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Good Practice: Streamlined care - Full spectrum ultrasound scans

Marion Long describes a highly successful PBC service in Surrey and its plans for satellite clinics.

Dr Chris Evans (left) with sonographer Rachel Ford and consultant radiologist Dr Robert Davies (Photographs: Jason Heath Lancy)
Dr Chris Evans (left) with sonographer Rachel Ford and consultant radiologist Dr Robert Davies (Photographs: Jason Heath Lancy)

Our practice, Dr O'Donnell & Partners in Farnham, has been running a diagnostic ultrasound service since 2008. Initially this was for our own NHS patients but it has since expanded to cover the patients of six practices under a practice-based commissioning (PBC) contract.

We decided three years ago to set up the service to reduce patient waiting times. The first NHS scans were carried out in May 2008. By December 2008, the service had attracted a lot of interest from local GPs and some from further afield, so Surrey PCT agreed to expand the service.

InsideVue
Since then, InsideVue, the limited company the partners set up to provide and run the service, has gone from strength to strength.

Unlike most community ultrasound services, InsideVue offers a comprehensive range of adult and paediatric examinations including abdominal, gynaecological (transabdominal/transvaginal), musculoskeletal, renal, 'small parts' (thyroid/testicular), soft tissue, and vascular as well as foetal viability/dating.

All examinations are undertaken in a fully maintained hospital grade ultrasound unit at our surgery, one of three practices sited at a community hospital in Farnham.

InsideVue came about following a strategic review by the partnership on how to improve patient treatment. Direct access ultrasound waiting times typically ran into months. So the aim was to set up a high-quality, patient-centred service with a rapid turnaround and fast, clear and concise reports to referring GPs.

Initially, the service was set up as a private concern and continues to provide scans for private patients - see www.insidevue.co.uk

Our next step was to contact Surrey PCT to offer the InsideVue service under PBC. This proved a frustrating exercise as then, and since, the PCT has been in a state of flux with changes to management and internal staffing structures.

It was many months before we finally got the go ahead to supply NHS ultrasound under the InsideVue banner.

Winning GPs' confidence was essential, primarily to persuade them to stop automatically referring patients to secondary care for scans. Our community hospital location with two other practices certainly helped with this.

Facilitating improvements
Scans are provided by a small team: a consultant radiologist and highly experienced sonographers. Audits are regularly performed, and patients are routinely surveyed to facilitate improvements to the service.

GPs send referrals electronically to InsideVue, which normally contacts patients by telephone on the same day.

Patients are usually pleasantly surprised at the speed.

The patient's appointment is within a few days of the referral and can be on the same day. The scan report, written by the clinician, is sent electronically to the GP usually on the same day as the scan. The whole process, from the patient referral to their GP receiving the report is usually on a four to five day turnaround.

Such is the service's success that InsideVue has been contacted by other practices wanting to send their patients to us. But we feel the future lies in running satellite clinics in GP settings and we have received expressions of interest about this.

With PCT approval, we could set up clinics using web-based technologies to network data, and an integrated picture archiving and communications system, enabling images and reports to be viewed at any time from any location. This means we could use existing administration staff to book appointments and process paperwork.

The cost of setting up the service involved the shareholders - the GP partners and their practice and business manager - putting up capital to form InsideVue as a limited company separate from the practice.

We lease the ultrasound equipment but there were upfront costs, the biggest of which was management time. One of the partners, Dr Chris Evans, was nominated lead GP and the practice and business manager, David Shakeshaft, was appointed managing director. The two spent a lot of time in meetings during which they were absent from practice duties.

There was no PCT funding. On-costs, such as governance and training, are met by the company, as are the costs associated with any under-used capacity.

The PCT pays a simple fixed price per scan. If this included a market forces factor, the cost of each scan would be around 18 per cent higher.

So the InsideVue service is highly cost effective and represents excellent value for taxpayers' money.

And there is a bonus. This is hearing almost every patient contacted say: 'Wow, that's efficient, it's better than going private' and knowing we've just saved the NHS money.

Service details
  • Dr O'Donnell & Partners is a Surrey practice with three whole-time equivalent

    GPs and more than 6,300 patients.
  • The practice is located at the Farnham Centre for Health along with two other practices.
  • InsideVue Limited was formed in 2007 by the GP partners and practice and business manager, who are also its shareholders and directors.
  • It serves more than 40 GPs from six practices with a total of more than 5 6 ,000 patients.
  • The average price per scan is just over £55 based upon the length of tim e it takes and combination of examinations required.
  • More than 2,000 ultrasounds are carried out a year and the number is rising.
  • Scans breakdown:
  • Abdominal 35 per cent,
  • Gynaecology 27 per cent,
  • Renal 13 per cent,
  • Musculoskeletal 8 per cent,
  • 'Small parts' 9 per cent,
  • Vascular 4 per cent,
  • Soft tissue 3 per cent,
  • Others 2 per cent.
  • More than two-thirds of patients are female.
  • Youngest patient was a year old (renal scan); oldest, 100 years old (abdominal scan).
  • More than 80 per cent of patients surveyed rated the service as excellent.

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