Speaker 1 00:03

Thanks for watching!

Speaker 2 00:10

Hello and welcome to Advanced Practice Weekly, my name is Ajay Bhatt and I will be your host today. I am joined by a very special guest from the Royal Marsden and I’m going to let her introduce herself and tell us a little bit about what she does there, so over to you.

Speaker 1 00:24

Hi, my name is Danielle Pinnock, and I am a Coordinating Education Supervisor in Advanced Practice at Royal Marston, and this entails me really supporting the practice assessors and supervisors that are working with the nurses and AHPs who are doing the pathways, so the advanced practice pathways. Practice assessors and supervisors obviously need support themselves, they need to be educated to be able to do this role, they need experience in the speciality where they’re working, but they also need support in how to give the right feedback, how to deal with students when they’re struggling, and also how best to support these students.

Speaker 2 01:09

Can you tell me what kind of training you do for your supervisors at the Marsden?

Speaker 1 01:13

Yes, so our supervisors will undertake a study day, so we run a study day at the Royal Marsden School here, and that will cover different types of feedback, different types of communication, obviously going through the pads themselves that the students have to fill in, and supervisors and practice assessors with them, and different types of teaching methods, how to get the best out of the time that they have with the students, and planning ahead really, because a lot of it is about organisation.

Speaker 2 01:46

So you’re in quite a unique situation there at the Marsden because you have your own kind of university there, right, and your own sort of teaching school within the hospital. Can you tell me a bit about your structure there at the Marsden and how things work?

Speaker 1 01:59

Yeah, sure. So the Royal Marsden School runs many different modules and they are validated by the University of East Anglia. So we work very closely with them. So it is a school that’s actually on site here and we teach nurses, but also other allied health professionals as well.  So for instance, in advanced practice, we run the master’s pathway in advanced practice, but it’s in cancer care. So it’s actually specialised. So we do modules as you would do in other advanced practice, but then there’ll be some optional modules as well that you can take from a big list of about 20 different optional modules in specialities of cancer care.

Speaker 2 02:45

Wow, that’s fantastic. And I’m assuming the majority of your advanced practitioners are nurses, is that right? And then you have your other allied healthcare professionals that bolt on.

Speaker 1 02:55

Yes, absolutely. The majority are nurses, but we have, for instance, have taught physios, diagnostic radiographers, somebody from speech and language therapy as well.  So yeah, we do get AHPs, but it would be nice to have more.

Speaker 2 03:11

recruiting as well on this podcast, I like that. So Danny, how is advanced practice transforming cancer care at the Royal  Marden?

Speaker 1 03:18

Well, I definitely think it’s improved standards of care and optimized service delivery as well. I think because advanced practitioners have a sort of a real breadth of knowledge, it’s definitely improved the flow of patients through the system because advanced practitioners can make complex decisions, perform complex care, and they act more autonomously.  This doesn’t mean to say that they don’t act in silo. They definitely talk to the multidisciplinary team very closely. We have many different specialities. So for instance, we’ve got AMPs working in children, young people, colorectal surgery, vascular access, acute oncology service, hematology, gynecology, urology, breast, mental health as well. And a lot of the AMPs are now running their own clinics. They’re doing testing. If they’re prescribers, which many of them are, they are changing treatment programs and plans to do with side effects, prescriptions, and running sort of end of treatment clinics for patients as well. So there’s a lot going on. Some also specialist procedures such as acidic drains and luminae, which is like a sort of colonoscopy procedure. They’re doing many of these, somewhat working in surgery as well and doing minor procedures in surgery and plastics. So it really has transformed the care of our patients.

Speaker 2 04:57

Wow. That’s amazing, isn’t it?  I mean, they’re really integrated into your service, aren’t they, in all aspects across the breadth of the hospital. They’re working in all sorts of different places and taking on really sort of complex procedures and autonomous roles in their own right, but yet working within that sort of MDT and being a big part of that sort of team. Yes, yeah. Is the aspiration there to increase your numbers of advanced practitioners? Is that something that you would like to see?

