BETTER CONNECTIONS AND NAVIGATION:
MACMILLAN CANCER NAVIGATOR SERVICE AT
IMPERIAL COLLEGE NHS TRUST
WiFi name: WifiLoveMCR
Password: internet
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WHAT IS THE CANCER NAVIGATOR SERVICE?
 Macmillan
Cancer Navigators is an enhanced phone
based service for cancer patients, their family/carers and
primary care services
 The
Navigators triage all calls from cancer patients, and
using a PRAG system are authorised to action calls or to
refer to more appropriate person primarily CNS
EVIDENCE OF NEED
 Poor
patient experience – as highlighted by successive
National Cancer Patient Survey results, particularly the
ability of patients to contact their CNS
 CNS
time inappropriately taken up with routine
admin/non specialist tasks reducing the time and
attention available for clinical work and innovation
THE CONTEXT
 Cancer
Navigators were developed as part of a Whole
System Redesign partnership between Imperial College
NHS Healthcare Trust and Macmillan Cancer Support
 Other programme work-streams include:
 CNS development
 Schwartz Rounds
 VBS
 Living With and Beyond Cancer
EXPECTED OUTCOMES
To improve patient experience by:
 Ensuring
that patients receive a timely response to their
queries and have a positive seamless experience of
accessing cancer services, support and information
 Freeing
up CNS time to focus on appropriate patient
support, clinical care and innovation
DESIGN AND INDUCTION
To create competent staff and raise the VALUE of the team
Orientation and training is essential for each Navigator: Attendance/observation of MDTS & relevant departments &
services
 - to enhance understanding of role & function
 Radiology diagnostics & treatment areas
 ensures visualisation of service & increased understanding of service &
treatment to reassure patients
 Ability to book/check appointments  ensures speedy response to patients
 Instigation of PRAG rated triage assessment sheets
 Designed to speciality needs with CNS teams
Key manager / leader initiatives
 Establishment of regular team meeting
 1 to 1s for each team member
 Monthly ‘Supervision Sessions’ whole team to attend
Promotion of service
 CNS to inform patients about the service remit
 Navigator information leaflet
Process-mapping: 62 day pathway
First OPA
Cancer Referral
Centre
Initial
Diagnostics
MDT Tracker
MDTT already takes
patient through this
part of pathway
MDT
Meeting
MDT Coordinator
responsible for MDT
actions
Trackers responsible
for tracking/booking
and contacting patient
at pre-diagnosis stage
Post MDT /
Diagnosis
MDT Coordinator &
CNS confirm which
patients have been
diagnosed
MDTC and CNS
allocate any actions to
Trackers and
Navigators
E.g. Whether the
Tracker continues to
book any further
investigations needed
or not
Staging
Diagnostics
Post MDT Navigators
make outbound calls
to patients
Navigators may make
investigation
appointments
depending on Post
MDT guidance
N.B. Escalation route
for Navigators if they
aren’t able to schedule
these?
Treatment
Navigators
responsible for
outbound calls to
patients
Escalation route to
CNS for clinical issues
and MDTC for CWT
related issues
End of
Treatment
Transfer to OAFU
If patient calls
Navigator at this
stage, refer to Tracker
Escalation route for
missed appts?
Navigators also
manage rebooking
process for patients at
this stage
EVIDENCE OF IMPACT
Improvement in score of National Cancer Patient Experience
Survey- most notably a 23% increase in the ability of patients to
easily contact their CNS
 Multiple CNS led innovations including:

PREPARE programme in OG- an innovative prehab programme leading
to nurse of the year award for lead CNS 2016
 Introduction of HIPEC: a specialised treatment for colorectal patientsone of only 5 centres in UK
 Redesigned Urology Pathway including multiple CNS led clinics and
development of Open Access Follow Up
 Development of telephone clinics across tumour sites

LEARNING
Renewal is central to success
 Ongoing communication between navigators and CNS teams
particularly is essential e.g. each attending the others team
meetings
 Team Leader necessary to manage the day to day activities
 Banding is such that there is likely to be a regular staff
turnover as staff seek professional advancement or perhaps
face-face roles
 Clinical supervision is critical
 Review of what does/doesn’t fall in the role remit is important
POSSIBLE FUTURE DEVELOPMENTS

Integrating the Navigator role with Tracker and OAFU roles to
ensure renewal of skills