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Independents' Day

The challenge of rapid diagnostics access

Michelle Webster and Beverley Slater of the Improvement Foundation outline the challenges diagnostics presents.

Michelle Webster and Beverley Slater of the Improvement Foundation outline the challenges diagnostics presents.

Getting rapid access to appropriate diagnostics continues to be one of the major challenges of 21st century healthcare. Despite major advances and innovations in the diagnostic technologies, the current systems that surround access are vulnerable to errors and inefficiencies.

By designing and managing services around patients' needs, practice-based commissioning can make a difference. Things that can go wrong with diagnostics include:

• Patients can get ‘lost' in the system with no overall coordination of their journey

• Some tests that should be undertaken ‘in parallel' are instead undertaken one at a time so that the whole process takes longer than it should

• The disease may have worsened or become ‘untreatable' during the periods it has taken to get a diagnosis

• Tests may be repeated because the receiving clinician does not trust the diagnostic interpretation

• Patients may feel ‘messed around' through multiple appointments at inconvenient locations.

Accessing diagnostics introduces complexities into the patient journey. These are partly as a result of:

• Many diagnostic tests requiring specialist interpretation involving a range of professionals, including among others radiographers, medical physicists, histologists, cardiac physiologists – so communication systems must be excellent

• The patient journey algorithm that governs when a patient needs which diagnostic test may be complex, possibly involving access to judgments from a senior clinician at key stages – so good administrative coordination is essential

• Speed is always of the essence.

The articles in this edition highlight excellent work in improving access to diagnostics by PBC, bringing services closer to home and building the care pathway around the needs of patients.

All three of the examples involve one-stop clinics combining diagnostics, consultation and management plan in one visit at a community location, improving timeliness and convenience for the patient at the same time as reducing cost.

The West Hertfordshire primary care clinical assessment and treatment service has reduced the pathway from three outpatient appointments to one and is now able to provide a hysteroscopy service in primary care. Similarly, Croydon provides a one-stop service for menstrual disorders. This clinic has introduced an additional innovation which is the ability to immediately fax the outcome of the clinic to the referrer, and provide patients with a copy of this letter.

A heart failure clinic in Leicester provides echocardiogram, interpretation and management plan in one local visit, reducing the time to diagnosis and providing a local service to patients at a lower cost than the hospital service.

With careful business planning, these services have demonstrated win/win results for patients and commissioners. But one of the more challenging aspects of developing community diagnostics services is that of creating an effective interface with secondary care services. All these case studies indicated having to work hard at this.

However, in both the West Hertfordshire and Croydon services consultants now form part of the team delivering the community service and are able to list patients directly on to surgical lists if necessary.

Engagement with secondary care is likely to remain an issue for future community diagnostic services, and one that will need local solutions. However, in Lord Darzi's Next Stage Review of the NHS, High Quality Health For All (Department of Health, 2008), all regional visions have emphasised the importance of rapid access to diagnostics in convenient locations.

It is now up to practice-based commissioners to continue to make patient-focused diagnostic services a reality.

Michelle Webster is national commissioning lead and Beverley Slater is national knowledge management lead for the Improvement Foundation

Focus on...diagnostics

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