Cluster A

1
Cluster A
2
Comprehensive and Cancer Service Networks

• Cluster A all have 1 CLRN and 1 service network
  (not necessarily coterminus)
• Cancer Service and cancer research have common
  aim (improving patient outcomes)
• Strength of current arrangement
• embedding research into the management of cancer
  patients through MDTs and patient flows and is
  not optional
• Linking with commissioning and clinical
  guidelines though SSGs

3
Networking

• More efficient method to utilise resources
• Willingness to share resources
• Sharing of costing templates, Quality Management
  group
• Several joint training initiatives
• Cluster group- benchmarking to lead to further
  improvements
• Improve IS to allow clinicians to access regional
  and national trial information in clinics

4
Flexibility of funding

• Education of NHS organisations - respond more
  quickly to implement or lose it
• Flexibility so can underwrite e.g. commercial
  stream/NCRN adopted studies money under control
  of NCRN mgr

5
Screening prevention

• Link in with service network, cancer reform
  strategy
• Public Health strategy, health promotion
• Embedding research into service agenda
• Link in with CLRN and PCRN to discuss resourcing,
  other research fund awards
• Skills required links with university

6
Cluster B
7
Flexibility of Funding

• Ensure all yearly allocation is spent, explore
  ways to ensure no underspend is accrued.
• Work closely with RD departments to jointly plan
  long-term use of funding (NCRN, FSF, CLRN). Think
  creatively about flexibility of funding. Develop
  bidding template.
• Consider and plan skill-mix for the future.
• Clear guidelines needed around bidding process
  including application forms.
• Good communication from NCRI about priority areas
  allowing reasonable lead-in period for networks
  to respond to changes - London based post should
  help.
• Adequate notice from CC about money available, 2
  year commitment essential.

8
Screening and Prevention

• Play a leading role in training and sharing
  expertise informed consent, access to GCP
  training.
• Expand number of CTOs to run non-randomised
  cancer trials and screening trials.
• Increase number of prevention RCTs in portfolio.
• Link with CLRNs primary care networks and service
  networks.
• Start to explore logistics of sending staff out
  to primary care setting even if only to provide
  short-term support and training.

9
Comprehensive and Cancer Service Networks

• Reasons AGAINST re-drawing
  boundaries
• Interacting with more than one CLRN provides
  increased opportunities for attracting funding
  for cancer.
• No need to redefine boundaries as close working
  with CLRN inevitable however, essential that
  cancer is represented on the Board.
• Concern that autonomy of research networks will
  be undermined and may be taken over entirely by
  CLRNs in time if boundaries co-exist.
• Long-established relationships between clinicians
  disrupted by more change.
• Cancer Research Networks would become too large
  to manage effectively.
• Being embedded in service network gives access to
  key groups NSSGs, MDTs, Drugs and therapeutics
  groups etc

10
Comprehensive and Cancer Service Networks

• Reasons FOR re-drawing boundaries
• Less confusion over accrual figures.

11
Responding to Initiatives

• Work closely with RD departments to jointly plan
  long-term use of funding (NCRN, FSF, CLRN). Think
  creatively about flexibility of funding.
• Motivate staff to adapt swiftly to changes by
  good communication and feedback.
• Know your strengths and respond only to
  initiatives that suit your network. Be realistic
  about your limitations.
• Think about integrating research teams to improve
  flexibility eg. combine commercial, ECMC and NCRN
  teams.
• Br prepared for RNM role to change
  responsibilities likely to expand, think about
  your skills and consider training and support
  needs.

12
Networking

• Investigate referral pathways. Ensure pathways
  are robust and effective.
• Engage PCTs and CLRNs in discussion about travel
  costs for patients. CC to obtain agreement from
  PCTs about payment for patients treated out of
  area.
• Work with service network to expand capacity in
  sites delivering trial treatments ahead of
  increased referral.
• Engage consumer groups in publicising trials
  across and between networks.
• Raise awareness of trials in neighbouring
  networks. Development of database to provide
  information about trials in all networks create
  regional admin posts to do this and similar work.

13
Data quality

• Arrange for regular audit employ external
  auditors if necessary (Maxine has details).
• Discuss annual programme of external audit with
  CLRNs.
• Develop relationship with CTUs to identify
  process for alerting RNM or designated person of
  serious data issues.
• Arrange internal audit across network.
• Develop regional post for auditor/governance
  officer.

14
Changing the Culture

• Protect Consultants PA time for research-related
  work.
• Ensure CLRN money for service support is used
  appropriately.
• Effective representative for research at Trust
  Board level.
• Making research a viable career opportunity for
  clinical and non-clinical staff.
• Provide adequate office and clinical space for
  research.
• Point out hosting costs now provided.
• Excess treatment costs barrier to opening trials.

15
QQR cluster C

• 1 Funding - Resources used effectively.
  Clinicians, sickness/mat leave, surgical clinics,
  pharmacy post 2 years show better results
• 2 Screening and Prevention - establish links and
  offer support/training, communication, resources
• 3 CLRN and Cancer Service Networks Established
  links with service network, research culture as
  standard practice. PCTs, large team support.

