Claire Read speaks to Johanne Vass about how she created a nurse-led, one-stop, rapid-access clinic, which provides care for patients with sarcoma.
There are clear guidelines on the best course of action if someone is suspected of having a sarcoma, and they can be summed up in just a few words – consult with a specialist, quickly. Ideally that would be within a one-stop rapid access clinic, but existing pressures on consultant surgeons and radiologists mean such set-ups are often challenging to create.
In South West Wales, they solved the challenge by taking a different approach. “[We asked] why can’t a nurse with the right experience and academic background ful l that role as clinic lead? And so that’s what happened,” explains Johanne Vass, Macmillan sarcoma advanced nurse practitioner.
Her work on creating the nurse-led rapid access clinic began back in 2011. “It was set up initially as a pilot in one health board, Abertawe Bro Morgannwg University Health Board where I work, and I was employed two days a week to set up the clinics,” remembers Ms Vass.
“Early diagnosis is key in sarcoma – it has a massive impact on prognosis”
“Then in early 2012 we obtained Macmillan funding for the post. It became a full-time substantive post, and we were able to roll the clinic out to a second health board in West Wales – Hywel Dda University Health Board.”
Each week, she sees patients who have been referred by their GP because of concerns of a possible sarcoma – a rare type of cancer that develops in the bones or in soft tissue.
“There are referral criteria for the clinic, which we use across the UK in sarcoma and they are pretty broad,” Ms Vass explains. “So patients who present to their GP with a lump that meets one of these criteria can be referred to the clinic. Within 10 working days, the patient will have a 30-minute appointment
Johanne Vass began work on creating the nurse-led rapid access clinic back in 2011 with me, where they have a clinical assessment, and I will then decide whether the soft tissue lump is suspicious or not.
“If there is any suspicion, then they will go straight to radiology that day and have an ultrasound scan with a sarcoma radiology consultant. And on the basis of the ultra-sound, if they need a biopsy, that will usually be done on the same day as well. Quite often the results will be available by our multidisciplinary team meeting the following week.”
“Since sarcoma is a rare cancer, it’s not understood very well outside of a specialist service and people were quite pleased to have some expertise”
Since sarcomas are rare, the majority of patients Ms Vass sees will be discharged, however, she explains it is preferable for GPs to refer should they have any concerns, and thinks having a nurse-led clinic may help with that. “Early diagnosis is key in sarcoma – it has a massive impact on prognosis.
“Perhaps the GP might be a bit hesitant to refer to a consultant specialist service and end up not referring. Hopefully [with the nurse-led clinic] we’re lowering the threshold, patients are referred in, and they get early intervention by the right people.”
Asked whether setting up the clinic was hard work, Ms Vass provides a slightly surprising answer – no, not really. “I think we’re probably quite fortunate in that one there was no service, so there was nothing that needed to be changed, which does make it a little easier although it can perhaps be a bit intimidating.
“The other thing is that since sarcoma is a rare cancer, it’s not understood very well outside of a specialist service and so I think people were quite pleased to have some expertise.
“What you really need to have is a champion; it’s a team effort, so you need people behind you when you are presenting your ideas”
“Obviously the people who fund specialist services in Wales had to agree and it had to be supported at health board level. And we had a lot of support from Macmillan and from the Wales Cancer Network.”
When asked for her advice to other nurses seeking to create new services, Ms Vass emphasises the need for such support but also stresses the imperative to drive change.
“If you can identify a better way of doing things, then you shouldn’t be afraid to challenge the current situation,” she argues. “Don’t accept the status quo – if it’s not working for patients and it’s not working for service providers, then it’s not working.
“I think we shouldn’t just continue to do things in the way we’ve always done them because it’s the way we’ve always done them. What you really need to have is a champion; it’s a team effort, so you need people behind you when you are presenting your ideas. If you can present your case, make your case well, then you should just do it.”
She adds: “Within nursing, and also within healthcare, there are opportunities for constant improvement. And that’s great.”