Post on 17-Jan-2016
description
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
- FDG
- other PET
Costs
Convenience
Home or away?
FDG production
Hospital radiopharmacy
Facilities
Need to update, replace or advance but no cash?
New build? New equipment? PET/CT?
Independent providers of PET/CT In UK
Alliance Medical In Health Lodestone patient care Paul Strickland Cobalt
My Background in PET/CT
Fixed site opened 2003 Referral base established with cancer
network Learning curve for all of usExperience with mobile service
PET/CT, Home versus away
Access
Ability
Availability
Affability
Home advantages
Knowledge of referral system Knowing the people – clerical - clinical Access to the people Access for the patient
What is important to the patient?
++++ Prompt appointment i.e tomorrow! Confidence in the clinical team Privacy Comfort Communication Results
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
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.
The clinical worries
National procurement, winners and losers
Cash driven Quantity versus quality Cherry picking Remoteness Contact
Reporting those examinations
Private sector utilising teleradiology and PACS
Eg e-locum
Home team
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”!!
Mobile PET
Mobile Cardiac Service
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
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???
Training
Very few trained PET/CT clinicians Can training be delivered without
sacrifice to quality? Can these docs all be trained by 25th
June???
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??
The Money!!
Does it make sense? Local SLA may represent better value? Do we have the resources??
Was there or is there a better way?
Maybe, but we now have to make the best of it!!!!
Beware! It`s not always what it seems to be!
Service provision
Mobile solution Eg cardiac or PET/CT
Fixed site Eg dedicated private facility
It shouldn`t be just about money
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
So, Pros and Cons!
Protocol and procurement versus patient care??
Quality Quantity “ pile `em high ,sell `em cheap” Clinician working in nice environment Income