1. North Cumbria Acute Hospitals NHS Foundation Trust CNS Data: two site comparison

2. Seen by CNS CNS on leave. P/time colleague unable to cover. Unusual week: Only one consultant. Otherwise, would have missed some patients. (RATIOS: Nurse-to-Consultant) Does not reflect how difficult this is to achieve!

3. Where were patients first seen? Numerous clinics on numerous days.

4. Days of the week One stop clinic. Usually, two consultants, before MDT. Usually, ‘breaking bad news’. Same day as Oxygen Clinic. Only day with x2 nurses.

5. Which ward? Not discussed this am.

6. Potential Long-term measures identified (this morning) Ideally, move Oxygen clinic away from Friday so LCNS can focus on ‘breaking bad news’ and Carlisle colleague can cover LCNSs patients more effectively on times of leave. Ideally, Friday to be ‘breaking bad news’ only (only one kind of paperwork to complete) Ideally, Lung cancer/ 2wws in Tuesday clinic only. Thursday to be general respiratory clinic?

7. Helpful measures identified (this morning) Consultants to always pass patients their local LCNS contact details, as well as contact details of other LCNS (for diagnostic phase - trial) Carlisle LCNS to always receive copies of clinic letters and MDT Outcomes Answer machine messages to give both LCNS numbers LCNSs to cover each other’s leave (term-time/ out-of-term time)

8. Whitehaven – ‘One stop clinic’ Whitehaven – ‘One Stop’ Clinic Format 9am(9.20am)(9.40am)(10am)(10.20am)(10.40am) 12.00 Patient 1 LCNS(Full history)Clinic Nurse CT Scan (can be longer)Consultant 1 Respiratory patient? CT Scan (can be longer)LCNS/ Consultant 1 Patient 2 Clinic NurseConsultant 1LCNS Respiratory patient? Patient 3 Clinic NurseConsultant 1 CT Scan (can be longer)LCNS/ Consultant 1 Respiratory patient? Patient 4 Clinic NurseConsultant 1 CT Scan (can be longer)LCNS/ Consultant 1 Respiratory patient? Patient 5 Clinic NurseConsultant 2 CT Scan (can be longer) LCNS/ Consultant Missed patient?