East Midlands Radiology Consortium (EMRAD)


>>Dr Tim Taylor: Hello, thank you very much
for staying around. Do please take your seats again already. My challenge now is to keep
you awake after lunch, and to stop you looking that way at the cricket which I can see from
a great view here. So here we go. My name’s Dr Tim Taylor, I’m a practicing consultant
radiologist, I’m also the EMRAD medical director. This is Andrew Fern who’s the senior responsible
owner for the EMRAD consortium, and this is Dr Mike Brookes who’s our business analyst.
So first off, we’re a clinical radiology consortium, our whole purpose is centred around the patient,
that’s what we exist for, is patient care. So for the next five minutes I’m going to
describe a little bit about what we’ve learned so far and how we think we could share some
of that stuff nationally for the benefit of the NHS should we get through vanguard. So we’ve spent the last two years designing
building and now deploying an exceptional – though I say so myself – imaging technology
across a big collaboration of seven Trusts. We’re serving in the East Midlands about six
and a half million people, and Mike over here as a clinician money is strange, but Mike
says that it will save us as a consortium about £10 to £15 million over the next ten
years compared to what we’re currently paying. From my point of view it brings immediate
benefits for the patients, to carers and to clinicians – but that’s not enough, we can
do more.>>Unidentified male speaker: So what have
we done so far, we’ve persuaded seven acute Trusts who needed to replace their imaging
technology to work collaboratively to design, procure, and then enter a ten year fully funded
contract to build a single shared repository of all images across the East Midlands. That’s
quite big really. Those seven Trusts and their 12 hospitals, their ATDs and their myriad
of clinical networks will be able to do what we’ve all wanted to do ever since the national
programme for IT developed PAX, and that is share images quickly and easily with any other
clinician with a shared interest in the patient. Through a no due competitive dialogue procurement
we selected cutting edge technologies that will not only provide any image anywhere,
but it will provide the core building block for us to be seen as a national benchmark
for new models of NHS clinical collaboration within radiology. The first steps we’ve already taken. We’ve
created an NHS framework contract for other consortia across England to help avoid procurement
costs. We’ve developed a consortia model that others can pick up and use. We’ve created
a governance model that will ensure safe and legitimate clinical sharing. We’ve done that
by having the chief executives of the seven organisations fully behind our programme of
work. We’ve also been working with the Royal College of Radiologists, with Health Education,
England, the Academic Health Science Networks locally, our local clinical networks, our
commissioners, our staff, and most importantly the people that we serve to help us shape
what might be possible. But why work collaboratively?>>Unidentified male speaker: So I’m not going
to tell you anything that you don’t know but radiology services in the UK are in trouble.
Over the last decade we’ve had loads of clinical networks spring up and flourishing, absolutely
rightly, cancer, stroke, major trauma, paediatrics, these are all absolutely crucial clinical
networks providing service to the patient at their point of need. The problem is radiology
has really struggled to keep pace and we’re now in the paradoxical situation where you
can have a patient move across a region or across a network faster than their images
can. That makes no sense. Despite massive investment in scanners the additional piece
that goes with those scanners is someone to interpret those images. And that investment
hasn’t been able to keep pace either. So national data from the Royal College of
Radiologists backed up with data from Health Education, England, shows that in the certainly
in the East Midlands we have a massive recruitment problem and I’m sure some of you do too. We’re
really down on the number of whole time consultants that we have in radiology. We have a massive
problem with retention as well in terms of retirement over the next ten years. And this
affects all Trusts, big and small, in different ways. So the big Trusts are pushing really
hard to match their emergency department and urgent care targets, and they struggle with
the elective work. The smaller Trusts don’t have capacity to provide that work so they
end up outsourcing which costs a load of money to be honest. And it’s reported by the same
people, NHS consultants. So the more we’ve worked on this the more we believe we’ve got
another way of working potentially that works in collaboration, not in competition with
the things that are currently working. So for example, by developing a regional family
of radiology Trusts using the important but actually quite a small part of technology
that sits underneath that, and building with a massive amount of clinical engagement we
think we can provide expert care closer to the patient regardless of the location with
really solid clinical and information governance support, and with patient involvement at the
ground level because issues like information governance and clinical governance are really,
really important to people. We think we can possibly provide an in-house NHS alternative
to outsourcing. It’s the same people doing the work after all. We can’t, and we’re not
going to be able to fix the problem of over demand and under capacity. We can’t magic
people out of thin air. But what we can do is make our region an attractive place to
work and an attractive place to stay working, and an attractive place to work even after
retirement if you want to. And that model is cascadeable across the whole NHS we think.
