnaire to assess how much staff already know about AO
and then prove the difference you have made over time.
• Get involved with established training and induction programmes for key staff
groups.

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7 Day Service
• The most common challenge to be raised at the workshops and one that there is no
easy answer to! Main considerations are: funding, staffing, skill mix, what the
weekend service should look like – same as during the week or reduced. Is there the
same need in your area OOH?
• Consider working with colleagues: can a joint service be provided at weekends with
palliative care/site specific CNS involvement?
• Could a CNS be present in A&E at weekends to provide expert advice, but with the
clinical support of the A&E team?
Working across primary and secondary care
• Make contact with your local ambulance service: do they have a computer system
accessed by their paramedics where relevant patient info is stored? This can help
ensure patients get the appropriate care and may avoid being brought to A&E.
Consider getting teaching programmes set up with the paramedics on AO
presentations.
• Make contact with the GP Cancer lead within your local commissioning groups (or
similar): they can assist in reviewing what the local need is and what services you can
link into in primary care. Input at primary care conferences to promote
service/educate GPs and practice nurses/ANPs on AO.
• Are there Macmillan GPs in your area who may be able to help?
Useful contacts
• Dr Arun Selvaratu: oncologist at Southampton. Large AO service with acute
assessment unit and several ANP posts; providing a 7 day service:
arun.selvaratu@uhs.nhs.uk
• Dr Sharath Gangadhara: oncologist at Bath; looking at 7 day service currently:
sharath.gangadhara@nhs.net
• Clare McGuire: works at Basildon and Thurrock NHS trust where palliative care are
supporting a 7 day service: clare.mcguire@btuh.nhs.uk