Recommendations to deliver imaging in the right place at the right time

Improving the experience of patients should be at the heart of work to increase capacity in radiology services within the constraints of COVID-19, according to a new national report on the specialty from the Getting It Right First Time (GIRFT) programme.

The GIRFT report – written by Dr Katharine Halliday, a leading radiologist from Nottingham University Hospitals NHS Trust – examines ways of meeting the ever-increasing demand on radiology units in England at the same time as shaping a better service for those who use it.

Radiology services are vital to almost every specialty in the NHS to ensure patients receive high-quality, effective and timely treatment. The NHS carries out almost 120,000 radiological procedures in England every day and the number is increasing by 1.3m annually. The fastest growth is in MRI and CT scans, where demand outstripped capacity even before the COVID-19 pandemic, which has since resulted in longer waits and further limited imaging capacity.

Professor Sir Mike Richards’ recent review of diagnostic services Diagnostics: Recovery and Renewal – commissioned by NHS England and NHS Improvement – called for an urgent increase in diagnostic provision, including the creation of community diagnostic hubs, or ‘one-stop shops’ away from hospitals.

This aligns with recommendations in the GIRFT report, which identifies ways of maximising existing capacity and planning service expansion. During the pandemic, trusts adapted quickly to enable separate scanning for patients with proven or suspected coronavirus. This separation can now be developed to create sites for ‘hot’ urgent work and ‘cold’ pre-booked appointments to help prevent last-minute cancellations and allow patients to receive all the imaging they need in a single visit, close to their homes.

Other patient-centred measures outlined in the report include:

• Online booking and extended hours for outpatient appointments to ensure imaging can be arranged to suit the patient, helping to reduce non-attendance.
• Dedicated day case units or beds for patients having interventional radiology procedures, to help prevent delays and hospital-acquired infections, and free up beds elsewhere.
• Delivering faster results by increasing the amount of reporting carried out at home by radiologists and reporting radiographers.
• Reducing the stress of delays by using artificial intelligence (AI) tools to support scheduling, prioritisation and, in due course, some aspects of image interpretation.

The GIRFT report is based on visits to more than 140 radiology units across England. While it recognises the issues facing the specialty – high demand, a workforce shortfall and ageing equipment – it makes recommendations which put the needs and safety of patients at the heart of the service using existing resources, as well as highlighting where extra investment is needed.

Dr Halliday was advised in the review by Dr Giles Maskell (consultant radiologist at Royal Cornwall Hospitals NHS Trust), Elaine Quick (former radiology service manager at Salford Royal NHS Foundation Trust), and Lucy Beeley (group manager for radiology at Mid Yorkshire Hospitals NHS Trust).

Dr Halliday said: “COVID-19 has drastically affected the way healthcare is delivered worldwide and the pandemic has made our recommendations even more pressing. Workforce and equipment shortages have been thrown into stark relief and cramped departments are not suited to social distancing.

“Agility and flexibility will be key in dealing with the large numbers of patients who are now waiting for investigations and this can only be achieved with cross-organisational working, good data and robust IT systems.

“We were pleased to see the recent Diagnostics: Recovery and Renewal review call for a ‘one-stop shop’ approach to diagnostics, and we firmly believe this would make imaging services quicker and safer for patients.”

Dr Maskell added: “We want to make radiology services more patient-centred, with pathways and facilities designed around patient needs.

“Clearly, increasing capacity within the service is integral to that, as it will allow imaging to be provided sooner and results reported faster. But there are also opportunities, drawing on existing good practice and the rapid changes which were required to respond to COVID-19, to improve facilities for patients in hospitals and enhance the support given at all stages of the patient journey.”

The report also suggests innovative approaches to staff recruitment, retention and training, with a key recommendation calling for trusts to ensure all members of the radiology team receive the training they need to enable them to work at the top of their licence. A move to imaging networks, as outlined in NHS England and NHS Improvement’s 2019 Transforming Imaging services in England: a national strategy for imaging networks, will facilitate this.

The GIRFT report is supported by The Royal College of Radiologists (RCR). Dr William Ramsden, vice president for clinical radiology, said: “The investigation into variation and innovation across imaging services has been a rigorous undertaking by Dr Halliday and her GIRFT team, and the RCR is grateful to have been consulted for advice throughout.

“The resulting report is truly comprehensive, clearly stating the pivotal role of imaging in patient care, alongside the complex and significant pressures facing departments, and making positive recommendations to improve diagnostic and interventional radiology provision across England.” The Society of Radiographers has also given its support to the report. Chief executive officer Richard Evans said: “The report should be seen as a toolkit for good management of services and a call for NHS trusts to ensure that their diagnostic imaging services are resourced and aligned to the Quality Standard for Imaging, to enable best practice in the interests of patients and staff alike.”