Agenda item

BREAK

Dr Robert Blundell (Vice Chair, Kent Local Medical Committee), Dr Stephen Meech (Kent Local Medical Committee), Di Tyas (Deputy Clerk, Kent Local Medical Committee), Jochen Worsley (Locality Practice-Based Commissioning Manager, NHS West Kent), Sheila Pitt (Head of Cancer, Long Term Conditions and Therapies, NHS Eastern and Coastal Kent), Patricia Davies (Director of Performance Improvement, NHS West Kent), and Andrew Scott-Clark (Deputy Director of Public Health, NHS Eastern and Coastal Kent) were present for this item.

(1)       Representatives from NHS Eastern and Coastal Kent began this item with an overview explaining that the health needs in the two halves of the county differed due to the levels of deprivation in the coastal areas.  However, the situation regarding diagnostics had improved over the last two years and out of 115 GPs, many now undertook diagnostic phlebotomy and cardiology work.  However, more work needed to be done to ensure equality of access.

(2)       NHS West Kent echoes the sentiments about progress having been made about waiting times.  The point was made that the majority of referrals for diagnostics were made by consultants and not GPs and that projects were underway to move more services for people closer to home.

(3)       Representatives from the Local Medical Committee (LMC), representing GPs, made the point that better access to diagnostics, and more responsibilities for GPs was welcome, but carrying out the tests and interpreting the results increased workload and had resource implications.  In some instances results could be returned from suppliers the same day and some results could be sent on the computer, such as blood work.  Many tests were carried out directly by GPs with a Special interest (GPwSI).

(4)       A straw poll carried out by the showed GPs had a high level of satisfaction with the situation regarding diagnostics in Kent.  One of the main themes was that GPs often had to refer patients to a consultant in order to access some diagnostics, and there was a call for more direct access.  Out of all the diagnostic tests, satisfaction with the provision of x-rays rated the lowest.

(5)       Most x-ray results were made available in 1-2 weeks, but it could be longer.  This was a generalised problem, and often one of administration in the sense that the tests had been carried out but the results took time to type up.  The increasing use of electronic communication of results was improving the process.

(6)       The important point was made that time was not necessarily a problem, clinically, but medical professionals had a role in reassuring patients until the results were known. 

(7)       Many tests were carried out directly by GPs with a Special Interest   and the services available did differ by practice.  It was explained that Primary Care Trusts had responsibility to ensure services were safe and accessible and that where GPs did not offer an enhanced service, they looked at what alternatives could be provided.  The example was given that all anti-coagulation services had been moved out of Acute settings in East Kent.

(8)       The apparent higher rate of diagnostics in East Kent compared to West Kent was discussed and the question posed as to whether this was due to poorer health or the culture of General Practice.  It was not possible to give a direct explanation as there were many factors involved, but through questioning members posited the possibility that patients accessing private diagnostics directly in West Kent may be a contributing factor.

(9)       Connected to this point, representatives from the Local Medical Committee made the observation that the 18-week target in place until recently was clinically insensitive but that in cases where it was necessary, ways could be found around the standard system.  However, this would not affect the waiting times overall as patients would not be replaced in the queue, just moved back one place.

(10)     The broader point was made that access to diagnostics had an impact on other resources.  For example, accessing a private diagnostic service could cost £50, but this would be cheaper than a patient going to Accident and Emergency and getting a test there, costing £100.

(11)     Two specific points were made about audiology.  One related to the time it took to make repairs to digital hearing aids, and it was explained that digital hearing aids needed to be custom made to match the individual patients’ hearing aid frequency, and this could be a cause for apparent delay.

(12)     One Member suggested that extra capacity for delivering audiology appointments could be provided at the Royal Victoria Hospital in Folkestone. NHS Eastern and Coastal Kent promised to contact East Kent Hospitals NHS University Trust to examine the feasibility.