Urological cancer

RM Partners has established a Urology Pathway Group, with representation from urology multidisciplinary teams involved in the care and treatment of urology cancer, across West London. The role of the group is to improve services for all urological cancers (bladder, kidney, penile, prostate, and testicular) with a key focus on ensuring equity of access and services.

This includes:

• Identifying areas for service improvement
• Implementing best practice and service redesign strategies
• Delivering NHS England best practice timed pathways
• Embedding national guidance
• Developing quality standards

The group is working on various areas of service improvement, including streamlining and transforming multi-disciplinary team working; developing training and support packs for staff working within urology cancer services, including MDT coordinators and primary care colleagues, and providing workforce training and development within nursing teams.

Best Practice Timed Pathways

NHS England has been developing best practice timed pathways for a range of cancers, to support the on-going improvement effort to shorten diagnostic pathways, reduce variation, improve patient experience of care, and provide models to support sustainable improvement to meet the Faster Diagnosis Standard.

In 2018, RM Partners piloted the RAPID (Rapid Access to Prostate Imaging and Diagnosis) prostate pathway that utilises ‘first in the world’ technology which fuses live ultrasound and MR images for a revolutionary biopsy procedure. The pilot, run in collaboration with Epsom and St Helier University Hospitals Trust, Imperial College Healthcare Trust, and St George’s University Hospitals NHS Foundation Trust, won the 2018 HSJ award for acute sector innovation as it reduced waiting times for men referred with suspected prostate cancer.

The RAPID pathway has since been implemented successfully across all Trusts within West London and is included in the guidance from NHS England on implementing a timed prostate cancer diagnostic pathway.

The best practice timed pathways for bladder, renal/kidney, testicular and penile cancers are currently being developed by NHSE, with representation for input from the Urology Pathway Group, with a proposed publication of spring 2023.

Currently work is being undertaken by the group to improve existing bladder cancer pathways in west London by developing ‘straight to test’ pathways, and support a more timely diagnosis and treatment pathway, in particularly for patients with muscle invasive bladder cancers.

MDT Streamlining/Transformation

As outlined in Streamlining (england.nhs.uk), NHS England developed guidance to enable cancer multi-disciplinary teams (MDTs) to respond to the changing landscape in cancer care, as recognised in the NHS Long Term Plan and the Independent Cancer Taskforce Report.

The key principle to achieve MDT streamlining is that all patients remain listed and recorded at the MDT meeting. However, patients will be stratified into two groups: those cases where full discussion at the MDT is required, for example due to clinical complexity or psycho-social issues, and those cases where a patient’s needs can be met by a standard treatment protocol (or Standard of Care), and so do not require discussion at the MDT.

In July 2022, the RM Partners Urology Pathway Group developed and agreed MDT ‘Standards of Care’ protocols for its network. (see Useful resources).

Staff training/support packs

Training and support packs for staff, which provide an overview of the urology cancer pathway, have been developed by stakeholders within the RM Partners Urology Pathway Group, to support new staff into urology cancer related roles. Further work is being undertaken to develop education/support packs specifically for Primary Care.

Workforce

As part of the NHS Long Term Plan, RM Partners with support from Health Education England, is developing resources to support cancer clinical nurse specialist roles and support development into Advance Clinical Nurses. Frameworks are being developed to indicate the experience and education needed for progression into these roles. Through the development of cancer nurses, the network has a longer-term aim to move all prostate biopsies to nurse-delivered, via a local anaesthetic approach.