The past year has seen incredible efforts from all corners of the NHS in maintaining essential services as much as possible. Both clinical teams and individuals have played their part in adapting pathways and transforming physical sites to be able to perform diagnostic services while keeping vulnerable patients as safe as possible.
One of these individuals is Tanya Gill, Macmillan Urology CNS (Clinic Nurse Specialist) Team Leader and Team Lead & Clinical Nurse Specialist at Frimley Health NHS Foundation Trust, who has helped move the Trust’s prostate cancer diagnostic service into a one-stop prostate clinic in an outpatient setting, while eliminating all TRUS biopsies from the pathway in the process.
The One-Stop Clinic
Frimley Health NHS Foundation Trust provides NHS hospital services for around 900,000 people across Berkshire, Hampshire, Surrey and South Buckinghamshire. These services are provided from the Trust’s three main hospitals of Frimley Park, Heatherwood and Wexham Park as well as from outpatient clinics and diagnostic services at Aldershot, Farnham, Fleet, Windsor, Maidenhead, Bracknell and Chalfont St Peter.
The Trust’s aim is to provide its patients with the highest quality healthcare possible; an ethos that is reflected through its innovation in the prostate cancer diagnostic pathway with the establishment of a one-stop prostate clinic approximately two years ago, in 2019.
“Our aim for the one-stop clinic was to have a single-touch point for men who were referred with suspected prostate cancer,” explains Tanya Gill, clinical nurse specialist at Frimley Health NHS Foundation Trust – and the team lead for the clinic. “We found that men were having multiple appointments with multiple different clinicians; delays were inevitable, which is far from ideal both in terms of the patient experience and the efficiency of our prostate cancer pathway – and we wanted to change that.”
Under the guidance of Mr. Marc Laniado, consultant urologist and urology cancer lead at Frimley Health, Tanya was responsible for setting up the one-stop clinic. Initially, this involved her triaging patients by phone at the point of referral from their GP, and then booking suitable patients in for an MRI and consultation, with a biopsy slot held that same day for a patient that might need further diagnosis. At that time, the biopsy methods used were a combination of transrectal (TRUS); transperineal (TP) biopsy using a grid template; and LA TP using the PrecisionPoint™ transperineal access system, a new methodology that allows transperineal biopsies to be conducted under local anaesthetic in an outpatient setting’ whilst improving cancer detection rates and reducing the risk of biopsy related infections
Then COVID-19 hit.
The Impact of COVID
With her background in intensive care, during the first wave Tanya was redeployed from the one-stop clinic back into the ICU, and the one-stop clinic paused as the NHS grappled with the influx of COVID patients. However, as elective services resumed, it both facilitated – and demanded – changes to the set-up of the clinic.
“Of our three hospitals, Wexham and Frimley were designated ‘red’ sites, and Heatherwood ‘green’,” Tanya explains. “This meant we could resume diagnostics services, but there were still huge challenges. We no longer had access to theatres for general anaesthetic procedures, and the requirements for patients to isolate ahead of day surgery rendered the one-stop clinic impossible.”
Yet, Tanya was determined to resume the clinic and ensure patients were still being seen, which involved drastic measures on her part, as she explains: “Together with a colleague, I went in to Heatherwood one weekend and basically cleared out rooms that were unused, or being used for storage, as part of a wider hospital refurbishment, and transformed them into our own outpatient setting with waiting rooms, a consultation area and my own biopsy room, all on the green site.”
In parallel, the Trust made the decision to remove the TRUS biopsy from its pathway altogether, due to higher risk of sepsis and biopsy-related infections, as well as the chances of patients requiring a re-biopsy. “Prior to the pandemic, I had already been receiving training in LA TP with PrecisionPoint,” Tanya explains. “This was massively sped up in 2020, with support from Mr. Laniado who has encouraged and helped teach me to become competent in the technique. This means I am now one of about 30 nurses in the UK carrying out this procedure completely.”
As of May 2021, Tanya now helps to run Frimley Health’s one-stop prostate clinic, as well as performing additional LA TP prostate biopsies on a separate list.
She explains: “I triage and identify patients who are suitable for the one-stop clinic; booking them in and ensuring we everything we need on the day to turn around the MRI review, and – if Mr Laniado feels it necessary – carrying out the biopsy.
“This has obvious benefits for patients, as we’re able to minimise the amount of time they have to spend at the hospital, as well as having a potential diagnosis and treatment plan in place about 7 to 10 days from referral,” she adds.
While Tanya has driven a lot of the innovation herself, she is adamant that she wouldn’t have achieved it without the support of a wider team at Frimley Health. “Obviously, I consider myself very lucky to have had the support of Mr Laniado, who has pushed and pushed,” she says. “There are probably a lot of nurses who don’t have that level of support behind them, who otherwise could achieve similar things to me.
“But, really, it’s a credit to the whole multi-disciplinary team here that we’ve pulled this off, from our radiology team, our service leader who supported the purchase of the PrecisionPoint equipment, our admin team who help me with reporting and appointments – as well as those external to Frimley Health who have made themselves available to train me during these challenging times. I am genuinely in awe of what we’ve been able to achieve for the betterment of patient care.”
It’s important to recognise not only those men and their families who go through the emotional and physical side effects of living with cancer, but also the tenacity and dedication of our healthcare professionals – those such as Tanya – who are committed to making the patient experience and outcome as good as it possibly can be.