Speaker 1 05:25

Yes, absolutely. I think although we do already have at least 40, I think it is at the moment.  Yes, I think it is an area which will be growing in the future. I think the NHS need advanced practitioners and health professionals and advanced practice for sure. Yeah, I think it definitely helps the patient and as I said, helps the flow of patients through, as we know, we’re so busy. So I think anything that can help that flow is a positive

Speaker 2 05:55

Yeah, I think having those staff members that have a huge amount of experience to fall back on and then having that added advanced practice training really makes a huge difference, doesn’t it? They can really sort of take on those bigger cases and those complex patients and be able to manage them well, having all that sort of leadership experience as well, because a lot of them come from a lot of leadership backgrounds, don’t they?  It’s amazing.

Speaker 1 06:15

Yeah, absolutely. Yeah, not just clinical, it’s, you know, obviously covering all the four pillars as well, you know, they’re very much involved in education with with our other nurses as well, which is great.

Speaker 2 06:26

Danny, can you tell me a little bit about the differences between your advanced practitioners and maybe some of your other specialist practitioners or practitioners that are working in slightly different levels?

Speaker 1 06:36

Yeah, sure. Well, the advanced practitioners definitely have a wider breadth of knowledge, I would say, than some of the other specialists, like maybe a CNS. So they’re really covering and making complex decisions as well as assessing patients and ordering investigations and then acting on those and even diagnosing patients in conjunction with the MDT team. Many will describe, but not all, and that is dependent on where they work.  But it doesn’t mean that AMPs can’t be specialists in their fields. They can still very much specialise in a field and most do here, but it’s this sort of wider breadth of knowledge that they have and they will bring with them sort of education experience and leadership experience as well and really advanced communication skills, which is another very important aspect of their job.

Speaker 2 07:28

Thank you very much. I’m Danny Pinnock from the Royal Marsden Hospital.  Thank you so much for coming onto the podcast and sharing your experiences of working at the Marsden and all the great work that you’re doing. It’s been lovely having you on.

Speaker 1 07:38

Thank you, AJ. It’s been a pleasure. Thank you very much.

Speaker 2 07:41

Thank you so much for Danny Pinnock, and I’m now joined in the studio by Victoria Sinnett from the Royal Marsden, and she’s going to tell us all about her role. Thanks for joining me, Victoria.

Speaker 3 07:52

Well thank you very much for having me first of all. I’m currently in a role at the Royal Marsden as a consultant breast radiographer.  So I’ve been at the Marsden for 23 years and I qualified as a radiographer back in the late 90s but over years have been undertaking a range of advanced practices that has then led me to being in this consultant radiographer role. Fantastic.

Speaker 2 08:14

Can you tell me a little bit more about your advanced practitioner training and when did you do it?

Speaker 3 08:19

Sure, so I graduated as a diagnostic radiographer in 1997, so I’m rather showing my age but having qualified as a radiographer I then had an interest in breast imaging and I was fortunate to be able to undertake a postgraduate qualification in performing mammography. That was the first thing that I did and then from then that led me into other opportunities whereby I was able to undertake mammography interpretation so I was then trained with a further postgraduate qualification to interpret the mammograms that we were performing.  Then I undertook my master’s degree and then since that I’ve undertaken a postgraduate certificate in breast ultrasound so that I can now perform breast ultrasound studies and then since then have been trained to undertake the biopsy procedures that we perform for diagnostics. It’s taken a long time but it’s really rewarding because I think the challenge with radiography sometimes can be that you know you meet the patients and you can spot things on the imaging but it’s down to a radiologist to report them historically but what’s been so beautiful about breast imaging over the years is that I think first and foremost it was born from a shortage of radiologists but as radiographers we’ve been able to prove that we’re actually able to do these advanced practice roles and so the universities have created courses to do that so that we’re properly accredited and affiliated with the universities and where we’re employed through to undertake this advanced practice so mammography reporting has been around for a good few years now with radiographers but I think once that happened within the breast screening service it then gave further opportunities so small numbers still but radiographers have been trained to undertake things like breast barpsy procedures to undertake localization procedures to help facilitate surgery and increasingly performing things under MRI guidance as well so it’s a really exciting area of radiography to be in.

