scottish clinical imaging network (scin ) 2017-2018 annual

SCIN Annual Report 2017/18

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Scottish Clinical Imaging Network (SCIN )

2017-2018 Annual Report

Dr Hamish McRitchie, SCIN Clinical Lead

Dr Fiona Hawke, SCIN Imaging Manager

Mrs Alexandra Speirs, SCIN Programme Manager


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Contents Executive Summary ...................................................................................................................................... 4

1 Introduction .............................................................................................................................................. 5

2 SCIN Purpose .......................................................................................................................................... 6

3 SCIN in 2017/2018: Report against the Work Plan .................................................................................. 7

3.1 National Specialist Screening (NSSC) SCIN Review ......................................................................... 7

3.2 Communication and Engagement ..................................................................................................... 7

3.2.1 Stakeholder Engagement and Education: Radiographer Focused Event .................................... 8

3.2.2 Communication and Engagement: 3rd Inter-University Radiographer Conference ....................... 9

3.2.3 Communication and Engagement with Medical Physics (MPNET) .............................................. 9

3.2.4 Communication and Engagement: iRefer .................................................................................... 9

3.2.5 Communication and Engagement –Scottish Paediatric Epilepsy Network (SPEN) .................... 10

3.3 PET-CT: Working Group ................................................................................................................. 10

3.3.1 PET-CT: Key Performance Indicators (KPI’s) ............................................................................ 11

3.3.2 PET-CT: Review of Indications Report ...................................................................................... 12

3.4 NHS Shared Services Imaging Portfolio Board ................................................................................ 14

3.4.1 NHS Shared Services Imaging Portfolio Board Reporting Radiography .................................... 14

3.5 Quality Improvement ....................................................................................................................... 15

3.5.1 Quality Improvement: Radiology Dashboard ............................................................................. 15

3.5.2 Quality Improvement: Scottish Imaging Self Assessment Tool (SiSAT) .................................... 15

3.5.3 Quality Improvement: DNA and Urgency Codes ....................................................................... 17

3.5.4 Quality Improvement: Clinical Decision Software ...................................................................... 17

3.6 Direct Access to Imaging: Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy ......................................................................................................... 17

3.7 Seven Day Working in Imaging: Report for the Sustainability and Seven Day Services Taskforce. . 18

3.8 Horizon Scanning ............................................................................................................................ 18

3.8.1 Horizon Scanning: Are you sitting comfortably? ........................................................................ 18

3.8.2 Horizon Scanning: East Midlands Radiology Service (EMRAD) ................................................ 19

3.8.3 Horizon Scanning: Computed Tomographic Colonsoscopy (CTC) ............................................ 19

3.8.4 Paediatric Workstream .............................................................................................................. 19

3.9 Scottish Radiology Transformation Programme (SRTP) .................................................................. 20

4. Looking forward to the year ahead ........................................................................................................ 21

4.1 Education ........................................................................................................................................ 21

4.2 PET-CT ........................................................................................................................................... 21

4.2.1 PET-CT Working Group ............................................................................................................ 21

4.2.2 PET-CT KPI’s ........................................................................................................................... 21

4.2.3 PET-CT Capital Funding ........................................................................................................... 21

4.2.4 PET-CT Health Board Boundaries ............................................................................................ 21

4.2.5 Scottish Imaging Self Assessment Tool (SiSAT) ...................................................................... 21


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4.2.6 Quality Improvement: DNA and Urgency Codes ....................................................................... 21

4.2.7 Demand Optimisation ............................................................................................................... 21

4.2.8 Develop an Atlas of Interventional Radiology ............................................................................ 22

4.2.9 Scottish Imaging Pathway for Primary Care Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy” ............................................................................... 22

4.2.10 Develop a sustainable workforce ............................................................................................ 22

4.2.11 Advanced Practice in Radiography in Scotland ....................................................................... 22

4.2.12 Communication and Engagement ........................................................................................... 22

5 Work plan SCIN 2018/19 ....................................................................................................................... 23

Appendix 1: Network Governance .............................................................................................................. 30

Appendix 2: Steering Group Representation ............................................................................................... 31

Appendix 3: Finance ................................................................................................................................... 33

Appendix 4: Radiographer-Focused Event ................................................................................................. 34

Appendix 5: PET-CT KPI’s (April 2017-November 2017) ............................................................................ 38

Appendix 6: Direct Access to Imaging Survey ............................................................................................. 41

Appendix 7: Seven Day Access to Imaging Services .................................................................................. 43

Appendix 8: SCIN Horizon Scanning Poster ............................................................................................... 48


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Executive Summary The Scottish Clinical Imaging Network has successfully accomplished a wide ranging and varied programme of activity during the 2017-18 reporting period.

Dr Hamish McRitchie (NHS Borders) was appointed as the lead Clinician in August 2017, following Dr Anne Marie Sinclair’s tenure ending in April 2017.

The network review was undertaken as part of the National Services Committee (NSSC) commissioning requirements. With approval from NHS Boards and Scotttish Government for a further cycle of national designation, this provided SCIN and its stakeholders with the opportunity to develop a 3-5 year strategic work plan to improve the quality of imaging services across NHS Scotland.