So what do we need to make this happen?>>Unidentified male speaker: So by this time
next year all seven Trusts will have deployed a successful technical solution. The concept
of a single patient imaging record across the East Midlands will have started to transform
the way in which we deliver clinical care. A regional clinical governance network to
support the new ways of clinical collaboration will have been set up with patient involvement
from the ground. We will be reporting and supporting collaboratively across the East
Midlands. We will develop an East Midlands wide radiology service. The first of numerous
cross Trust clinical appointments will have been advertised, and further Trusts and other
consortia will be exploiting the work that we’ve done in EMRAD.>>Dr Tim Taylor: So finally how can vanguard
help? It sounds really exciting but what do we need from vanguard, thanks. There are several
specific areas which we would really value vanguard support. Firstly actually helping
us get the word out, there’s strength in collaboration. The practicalities of setting up a collaborative
network aren’t as scary as certainly I thought they might be as a clinician. It is practically
doable. You just have to get the right people doing the right things with the right input. Secondly I would really love some help to
develop NHS contracts that accommodate new ways of working across Trusts that don’t rely
on myriad different honorary clinical contracts. Different ways of payment models, that don’t
currently exist to support our aims. I’d also love national support for a kind of working
together clinical governance framework. We have an EMRAD clinical governance framework,
we’re setting it up, it’s really important to us. But we need support, we need national
involvement and heads up with that. We also would like deployment support and development
support between EMRAD and our other technical partners, so that we can develop and create
an NHScentric brokerage system with appropriate business intelligence, clinical governance
and information governance, so that we can really make a world class system in the East
Midlands.>>Unidentified male speaker: So in summary
we’ve built a solution that we passionately believe, you’ll get the passion. That we can
help the NHS help itself by working differently because we can’t continue to work in the way
that we have been doing. Thank you very much for listening, we’re happy to answer any questions
that you might have.>>Unidentified female speaker: Thank you very
much. No questions? A lady here in the blue.>>Kathy Pritchard-Jones: I’m Kathy Pritchard-Jones
from UCL Partners. I’m interested in your governance model about how you’ve set it up
to react to unexpected abnormal findings.>>Unidentified male speaker: Yes, that’s a
really, really interesting question, but one I’m very happy to answer. So unexpected findings
are a problem. Just getting for example if I find a lump on a chest x-ray how do I make
sure that the clinician and ultimately the patient gets that report as quickly as they
possibly can? Many of us have real problems with that. It was one of the fundamental cornerstones
of actually our procurement was to make sure we have something and we’ve actually got a
very, very good technical something to make that work. But as with everything else the
technical something isn’t the important bit. The important bit is making sure that the
clinical governance around what you do in your organisation, and more importantly what
you do across the EMRAD organisation is 1, rock solid and 2, absolutely reproducible.
And that’s why the clinical governance is so important which is why it’s set up. And
you end up with in broad terms, you end up with SOPs and high level agreements and patient
involvement very, very early on. But it is manageable and we’ve managed it.>>Unidentified male speaker: I think it’s
important to realise we’re not just talking about a technical solution here, people make
things happen. So part of that drive is to have someone like Tim with the passion, with
the drive to engage with clinicians across the consortia, to make sure those clinicians
feel part of the process and have been over the last two years to help design and build
the solution that they’re going to be using, and they’re going to feel strongly about when
they go forward.>>Unidentified female speaker: Question from
table nine.>>Shelley Dolan: Thank you. Shelley Dolan
from the Royal Marsden London Cancer Alliance. Fantastic idea, really, really important.
