Building a healthier future for our NHS through joint working

Mark Toms profile: Article on joint-working

In a resource-scarce and budget-strained environment, Joint Working Projects between the NHS and the pharmaceutical industry are helping to meet the healthcare challenges of the 21st century. How?

It was during a routine meeting at NHS Lothian in 2014 that an idea was conceived for a new Joint Working Project (JWP) that would profoundly change the way people with cancer in the UK are treated. The Novartis Oncology team and Mira Farquharson, a consultant at the Western General Hospital in NHS Lothian, were mapping the patient journey in myeloproliferative neoplasms (MPNs), a rare type of blood cancer. Together they identified a number of pressure points in service delivery and soon realised the current situation was unsustainable. Increasing incidence of cancer diagnoses, an ageing population, and the development of more personalised and targeted cancer therapies meant that more healthcare professionals’ time was required to meet patients’ needs.

More people were surviving cancer, but the service was working at full capacity and was unlikely to cope with future demand.

The service model

Against the backdrop of a new NHS Scotland Cancer Strategy Plan, Novartis and the NHS Board worked in partnership over time to develop and pilot a new patient care pathway. As part of the JWP, they funded a MPN clinical nurse specialist who could offer patients telephone and outpatient clinics and manage patients who were clinically stable and did not have complex needs. The nurse-led service covered education, lifestyle advice, support, guidance and assessment throughout the patient’s journey.

It was a huge success – 94% of patients said the NHS Board’s service had improved since the clinical nurse specialist joined. Crucially, the new model released 800 consultant appointments each year, freeing up consultant time to manage more difficult MPN cases. At the conclusion of the two-year pilot, evidence that the new pathway worked – and even gave the NHS Board cost-savings – was so robust, the Board continued the investment into a permanent clinical nurse specialist. A second JWP has now started in NHS Fife which was built on the learnings from NHS Lothian. Dr Kerri Davidson, Consultant Haematologist, Victoria Hospital, Fife, said: “Without the enthusiasm, support and efficiency of the Novartis team, we would never have got this MPN service development off the ground.”

A paradigm shift

This type of JWP, where Novartis Oncology supports NHS organisations to utilise skills within the existing team to create new care pathways, has been rolled out across the UK and in services for breast cancer, neuroendocrine tumours (NETs), MPNs and rare cancers. Typically, Novartis and the Trust with whom they partner offer nurses or pharmacists the opportunity to train to become prescribers and undertake a clinical examination which enables them to take responsibility for a group of patients themselves. Since 2014, over 30 projects of this kind have been initiated and more are in the pipeline. Although consultant oncologists have traditionally been at the heart of cancer care delivery, a more inclusive approach validated through this type of JWP shows that a multidisciplinary team of doctors, nurses, pharmacists and others can work together in new ways to deliver better care to more patients.

Transparency and trust

JWPs can take multiple forms, but all projects are designed to identify and adopt sustainable innovation that will deliver benefits to patients, the NHS and industry. The strict governance structure of JWPs demands that identified milestones have to be reached before funding from either partner can be released. Detailed benchmarking and evaluation means that although projects are highly localised, they aim to establish best-practice models that can be adopted more broadly across the health service.

Leveraging data science and digital

It’s not just unlocking new skill sets within teams that Novartis is focusing on within JWPs. Within the 50+ NHS-Novartis Oncology collaborations, several are using data science to better patient outcomes. At the Christie NHS Foundation Trust in Manchester, the team knew that despite overall improvements in the outcomes of patients with breast cancer in the UK, significant differences remained in the presentation and management of the disease. A JWP with Novartis was implemented to analyse patients’ experiences of the breast cancer service at the Christie in real-time. Patients were asked to capture their thoughts and feelings as they received care using the app uMotif. It is hoped that the project will improve the speed of decision-making and treatment initiation (a key priority within the Cancer Strategy Plan) and be more responsive to patient needs.

Collaborating beyond cancer

JWPs are embedded in Novartis UK’s DNA – we are proud to be a leading industry investor in JWPs in the UK and, outside of oncology, our partnerships span multiple therapeutic areas including cardiology, rheumatology, neurology, dermatology and ophthalmology.

Preliminary outcomes from an ongoing JWP focused on heart failure (HF), also in NHS Lothian, reported in January 2018, show a new hospital-based specialist HF service is already reducing mortality rates, ensuring more patients receive the specialist and follow-up care they need and readmission rates are lowering. At the start of the project, an audit conducted by the Novartis-NHS JWP team showed patients were frequently not being seen by a HF specialist prior to discharge from hospital, which was reflected in higher-than-desirable readmission rates. Following the implementation of the new service, an estimated 91% of patients are now receiving input from a specialist during hospital stays versus less than 50% previously.

Novartis is proud of its collaborations with the NHS – we believe we have a responsibility to create a healthier and more sustainable NHS. By working in close collaboration, sharing knowledge and experience with transparency, JWPs will support patients to have a better NHS experience and improve their disease outcomes. We have come a long way since 2014, but the results speak for themselves.

As we face increased demands for care, JWPs offer a powerful new model of service delivery that will help to meet society’s new and unrelenting healthcare pressures.


Mark Toms is Medical Director and Chief Scientific Officer, Novartis UK.

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