The Christie NHS Foundation Trust

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

Project Period: 24 months

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.

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 & Duration: June 2019 – August 2021 (26 months)

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

Partner Organisation(s): The Christie NHS Foundation Trust

Completion Date: December 2021

Outcome Summary: 

Freeing up capacity within the NET clinical team and enhancing patient care by introducing a Clinical Support Worker (CSW) role to manage non clinical tasks. Permanent funding of the role has been secured by the Trust from January 2022.

Key Project Outcomes Data:

Unplanned admissions of NET patients to the Oncology assessment unit has reduced by 68% over the duration of the project and average length of stay has reduced by 40% with 29% more patients feeling they got to spend enough time with the HCP during their consultations.

Outcomes: 

Telephone clinic: 57 patients were referred to the new telephone clinic to be formally assessed by the nursing team.  A snapshot audit for the first year revealed that 23% of patients required earlier medical intervention. The introduction of a telephone clinic run by the Clinical Nurse Specialists (CNS), as a result of freeing up of workload following in the introduction of the CWS, allows for rapid safety netting of patients with unresolved symptoms, which in turn promotes patient safety

Holistic needs assessments (HNA): Following a 6 week trial of HNA, 65% of new NET patients have now been offered a Holistic needs assessment, exceeding the 60% target. 31% of the patents offered HNA declined, as they felt their needs and concerns had been met by the clinical team already. 

Patient Satisfaction:

Staff Satisfaction:

Unplanned Admissions and Length of Stay: ​​​​​​​

Patient survey regarding their views on the NET clinic:

Question:	Compliance (Jul 2018) n= 51	Compliance (Nov 21) n= 21
Patients feel that they have been given adequate information that they understand about their condition	34/49 (69%)	14/20 (70%)
Do you feel you were given the information in a way that you could understand?	37/50 (74%)	16/21 (76%)
Did patients feel that they were treated with dignity and respect during their consultations (%Yes all of the time)	44/50 (88%)	19/20 (95%)
Did patients feel they got to spend enough time with the HCP during their consultations (% Yes definitely)	33/50 (66%)	19/20 95%
Does the patient know who to contact should they have any problems or queries (% Yes)	44/51 (86%)	18/20 (90%)

Quote From Partner:

“The collaboration between the pharmaceutical company and our Neuroendocrine team has led to a very successful JWP. The introduction of a Band 4 Clinical Support Worker (CSW) has improved the quality of care the Clinical Nurse Specialists can provide and resulted in an improvement in patient satisfaction. Not only did this project positively impact patient care, it also improved staff satisfaction by increasing capacity and reducing administrative tasks. The detailed data collected throughout the two years, all contributed to the success of the project and this data was utilised to secure permanent funding.” Natalie Barratt, HPB and Neuroendocrine Clinical Nurse Specialist

The Conclusion:

The CSW role has been invaluable to the NET clinical team and has improved the quality of care the nursing team provide; for example, holistic needs assessments have now been introduced. In addition, a dedicated telephone clinic allows for rapid assessment of patient’s clinical symptoms and intervention, which promotes patient safety. The CSW role has increased the capacity of the nursing and medical team by reducing administrative tasks which in turn has improved staff satisfaction. Patient satisfaction has also improved over the duration of the project. Permanent funding for the role has been secured by the trust from January 2022. 

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