Transformation Directorate

Breast Pathway Management solution is in use by teams at North Manchester General Hospital (part of the Manchester University NHS Foundation Trust)

A team from North Manchester General Hospital required a solution that manages the care pathways of all the Breast Unit breast patient referrals. The project began as a breast cancer remote monitoring implementation and evolved to meet the team’s requirement for a single tracking system.

The unit treats patients with breast cancer, benign breast conditions and those requiring gender reaffirmation services, and includes the provision of remote monitoring and Patient Initiated Follow Up (PIFU) to cancer patients.


In 2016 the Unit began participation in a pilot study to introduce supported self-management (SSM) for breast cancer patients across Manchester, in conjunction with Macmillan and another breast unit, and supported by Manchester Vanguard. As an interim measure the Unit used Excel spreadsheets to manage the process while the breast care nursing team used a Microsoft Access database to document contacts with all patients. However, the potential for error, such as the missing of scheduled mammogram tests, grew greater as the number of patients increased.

Staff on the Breast Unit had also recognised how inefficient it was for them to switch between separate databases such as radiology, as well as potential risk when transferring data over.


Staff on the Breast Unit team wanted a fully integrated breast pathway tracking solution with easy access to patient data within one environment. Allowing them to remain patient-focussed, maintain patient safety and deliver high quality care.

Solution and impact

Civica’s InfoFlex fully integrated Breast Pathway Management solution provides a smooth and secure means of managing diverse care pathways on one system, facilitating existing processes and using interoperability to provide quick, easy access to relevant information from other systems without the need for separate logins.

The InfoFlex software was selected to automate the supported self-management process after its success as a SSM solution had been demonstrated in the Colorectal Unit at Wythenshawe Hospital which is also part of the Manchester University NHS Foundation Trust.


InfoFlex is a web-enabled integrated shared care solution supporting all aspects of cancer care. It is designed specifically to allow modelling of clinical processes without the need for programming.

The InfoFlex breast pathway management solution provides clinicians with a fully-integrated tool to track and monitor their patients on the pathway. It also has a range of patient assessment tools, including:

  • quality of life (QoL) measures
  • patient-reported outcome measures (PROMs)
  • patient-reported experience measures (PREMs)
  • patient portals
  • patient care plans and results

The shared care solution supports the needs of clinicians, GPs and patients through care planning and delivery, as well as supporting patient choice and control. InfoFlex has its own integration engine for links to third-party platforms both in the Trust and in the community.


InfoFlex breast pathway management solution:

  • Improves patient safety, particularly patients on PIFU, as automatic flagging of tests due means no patient inadvertently misses a test and transcription errors are avoided.
  • Provides efficient patient monitoring as interfaces to other trust systems allow quick and easy access to patient information and enable the live tracking of a patient’s progress along their care pathway.
  • Gives clinicians access to a clear, user-friendly system saving time that can be used for patient care.
  • Facilitates the writing of reports and production of quality audits, business cases and PROMS.
  • Saves administration and clinicians’ time and eliminates the need to log in to separate systems to gather patient data.


The solution was designed to monitor cancer and non-cancer breast pathways. The breast stratified follow-up (SFU) design allows users to schedule and carry out reviews of tests based on age, menopausal status and current therapies. These pathways typically last over a 5-year period and include an annual mammogram test, although they can continue until a patient reaches screening age. To support reviews, all results of imaging (such as DEXA, MRI, CT and USS), as well as pathology results, are brought into InfoFlex. InfoFlex documents can be transferred to the Trust’s document repository.

In addition, the design facilitates the management of outpatient appointments, records contacts, and captures holistic needs assessments.

Key learning points

Having all the clinical data in one shared care environment allows the clinicians to see a complete integrated view of the treatment.

Managing the patient’s pathway through remote monitoring and patient dashboards enables patients to maintain a holistic view of their wellbeing through cancer tracking, while alerting clinicians to any deterioration in their condition.

Viewing historical data from the patient assessment tools, such as questionnaires and PROMs, gives a greater understanding of the patient’s condition providing the basis for targeted advice.

Key figures/quotes

Amanda Snippe, lead nurse and Macmillan breast clinical nurse specialist, explained what led to the discrete SSM project becoming a fully integrated breast pathway tracking solution:

“It was partly due to us always wanting the best that we could have and partly perhaps not knowing what more functionalities another solution could provide. Basically we didn’t want to waste time going into different hospital systems. We wanted one system and to be able to access as many things as possible that would make it easier and quicker, with less room for error than if data was being manually transferred.”

Find out more

More about Infoflex

Find out more about the NHS Cancer Programme resources to support personalised stratified follow up (PSFU) with digital remote monitoring systems (RMS) from the Cancer Alliances Workspace on the FutureNHS Collaboration Platform (access via your Cancer Alliance - contact details here).

Infoflex is included in the NHSX/NHS England and NHS Improvement 2021 Digital Remote Monitoring System Implementation Guide, available from the Workspace here (account required).

Key contact

Amanda Snippe, lead nurse and Macmillan breast clinical nurse specialist

Marc Warburton, managing director, Civica