Cluster A

1. Cluster A The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

6. Cluster B The National Cancer Research Network is part of the National Institute for Health Research

7. Flexibility of Funding • Ensure all yearly allocation is spent, explore ways to ensure no underspend is accrued. • Work closely with R&D 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. The National Cancer Research Network is part of the National Institute for Health Research

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. The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

10. Comprehensive and Cancer Service Networks Reasons FOR re-drawing boundaries: Less confusion over accrual figures. The National Cancer Research Network is part of the National Institute for Health Research

11. Responding to Initiatives • Work closely with R&D 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. The National Cancer Research Network is part of the National Institute for Health Research

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. The National Cancer Research Network is part of the National Institute for Health Research

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. The National Cancer Research Network is part of the National Institute for Health Research

14. Changing the Culture • Protect Consultant’s 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. The National Cancer Research Network is part of the National Institute for Health Research

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. The National Cancer Research Network is part of the National Institute for Health Research

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, R&D audits. The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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) The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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. The National Cancer Research Network is part of the National Institute for Health Research

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) The National Cancer Research Network is part of the National Institute for Health Research

25. QQR – cluster E The National Cancer Research Network is part of the National Institute for Health Research

26. 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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

29. 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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 The National Cancer Research Network is part of the National Institute for Health Research

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 R&D 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 The National Cancer Research Network is part of the National Institute for Health Research