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A Clinician`s perspective…….

A Clinician`s perspective……. Dr John R W Hall FRCP FRCR. Got one of these ?. But want one of these??!. The answer?. Get the independent sector in??!!. Nuclear Medicine possibilities. Areas to consider might include: Provision of isotope – general diagnostic

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A Clinician`s perspective…….

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  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? Hospital radiopharmacy FDG production

  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 25th 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. Beware! It`s not always what it seems to be!

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

  28. It shouldn`t be just about money

  29. 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

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

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