City Hospitals Sunderland NHS Foundation Trust serves a population of around 350,000, as well as providing specialist services for the wider area. Urology services in the Trust are based on a hub and spoke model, with Sunderland being the hub, working in partnership with ‘spoke’ sites in Durham and South Tyneside.
Prior to the project, there were no prostate-cancer specific Clinical Nurse Specialists (CNSs) in the Trust. Instead, CNSs worked across the five urological cancers. This had a number of limitations, particularly around patient access to a CNS, and experience and quality of care; for example, patients did not always have a CNS present at diagnosis. These issues were highlighted by the 2012/12 National Cancer Patient Experience Survey, where the trust scored poorly for prostate cancer. The need for prostate cancer-specific CNSs was further enhanced by the rising incidence of prostate cancer in the area.
To address these problems, the project employed two prostate cancer specific CNSs (funded at Band 7).
The nurses introduced a service for patients from diagnosis through to follow up and survivorship, including a nurse led review clinic and Holistic Needs Assessments (HNAs). The aim was to provide a more coordinated and seamless care pathway, as well as ensuring that patients were handed over safely and effectively to primary care.
All patients were given the CNSs’ contact details, and made aware that they could contact them at any time.
Alongside their main CNS work, the team ran pre-op workshops for men undergoing radical prostatectomies, in order to prepare them better for surgery. They also ran two survivorship workshops per year.
There have been some time restraints with the new service particularly in relation to HNAs and finding the best way to complete them. It remains an ongoing challenge to successfully complete the HNAs and ensure that the men have time to review their answers. Several options have been trialled including posting the HNAs to patients at home, phoning patients and offering clinic appointments. The best way to complete the HNA is still being reviewed.
There was some resistance to change in relation to the pre-op workshops by other health care professionals. Ongoing communications with health care professionals about the benefits of the workshops helped to resolve this.
Patients have responded positively to having their prostate cancer follow up performed by the CNS in the nurse led clinic. Consultants are also utilising and referring patients into the clinic. The business manager has recognised the increase in numbers within the nurse led clinic and acknowledged the positive impact this has had on capacity in consultant led clinics.
Results from a patient experience survey for the service including the pre –op workshop include:
Following on from the funding by Prostate Cancer UK both posts will be funded long term by City Hospital, Sunderland.
This project has been funded through our Health and Social Care Professionals programme
If you would like to learn more about this project please contact healthroles@prostatecanceruk.org