By offering people choice in health and care services such as diagnostic services, in the years ahead we expect to see more services being offered by a much wider range of NHS, private and voluntary providers. The following case studies illustrate how this might work in practice.
The InHealth London NHS Diagnostics Service
- The InHealth London NHS Diagnostics Service was established in 2007 to provide additional capacity in diagnostics and to enable London GPs to make direct referrals for their patients. The service included provision of community based ultrasound, echocardiography, cardiac physiology, MRI, X-ray, endoscopy and phlebotomy.
- These services were initially provided on 31 community based sites across London. After two years of providing this service it was decided to expand the modalities on offer to include audiology and hearing aid fitting and DXA scanning.
- In 2009 there were 1800 referrals each week from GPs and other specialist clinicians such as extended scope physiotherapists and GPs with a special interest. The service was operating from 64 sites at the end of 2009.
- Electronic reports were available to GPs within 48 hours of the patient being seen in the clinic.
- From the beginning of the scheme, in order to ensure that GP referrals were appropriate, a clinical triage function was established at the point of receipt of referral. This ensured that every test requested was appropriate, that the patient could be scanned safely and that the appointment for the test was planned for an appropriate setting.
- Three initiatives: referral guides, structured referral forms and feedback were used to improve the appropriateness of referrals for diagnostic tests from Primary Care.
- Feedback from patients was consistently positive with 98% reporting that their experience of the service was very good or excellent.
- A study, using a questionnaire survey, was carried out to review the clinical management outcome for 800 patients referred directly by their GP for a diagnostic test, MRI or ultrasound scan or echocardiogram. Direct access to a diagnostic test, following clear guidance provided to GPs, resulted in 71% of patients being managed in primary care following the report being received by the GP.
- The service has resulted in more convenient and personalised healthcare for the patient and prevents patients who do not need to be managed in secondary care from being referred to a specialist, increasing the capacity in secondary care for patients who do need specialist management.
Electrocardiogram (ECG) with remote interpretation services.
ECG is the basic tool for diagnosing heart problems. GPs are not always equipped to interpret ECG tests and consequently many refer their patients to secondary care for outpatient appointments or to diagnostic centres.
Broomwell Healthwatch, a private provider based in the North West, offers GP practices, medical centres, and hospitals access to immediate, expert, clinician interpretation of ECG test results. This means ECG results can be interpreted immediately, and within the GP practice, thereby having great potential to save NHS money by reducing the need for outpatient referrals and improving patient care by enhancing patient convenience and reducing waiting times for diagnostic tests.
Practices that use the Broomwell ECG machines send ECG results to the Broomwell Healthwatch Centre down a telephone landline and receive an immediate verbal interpretation followed, within minutes, by a full written clinician interpretation. The cardiology specialists at the interpretation centre are fully qualified, regularly assessed and traces and interpretations are audited and quality controlled.
Practices who have their own ECG machine send the ECG recordings to the centre by email or fax and receive the same interpretation service.
Broomwell HealthWatch has established 12 lead ECG facilities in community settings, both in GP practices and at NHS Walk-In Centres in many areas around the country and especially in the Greater Manchester, Lancashire and West Midlands areas.
The centre handles over 1,400 ECGs per week and a high degree of acceptance has been shown among primary care physicians along with better patient experience and significant reductions in the number of referrals to Cardiology Clinics which has freed-up staff within the Acute Trusts so they can concentrate on more serious patient care.
I have heard many different reports about the InHealth London NHS Diagnostics Service but all of them describe a service that I would not want to take my Father or Mother to.
I have heard of patients being confused about who they can go to for aftercare. There is either none or very little verification carried out (real ear measurements), no counselling. Poor facilities in the mobile units & lack of equipment in clinic to assess patients effectively.
From Northern Lincolnshire and Goole NHS Trust. We have 3 Hospital sites over a 70 mile radius with greedbelt inbetween – how would we be able to provide a a new strategic direction to Diagnostics. Are there any other models in the Country of a disperate population which would help us reshape our services?
There is a mobile diagnositic unit in my area – care closer to home scenario. However, there are many instances where a consultation is carried out in one area [ close to home] but the results are given at a different location [ far away from home]. This is the problem – a quick fix wihout any foresight to ongoing needs. I also know of cases where a GP refers to ICATS – the patient travels “outside” the area for asessment , to be told a hospital appointment is necessary and they are re-referred back to the local hospital for a hearing aid. . It was quite clear that a hearing aid was the treatment required, so why follow this pathway. Time wasted and patient left confused and frustrated
I daily receive in hospital casenotes and community referrals audiometry which has been carried out in the GP’s surgery ususally by a healthcare assistant with rediculous results – these audiograms are being read by the GP’s and acted upon – how come ?
Are we regulated as audiologists ? Why do we as audiologists know that it takes years of experiance to test with diagnostic procedures and manage patients with hearing loss appropriately . With one single swoop the government have managed to downgrade our profession. Or is it that Audiology departments nationally are digging thier own holes to fall into ? The jury is out now , and there is nothing that can be done to stop the escalating trend , except sit back and wait for the litigation cases to appear , or is it that the accountants have yet again given thought to cost effective means ? Have they worked out that the NHS can afford X amount on litigation so everything that is going on will be able to continue , as the books will still show a profitable decision ? Britian has lost its manufacturing industry , its citizens are now being robbed of thier caring health service.
I have run community ultrasound services in two GP health centres since 1996.
These are excellent services backed up by audit on both clinical ouctomes and patient and GP satisfaction questionnaires.
We have now been informed we must become AQP by 1/4/2012.
There will be some benefits in doing this but this will also possibly increase prices if we go to a national tarriff.
I have several concerns and would like to be able to discuss thse with some-one and as I have had 16 years experience doing this (think we were the first to do community based ultrasounds) I feel I have much to contribute.
Sally, thanks for your comments.
You can find more information about what this means for providers here: http://healthandcare.dh.gov.uk/what-this-means-for-providers/