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

- 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