Better Connections and Navigation: Macmillan Cancer Navigator Service at Imperial College NHS Trust

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What is the Cancer Navigator Service? Macmillan Cancer Navigators is an enhanced phone based service for cancer patients, their family/carers and primary care services The Navigators triage all calls from cancer patients, and using a PRAG system are authorised to action calls or to refer to more appropriate person primarily CNS

Evidence of Need Poor patient experience – as highlighted by successive National Cancer Patient Survey results, particularly the ability of patients to contact their CNS CNS time inappropriately taken up with routine admin/non specialist tasks reducing the time and attention available for clinical work and innovation

The context Cancer Navigators were developed as part of a Whole System Redesign partnership between Imperial College NHS Healthcare Trust and Macmillan Cancer Support Other programme work-streams include: CNS development Schwartz Rounds VBS Living With and Beyond Cancer

expected outcomes To improve patient experience by: Ensuring that patients receive a timely response to their queries and have a positive seamless experience of accessing cancer services, support and information Freeing up CNS time to focus on appropriate patient support, clinical care and innovation

Design and Induction To create competent staff and raise the VALUE of the team Orientation and training is essential for each Navigator:- Attendance/observation of MDTS & relevant departments & services - to enhance understanding of role & function Radiology diagnostics & treatment areas ensures visualisation of service & increased understanding of service & treatment to reassure patients Ability to book/check appointments - ensures speedy response to patients Instigation of PRAG rated triage assessment sheets Designed to speciality needs with CNS teams Key manager / leader initiatives Establishment of regular team meeting 1 to 1s for each team member Monthly ‘Supervision Sessions’ whole team to attend Promotion of service CNS to inform patients about the service remit Navigator information leaflet

Process-mapping: 62 day pathway First OPA Cancer Referral Centre Initial Diagnostics MDT Tracker MDTT already takes patient through this part of pathway If patient calls Navigator at this stage, refer to Tracker Escalation route for missed appts? MDT Meeting MDT Coordinator responsible for MDT actions Trackers responsible for tracking/booking and contacting patient at pre-diagnosis stage Post MDT / Diagnosis MDT Coordinator & CNS confirm which patients have been diagnosed MDTC and CNS allocate any actions to Trackers and Navigators E.g. Whether the Tracker continues to book any further investigations needed or not Staging Diagnostics Post MDT Navigators make outbound calls to patients Navigators may make investigation appointments depending on Post MDT guidance N.B. Escalation route for Navigators if they aren’t able to schedule these? Navigators also manage rebooking process for patients at this stage Treatment Navigators responsible for outbound calls to patients Escalation route to CNS for clinical issues and MDTC for CWT related issues End of Treatment Transfer to OAFU

Evidence of Impact Improvement in score of National Cancer Patient Experience Survey- most notably a 23% increase in the ability of patients to easily contact their CNS Multiple CNS led innovations including: PREPARE programme in OG- an innovative prehab programme leading to nurse of the year award for lead CNS 2016 Introduction of HIPEC: a specialised treatment for colorectal patients- one of only 5 centres in UK Redesigned Urology Pathway including multiple CNS led clinics and development of Open Access Follow Up Development of telephone clinics across tumour sites

Learning Renewal is central to success Ongoing communication between navigators and CNS teams particularly is essential e.g. each attending the others team meetings Team Leader necessary to manage the day to day activities Banding is such that there is likely to be a regular staff turnover as staff seek professional advancement or perhaps face-face roles Clinical supervision is critical Review of what does/doesn’t fall in the role remit is important

Possible Future Developments Integrating the Navigator role with Tracker and OAFU roles to ensure renewal of skills