1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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