Speaker 2 10:08

Okay, brilliant. So how has advanced practice transformed patient care in your area of work?

Speaker 3 10:17

So traditionally, a radiologist historically would have done the examinations like breast ultrasound. So a patient, for example, the work that I do in the morning at the Marsden is what’s called a triple assessment one-stop clinic. So these are patients that have gone to their GP generally with a symptom that’s concerning them, that is concerned that it might be a symptom of breast cancer, and then they’re referred to specialist centres with Marsden being one of them. And when the patients have been examined by either an advanced practice nurse or a surgeon, then they are then referred for imaging. So they’d usually go from mammogram, and then sometimes breast ultrasound, and traditionally with the kind of, I guess, old-fashioned roles, the radiographer would perform the mammogram, and then that’s where the radiographer’s input would have stopped.  Whereas now, a radiographer can actually perform the ultrasound and interpret the mammogram and do the biopsies. And what’s really nice is, for me personally, I only work in breast imaging. So it’s been really helpful in terms of patient workflow and a patient, the relationships you build with patients, because I now see the same patients, I can see them right from diagnosis, right up to when they’re midway through treatment and following them up once they’re on their chemotherapy, for example. Whereas our radiologists are often stretched quite thinly, they are expected to go to other parts of radiology and rotate around all of that. And I think sometimes that can be quite challenging because the patient might necessarily see the same familiar face, whereas actually we’re really lucky at the Marsden because people like me and I’ve got a colleague at the Chelsea branch that does the same. We are almost like the face of breast imaging from a radiographer’s point of view, and have got to as high clinically as we’re able to get to help make sure that things are nice and streamlined to the patients in all aspects of breast imaging.

Speaker 2 12:04

There’s a really nice bit of continuity of care for those patients, they see the same person, and that’s really important at a time when things probably could be quite stressful because they’re coming to you potentially with a lump or something that’s a bit not right. So automatically people think of the worst possible case scenario and to have someone like you to help them through that journey is probably really important.

Speaker 3 12:26

Yeah, and I think also you then do often see the same patients later on in their journey, so you’ve seen them could potentially be the most traumatic part of their life, but then actually it’s so nice then to see them again and so nice. The amount of patients that say to you, oh my goodness, thank you so much for the way that you diagnosed me, and you think, oh my goodness, what do you mean thank you for diagnosing you?  Because it’s awful to say that to people, but I think it’s so nice to feel that actually you can do it with compassion, it’s apparent that you care, and then when they see you later on, it’s just so nice that you’re then able to give them good news that maybe their tumor’s shrinking, and actually it was rubbish to start with, but in terms of the stress of anxiety of a diagnosis, but actually they’re out on treatment now, and the same face is then giving them good news, because it’s really stressful for patients often to come back to the place that they were diagnosed, and a lot of them say that they find that really quite anxiety driving, but then I think it’s really nice if they then see a familiar face that can see them a bit further through, so it’s great.

Speaker 2 13:23

And also that this can sometimes be a time critical situation, can’t it? So if you pick that up or find it very early, then the prognosis is often a lot better. So of course, if you do find it and you give them a diagnosis, but it’s done early, you pick up potentially making a huge difference. So that’s probably another reason why they’re thanking you, which is amazing.  Okay. And when you’re undertaking your ultrasound, you’re interpreting the images that you’re seeing on the screen at the same time. Is that right?

Speaker 3 13:50

Yeah, correct. Yeah, absolutely.  So ultra standards of dynamic study. So you’re, you do take images that can be looked at later on, but really the most of the information you get is while you’re actually performing the study. So, and then the vital part of being able to do that well is that you, you know, a patient’s looking at you expectantly the whole time you’re doing that study, because they know that you can see what is going on. So you have to have really high level communication skills, you have to be able to judge how you think a patient might like to be told, you know, some patients just don’t want to be told, others want to be told absolutely everything. And you have to, it’s a real skill to be able to work out quite quickly from having only had a couple of words with the patient up to that point, which way you think that they’re going to want this this information to be handled and been dealt to them.

