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’.

UCLH is the designated SupraCentre for the South Region and contracted for delivery of Tier 1 and 2 activity for North & North West London and Tier 3 and Tier 4 activity for the South region, South West and London. It is also the designated national centre for paediatric SRS/SRT for the South region, South West and London working in partnership with Great Ormond Street Hospital.