Effective Cancer management: framework

Allied Health Professions

A diverse group of clinicians who deliver high-quality care to patients across a wide range of care
pathways and in a variety of different settings. They play an important role in the cancer pathways and
modern health and social care services.

*AHPs include dietitians, physiotherapists, diagnostic radiographers, therapeutic radiographers, speech
and language therapists.

Advance Nurse Practitioner (ANP)

A highly skilled nurse who can be placed within primary care to clinically assess and make decisions on referral to secondary care, where there is a suspicion of cancer. ANPs can also be found within secondary care, often playing a core role in cancer pathways be that running clinics or performing diagnostic tests for example.

Active Clinical Referral Triage (ACRT)

Ensuring that all referrals to secondary care (including advice and patient-led referrals) are triaged by a senior clinical decision maker to evidence-based, locally agreed pathways after reviewing all the appropriate electronic patient records.

Cancer Manager Forum (CMF)

Network of Cancer Managers, and others who participate in managing cancer patients, across NHS Scotland. The peer-to-peer forum, that meet quarterly, enables the group to seek support and build successes from shared experiences.

General Practitioner (GP)

GPs are largely found in Primary Care and are often the source of referral for patients to secondary care where there is a suspicion of cancer.

General Dental Practitioner (GDP)

Dentists can also refer patients urgently where there is a suspicion of cancer of the mouth/neck.

Multi-Disciplinary Team Meeting (MDT)

The MDT is a diverse group of clinical professionals (medical, nursing, allied health professionals (AHPs), radiological, pathological, oncological etc.) working together to reach and grade a cancer diagnosis. The MDT will discuss a range
of clinical investigative results to agree treatment options for patients diagnosed with cancer.

An MDT will usually meet on a weekly basis to ensure cancer treatments and holistic needs can be agreed and delivered in a timeously manner. The MDT attendance, discussion and decisions must be recorded, filed and shared appropriately e.g. clinical portal and sent to the GP.

Prehabilitation

Prehabilitation helps a patient prepare as best they can for treatment. A ‘universal’ prehabilitation focuses on physical activity, psychological support, nutritional care, smoking cessation and alcohol reduction to prepare people for their cancer treatment

RefHelp

RefHelp is a local referral management website providing accurate, up-to-date guidance to support NHS Lothian referrers with their referrals to secondary care services. It reflects a consensus between local clinicians at the interface and seeks to build relationships and understanding across primary and secondary care. The guidance provided is designed to be readily accessible and to help referrers – GPs, secondary care clinicians, dentists, optometrists, practice nurses, third sector, etc. – make the best possible referrals( including USOC referrals) in Lothian.

As a trusted source of evidence-based referral information, RefHelp is constantly evolving to ensure the content reflects the latest referral advice and guidance. As such, clinical specialties are asked to review their content every two years.

The team consists of Primary Care Referrals Advisors and Outpatient Redesign project staff who work with clinical specialties to develop and review their patient pathways and referral guidelines.

Standing Operating Procedure (SOP)

A set of step-by-step agreed instructions manual compiled by the NHS Cancer Management Team to help staff carry out the routine operating procedures in a consistent manner. The SOP will achieve efficiency, quality input and uniformity while reducing error and misinformation. The Cancer SOP should be clear in dynamic tracking and escalation to ensure pathways are managed effectively. The SOP supports and empowers the staff to perform their job function consistently and appropriately.

Terms of Reference (ToR)

ToR's are a set of collective priorities for delivery of a task in an efficient manner with descriptions on the roles and responsibilities of the function and for staff members in certain designated positions e.g. Chairmanship, agenda, meeting schedule etc.

A Cancer MDT ToR (for example) will explain the process of the clinical discussions and outcomes. The tumour specific ToR will support the professional discussion in a managed environment to ensure consistency and efficiency with followed actions.

Urgent Suspicion of Cancer (USC)

When there is a referral to secondary care where the patient has signs and symptoms that that are suspicious and may lead to a cancer diagnosis. The referral will be promptly managed in secondary care to ensure the appropriate pathway and tracking commences as soon as possible.

Waiting Times Adjustments (WTA)

Within a cancer pathway there may be some areas of delay. These pathway delays can be adjusted to discount periods of patient unavailability, patient induced delays and medical suspensions. Patients may choose time to consider their options or in some instances the patient has other medical conditions that need to be considered before any treatment plans or investigations can take place.

Measures the time from the date of receipt of initial urgent suspicion of cancer (USC) referral into secondary care until the date of first treatment. There is a 95% compliance for this standard.

This includes

• Patients urgently referred with a suspicion of cancer by a primary care clinician (ANP, GP or GDP);

• Patients who attend A&E/direct referrals to hospital where the signs and symptoms are consistent
with the cancer diagnosed as per the Scottish Referral Guidelines;

• Patients referred through a National Cancer Screening Programme.

The Board of first treatment is responsible for meeting 95% compliance with the 31-day standard, measuring the time from the date of decision to treat until the date of first treatment.

This includes all patients diagnosed with cancer, regardless of the route of referral.