A PET-CT Capital Funding and Replacement Group was initiated in April 2017, the remit of the group was to produce a cohesive replacement programme for Scotland, including the planning and delivery of an effective radio pharmaceutical service.

In July the PET-CT Review of Indications Report was published, the culmination of a significant programme of work to provide national guidance on standard investigations for which PET-CT would be indicated. NHS Scotland now has a means to ensure an equitable, effective PET-CT service.

SCIN facilitated its first Radiographer-focused event in June. The event was an opportunity for the network to explore and seek solutions tothe issues facing NHS Scotland’s Radiographers, including development opportunities presented by the current policy drivers.

In August, the strategic Imaging landscape changed following NHS Board Chief Executives’ approval of the Shared Services Business Case and the establishment of the Scottish Radiology Transformation Programme (SRTP). The announcement of this funding has enabled the SRTP to progress the Radiology Dashboard and Clinical Decision Support Software (CDSS) projects that had been initially developed within the SCIN Quality Improvement group.

The Scottish Imaging Self Assessment Tool (SiSAT) was developed, enabling SCIN and the Information Management service (IMS) to develop a user-friendly platform that incorporates a “scorecard” that is generated at the time of completing the report. This will be useful to all imaging departments in meeting Ionising Radiation (Medical Exposure) Regulations (IRMER) requirements and has the potential to build a national programme of improvement work.

The network is grateful to Dr Fiona Hawke for the leadership what she provided to specific elements of the workplan pending the appointment of the lead clinician.


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1 Introduction Diagnostic services are an essential part of the patient journey. They assist the clinical team in reaching an accurate diagnosis; ensuring patients receive appropriately tailored treatment and avoid unnecessary clinical interventions.1 It is suggested that around 60-70% of diagnoses are based on imaging and laboratory tests, highlighting their importance in influencing medical decision making.2

Managed Diagnostic Networks are defined as co-ordinated groups of health professionals that support diagnostic services to continuously improve service delivery, to ensure equitable provision of high quality, clinically effective services.

The Scottish Government3/4 identified that diagnostics are central to whole systems/service redesign of the NHS in Scotland. Since Networks have significant involvement in progressing a number of key pieces of national strategic work which include:

Shared Services

National Delivery Plan for Healthcare Scientists

National Clinical Strategy

Realistic Medicine

1 Diagnostic Steering Group Report: Report of the Diagnostic Short life working Group July 2013

2 NHS Scotland National Framework Advisory Group Diagnostic Services Report, 2005

3 A National Clinical Strategy for Scotland 2016.

4 Realistic Medicine Chief Medical Officers Annual Report 2014-2015


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2 SCIN Purpose Scotland’s imaging network was initiated following publication of reports from Audit Scotland (2008) and the Scottish Government Health and Social Care Directorates Diagnostic Steering Group (2009). The recommendations were wide ranging, tasking Scottish Government and NHS Boards with specific work. The initial remit of the Network was to work across NHS Board boundaries, acting as a conduit between Radiology services and Scottish Government / central projects.

In 2016, the network reviewed and revised its vision and branding. The network’s mission statement is below.

SCIN aims to influence the provision of an innovative, equitable, patient centred, high quality, clinically effective imaging service in Scotland


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3 SCIN in 2017/2018: Report against the Work Plan During the period 2017-2018 the network led and supported the delivery of a challenging and extensive programme of work during a period of significant change.

3.1 National Specialist Screening (NSSC) SCIN Review

During 2017-18, in line with NHS Scotland’s national commissioning policy, SCIN was reviewed for the first time since designation. The purpose of the review was to inform a decision on continuing central funding; based on the extent to which SCIN was meeting the needs of its stakeholders, including NHS Scotland’s vision for diagnostic services.

Following analysis of the evidence presented, the Expert Review Group (ERG) concluded that SCIN had added considerable value since inception; highlighting the following as successes:-

Initial development of the Imaging Dashboard, now part of the SRTP plan for national roll out

Publication of the Direct Access to Imaging Pathway “ A Scottish Imaging Pathway for Primary Care: Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy”

National framework for outsourcing of Imaging

Exploring Seven Day Working in Imaging, including publishing the Report for the Sustainability and Seven Day Services Taskforce

Publication of the Interventional Radiology Report: Interventional Radiology Services in Scotland: A discussion paper

PET-CT: Collating and analysing PET-CT data; developing an evidence base in PET-CT; Producing a PET-CT Review of Indications Report for the use of PET-CT.

Facilitating five national Imaging events.

The ERG acknowledged that the imaging landscape had changed considerably since the SCIN objectives were agreed in 2014. It acknowledged the important contribution that SCIN had provided to the NHS Shared Services Portfolio Board, working collaboratively to develop a visionary business case for sustainable imaging services across Scotland.

The ERG noted that the work SCIN had progressed as part of its programme of activity had provided the foundation from which the SRTP could progress the transformation of imaging services: in relation to IT connectivity; progressing a National Imaging Data Set; Clinical Decision Support Software (CDSS); Quality Assurance and Clinical Governance for Cross Boundary Reporting.

