1. A Clinician`s perspective……. Dr John R W Hall FRCP FRCR

2. Got one of these ?

3. But want one of these??!

4. The answer? Get the independent sector in??!!

5. Nuclear Medicine possibilities Areas to consider might include: Provision of isotope – general diagnostic - FDG - other PET Costs Convenience

6. Home or away? FDG production Hospital radiopharmacy

7. Facilities Need to update, replace or advance but no cash? New build? New equipment? PET/CT?

8. Independent providers of PET/CT In UK Alliance Medical In Health Lodestone patient care Paul Strickland Cobalt

9. My Background in PET/CT Fixed site opened 2003 Referral base established with cancer network Learning curve for all of us Experience with mobile service

10. PET/CT, Home versus away Access Ability Availability Affability

11. Home advantages Knowledge of referral system Knowing the people – clerical - clinical Access to the people Access for the patient

12. What is important to the patient? ++++ Prompt appointment i.e tomorrow! Confidence in the clinical team Privacy Comfort Communication Results

13. What`s important to the clinician? Prompt appointment i.e tomorrow! Confidence in team Availability and timeliness of report Availability and timeliness of images Communication Discussion at MDT Follow up

14. What`s important to the radiologist and nuclear medicine physician? All of these things!!! I.e the patient, the service, the outcome, the communication, the clinical team etc.

15. The clinical worries National procurement, winners and losers Cash driven Quantity versus quality Cherry picking Remoteness Contact

16. Reporting those examinations Private sector utilising teleradiology and PACS Eg e-locum Home team

17. The patient`s worries When is my appointment? No choise No contact Don’t know the team They don’t know me “I don`t want to be in a van”!!

18. Mobile PET

19. Mobile Cardiac Service

20. The mobile solution…. Visit once or twice a week Pile `em high, sell` em cheap What if it breaks down? What if isotope fails? Rebooking? Remote reporting

21. The MDT DGH has MDT for lung Tue 8a.m,for colorectal Thursday 5pm, haematology Fri 1pm and upper GI alternate weeks on 2 sites. Can this be delivered???

22. Training Very few trained PET/CT clinicians Can training be delivered without sacrifice to quality? Can these docs all be trained by 25 th June???

23. Can we or should we make it work? Clinician and patient have to accept this is a second class service but better than none?? It will get better over time?? Patient numbers will increase as knowledge of the power of this study increases, can the system cope??

24. The Money!! Does it make sense? Local SLA may represent better value? Do we have the resources??

25. Was there or is there a better way? Maybe, but we now have to make the best of it!!!!

26. Advantages to the clinician Possibility of working in better conditions Working with state of art equipment Ensuring reliability of supplies Potential for network working on “neutral” territory Utilising teleradiology, home links Income generation!!

27. Beware! It`s not always what it seems to be!

29. Service provision Mobile solution Eg cardiac or PET/CT Fixed site Eg dedicated private facility

30. It shouldn`t be just about money

31. Disadvantages of IS involvement National procurement process ie PET/CT Loss of local autonomy Cherry picking Threat to local healthcare economy Loss of income to NHS? Remote reporting eg MDT support

32. So, Pros and Cons! Protocol and procurement versus patient care?? Quality Quantity “ pile `em high,sell `em cheap” Clinician working in nice environment Income