Community Diagnostic Centres (CDCs) were founded to allow patients to access diagnostic services closer to home without needing to attend acute care facilities where urgent scans often lead to delays and cancellations. However, recent reports have cast doubt on whether CDCs are actually working to reduce diagnostic delays.
A report from the All Party Parliamentary Group (APPG) for Diagnostics, “CDCs Unveiled: Challenges & Triumphs”, published at the beginning of 2024, identified some key issues that are affecting the success of CDCs. Two of the biggest issues are:
Workforce capacity is still a limiting factor for how quickly patients can be diagnosed.
Poor digital infrastructure at many CDCs is holding back progress.
The core diagnostic services covered by CDCs are imaging (e.g. MRI and CT), physiological measurement (e.g. echocardiography), and pathology (e.g. phlebotomy). There are now 127 active CDCs across England, with at least one CDC operating in each Integrated Care System (ICS). However, data from September 2023 shows that only 6.5% of NHSE diagnostic tests took place in a CDC.
The fundamental issue facing NHS imaging services is that there are simply not enough radiologists to cope with the ever-rising demand for scans. Radiologists are reporting dealing with unmanageable workloads, and this is accelerating radiologists leaving the workforce and compounding the problem. Feedback gathering for the APPG for Diagnostics report was unanimous in agreeing that CDCs have introduced a notable increase in workload.
The APPG Chair, Maggie Throup MP, commented: “Workforce capacity remains a limiting factor. It is impossible to realise the benefits of the programme without adequate staffing to operate CDCs. Questions remain over how the programme plans to expand the workforce to meet demand and how NHS England’s Long Term Workforce Plan will play into this.”
RCR data shows that 88% of CDCs are staffed with existing Trust employees. 91% of the radiology Clinical Directors in England say that reporting scans for CDCs has increased their workload, and 41% say that the increase has been unmanageable. For imaging in particular, CDCs have increased the physical capacity to do more scans, but the capacity to report on those scans has not increased. Without a dedicated workforce growth and retention plan, CDC’s are never going to be able to significantly impact waiting times.
Managing radiologists’ workload and streamlining operations is probably one of the best retention strategies for CDCs and radiology departments alike. This is where digital infrastructure is key. The right digital tools can help CDCs to manage radiologists’ workload, speed up referral times, and cut down unnecessary delays.
Some of the issues CDCs have reported are incredibly basic, such as unreliable Wi-Fi services and paper or telephone-based referral systems. Effective data sharing has also been identified as a key source of delays, particularly for radiologists who are unlikely to be based at a CDC and so are reporting on scans remotely.
A recent case study at North West Anglia NHS Foundation Trust has shown the potential impact of improving image transfer systems in an acute care setting. Using Hexarad’s Edge integration software, NWAFT was able to reduce the time it took to transfer an image to a radiologist by an average of 20 minutes, with Head CT scans typically sent to reporting radiologists in less than 5 minutes. This is just one example of how important efficient data-sharing technology can be.
The potential benefits of CDCs are huge, but the issues they are facing are unfortunately the same as radiology departments across the UK. Without more support to expand the radiology workforce capacity and encourage digital infrastructure upgrades, with a focus on streamlining and improving efficiency, radiology is going to remain a massive bottleneck in the NHS.