Speaker 2 14:34

So how do you in your role collaborate with other members of the MDT team, the multidisciplinary team at the Marsden? How do you sort of fit in with the rest of the work that goes on there?

Speaker 3 14:45

So we’re really lucky because I like to think that we are highly thought of within the team because working with all the different specialties is obviously really important and it underpins the patient care. So we are entirely involved with the multidisciplinary team.  Personally, I’m one of the people that presents the MDT meetings from a radiology perspective. We work really closely with our surgeons. They see the work that we do and they respect the work that we do and they certainly don’t treat us any different to any of our doctor radiology colleagues because they see that we’re integral to the patient care.

Speaker 2 15:19

You’ve gone through that advanced practice journey, you’re now at a consultant level which is absolutely fantastic and we want to see more advanced practitioners at that level and becoming those really inspiring visual leaders. Do you have other advanced practitioners that work in your team underneath you or within your area?

Speaker 3 15:39

Yeah we’ve got so we’re again really lucky that there’s a lot of radiographies at the Royal Marston that have actually been trained in various procedures so within breast imaging we’ve got a couple of colleagues that are already trained to perform interventional procedures so they’ll be part of these one-stop clinics that I described whereby they will do diagnostic boxes on the patients and then we’ve got other people that are actually training at the moment as well so it’s a radiography is really important to the breast service at the Marston because of the skills that we’ve developed over the years.

Speaker 2 16:09

So are there any innovative practices or technologies that you’re currently using or are planning to use within the area of specialism?

Speaker 3 16:18

So again, being fortunate in the role that I’m in, I am involved in quite a lot of research work. We are lucky with the equipment, the standard of the equipment that we have at the Marsden. And we are currently using a new technique, which I was the world’s first to actually use, which is a marker clip that is helped with the surgeons to facilitate more accurate surgery. So we placed these markers into breast cancer, breast cancers to help the surgeons to actually then excise them. And the technology of using these markers has been around for a few years, but they’ve actually improved the metal that they use and they’ve improved the detector that they use. And we were the first center, as I say, to actually have this new clip. And yeah, I was the first one to put it in. So, and that’s been amazing because that then led me to being able to go to international conferences and present the work that we’ve done. So that’s really exciting.  And I’ve also been able to go to India and do some work with them on a view to help where we’re injecting a drug to help patients with their radiotherapy treatment as well. So even though I work within diagnostics, because we do the breast intervention, I’ve been trained to inject this particular drug that helps, hopefully, when the results are published, hopefully show that it’s a radio sensitizer for patients before they have the radiotherapy. And that’s been particularly interesting in communities such as in India, where they don’t necessarily have the access to healthcare that we’re all lucky enough to have in the UK. So we’ve been able to go and introduce that over there, which has also been really exciting.

Speaker 2 18:01

Wow. I mean, that’s incredible stuff, isn’t it?

Speaker 3 18:06

Yeah, but it is. It’s amazing. It is pretty amazing.

Speaker 2 18:09

really is. I mean I guess for you it’s just your day job. What are the biggest challenges that you faced in cancer care and how do advanced practitioners help address them?

Speaker 3 18:19

I think the challenges have increased in terms of definitely since COVID, there is definitely health anxiety. There’s become evidently more health anxiety generally.  So we do have huge numbers of patients that present for diagnostics to the breast service clinics. But what’s really important is to remember that even if it’s considered that maybe the GP shouldn’t have referred them because it’s considered that there’s a really low risk of being a cancer, for that patient to be referred to a specialist centre to be seen by specialist staff who diagnose breast cancer on a routine basis, their anxiety is very real. And so for them to be reassured is just so important. It’s so nice that, you know, even though I work within breast cancer diagnosis, and that is the primary part of my job is obviously to diagnose breast cancers, it’s really important that we can also play a part in actually reassuring well women that actually their symptoms are not a sign of cancer and how to manage their breast health and to make them more aware so that they are then able to feel that they are comfortable and confident to access breast cancer services again in the future should they need it.  And I think that that’s, I think as radiographers, we’re really well placed to provide that support with female. It’s all it’s females that work within this role because of the way that the sex discrimination act enables it to be just women. And so I think we’re really well placed to actually be able to have really good communication with these patients and reassure them and encourage them to access treatment and services if they require them.