Have you thought about how you’re going to bring on, if you like, the next generation
of radiographers but also perhaps apprentices and new models of growth, because as you say
the workforce is a key issue.>>Unidentified male speaker: Yes, so this
is really interesting. Health Education East Midlands have very clearly shown us and Health
Education England, that it’s not just consultants radiologists, it’s radiographers, it’s ancillary
staff. Just getting radiology departments running and keeping them running is really
tricky. So part of the reason for going through the vanguard process is to say, well how can
we make radiology a really attractive thing to work in? And actually speaking personally
it’s not an attractive thing to work in when you’re being smashed with targets and two
week waits going to one week waits and your work list just goes up and up and up. And
that’s the same for radiographers as well. However, in our region you’ve got some really
big busy hospitals which frankly are quite hard to work in. And you’ve got some much
smaller hospitals which offer a different model. They work in a different way. I think
there’s a lot of scope for people, because the network becomes a family of Trusts. Why
stay in one? You can work in all of them. That’s what we need the vanguard for.>>Unidentified male speaker: We’ve learned
actually across the consortia and there’s a mix of district general hospitals and large
acute teaching hospitals in the consortia. We’ve learned that the best practice isn’t
always from those large acute teaching hospitals. And actually the most efficient practice has
come from the DGHs. By learning we can actually share that working practice across the consortia
first and then hopefully much more widely.>>Unidentified female speaker: Can we just
take a question here from the lady on table four.>>Unidentified female speaker: [Inaudible]>>Unidentified male speaker: There is no such
thing as a bog standard DGH, they are all fantastic places.>>Unidentified female speaker: Very interesting
in terms of what you say because I do think that radiology represents one of the biggest
workforce challenges we have. But I wondered if you’d [Inaudible] I mean we’re busy buying
imaging expertise from private companies and what have you, but I wondered if you have
had any difficulty getting the consultants to sell their discretionary time to you as
opposed to a private provider? I mean have they welcomed it? How have they really taken
to it?>>Unidentified male speaker: The clinical
answer is, I would much rather work for my organisation and for my NHS colleagues. I’m
an NHS clinician; I want to provide this service. Third party organisations have created a way
of providing a service outside of the NHS because our models weren’t sufficiently mature.
I think this has a really good chance of creating a mature safe model with clinical governance
that means it just becomes seamless with part of our normal day to day working.>>Unidentified female speaker: Sounds like
a win, win, win, really.>>Unidentified male speaker: I’m hoping so.>>Unidentified female speaker: I just want
to take one question from[Inaudible] there’s two people here desperate to ask questions,
so do you want to take the second one in the front and then we’ll then try and quickly[Inaudible]
if you ask very quick questions we’ll try and take them both.>>Geoff Belling: Geoff Belling, UCLH. I’m
just interested how much this model could roll out across other things. You must have
thought about pathology and various other support services.>>Unidentified male speaker: Yes, we have.
So in the original contract that we put out other ologies were part of it. Not everything
in medicine is quite as tecchie savvy as radiology might be, and believe me some of the my colleagues
are not tecchie savvy. We’re used to working in front of screens, we’re used to the concept
of shared workloads. In fact some of us working in the private sector are quite familiar with
this sort of model anyway. In terms of other ologies well you’ve immediately got pathology,
you’ve got ophthalmology, in fact you’ve got anything that has an imaging resource that
becomes a single, kind of, weak point, and yes it’s roll out [unclear 00:13:59]. We’ve
had discussions with radiotherapy and pathology already.>>Unidentified female speaker: I’ll just take
the gentleman[Inaudible] the very last question.>>Steve: Steve, one very quick one. The buzz
word seems to be patient involvement, you’ve mentioned it twice, can you tell me something
about it?>>Unidentified male speaker: Yes, very easy,
very quick. So for example let’s take clinical governance, I mean radiology is one of those
secondary specialities, you’ve probably never seen a radiologist unless they’ve put a needle
in your neck or something like that. But in terms of getting them involved, we create
a regional patient record, there is no chance we can create a safe regional patient record
unless patients and carers have been thoroughly involved right at the beginning of writing
the information governance for that, it just won’t work. So we’ve had patient representatives
actually critiquing and drafting our first drafts of every document in the IG space.
Similarly in the clinical governance space we’ve got patient representatives sitting
as a member of the clinical governance board for the region. It’s fundamental that this
works.>>Unidentified male speaker: The people we
serve need to trust us and that means that we’ve got to engage with people that we serve.>>Unidentified female speaker: Thank you very
much, that’s East Midlands Radiology Consortium.

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