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Good Practice: service development - PBC ultrasound pilot success

A Northumberland community scan project is good for patients and the NHS, writes Julie Griffiths.

Sonographer Susan Davis (left) with Frances Naylor, who masterminded the gynaecology ultrasound pilot (Photograph: Julie Griffiths)
Sonographer Susan Davis (left) with Frances Naylor, who masterminded the gynaecology ultrasound pilot (Photograph: Julie Griffiths)

ach week Susan Davis, the sonographer for Blyth Valley Community Gynaecology Ultrasound Scan Service, sees around 20 patients with symptoms of ovarian cancer or post-menopausal conditions. She holds two clinics a week - one at Cramlingon Health Centre and the other at Blyth Community Hospital.

The service, which began in January 2009 as a 12-month pilot, has proved both cost-effective and popular with patients, and NHS North of Tyne has decided to continue it for an indefinite period.

Personalised service
Ms Davis believes the personalised service she offers is one reason why patients are enthusiastic about the clinics.

'Appointments are arranged by a phone call or text so that patients have a chance to ask me any questions before they come, which is reassuring for them,' she says.

The scheme covers all women among Blyth Valley's weighted population of 68,468, and patients referred to Ms Davis are seen within a few days.

'We are able to offer appointments within a week, with urgent referrals seen at the next available clinic,' Ms Davis says.

The scheme is the brainchild of Dr Frances Naylor, a partner at The Forum Family Practice in Cramlington and vice-chair of the Blyth Valley practice-based commissioning (PBC) group. Patients from the seven practices in the group are referred for scans. Dr Naylor says the idea was to find a way to help patients access care without having to travel to a hospital.

Convenience
'In Northumberland, people live in quite rural areas. Patients would often have to travel for ultrasounds to Newcastle, and North Tyneside,' she says.

Dr Naylor also believed that, aside from the convenience of a local service, patients would benefit from a personalised approach.

The referring GP faxes a form to Ms Davis and gives the patient information about how to contact the service and what the exam will involve. The patient then makes the appointment.

'When patients ring Susan to make the appointment, they speak to the person who will do the exam. It relieves anxiety. You can feel more "processed" in secondary care and, when it's a vaginal exam, it's important not to feel that way,' she says.

Dr Naylor has the support of her secondary care colleagues for the scheme. They helped draw up guidelines and provide clinical governance for Ms Davis.

The service had no teething problems but getting to the starting point proved a struggle:it took Dr Naylor two years to acquire funding for it.

Frustrating
This was especially frustrating as the service is not complicated. But the PCT was going through a re-organisation and this held up progress.

Dr Naylor says although people she talked to at the PCT were enthusiastic about the project, they were shifted into different jobs before a decision could be taken.

'I had to produce the business case more than once because people kept changing. Had there been stability, it would have been much easier,' she says.

The business case was strong. As well as offering patients the choice of a local service or having scans at a hospital, the figures stacked up.

The tariff price for ultrasound scans in secondary care was £63, while performing the same service in primary care cost £33.24. Savings were projected at £10,065 in the first year and £30,949 in the second.

While the potential savings to the NHS were sizeable, set-up and running costs were low. There was room rental and the sonographer's pay to fund.

Without taking into account Dr Naylor's time, that was the extent of the bill as the equipment is provided by Northumbria Healthcare NHS Foundation Trust. In 2008/9 (for three months), the costs were £2,994, rising to £9,205 in 2009/10.

Short waiting time
Mark Adams, director of planning and performance for NHS North of Tyne, says its cost effectiveness was one reason to back the service. The short waiting time for patients was also attractive. There were other reasons why it made sense.

'The improved equity of access to urgent and non-urgent ultrasonography could be demonstrated by a low did-not-attend rate and a more accessible service complemented and improved the care closer to home pathways,' he says.

The PCT's commissioning decision panel approved the project in November 2008 and funding was allocated from the Northumberland Service Improvement Fund.

This fund is for projects that show a reduction in costs and a better service for patients - and which can go on to become fully commissioned services across the locality.

So will Blyth Valley Community Gynaecology Ultrasound Scan Service continue long term? It seems likely to Mr Adams who said a review has begun. 'The indications are so far encouraging and demonstrate good positive patient outcomes,' he said.

There may even be scope for the service to extend beyond Blyth Valley. 'In this case, one of the considerations would be whether or not it would be possible to keep the highly personalised essence of this pilot while delivering it on a larger scale,' Mr Adams added.

Community gynaecology ultrasound
  • Around 20 women with symptoms associated with post-menopausal conditions and ovarian cancer are seen each week.
  • Patients referred by GPs at the seven practices in the local PBC phone or text the sonographer for an appointment and ask questions in advance about their scans.
  • Clinics are held twice a week: one in the community hospital and one at a health centre.
  • Costs are kept down by employing the sonographer on a sessional basis.
  • Seven GP practices in the PBC group refer to the scheme.

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