Acute Oncology Service (AOS) in NHS Scotland: principles

Appendix 5 – Accessible Version of Section 12 Recommended Overarching Specialist AOS Model Requirements

The model describes how services can sit across the country, and regional network areas, and the components required to achieve the service outcome measures and clinical standards.

The graphic shows a series of coloured boxes in tabular format containing text.

The top level shows the high level delivery requirements and has a double headed arrow to display that communication is required back and forth.

NHS Scotland agreed service specification for Acute Oncology (AO):

• Funding requirements to be identified and agreed
• Build into NHS Boards contracts as part of service provision

AO Group/Board; whose role will be to support:

• Education and Training Plan
• Analysis of data
• Links to palliative care and Early Supportive Care
• Research

The applicable services are then subdivided into Locality Delivery and Centralised/Co-ordinated Functions.

Under Locality Delivery lies responsibility for Emergency Care. The services listed in this category are:

• Core Acute Oncology Service Team.
• Emergency Departments/Acute Medical Units (AMU).
• Malignant spinal cord compression (MSCC) - definite clinical diagnosis or high level of clinical suspicion.
• Malignancy of unknown primary origin (MUO) pathway/multi-disciplinary team (MDT).
• Onward Referrals:
  • Specialist Palliative Care team.
  • Same day emergency care.
  • Site specific multi-disciplinary team/clinical nurse specialist.
  • Central malignant spinal cord compression service.
  • AO/emergency hot clinics.
  • Parental team/treating.

Under Centralised/Coordinated Functions lies responsibility for Supplementary Services. The services listed in this category are:

• Local/regional Cancer Treatment Helplines – provision of 24 hr support and advice for All patients.
• Professional advice 24 hour access for health care professionals (provided by Cancer Centre on-call rota).
• MSCC coordination / Spinal MDT.
• Specialist interventions.
• Research.

There is also a category titled Urgent Care (within 48 hours); this spans both the Locality Delivery and Centralised/Co-ordinated Functions. There is a note to advise that it may be preferable that they are delivered as a separate service with close links and clear referral pathways to the local AO teams. The services listed in this category are:

• Oncological complications i.e. ascites; effusions; pain - access to same/next day AO review/hot clinic or rapid return to emergency clinic.
• Emergency clinic review for front door presentations.
• MSCC – low level of suspicion – manage via spinal MDT.
• Treatment complications – systemic anti-cancer therapy (SACT)/immuno-oncology. Access to same day/next day AO hot clinic. For SACT sites incorporating an ambulatory clinic at the site that can be accessed by both the local teams and also Cancer Centres to provide ambulatory care for AO (complications of treatment, symptom control).
• MUO pathway – need to ensure that there are clear pathways for referral of patients with MUO/carcinoma of unknown primary (CUP) to AO teams and also clear pathways and timelines for patients diagnosed as MUO/CUP to be discussed at the local CUP MDT meeting.

Three further areas span both the Locality Delivery and Centralised/Co-ordinated Functions, and all services are then listed. These are:

• Ongoing education and training across all specialities.
• Data collection.
• Service coordination and cross cover.

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When further developing this model locally the following will require to be considered:

Where – AMUs operate under significant capacity pressures. The covid-19 pandemic has reinforced the requirements for physical distancing, and the particular importance this holds for clinically extremely vulnerable patients.

Specialist AO teams will help to decompress AMUs and thereby improve safety and quality of care for all patients.

Who – This will require input from a well-trained and coordinated multidisciplinary team. Specialist centres which provide regional oncology services should therefore be tasked with working with all partner NHS Boards to design equitable hub and spoke services, appropriately tailored to local needs.