A New Model for a Primary Care Based Diagnostic Treatment Centre (DTC) Malcolm Clarke Brunel University Russell Jones Chorleywood Health Centre

SIHI 2003 Consultation & Referral CONSULTATION PMH & LETTERS INVESTIGATIONS HPC,PMH, DH,SH,&RISK EXAMINATION PRIMARY CARE OPINION SECONDARY CARE OPINION

SIHI 2003 Coronary Heart Disease GP Cardiologist Exercise Test Cardiologist Angioplasty/ CABG Cardiologist Angiogram Patient Referral Letter Discharge Letter

SIHI 2003 Anxieties  Patient fear and confusion  Lack of information  Communication  Isolation of health professional  Inaccurate referral  Inappropriate referral  Delay

SIHI 2003 Goals for Primary Care  Accurate referral  Accurate diagnoses  Lower referral rate  Use of Technical solutions  Reliable and affordable  Change in roles  Multi-professional  Integrated working  Collaboration across community/primary/secondary care

SIHI 2003 A Technology Approach Techology supports The Virtual Team Current Hierarchical Structure New Peer Structure

SIHI 2003 Technology Assisted Consultation Process GP Exercise Test Angioplasty/ CABG Cardiologist Angiogram Patient Discharge LetterVirtual Consultation Exercise Report Management

SIHI 2003 Vascular Surgery Referral District Nurse Digital Photo Peripheral BP Duplex U/S Vascular Surgeon Surgery Patient Virtual Consultation Evidence Based Referral Follow Up Management Virtual Consultation Management

SIHI 2003 The Virtual Team Patient Consultant Nurse Doctor

SIHI 2003 The Benefits  Full history from patient and doctor  Whole medical history available  Exact, evidence based referral  Advocacy  Management negotiated and agreed  Patient satisfaction  Professional Education  Information moves, not the patient

SIHI 2003 Pre-Surgery and Doppler Femoral ArteryBehind KneeAnkle

SIHI 2003 Post-Surgery Follow-Up First Home Visit

SIHI 2003 Post-Surgery Follow-Up Second Home Visit

SIHI 2003 Post-Surgery Follow-Up Teleclinic The Introduction

SIHI 2003 Post-Surgery Follow-Up Teleclinic

SIHI 2003 Post-Surgery Follow-Up Teleclinic The Farewell

SIHI 2003 An Information Exchange

SIHI 2003 Benefits  Referral  Outpatient appointments reduced by 75%  Consultation time reduced by 33%  Prioritisation  Technical solutions  Evidence based referral  Process  Collaborative teams  Education

SIHI 2003 Concerns for Roll Out  ‘Owned’ by hospital  2 nd class  Primary care refers and withdraws  Further burden to hospital trusts in difficulty  ‘ Owned’ by PCT  Primary care refers and withdraws  PCT creates another hospital

SIHI 2003 A Third Way  Primary Care owned Diagnostic Treatment Centre  Owned and run by Primary Care for Primary Care  Exploits existing skills of Primary Care  Low cost – easy to use – technology  Simplified diagnostic tests

SIHI 2003 Healthcare in W&3RPCT 1 2 3

SIHI 2003 Distribution of DTS in Zones 1 2 3

SIHI 2003 DTS support by AIDMAN Oxford -40 Hemel - 15 Amersham -12 StMary’s - 30 MtVernon - 5 Northwick - 15 Anywhere -X

SIHI 2003 Benefits  Shared Expertise and Resource  Fast Access  Accurate Referral  Improved efficiency  Increased skills

MSc Telemedicine and eHealth Systems Malcolm Clarke Course Director Information Systems and Computing Tel: