Home > Library > Diagnostic and Treatment Centres - DTC: the future of healthcare? >

Case study: Chorleywood Health Centre

Dr Russell Wynn Jones GP

Some of the answers that DTCs are looking to provide already exist in general practice.

General practice trying to ‘bolt’ a number of things together to make a difference: making access to NHS service better and more pleasant, making pathways more effective, understanding more disease profiling and providing healthcare at or close to home – i.e. without patients having to go to hospital so often.

GPs at the centre started to change the way they worked to provide a broader set of services to undermine the idea that you always have to go to hospital with a question. If the patient did have to go to hospital they should go with a diagnosis that was as accurate as possible.

This included looking at areas where services could be provided by others. For example, six graduate nurses now run morning surgeries and diagnose and their diagnoses are recognised as being ‘as good as’ that of the GPs. Liked by patients. Another example sees a nurse and a physiotherapist training to use imaging systems. Changing the way GPs work should allow them more time to develop specialist skills.

Attention has been paid to matching need to services, reducing access time, profiling patient populations, developing a patient register and an electronic patient record system.

Usually the patient has to move around a great deal and wait on different parts of the health service to respond. The practice has developed the use of IT to provide ‘virtual consultations’, where the patient and GP are connected directly to, for example, a CHD consultant via video-conferencing/web-based technology. This can save the patient the procedure and time of booking an appointment with a consultant and can lead to better diagnosis as the doctor and consultant can confer and ask the patient questions in ‘real time’.

Another pioneering technique for consultations has been to have more people present with the GP and the patient, for example a nurse and another doctor. Again, this has been found to improve the quality and accuracy of diagnoses.

The practice has looked at how it can provide some of its own imaging services and use technology to provide imaging services remotely. For example, video technology was able to save an elderly lady a visit to a clinic when her symptoms were shown ‘live’ on video to a consultant.

The surgery has an 86 per cent accuracy rate for diagnosing.

Surgery looked at its patients in the local acute hospital. Found that over half need not have come to hospital, about 30 per cent may not have needed to be there at all. Worked out that most could be stabilised in 72 hours. The practice thought it could ‘do something about’ acute illness. As a result it is also using technology to provide better home care. For example, having recognised that many terminally ill patients do not achieve their wish to die at home, a ‘virtual’ bedside monitoring system is being developed.

There is no reason why General Practice cannot be regarded as a DTC. The issue is services not buildings although there needs to be clarity over responsibility and ownership.

Providing for the flow of information is key.

General Practice can provide a range of ‘DTS services’, particularly the diagnostic element. This can include imaging services such as ultrasound and fundoscopy as well as duplex scanning, gastroscopy, sigmoidoscopy, echocardiography and stress testing.

Ingredients for successful DTSs are seen to be:

• active involvement of primary care
• specialist medical skills
• multi-skilled technicians
• multi-skilled nurses
• shared electronic records
• broadband for images
• established systems and links between practices and DTSs and their secondary and tertiary providers.

< < Previous - Next > >