Scott's story

About Scott

Scott Little is a CNS at the Lothian Prostate Cancer Specialist Nurse team in Scotland. Scott tells us about the current structure of the team, how they deliver care to men from diagnosis to post-treatment follow up and challenges they face.

The situation

Current set-up

The team cover the Lothian area, but can also see and be referred patients from Fife, The Borders and Dumfries and Galloway.

The team:

• Uro-oncology - three Band 6 CNSs
• Four Band 7 Specialist/Advanced Nurses which compromises
• One CNS
• Two Advanced Nurse Practitioners (ANPs)
• One robotic surgery coordinator

Our referral process

Scott said, “Each week our trust receives approximately 20 referrals of men with a raised PSA. All referrals are then consultant-triaged to a raised PSA pathway (overseen by our urology ANPs).

“These referrals are separately triaged by our ANP team to check for other causes of a raised PSA before sending patients to clinic, mpMRI or biopsy. Through this we aim to reduce patient anxiety, improve communication and remove inconsistencies in the clinical decision making we currently see with consultant led triaging.”

Diagnosing patients

Scott said “Our ANPs perform prostate biopsies and see patients with a prostate cancer diagnosis in clinic to deliver the diagnosis and discuss the treatment options”.

Treating our patients

Scott says, “Our urology CNS oversees men on Active Surveillance. Using the same CNS keeps our approach consistent as our patients have one point of contact for support.

“The robotic coordinator’s role is to support the delivery of men undergoing robotic-assisted radical prostatectomy (RARP). They’re also the first assistant in theatre during the procedure.”

Delivering support

Scott said “One of our ANPs and our urology CNS provide further support, post treatment, through our erectile dysfunction clinic.

“Our uro-oncology team will see most of our newly diagnosed patients. They act as a point of contact and to transfer patients from urology to the oncology setting. They’ll see all men post brachytherapy and external beam therapy for up to two years in clinic. They also provide clinics and support for men with metastatic castration-resistant prostate cancer, receiving Abiraterone/Enzalutamide and Radium.

“Our uro-oncology team provide lifelong support for all men discharged to the postal follow-up service.”

Our challenges

Scott says “Whilst we have a research team based in oncology, there’s no formal urology research team and this work tends to be picked up by the CNS and ANPs.

“Our service is reasonably well staffed but there’s a lack of career development and not enough succession planning. Both our ANPs are now beginning to plan for their retirement. We also have a shortage of time to plan for and be involved in nurse led research.

“There is desire within our Trust for CNSs to take on further learning through a Master’s degree but there isn’t much support for staff to make this possible.

“The future will present further challenges for us, with increasing volume of patients, which will increase the pressure on all services.”