A New Model for a Primary Care Based Diagnostic Treatment Centre (DTC)

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

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

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

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

5. 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

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

7. Technology Assisted Consultation Process Patient GP Management Exercise Test Exercise Report Discharge Letter Virtual Consultation Cardiologist Angiogram Angioplasty/CABG SIHI 2003

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

9. The Virtual Team Nurse Consultant Patient Doctor SIHI 2003

10. 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

11. Pre-Surgery and Doppler Femoral Artery Behind Knee Ankle SIHI 2003

12. Post-Surgery Follow-Up First Home Visit SIHI 2003

13. Post-Surgery Follow-Up Second Home Visit SIHI 2003

14. Post-Surgery Follow-Up Teleclinic The Introduction SIHI 2003

15. Post-Surgery Follow-Up Teleclinic SIHI 2003

16. Post-Surgery Follow-Up Teleclinic The Farewell SIHI 2003

17. An Information Exchange SIHI 2003

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

19. Concerns for Roll Out • ‘Owned’ by hospital • 2nd 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

20. 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

21. Healthcare in W&3RPCT 2 3 1 SIHI 2003

22. Distribution of DTS in Zones 2 3 1 SIHI 2003

23. DTS support by AIDMAN Hemel - 15 Oxford -40 2 Northwick - 15 Amersham -12 3 1 MtVernon - 5 Anywhere -X StMary’s - 30 SIHI 2003

24. Benefits • Shared Expertise and Resource • Fast Access • Accurate Referral • Improved efficiency • Increased skills SIHI 2003

25. MSc Telemedicine and eHealth Systems Malcolm Clarke Course Director Information Systems and Computing Tel: 01895 203220 Email: malcolm.clarke@brunel.ac.uk www.brunel.ac.uk/depts/cs