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Success for GPSI-run telemedicine

Real-time image transmission from GP surgery to radiologist speeds diagnosis.

Persuading my practice-based commissioning (PBC) group, the Elm Park Consortium in Essex, to invest in telemedicine equipment has enabled us to provide a truly innovative and fast diagnostic service in the community for benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTs).

The potential cost savings are huge. For every 200 patients seen (the average per year for a typical practice) the amount saved is around £60,000. If, for example, similar services covered 200 practices, the saving to the NHS is potentially £12 million annually.

As a result, Havering PCT has commissioned these services across its area.

Additional service
We have also harnessed the technology to provide an intermediate gynaecology diagnostic service. As a urology GPSI, I provide the BPH/LUT service from my surgery in Hornchurch and for the other practices in our consortium.

My wife, Dr Sulbha Despande (whose practice is in Barking) is a GPSI in gynaecology and she provides the gynaecology service. We both work under consultant supervision.

The capital cost of the equipment was £32,000. This consists of a digital ultrasound machine with a computer that can save nearly 6,000 images and has video conferencing software.

Live ultrasound images are transmitted in real time via ISDN link to the University of Portsmouth's radiology department. There the consultant radiologist can communicate with the GPSI by audiovisual link about the diagnosis while the patient is being scanned.

Shared-care programme
These urology and gynaecology services including clinical protocols and patient pathways were developed under a shared-care programme by local consultants and the respective GPSIs.

All the GPs from the seven PBC commissioning consortia in the PCT refer patients to these services. Since the urology service started five years ago, 650 patients had attended by August 2007, and from February 2006 to December 2007, 400 patients have attended for gynaecological diagnosis.

The quality of shared and forwarded tele-ultrasound images (SAFI) was independently analysed against hard-copy images by the consultant radiologist in Portsmouth.

Statistically the SAFI images were 90 per cent significant as far as diagnosis and technical quality is concerned.

This study was published in the Journal of Telemedicine and Telecare in 2004.

The cost of each tele-ultrasound consultation with clinical examination is £100, which compares very favourably with referring the patient to secondary care, where diagnostic testing and examination costs around £400 for BPH/LUTS or around £224 for gynaecological diagnosis.

Strict inclusion and exclusion referral criteria are followed for the intermediate gynaecological services. A woman needing an ultrasound examination can have this immediately at the surgery.

Women requiring invasive diagnostic investigations are referred to the local consultant gynaecologist, while endometrial biopsies, insertion of a Mirena IUS and minor surgical procedures such as cervical polypectomies are done in primary care.

These innovative services have brought outpatient waiting times at the local acute hospital below 13 weeks.

They also demonstrate that tele-ultrasound consultations are feasible for appropriately trained and supervised GPs who are interested in the field of telemedicine.

The benefits and money-saving potential have attracted the attention of health minister Ben Bradshaw (pictured) who visited my practice last month.

Dr Ashok Despande, a GPSI in urology in  Essex and chairman of the Elm Park Practice-Based Commissioning Consortium.

TELE-ULTRASOUND UROLOGY
Patients
Total number of patients seen
(Jan 2003 - Aug 2007)
650
 
Number seen within 12 weeks485 (74.6%)
Treated in primary care500
(76.9%)
Referred to secondary care 150 (23.1%)
Costs
Each primary care ultrasound including examination £100
Hospital diagnosis approx £400 including uroflometry
Saving per 200 patients £60,000

TELE-ULTRASOUND GYNAECOLOGY
Patients
Total number of patients seen
(Feb 2006-Dec 2007)
400
 
Those treated in primary care291
(72.8%)
Referred to secondary care109(27.4%)
Ultrasound scans performed245 (61.4%)
Seen within 12 weeks324 (81.1%)
IUS Mirena fitted 34 (9.0%)
Menstrual disorders 158 (39.5%)
Polycystic ovarian disease 25 (6.3%)
Cervical polyp diagnosed 48 (12.0%)
Cervical polypectomies performed 42 (10.5%)
Costs
Each primary care ultrasound including consultation and management  £100
Hospital ultrasound service  £224
Saving per 200 patients  £24,800

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