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

2. WiFi name: WifiLoveMCR Password: internet Join the conversation on Twitter using #DrivingChange

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

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