Project Name: Royal Marsden Breast Cancer Capacity Service Redesign

Project Summary:

The Collaborative Working Project (CWP) aims to free up capacity within the breast cancer pathway with the addition of a dedicated new role (the “Systemic Anti-Cancer Therapy Lead Advanced Clinical Practitioner (SACT LACP)”) providing pre-treatment education and optimisation, and support for the management, pre-assessment, review, education, and follow-up of metastatic breast cancer (mBC) patients who are eligible for Systemic Anti-Cancer Therapy (“SACT”) therapies. There is a national attention on the stability of breast oncology services and an urgent need to pilot new workforce options and ways of working to manage increasing demand. Demand is increasing at an unprecedented rate within breast oncology services at the Royal Marsden NHS Foundation Trust (RMFT). 

Specifically, by using established Process Mapping methodologies1 to integrate the new workforce role into all aspects of the service, the CWP aims to: 

  • Improve patient outcomes and experience by having a dedicated single point of patient contact to educate patients in relation to the available SACT options in the UK and conduct the relevant monitoring required e.g., blood glucose, ECG monitoring, respiratory monitoring, cardiac function. At present, SACT therapies which require these monitoring could potentially be delayed because of the service implications.
  • Provide a single point of contact to the wider clinical team to educate and provide ongoing advice and guidance so that all NICE approved treatment options are available to the patient.
  • Decrease the clinic burden on the current workforce and increase their satisfaction, reducing the risk of workforce burnout.
  • Optimise the proportion of duties performed by each healthcare professional (HCP) that are most appropriate to their skillset.
  • Gather relevant service metrics to develop a business case for the ongoing employment of the new workforce role beyond the scope of this project.
  • Reduce unplanned medical reviews and admissions.

Following commencement of the project the CW Partner uncovered that there were more patients than expected that required review. To ensure all patients have timely access to clinic appointments and treatment the Parties have agreed that an additional 8A Advanced Clinical Practitioner (ACP) 0.2FTE would be required for the remainder of the duration of the project (approximately 6 months clinical duration) at Kingston Hospital. The role will mirror the existing CWA post, completing all of the duties of the SACT LACP at the Kingston site.

Planned Milestones:

MilestoneDescription
1Kick off meeting – completed AS OF THE AMENDMENT NO.1 EFFECTIVE
2

Confirmation from the CWP of the employment of SACT LACP; on-boarding 
and familiarisation. 

Complete collection of baseline aggregate comparator data – completed AS 
OF THE AMENDMENT NO.1 EFFECTIVE

3

Novartis Solution Implementation Manager* and Professional Relations 
Manager* to conduct Pathway Mapping Workshop 

Commencement of Clinical Activity- completed AS OF THE AMENDMENT 
NO.1 EFFECTIVE

4Carry out 3 months of clinical operations according to the developed 
protocols completed AS OF THE AMENDMENT NO.1 EFFECTIVE
5

Carry out 6 months of clinical operations according to the developed 
protocols. – completed AS OF THE AMENDMENT NO.1 EFFECTIVE

Develop business case to support future funding by the CWP to 
continue with the service

6Carry out 9 months of clinical operations according to the developed 
protocols.
7

Carry out 12 months of clinical operations according to the developed 
protocols.

Submit business case to support future funding by the RM to continue 
with the service

8The Royal Marsden will host a virtual lunch and learn session to share 
the learns and outputs of the CWP with a trust  
9

Submit final CWP report to Novartis.

Within 2 months of completion of clinical activity the CWP, in collaboration 
with Novartis, is to develop the outcomes summary for publishing in line 
with the ABPI guidelines

*Solutions Implementation Manager is a non-promotional role within Novartis
*PRM working under non-promotional role in this meeting

Expected Benefits:

Expected benefits to patients.

  • Increased access to equitable, consistent, and standardised care for mBC
  • Increased access to education on mBC and treatments, to improve adherence and consequently improve patients' outcomes: supported by a personalised care plan. 
  • Reduce patient waits in the clinic given extra capacity created by new workforce role.
  • Reduce unplanned medical reviews and admissions.

Expected benefits to the organisation.

  • Increase the overall quality of care and improve equity of access to specialist care for patients with mBC requiring treatment initiation, evaluation, and monitoring.
  • Provision of subject matter expertise to educate other members of the clinical team on treatment options.
  • Provide a single point of contact for patients, thereby reducing the potential for unplanned calls being received by the wider clinical team.
  • Free up consultant capacity for clinical activities that are unique to their skillset.
  • Reduce use of emergency triage line and unplanned admissions
  • CWP would highlight RMFT as an exemplar.

Expected benefits to Novartis.

  • Better understanding of overall HCP and patient needs
  • Optimal use of medicines in line with local/national guidance (including Novartis medicines) in appropriate patients
  • Ethical, professional, and transparent relationship between Novartis and the Healthcare Organisations

Start Date & Duration: November 2023 18-month project 

FA-11347297 | January 2025