Leeds Teaching Hospitals NHS Trust (LTHT)
Development of an administrative led remote service supported by Trust IT systems and clinical team
Meet Leeds Teaching Hospitals NHS Trust (LTHT)
Leeds Teaching Hospitals NHS Trust (LTHT) was established in 1998 and is one of the largest trusts in the UK. Prostate cancer services at Leeds have evolved over time in response to changes in need. Demand for services have grown rapidly, however resources available have not grown at a proportionate rate. This project focused on the development of an administrative led remote follow-up service which aims to provide remote support, assessment and information to empower men receiving long term prostate cancer follow-up and promote self-management.
The big idea
The original aim of this project was the development of an IT system driven virtual clinic, which aims to provide remote support, assessment and information to empower men receiving long term prostate cancer follow-up and promote self-management.
When the CNS started in post, it was established that first there needed to be a review of the current service and systems in order to understand service demands and the resources available. In addition, the team agreed that ensuring there was consistency within prostate cancer follow-up across the service was an important step before the virtual clinic could be introduced.
The team felt it important to ensure that men with similar disease profiles and risk factors were being assigned to the same follow-up care and a total of 21 evidence based risk stratified pathways of follow-up care were developed, agreed and implemented.
During the project it was identified that IT software initially identified to run the remote monitoring clinic had limited functionality and was not suitable for the virtual clinic. The CNS developed an administrator led service which used the current IT systems available. The model had clearly defined follow-up pathways, guidance on escalation and with clinical support and could provide the remote service until the Trusts IT team had completed development of their current Patient Pathway Management (PPM) system to incorporate a pathway driver.
Finding out what works
A Band 3 administrator has been trained in the use of the IT systems and remote monitoring service processes. Patients receive a letter at the beginning of the month their review is due which details which blood tests are required. The patient takes the letter to their GP surgery to arrange and have the required tests.
The Band 3 checks for results on a weekly basis of those patients invited to attend for blood tests. If the test results are within the agreed parameters the patient is sent a template letter stating blood test results, when and how they will be followed up, how frequently they should have their PSA checked in the future, signs and symptoms that may indicate a cancer recurrence and need investigating plus details of their diagnosis and a treatment summary.
Any blood test not within the agreed parameters is reviewed by the CNS who advises on action to be taken, continue with planned follow-up or book urgent clinic appointment.
Further work is being undertaken by the Trusts IT team to develop the pathway drivers within PPM following which the pathways will be uploaded into the system and patients electronically tagged to that pathway to implement the virtual clinic with administrative support they initially planned to develop.
- Undertake patient experience work prior to the project development to ensure patient engagement and to guide project development.
- Involve members of the multi-disciplinary team in project design to facilitate clinical team engagement and robust project planning.
- Engage the CCG at project commencement to ensure the project develops in line with all stakeholders priorities and work streams.
- Work collaboratively with non clinical colleagues to ensure processes and systems are correctly understood and fit for purpose.
- Fundamental to have a project leader with appropriate clinical knowledge in additional to the clinical team with no clinical responsibilities.
Initial patient feedback has been positive
'Great improvement in communication skills as letter I received was in language that is easily understood.’
‘I have always known the PSA was important but never had any idea it was a bad sign.’
Patient experience survey has been completed as a baseline and will be repeated in 12 months following completion of project to assess the improvements and impacts since the implementation of the pathways and remote monitoring service.
Initial results are showing improved use of resources. Since the introduction of the remote monitoring service the long term follow-up care of 700 men has been transferred from Consultant and CNS led follow up.
Work is being completed to estimate financial implications for LTHT and the CCG in relation to the changes made through the redesign of follow up services.