Overview of the Service Model
A new four-tier clinical model for SRS/SRT Services The Clinical Model) has been developed by NHSE. The model is based on established patient pathways and the complexity and rarity of the clinical indications that can be treated with SRS/SRT.
The Clinical Model
Tier 1 activity (Neuro-oncology): Deemed to be of lower complexity this includes cerebral metastases and non-skull base meningioma’s and follows the patient pathway for patients via a regional neuroscience (neuro-oncology) MDT and in conjunction with TYA MDTs and pathways.
Tier 2 activity (Skull-base): includes tumours such as Vestibular Schwannoma, pituitary, meningioma, etc requiring co-location with a full skullbase team and following the patient pathway via a regional skull-base MDT in a neurosurgical centre. Pituitary indications require full pituitary MDT.
Tier 3 activity (Vascular): Includes cases such as Cerebral Arteriovenous Malformations and cavernomas. Requiring co-location with a full vascular MDT and full imaging support services, such as Digital Subtraction Angiography
Tier 4 activity (other non-tumour indications): Includes trigeminal neuralgia. Lower volume; best carried out in fewer centres, enabling appropriate staffing skill-mix, MDT support, co-located services and appropriate equipment. Requires co-location of relevant MDTs – functional, epilepsy, pain services.
The Service Model
The clinical model is being delivered through a service model consisting of:
The delivery of Tier 1 and Tier 2 only activity based on existing neurosciences networks that have a population footprint of 2 million in order to deliver a minimum of 100 SRS/SRT cases per year;
The delivery of Tier 3 and Tier 4 activity, because these clinical conditions are rare, based on a further grouping of neurosciences networks and are therefore considered to be ‘supra-network’.
A partnership between Sheffield Teaching Hospitals NHS Foundation Trust and the Thornbury Gamma Knife Centre is the designated SupraCentre for the North and Midlands Region and contracted for delivery of Tier 1 and 2 activity for East Riding of Yorkshire and South Yorkshire and Tier 3 and Tier 4 activity for the North and Midlands.