1. Working Across Cancer Networks Steve Williamson Principal Pharmacist Cancer Services Northumbria Health Care Trust & Lead Pharmacist - Northern Cancer Network

2. A Pharmacists experience of working with the CSC and a Cancer Network Development of a Network Pharmacist role Bringing togeather colleagues across the Network - examples of what we can acheive Multi-professional working Chemotherapy Protocol Handbook Chemotherapy service review and capacity (Only a Tiny mention of Clinical Governance - phew!)

3. ‘Up North’ Northern Cancer Network Wide geographical area with a population of over 2 million. Northumbria Healthcare Trust Most northerly NHS Hospital Trust Geographically one of the largest

4. Northern Cancer Network NCN One of the first Cancer Networks Linked with CSC from first wave NCN covers 3 SHA’s, 12 PCT’s and 7 Hospital Trusts  City Hospitals Sunderland NHS Trust  Gateshead Health NHS Trust  Newcastle upon Tyne Hospitals NHS Trust  North Cumbria Acute NHS Trust  North Durham Acute NHS Trust  Northumbria Healthcare NHS Trust  South Tyneside Healthcare NHS Trust Cancer Centre in Newcastle Cancer Units in Ashington, Carlisle, Durham, Gateshead, Hexham, North & South Sheilds, Sunderland, Whitehaven

5. Northern Cancer Network NCN Organised into various groups under direction of a Strategy Board and Clinical Advisory Group Includes; –Patient Panel, NCRN, Commissioners, Nursing, Tumour Specific Groups, information, Non-Surgical Oncology, Support Professions, Pharmacy, Systemic Therapies (D&T). Full time Lead Clinician /Network Manager Well established full time support staff Regular project/ secondment posts.

6. Development of a Network Pharmacist role April 1999 Pharmacist involved forming in Network Clinical Support Profession Group July 2000 CSC arranged pharmacy meeting NCN Pharmacists invited to CSC Blackpool conference Dec 2001 CSC commissions chemotherapy project for NCN Jan 2001 Project Pharmacist forms network pharmacy group against initial reluctance from pharmacy managers

7. Network Pharmacist Role Providing accurate High Cost/ NICE Drug expenditure reports for network commissioners & budgetary forecasting Project work, looking at chemotherapy staffing and facilities in conjunction with seconded chemotherapy nurse Promoting multi-professional working with CSP group Part of Network’s D&T - Systemic Therapies Group Maintaining Network Chemotherapy Handbook General point of contact for network pharmaceutical issues However - so far non permanent as funding only available for intermittent secondments (spend equivalent of two sessions a month on Role - supported by own Trust)

8. NCN Cancer Pharmacist Group Representatives from all Trusts in NCN area Quarterly meetings Initially no clinical oncology pharmacy posts in NCN area Group facilitated gradual re-engineering/ expansion of roles from pure aseptics (supply) roles to include clinical duties. Expanded to include palliative care pharmacists Groups Mission Statement ‘To ensure the safe, effective and economic delivery of chemotherapy and clinical pharmacy services to cancer patients and meet the demands of the National Cancer Plan and Manual of Cancer Service Standards.’

9. NCN Cancer Pharmacist Group AIMS To raise the profile of pharmacy services in cancer care To ensure there is sufficient pharmacy manpower and facilities within the NCN to provide services to cancer patients. To promote the specialist role of pharmacists and pharmacy technicians in the delivery of cancer services. To ensure cancer patients receive best pharmaceutical care. To promote the best value use of cancer medicines. Ccommunication and peer support. To enable and co-ordinate the sharing of good practice Promote continued professional development, training and educational opportunities in cancer services for pharmacy staff.

10. NCN Cancer Pharmacist Group Achievements (so far) Developed Chemotherapy Capacity Planning Tool Developed standardised network pre-printed prescriptions Facilitated development of clinical pharmacist roles Ensured funding made available to support pharmacy staffing from NCRN initiatives Programme of evening educational meetings. Looking at contracting for high cost medicines.

11. NCN Chemotherapy Documents

12. Cancer Unit Chemotherapy Handbook Prepared following Cancer Unit Chemotherapy Review Approved and Launched April 2002 Published on the NCN Website ( nww.cancernorth.nhs.uk) Reviewed and updated Annually Interim updates/ new regimens posted on NCN website

13. Why did we need a handbook? Manual of Cancer Services Standards-Standard 6/8 ‘..list of acceptable chemotherapy regimens for the network’ Northern Region Haematologists Handbook need an equivalent resource for solid tumours MCSS Standard 6/14 ‘..written guidelines/protocols for prevention and treatment of complications’ Clinical Governance & Risk Management Prevent unorthodox and unpredictably varying practice which is against the opinion of peers in the network

14. Benefits of the Chemotherapy Handbook Time saving process - detailed regimen information available to staff in each cancer unit Standardisation of regimens across the network Patient benefit - information readily available on site To support and facilitate consistent good practice Use as a learning resource for chemotherapy staff

15. Limitations of the Chemotherapy Handbook Not a recipe book for the use of chemotherapy Not a proscriptive list Not ‘policed’ by pharmacy and nursing staff Does not include Cancer Centre only regimens Does not include clinical trial regimens Guidelines compliment, not replace local practice

16. Handbook Contents Cancer unit/ cancer centre chemotherapy contact details Approved solid tumour chemotherapy regimens for Breast Gastrointestinal Gynaecological Lung Superficial Bladder Network Guidance on Use of Anti-emetics Neutropenia Guidelines Extravasation Guidelines Appendices

17. Chemotherapy Capacity Project Visited each NCN Cancer Unit & Cancer Centre Visited day unit/ ward and pharmacy Collaborative ‘style’ approach to assessment to avoid audit overkill - (time of peer review visits) Refernce standards Manual of Cancer Service Standards JCCO ‘ Cancer Units’ Dec 2000 RCN chemotherapy guidelines Aseptic Dispensing Standards

18. Project Methodology Pilot Visits Questionnaire Informal discussion with Nursing and Pharmacy Staff Inspected facilities - ward and pharmacy Written report prepared for each unit

19. Cancer Unit Visit Reports Profile of unit wOpening Hours wWeekly work pattern wStaffing Facilities Management Structure Policies and Procedures AdministrationLine Care NeutropeniaExtravasation Anti-emeticAnaphylaxis Emergency Admissions Chemotherapy regimens used

20. Factors Affecting Capacity Pattern of Work Booking System Writing of Scripts Blood Monitoring Receipt of Chemotherapy Patient Numbers Other Activities Patient Review

21. Pharmacy Capacity Assessment Current workload Daily pattern of work Timing of prescriptions Preparation in advance Number of Isolators/ Clean Rooms Staff Commitments

22. Pharmacy Chemotherapy Capacity NCN pharmacy group developed formulae to allow accurate comparison of capacity in all NCN hospitals; Items x (19P+21T+11A) + ( 52T x N o of sessions) + (Adjusted items x 5T) Where P=Pharmacist time;T=Technician time; A=ATO time (mins) Formula based on bench markeing time taken to prepare each different chemotherapy type to give standard adjusted doses, e.g. 5-FU syringes are simple to prepare, 1 item = 1 adjusted item, Paclitaxel takes longer to prepare, 1 item = 5 adjusted items. Formula must be adjusted to account for non-productive activity.