Speaker 2 19:57

Yeah, I think patient’s anxiety and stresses are what they feel and it’s not for us to judge what it is and I say that to a lot of my colleagues in the ambulance service. When someone calls an ambulance, they are genuinely distressed, they genuinely need some help.  Okay, so how do you see the role of advanced practitioners evolving in cancer care over the next few years?

Speaker 3 20:18

I just see it further expanding. I think we’re working in an industry that has huge amounts of demands on its services. There’s clearly not enough of the traditional doctor roles to go around, you know, there’s all these additional procedures the patients are now undergoing, more complex, more patients. And I think whether it be rage aquifers or any allied health professional or nurse that is able and willing to be trained, you can train these really high caliber staff into being able to do a whole range of advanced practice techniques. And I think things that traditionally patients and the population consider would be a doctor role is changing, it’s constantly changing. And I think we’ve seen maybe even just the tip of the iceberg, but it will definitely continue to evolve. Because I think those of us that are in it have proven that we’re able to do it. And I think we’re continuing to prove that there’s great scope for far more advanced practice than is already happening.

Speaker 2 21:11

Yeah, I completely agree. I think there’s loads of scope out there for us to take these, we’ve got these huge vast numbers of experienced people with 10-15 years experience in their chosen field and then to give them those extra skills and a bit more training and that master’s degree to just push it a bit further and then they can pick up these sort of complex patients, work on their own.

Speaker 3 21:32

Yeah, but the physios do increase, the physios do it, and yeah, they’re certainly in the ambulance service, don’t they? So it’s yeah, it’s great.

Speaker 2 21:39

Yeah, I mean, there’s when you look at the sort of different professions which are represented in advanced practice, the list is huge, you know, from from OTs to drama therapists to all sorts of different stuff, things you wouldn’t even consider. It’s great.  Okay, fantastic. So if there’s one thing that you’d like the public or other health care professionals to understand about advanced practice in cancer care, what would it be?

Speaker 3 22:02

I would like patients to understand that we’re not doctors sometimes. I think I have faced patients that when I used to be in uniform I would have patients say to me I’d rather be seen by a doctor even though I was as good if not arguably in some cases better than some of my medical colleagues.  I had more experience is what I mean I suppose. And then the minute you’re out of uniform the patients just automatically call you doctor and it’s I think I would really love for the public to or actually other professions within the health service to understand that advanced practitioners are really good at what they do can be really good at what they do and it’s okay that they’re not doctors and these traditional roles they’ve changed they have changed and they’re continuing to change and that every advanced practitioner should truly be respected for the work they do really appreciate the work they do because it’s not easy you know this takes years and years and it’s not an easy pathway and every advanced practitioner has invested a huge amount of often their own personal time in in reaching these levels and I just think it would be really nice if people could move past those traditional roles of oh well if you’re not a doctor then surely you shouldn’t be doing this or could I have a doctor instead because I think that there’s really time for that to change now.

Speaker 2 23:23

I agree. Victoria Sinnit from Royal Marsden, consultant radiographer.  Thank you so much for coming on to Advanced Practice Weekly. It’s been great talking to you and hearing about your journey and all the great work you’re doing there. So thank you very much for sharing.

Speaker 3 23:35

Absolute pleasure, thanks so much for having me.

Speaker 2 23:37

Brilliant. Thanks, everybody. Thanks for joining Advanced Practice Weekly. We will see you again shortly. Take care, everybody. Bye bye.