By David Thompson, Head of Digital Solutions, Gateshead Health NHS Foundation Trust

The Community Diagnostic Centre (CDC) programme, introduced in 2021, has delivered over 7 million appointments, aiming to boost diagnostic capacity, reduce backlog, and speed up diagnoses. According to recent NHS England guidance, the programme has led to a 30% increase in NHS diagnostic capacity and reduced waiting times for key tests by up to 14%. Nearly 80% of CDC patients are now seen within six weeks, enhancing early diagnosis rates for conditions like cancer and heart disease

However, given that NHSE has set a target to deliver 17 million appointments by March 2025. If we continue to track similar progress since the inception of CDCs in 2021, it is unlikely that we will meet these ambitious targets.

The need to unlock diagnostic capacity

At Gateshead Health NHS Foundation Trust, delivering our CDC was a top priority. Our capacity pressures were increasing, with a growing number of referrals in services such as imaging, spirometry, and point of care testing. It was a similar story at Newcastle Hospitals NHS Foundation Trust, our neighbour.

We knew that unlocking diagnostic capacity was incredibly important for our patients, but a lack of joined up working across the region meant it was difficult to achieve. We worked as separate trusts, assigning ‘Newcastle days’ and ‘Gateshead days’ for community diagnostic appointments. As a result, patients were either waiting a long time for an appointment, or not being seen at all.

We knew that we needed to bring the two trusts together to deliver an effective CDC. By combining – and effectively democratising – the diagnostic capacity of both organisations, more patients will be able to be seen more quickly, speeding up the diagnosis of conditions like cancer, COPD and heart disease, as well as enabling monitoring and observations throughout treatment.

Taking the right approach for our patients

The challenge was how to do it. Should we continue as we were, working independently? Should we procure a new patient engagement platform (PEP)? Or should we try to make the most of the existing technology we have in place?

It is easy to become distracted by the latest solutions available and think that bringing in something new is the only way to tackle the capacity problems we face. At Gateshead and Newcastle, it was about looking at our existing systems in a new way. That’s not to say that procuring a PEP isn’t a valid option, but for us, we knew we needed to innovate with the technology we had already deployed to release diagnostic capacity quickly. There wasn’t time to wait for another system to be implemented.

Within the north east, Newcastle and Gateshead have some of the highest levels of social deprivation and poorest health indicators, so redesigning our services to improve these outcomes couldn’t wait. The King’s Fund’s latest report on the impact of poverty on the backlog also does well to highlight just how important it is to address these social factors, and quickly.

Designing the best system

It was really important that what we did was collaborative between our two trusts, and clinically led. We listened to what our clinicians wanted, understanding the best way to design the diagnostic pathways to suit them. The pathways for services like radiology and imaging are really complex, so making sure the design was clinically led was crucial.

Working with Answer Digital as our delivery partner, we developed a sophisticated data architecture to join up all of our existing systems (RIS, PACS, EPR) at our two trusts. This will provide us with better visibility of our diagnostic capacity and most importantly, enable us to deliver care to people more quickly.Taking this approach and innovating with what we already had will enable us to maximise diagnostic capacity from day one, deliver timely care to the people who need it and putus in good stead to meet NHS England’s appointments target. 

Improving access to care

When patients had to come to our hospitals for appointments, we had a high DNA rate, with many people being unable to afford to travel in to the city, or being unable to make their appointment time. Our CDC, the MetroCentre, is located ina highly accessible location, with over 550,000 people being able to reach it by public transport in under 30 minutes which will greatly improve access to care.

Given the potential impact that the CDC could have on public health as a result is great, it’s been so important to us to get the design right. Taking the approach we did means the vast amounts of data that we have already collected in our existing systems is being joined up and put to use. This will provide us with the best view of our population, as well as the necessary infrastructure to deliver high quality care in the community.

Stay true to your trust’s PEP strategy

There are currently 155 CDC’s open in England, and government has stated that 160 must be open by March 2025, alongside the target of delivering 17 million appointments. Alongside the very modest increase in the number of CDC’s, this target seems unachievable. So, our priority should be making it possible to create capacity through the existing CDC’s as quickly as possible, in whatever way is best for each organisation.

As with most NHS programmes, there is not a cookie cutter approach. The concept that we have developed with Answer Digital is now being blueprinted for use at other organisations, and I hope what we have done at Gateshead and Newcastle is helpful for others embarking on similar journeys. However, the most important thing to make sure of – on whatever path you decide to take– is that it aligns with your overall PEP strategy and that you always keep what is best for your patients front of mind.

We have fostered a culture of continuous improvement, which will enable us to update our architecture over time as needs change and make sure the solution is futureproofed. We have a system in place that works, and that will deliver value from day one.Doing so is going to have a transformative impact on our population, reducing health inequalities and greatly improving access to care.