The role was given distinct workstreams, as agreed in partnership with Macmillan as part of the funding process. These workstreams included:

Transcription

1 Item 5-14c Regional Cancer Pharmacist Role Summary The Macmillan Regional Lead Cancer Pharmacist role was initiated at the beginning of June 2011 for a three year period, funded by Macmillan Cancer Relief on a secondment basis. The current postholder commenced on 1 st June 2011, and is scheduled to end on 31st May We are advised that the Directors of Pharmacy for each of the NoS Boards are supportive of continuing this role and this paper establishes the case for this and the resource and alignment options moving forward. RCAF members are minded of the current Oncology services challenges and that central pharmacy support has been highlighted as an important cohesive factor that can add longer-term support towards a collaborative and sustainable model at regional level. Background The East and West Cancer Networks have both been considered to have benefited from regional cancer pharmacy support. The decision to develop such a role for the north was supported by the Boards and the Regional Cancer Advisory Group in A successful bid to Macmillan was reached and a fixed sum of 213k was allocated for the three year position. An open application process was undertaken and the present postholder appointed on a secondment basis. The role was given distinct workstreams, as agreed in partnership with Macmillan as part of the funding process. These workstreams included: Supporting the development of safe and efficient chemotherapy services within the north Develop opportunities in partnership with primary care pharmacy services that would support patients at home living with cancer The bulk of the work has focused more on the first major aim with the SACT CEL and QPI Programme strongly influencing the work to date. In the first stages of developing the regional pharmacy role, challenges existed in an environment where little regional working existed in the delivery of chemotherapy services. Initially, a significant degree of effort was required to develop a more positive understanding of the possibilities of what regional cooperation could achieve for constituent members NHS boards in NOSCAN. In the main, confidence and trust have developed and some initial hurdles resolved, resulting in an increasingly positive mindset towards participating in, and the development of regional solutions. The development of the North Chemotherapy

2 Advisory Group (NCAG) has facilitated and increased in the sharing of documentation and best practice. A recent structural review of NOSCAN by Jim Cannon, Director of Regional Planning, North of Scotland Planning Group specifically recognised the need for a Lead Regional Cancer Pharmacist based upon the positive feedback during a consultation period. This has been given additional strength following the focus on Oncology services challenges in the north over the past year and the pivotal role that an overarching pharmacy service can provide. A number of significant pieces of work are continuing to be undertaken in relation to Systemic Anti-Cancer Therapy (SACT) service delivery and quality assurance in 2014 that we recommend to be maintained to support the NHS Boards within NOSCAN in achieving the required national quality standards. It is therefore considered that the regional role remains pivotal in maintaining the expertise, leadership and management required to deliver this important workstream. Analysis Work undertaken to date: Participation in the development of CEL (2012)30 Development and Chairmanship of the NOSCAN Chemotherapy Advisory Group (NCAG) Support the development of regional policies for treating SACT related morbidity Development of a process for CMG development and approval via the RCAF, supporting MCN s in taking this workstream forward. Governance arrangement for CEL protocols in CEPAS Support the implementation of 30 day mortality reviews across NOSCAN Support the development implementation of consent across NOSCAN Undertaken a pharmacy cancer service review for HNS Highland Undertaken a review of future Systemic Anti-Cancer Therapy (SACT) treatment for patients residing on island treatment of patient in NHS Orkney, now supporting development of implementation methodology. Recently undertaken a review on the provision of SACT services in NHS Western Isles Initiated and supported a tour of the NOSCAN Health Boards highlighting the governance requirement to meet CEL (2012)30 and the cancer QPI s. Participating in developments aimed at maximising the implementation of patient management through the Chemotherapy Electronic Prescribing and Administration System (CEPAS) Gained approval from all Boards to accept a regional SOP format. Provided support to all Boards in undertaking baseline audits against CEL(2012)30 Project-lead for the national SACT Dose-Banding project and support implementation in NOSCAN.

3 Participating in a research project investigating patient adherence to oral cancer medicines. Participated in the development of services involving community pharmacists. Involved in a research project investigating links between smoking cessation and development of lung cancer. Involvement in SMC as a Lead Assessor, now moving over to PASAG Significant projects currently outstanding: 1. Develop, implement and participate in the inter-regional and external auditing of SACT services in NOSCAN against CEL(2012)30 - GUIDANCE FOR THE SAFE DELIVERY OF SYSTEMIC ANTI-CANCER THERAPY - July Support the MCN s in the development of Clinical Management Guidelines and associated governance arrangement linked to chemotherapy choices. 3. Implementation of national, regional, and local solutions that will come out of the review of the SMC processes and the replacement for the (Individual Patient Treatment Review) IPTR processes with the PACS system currently in development stages. 4. Support the NoS Oncology service SLWG action plan relating to the integration of services in the north. This would include progressing the development of key service delivery systems such as integrating the three stand-alone CEPAS systems into one. Resource & Alignment Options The North of Scotland Planning Group is undergoing a structural review and therefore the options for this role ought to be considered vis-à-vis this as well as the ongoing Oncology service sustainability challenges. Option 1: Do not replace beyond the role beyond the fixed term period Pro s avoids funding and alignment issues Con s leaves a major gap in capacity for progressing the work outlined above and leaves risks around supporting the collaborative work to bring oncology services in the north together. Also leaves gaps in terms of accountability for the ongoing SACT CEL work and risks slowing down progress towards achievement. Option 2: Seek agreement to continue the role substantively aligned to the regional group

4 Pro s addresses the con s outlined in option (1) and ensures continuity of current work and ongoing workstreams. Reduces risk around the support necessary for the NoS oncology service collaboration. Con s no ongoing funding and alignment may not naturally sit within the current NoSPG structural review. Role not directly aligned within a supportive pharmacy environment. Line Manager not a pharmacist and not able to provide professional issues related pharmacy support. Option 3: Seek agreement to continue the role substantively operating across the region, but aligned to a Board Pharmacy Dept Pro s addresses the con s outlined in option (1) and ensures continuity of current work and ongoing workstreams. Reduces risk around the support necessary for the NoS oncology service collaboration. Improves professional and line management support to the role. Con s no ongoing funding and alignment may not naturally sit within the current NoSPG structural review. Role not directly aligned within a supportive pharmacy environment. Line Manager not a pharmacist and not able to provide professional issues related pharmacy support. Options 2 & 3 would be the supported way forward from the Pharmacy Directors, NOSCAN Manager & NOSCAN Clinical Lead. Funding options would include: 1. A full business case is prepared for the Boards requesting proportionate funding of the role at its current costs (AFC 8c + on-costs) 2. Funding is drawn from existing programmes. Currently funding is available for Project Support and Clinical leadership through the Transforming Care After Treatment project which the North is still to uplift. The role could be broadened to include these dimensions of work, which would also sit well with the second main aim outlined in the background section of the paper. The funding for this is circa 45k equivalent. This support is available for 5 years beyond which the role is funded as in option (1) above. This however leaves a gap of 40k, which would still require business case agreement. To ensure the position can continue meantime, TCAT & Cancer Modernisation funding could bridge a full year cost, with Modernisation funding being drawn proportionately from the Boards. 3. The role is offered part-time to the value of the TCAT funding. Recommendations Acknowledge the support to continue the role and therefore seek to agree the most achievable funding arrangements

5 Consider whether the post may be better aligned to a Pharmacy dept for future professional and line management support Support the use of TCAT funding to allow continuation of the position and the balance of the funding will be sought through a business case submission (including other non-recurring cancer funding streams as a short to medium term solution). Peter Gent Regional Manager - Cancer