16

• 4 Respond to Initiatives flexibility with
  staffing, across disease and localities. Flexible
  funding. Secondments, CNSs
• 5 Networking Referral for commercial studies
  and rare disease. Website. User groups. Cluster.
  Topic network/CLRN. Joint training. Team leader
  meetings. Cross Network posts. Peer audits across
  Trusts. EDGE.
• 6 Data Quality Audits other Networks data, NTL
  audits, RD audits.

17
QQR cluster D

• Q1 flexibility of funding
• Need longer and more details about funding
• Sort out trust HR processes
• Longer planning time but have plans ready

18
Q2 Screening and prevention

• Increased engagement with NIHR/NCRI about studies
  in pipeline (improving database).
• Increased links with primary care network
• Secondary care suppose possible primary care
  not possible
• Work with CLRN to put in place resources
• Adequate funding when study initiated
• Offer support and logistical advice working
  closely with groups in primary care engage PCT

19
Q3 comprehensive and Cancer service networks

• Referral pathways for trials are mapped around
  service pathways to deliver the cancer plan
  need to be the same
• Similar issues in cancer delivery to trials and
  shared learning
• Would end up being subservient to CLRN
• Cancer service should be what helps prioritise
  trials for patient groups
• Peer review and commissioning links with cancer
  network essential
• Engagement of cancer community very strong as
  result of this

20
Q4- responding to initiatives

• Only when trial behind but need to know
  pipeline studies
• Cancer reform strategy
• Have national database that patients can search
  per hospital
• Define available (locally, regionally or
  nationally)

21
Q5 - Networking

• Some difficulty around shared patients and credit
  for accrual
• Feed MDTs information to facilitate this
• Difficulty around trials with costs for drugs
  within trials - encourage collaborative
  commissioning.
• follow-up tariff negotiated by CLRN and easing
  regulatory burden to open trials for follow up in
  different trusts

22
Q-5 (continued)

• Standardisation of care will facilitate national
  solutions for example defining standard of care
  within trials
• Both regional and Cluster D(!) provide forum to
  discuss local issues and problems. Vacancy of
  RNMs is detrimental - ? Need to start to look at
  deputies.
• Improved access to training
• Need to feedback meetings and initiatives to CC

23
Q6 other key questions

• Data need to collect what is essential for
  trials only! (quality and timeliness will
  improve)
• Irrelevant data queries (particularly eCRFs)
• Need to be able to review CRFs to assess workload
• Feedback to RNMs if problems
• To fit in visits as RNMs would be very difficult
  but this could easily be fixed by better
  communication to us from CTUs. Also not area of
  expertise.

24
Questions not for QQ

• HR processes
• Needs to be specialists nurses in JDs.
• Part of consultant appraisals and workplans
• Service managers must have written responsibility
  for research in JD.
• Chief executives need to have this in their
  horizon. (star rating)

25
QQR cluster

• E

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1 Flexibility of funding

• FSF
• Useful for pump priming posts.
• Used suitably this year
• Redistribution exercise
• Generally happy with exercise
• One concern is that it may encourage networks to
  overspend?
• Realistic accounting
• i.e. money distributed to trusts for a post and
  then ring fenced by trust
• Currently the combination of FSF and underspend
• set up and post and then continue it for another
  year

27
2 Screening and prevention

• If NCRN network resources are needed but accrual
  does not count then this is difficult
• Support other topic networks (i.e.PCRN) at the
  CLRN level to access funds
• Networking influence
• Apply for redistribution money to support these
  trials

28
3 Geographical alignment

• 3 networks
• 1 service network 1 CLRN
• 2 networks
• 1 service network and 2 CLRNs
• Like current affiliation and alignment with
  service network
• Different CLRNs work differently
• Time spent working across multiple NSSGs

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4 How can we respond to initiatives?

• FSF and redistribution monies
• Commercial trials
• Hearing of them early enough
• Networking
• Centralised and hybrid networks have more control
  over flagging trials at the MDT level and inter
  network referrals
• Forward strategic planning

30
5 Networking

• Barriers to Patient referrals
• Cancer waiting times
• Referral of patients will not happen if trust is
  seeing minimum number of patients for service
• Difficulty in inter-network referrals is
  knowledge of other networks portfolios
• Credit of these referrals

31
5 Networking - cont

• Solutions
• Sharing portfolios
• Working with neighbouring networks
• Geographical meetings with other networks (as
  oppose to cluster)
• NSSGs useful to encourage referrals

32
Data quality

• Capacity issue
• Options include
• Use of underspend for auditors
• Use of centralised staff (Band 6) to audit trials
  at trusts
• Concerns with duplication with monitoring visits
  and trust RD audits
• No real knowledge of this taking place (i.e. if
  devolved)
• Dependent on local situation
• Benefits
• Highlight data quality issues early
• Better quality of data