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