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:
| Milestone | Description |
|---|---|
| 1 | Kick off meeting – completed AS OF THE AMENDMENT NO.1 EFFECTIVE |
| 2 | Confirmation from the CWP of the employment of SACT LACP; on-boarding Complete collection of baseline aggregate comparator data – completed AS |
| 3 | Novartis Solution Implementation Manager* and Professional Relations Commencement of Clinical Activity- completed AS OF THE AMENDMENT |
| 4 | Carry 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 Develop business case to support future funding by the CWP to |
| 6 | Carry out 9 months of clinical operations according to the developed protocols. |
| 7 | Carry out 12 months of clinical operations according to the developed Submit business case to support future funding by the RM to continue |
| 8 | The 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 |
*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
Project Name: Royal Marsden Breast Cancer Capacity Service Redesign
Organisation(s): The Royal Marsden NHS Foundation Trust
Completion Date: October 2025
Outcome Summary:
Royal Marsden Breast Cancer Capacity Service Redesign successfully transformed the delivery of SACT treatments and care to patients at the Royal Marsden.
Through the introduction of a dedicated Advanced Clinical Practitioner (ACP) role, the project improved clinic capacity, patient experience, streamlined service delivery, and enhanced workforce satisfaction.
The Pathway Mapping highlighted certain areas for discussion:
- Minor operational tweaks to Service Performance
- Variation in Care & Lack of Standardisation
- Communication Gaps
- Clinic‑Related Issues
- Pharmacy‑Related Issues
- Education, Roles & Patient Experience
Key Projects Outcomes Data:
- Establishment of nine regular Oral SACT Clinics across three Royal Marsden sites, creating a structured and sustainable model of care.
- Positive feedback from patients and staff via the Friends and Family Test, indicating improved satisfaction and confidence in care.
- Successful integration of monitoring and education into patient pathways.
- Introduction of innovations such as electronic Patient-Reported Outcome Measures (ePROMs).
- Additional funding Secured for Kingston site (0.2 FTE), enabling one extra weekly clinic and supporting ~20 patients per month.
Outcomes:
The Oral Systemic Anti-Cancer Therapy (SACT) Clinics Project at The Royal Marsden NHS Foundation Trust successfully addressed increasing demand and workforce pressures within the breast oncology services through the introduction of a dedicated ACP and the establishment of oral SACT clinics across three sites.
Nine regular clinics were launched, helping to deliver improved patient experience and streamlined service delivery, as evidenced by the positive feedback from patients and staff via the Friends and Family Test.
Additional achievements include securing funding for expanded capacity at Kingston, reducing pressure on satellite units.
The project also identified challenges in how NHS Trusts are reimbursed for oral SACT, an issue that has since been escalated to a national level and included in ongoing negotiations.
Despite challenges, including an NHS recruitment freeze, the initiative demonstrated a scalable and sustainable model, supported by a submitted business case and findings prepared for peer-reviewed publication.
Lessons learned highlight the importance of clear clinic ownership, capacity planning, and digital integration for long-term success. Overall, the project has helped transform care models, improved patient outcomes, and delivered measurable benefits to both patients and staff.
Conclusion:
The Oral SACT Clinics Project successfully transformed service delivery, improving patient experience and workforce wellbeing. Despite recruitment constraints, the model is scalable and sustainable. Future priorities include:
- Embedding ePROMs.
- Publishing project outcomes to the oncology fraternity.
- Continuing advocacy for the ACP role.
- Continued funding for the ACP roles following a successful Business Case submission.
FA-11578999 | December 2025