Radiology CPG Locality Stakeholder Meeting Service provided from 20 sites: 3 DGH, LLGH, Abergele + 15 Community sites Approx 300 WTE (35 medical, 60 A&C, 200 Radiography) Activity: approx 400k exams per year Budget: approx £18m Summary: The CPG is a relatively small CPG providing the radiology service for a very large organisation. This emphasises the scale of priorities, and we expect radiology to inform the decisions around service change, rather than lead them based solely on radiology priorities. Locality Stakeholder Meeting

Current Service Activity 2011 Modality Central East West CT 9430 10128 6878 Fluoroscopy 2678 3306 3151 Mammography 1461 2084 2921 MRI 4977 4491 3945 Nuclear Medicine 1293 1329 913 Plain Film 89564 76661 85359 Ultrasound 28622 30486 27542 Total 138025 128485 130709 Activity By Division 2011 For reasons of equipment cost and patient volumes and current referral management pathways, we do not consider it feasible to provide CT, Fluoroscopy, Mammography, MRI or Nuclear Medicine in community settings We have considered mobile facilities, but the additional cost and requirement to coordinate with appropriate medical cover (for contrast) or OP clinics (that may require plain film support), means that these are not feasible at present and these options have not been considered further. Locality Stakeholder Meeting

Plain Film & US Activity by Referral Source Site GP OP Grand Total ABERGELE 13 1682 1695 ALLTWEN 1745 140 1885 BLAENAU FFESTINIOG 881 30 911 BRYN BERYL 1402 105 1507 CHIRK 382 170 552 COLWYN BAY 5396 3572 8968 DEESIDE 4765 407 5172 DENBIGH 2578 250 2828 DOLGELLAU 2283 199 2482 ERYRI 2461 88 2549 HOLYWELL 5502 3051 8553 LLANDUDNO 5514 7107 12621 MOLD 4089 665 4754 ROYAL ALEXANDRA 6738 788 7526 RUTHIN 1385 95 1480 TYWYN 711 15 726 YSBYTY PENRHOS STANLEY 3067 536 3603 YSBYTY GLAN CLWYD 8855 39184 48039 YSBYTY GWYNEDD 13848 35978 49826 YSBYTY MAELOR WREXHAM 22864 38290 61154 94479 132352 226831 In summary- a significant volume of radiology service is already delivered from outside the DGH’s 21% of activity from all referral sources (A&E, IP, OP & GP) is delivered outside the 3 DGH’s For GP & OP referral sources, this rises to 29%, and considering just plain film and US referrals from GP’s and OP’s the figure is 35% Locality Stakeholder Meeting

Activity by Referral Source Data from previous slide presented as a normalised bar chart (3 DGH’s on RHS). Community sites deliver GP activity primarily, with relatively small contributions from OP activity 15/11/2018

Attendances to YG Locality Stakeholder Meeting Activity patterns (based on home post code) show that many patients attend DGH’s for plain film and US exams when there are community sites offering the service more locally. The factors influencing these patient flows are unknown. However since we know many of these are OP attendances, this is likely to be a significant factor, and emphasises the need to view provision of radiology in community sites in parallel with the plans for delivering OP clinics in these settings Locality Stakeholder Meeting

Attendances to LLGH Locality Stakeholder Meeting Activity patterns (based on home post code) show that many patients attend DGH’s for plain film and US exams when there are community sites offering the service more locally. The factors influencing these patient flows are unknown. However since we know many of these are OP attendances, this is likely to be a significant factor, and emphasises the need to view provision of radiology in community sites in parallel with the plans for delivering OP clinics in these settings Locality Stakeholder Meeting

Attendances to YGC Locality Stakeholder Meeting Activity patterns (based on home post code) show that many patients attend DGH’s for plain film and US exams when there are community sites offering the service more locally. The factors influencing these patient flows are unknown. However since we know many of these are OP attendances, this is likely to be a significant factor, and emphasises the need to view provision of radiology in community sites in parallel with the plans for delivering OP clinics in these settings Locality Stakeholder Meeting

Attendances to YMW Locality Stakeholder Meeting Activity patterns (based on home post code) show that many patients attend DGH’s for plain film and US exams when there are community sites offering the service more locally. The factors influencing these patient flows are unknown. However since we know many of these are OP attendances, this is likely to be a significant factor, and emphasises the need to view provision of radiology in community sites in parallel with the plans for delivering OP clinics in these settings Locality Stakeholder Meeting

Challenges Radiology is a service led CPG Need to be able to support other hospital activity Capital/revenue cost of new equipment £60-100k, + 10% maintenance Replacement at 5 years Staffing costs Unsupervised staff employed at AfC Band 6 Approx 20% higher staff cost Efficiency Health Board target to reduce diagnostic demand by 5% Target activity approx 15 per session Need to deliver radiology support to other CPG’s Plain film approx £60/80k,US approx £100k, equipment requires replacement at 5 year intervals for US Community staff employed at higher band than DGH staff undertaking similar duties, therefore approx 20% higher staff costs Health Board has set a target for reducing demand on diagnostics by 5% In comparison to DGH sites, critical activity for feasibility of a community radiology service = 15 patients per session for plain film & 8 per session for US, many sites not delivering this level of activity Locality Stakeholder Meeting

Efficiency Plain Film Activity Site Visits Session No. Per Session Mold 4806 10 9.4 Deeside 3885 8 9.5 Colwyn Bay 6250 12.3 Denbigh 3199 7 9.0 Holywell 6303 12.4 Royal Alex 7535 14.8 Ruthin 1607 3 10.5 Eryri 2591 9 5.6 Bryn Beryl 1542 10.1 Alltwen 1927 6.7 Blaenau 921 4 4.5 Penrhos Stanley 4242 8.3 Dolgellau 1753 4.3 Tywyn 730 2 7.2 Locality Stakeholder Meeting

Opportunities Improved Support for Minor Injury Units Deployment of new PACS could allow timely reporting for MIU referrals Improve interaction with primary care Identify a radiology consultant lead for each locality to enable work to improve access to appropriate services Improve service from fewer sites Concentration of radiology facilities reduces radiology costs, and maintains activity levels and efficiency at comparable levels to DGH setting Specific examples that highlight the key themes from a radiology perspective: Improve reporting turnaround times: e.g. Prioritise MIU referrals for hot reporting by radiographer at any site Improve dialog with referrers: e.g. Radiology lead for each locality to work with stakeholders and improve referral pathways and influence demand Increase availability for access but from fewer sites: maximises investment in equipment, improves cost efficiency, enhances level of support for MIU Locality Stakeholder Meeting