North West London Hospital Trust
Development of a training post for a CNS in prostate cancer care
Meet the team
North West London Hospital Trust covers a large area with several acute settings across three London boroughs (Harrow, Brent and Ealing); this means that patients often have complex care pathways with care being provided at more than one site.
The urology service is delivered by a large multidisciplinary team comprising of surgeons, oncologists, radiologists, and specialist nurses. Around 70% of the cancers treated by this team are prostate cancers. The team’s resources are stretched, largely as a result of the number of new diagnoses as well as continually managing men with a relatively stable condition from the secondary care setting.
The Prostate Cancer UK Nursing Workforce Survey 2014 found that the workforce is ageing and nurses caring for patients with prostate cancer are no exception. 49% (140) of nurses declared that they are eligible for retirement or intending to leave the profession within the next 10 years.
It is important that we look at models which support training posts.
The big idea
Prostate Cancer UK funded a training post for a Band 6 nurse. A training post was funded in order to develop a new specialist nurse able to; work in urology, support the capacity of the team and improve services.
The post supported the team of specialist nursing staff, allowing them to carry out key improvement projects that they otherwise would not have capacity for. The service improvement work ensured men met a CNS at diagnosis, and reviewed follow-up support for men after their treatment for prostate cancer.
Evidence of the challenges associated with follow-up care within the Trust were made clear in the National Cancer Patient Experience Survey and the Trust’s recent involvement in an NHS Improvement Study of patient satisfaction in cancer aftercare. The team wanted to address these challenges and improve services.
Making it happen
The post-holder, as well as developing new specialist skills and knowledge, offered the specialist team extra capacity which allowed them to undertake the following improvement activities:
- Starting a clinic at the point of diagnosis to ensure all men meet a CNS and have a Holistic Needs Assessment.
- Develop a nurse led telephone Active Surveillance clinic.
- Review survivorship services for prostate cancer patients.
The post-holder undertook learning activities throughout the contract in order to develop specialist skills in this area. They also received support and training from the senior nurses on the team.
One of the key lessons was to ensure that the multidisciplinary team (MDT) were kept informed of the service development work and the role of the CNS team and the training post. This helped to ensure that any changes had the support of the MDT.
The main outcome for this post was career development and to increase the specialist knowledge of a Band 6 nurse. During the time in post the knowledge of the nurse has improved. She has completed an MSc in Prostate Cancer Care. The role was reviewed midway through the project and progressed to Band 7 after proving that the nurse met the objectives set to work at this level. The funding for the role has now been picked up by the Trust and she is a permanent member of the team.
The other outcomes centred round capacity and service improvement. The introduction of the post has allowed the team to scope out and introduce a nurse led telephone Active Surveillance clinic for prostate cancer patients and a Holistic Needs Assessment (HNA) clinic. The HNA clinic is at point of diagnosis to ensure needs are identified and met and that all men met a CNS at this point.
Both these service developments have improved the service available to men. A survey conducted about the CNS service showed the patients were satisfied with the service, with 90% strongly agreeing that there were provided with sufficient emotional and psychological support by their CNS at diagnosis. 100% strongly agreed that they received sufficient information from their CNS at diagnosis.
The number of patients who are able to see a nurse at diagnosis has increased from 68% to over 95% since the additional role has been in place.