Download THE CANCER VANGUARD Jatinder Harchowal

NEW MODELS OF CARE –
THE CANCER VANGUARD
Jatinder Harchowal
Chief Pharmacist / Clinical Director, Medicines Management &
Clinical Support Services. Royal Marsden NHS Foundation Trust.
Objectives
• Background to the Cancer Vanguard
• Cancer Vanguard Medicines Optimisation Group
• Projects
• Why has this worked?
• Questions
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The National Cancer Strategy
Aim: To improve cancer services across the entire patient
pathway by 2020
• Fewer people getting preventable cancers
• More people surviving for longer after a diagnosis
• More people having a positive experience of care
• More people having a better, long-term quality of life
Six strategic priorities
Spearhead a radical upgrade in
prevention and public health
Transform our approach to
support people living with and
beyond cancer
Drive a national ambition to
achieve earlier diagnosis
Make the necessary investments
required to deliver a modern,
high-quality service
Establish patient experience on
a par with clinical effectiveness
and safety
Overhaul processes of
commissioning, accountability
and provision
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Overview of the Cancer Vanguard
One of the recommendations of the National Cancer Strategy was to
develop new models of care for cancer.
In 2015 the Cancer Vanguard was launched to test and fast-track
innovative and new models of cancer care.
The
Vanguard
covers a
total
population
of 10.7
million –
18% of
England’s
population
The Cancer Vanguard is made up
of three systems:
• Greater Manchester (led by the
Christie)
• West Essex North Central and
North East London (led by
UCLH)
• North West and South West
London (led by RM Partners)
RM Partners’ vision and aims
The RM Partners Cancer Vanguard has been tasked with radically restructuring our cancer care
systems to place the patient at the heart of service planning and delivery. We believe the three ‘gaps’
per the FYFV create a very clear case for change in the way cancer is delivered. We aim to enable and
drive this change for the patients of West London.
The three ‘gaps’
Working in
partnership,
we will
achieve
world class
cancer
outcomes
for the
population
we serve
Health &
Wellbeing
Care &
Quality
1 in 2 people will get cancer in their
lifetime. Cancer patients are diagnosed
too late, survival rates are lower than
international comparators and incidence
is increasing.
Patients receive inconsistent quality of
care, with varying outcomes and
experiences.
Our aims
Improve survival through early
diagnosis & detection,
harnessing world class research
Reduce unwanted variation,
through use of best practice
evidenced-based pathways
Improve patient/family
leadership, engagement and
experience
Prioritising living with and
beyond cancer
Improve access to expert
palliative and end of life care
Funding
The cost of cancer is rising at 9% per year;
this is unsustainable. The tariff system
often creates the wrong incentives and is
a barrier to reallocating resources along
the pathway.
Improve utility / reduce excess
costs through implementation of
new commissioning models
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What does the RM Partners system look like?
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Overview of Medicines Optimisation work
• 3 Chief Pharmacists RMH, Christie & UCLH met.
• Clinical Leadership, potential to challenge current
ways of working, deliver at pace and efficiencies.
• Support the Vanguard, reduce unwarranted
variation, improve patient experience
• Address specific issues with provision of cancer
drugs in line with the National Cancer Strategy
• Novel approach ‘Pharma Challenge’
• Work with the industry in a new way
Overview of Medicines Optimisation work
• Chief Pharmacists from 3 sites met in London
• 4th May 2016
• By 17th May 2016
 Liaised with ABPI & EMIG (Ethical Medicines Industry)
 Challenge sent to Pharma 26th May 2016
 Letter and proposal form
 ‘Pharma Challenge’ set up
• 24th June 2016 – 39 responses received
• 28th June 2016 – Reviewed by 3 Chiefs and 8
companies shortlisted to present
Overview of Medicines Optimisation work
• 5th July 2016 – Evaluation event held
 Pharmacists, Clinicians, Nurses, service managers,
project manager.
 3 projects chosen by end of the day
• Liaison with other experts to review other proposals
• 1st August 2016 - Project Initiation Documents drafted
• 23rd August 2016 – second presentation event, 4 more
proposals reviewed
 2 more projects shortlisted
• 21st September 2016, first joint MO group meeting
 Review and approve PIDs
 Agreed structure and governance
Timelines
4th May –
initial
conversation
24th June
– 39 project
proposals
21st Sep Agreed
projects and
first MO
Board
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Overview of Medicines Optimisation work
Chair
Rob Duncombe, Chief Pharmacist, The Christie
Deputy Chairs
Jatinder Harchowal, Chief Pharmacist, The Royal Marsden
Rob Urquhart, Chief Pharmacist & Divisional Clinical Director, UCLH
Group Members Jenny Scott, Programme Director, GM Cancer Vanguard (The Christie)
Kate Farrow, Programme Manager, UCLH Cancer Collaborative
Sarah Clarke, Divisional Manager, Royal Marsden
Dr Ciara O’Brien, Clinical Fellow, Medical Oncology, The Christie
Alison Hill, Lead Cancer Nurse, UCLH
Victoria Grandage, Consultant Haematologist , Paeds, UCLH
Matt Backler, Associate Director Financial Strategy, Royal Marsden
Steve Scott, Head of Informatics, RM Partners
Greg Stringer, Communications, GM Cancer Vanguard
Secretariat
Sue Whitworth, GM Cancer Vanguard (The Christie)
Additional support for London meetings: Tim Bill, RM Partners
What we have achieved so far….
 Amgen (Denosumab) – Breast (UCLH leading)
 Taking delivery of care out of the hospital setting
 Contribute to and share evaluation of service modelling
 QuintilesIMS – Metastatic Colorectal (GM Leading)
 Identify avoidable variation in m-Colorectal pathway
 Pilot and evaluate a patient App. (U-Motiff) PROMS
 Model potential savings when variance is reduced
 Testing the model of combining macro-data sets from across
multiple sites
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What we have achieved so far….
 Celgene. (GM leading)
 Presenting SACT data in a user-friendly format to clinicians to
identify possible areas for improvement.
 Amgen (UCLH leading)
 Developing models of care for the home delivery of SACT.
 BMS (UCLH leading)
 Adverse event monitoring of patients undergoing immunooncology therapies.
 Sandoz. Biosimilars (RMH leading)
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Biosimilars in Cancer
– First one (Biosimilar Rituximab) due end of March
– Sandoz proposed a non product specific approach
– Learning from previous uptake of Biosimilars
– Structured approach to include:
– Educational material to increase awareness
– Support for local policy implementation
– Patient Information
– Gather support from key stakeholders:
– BOPA, BSH, National Lymphoma Groups, NHSE
Specialist commissioning, UKMI, National
procurement groups
– Current experience from UCLH and RMH
Biosimilars in Cancer
– Aim to do once and share…
– http://cancervanguard.nhs.uk/biosimilars-gettingit-right-first-time/
What this collaboration and approach worked
• We exploited:
• both our scale (larger population)
• our combined expertise
• The models we are developing will both improve patient
outcomes and generate significant efficiencies:
• Spend on Rituximab in 2016 on all formulations – £186m
• Replicability of both the process and the new models
developed mean the national impact will be significant.
• Share progress and paperwork nationally
REFLECTIONS ON THE CLINICAL
LEADERSHIP
• Example of joint leadership across the country
• Strong existing pharmacy network
• Don’t wait to be asked
• Pacesetting, collaborative
• Systems wide leadership
• Not afraid to fail
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Any Questions ?