The SCIN Review was presented to the National Specialist and Screening Committee (NSSC) in March. The NSSC endorsed the continued designation of SCIN and recommended that SCIN should be reviewed in tandem with any assessment of SRTP progress, currently scheduled for August 2019.

3.2 Communication and Engagement

SCIN has a key role in communication and engagement with the Imaging community and its stakeholders. Following the review, the communication and engagement strategy was refreshed to maximise its effectiveness.


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During the reporting period SCIN issued three newsletters. This included one joint newsletter with

the SRTP. The newsletters inform the imaging community of the work that SCIN has done and is

planning to do in the next quarter.

SCIN also issued 4 bulletins as part of the review process.

The SCIN website continues to provide the imaging community and its stakeholders with relevant and current imaging information following specific changes towards a more user-friendly platform. The website links in specifically with the NMDN Twitter account, the use of this has developed significantly across all diagnostic networks in the reporting period. SCIN has benefitted from a range of retweets by senior stakeholders, including the Chief Medical Officer and NHS Scotland’s Chief Executive.

During the reporting period SCIN reached 41,294 people through Twitter

Figure 2: Most popular SCIN tweet

3.2.1 Stakeholder Engagement and Education: Radiographer Focused Event

SCIN successfully facilitated its first Radiography Focused Event in June 2017; the event was an opportunity for the network to engage directly with Radiographers and broaden it’s understand of the issues facing this profession and what the role of the network might be in improvement.

The event provided the Radiography community with the opportunity to engage with strategic and policy drivers as well as what work was being progressed in Imaging in NHS Scotland, including the SCIN workplan and the Shared Services Programme.

The event programme was dynamic and varied, with an impressive array of speakers covering all major strategic initiatives, including a presentation on Realistic Medicine by Dr Dave Caesar from the Chief Medical Officer’s team and a range of workforce development topics, including a numbers of presentations which enabled a detailed look at the evolving role of the radiologist and the radiographer and how the roles complement each other to deliver an optimal service. A more detailed report on the event can be found at Appendix 4.


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3.2.2 Communication and Engagement: 3rd Inter-University Radiographer Conference

Dr Fiona Hawke was invited to speak at the 3rd Inter-University Radiography Conference “Patient Centred Care”, held at Queen Margaret University, Edinburgh. The theme of the day was ensuring that patients are at the centre of all the work that is delivered.

Dr Hawke’s presentation “Patient Centred Care: - A Scottish Standard” highlighted work that SCIN had undertaken to support equity of access, investigation, quality and treatment for patients in Scotland.

Students were also offered an opportunity to get involved in SCIN.

3.2.3 Communication and Engagement with Medical Physics (MPNET)

Dose limits are set to protect workers and members of the public from the effects of ionising radiation. They are set at a level that balances the risk from exposure with the benefits of using ionising radiation.

In 2017 SCIN was advised that the IRMER 2000 guidelines had been reviewed and would be replaced by the IRMER 2018 Guidelines. The revision to the guidelines provided SCIN with the opportunity to collaborate with the MPNET to provide expert clinical advice to enable departments throughout Scotland to meet the new requirements. This resulted in the design of a poster that informed patients about the risks and benefits of having imaging procedures.

Once the posters have been approved and endorsed by COMARE (The Committee on Medical Aspects of Radiation in the Environment) they will be displayed in imaging and dental departments. Posters have been extremely well received with those endorsing them including Scotland’s Chief Dental Officer. There is interest from NHS England in progressing the SCIN/MPNet posters South of the Border, too.

3.2.4 Communication and Engagement: iRefer

The Royal College of Radiologists (RCR) developed the iRefer guidelines to enable referring GPs, radiographers, clinicians and other healthcare professionals to determine the most appropriate imaging investigation(s) or intervention for patients. iRefer provides practical guidance based on the best available evidence.

In June 2017, it was brought to the attention of SCIN that iRefer license (Vo.7) which had been purchased by the Scottish Government Health and Social Care Directorate (SGHSCD) in 2012 had expired.

SCIN provided national coordination to find a solution and in February 2018 was delighted that Scottish Government had purchased the iRefer license and it was available for staff to access. iRefer is available to all imaging clinicians at: https://www.irefer.org.uk/

https://www.irefer.org.uk/


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3.2.5 Communication and Engagement –Scottish Paediatric Epilepsy Network (SPEN)

In October 2017 The Scottish Paediatric Epilepsy Network consulted SCIN to ask if the network could identify Paediatric Imaging colleagues who would be able to provide expert Neuroradiology advice to Scottish Intercollegiate Guidelines Network (SIGN) who were revising the Epilepsy guidelines. SCIN was delighted to support the provision of clinical expertise in this important development

3.3 PET-CT: Working Group

Positron Emission Tomography-Computed Tomography (PET-CT) is a unique imaging tool which shows pathology by using PET to detect derangement in tissue metabolism and CT to show structural changes. PET-CT is a key diagnostic service which provides information to allow informed clinical management decisions and more effective targeted care. This contributes to more individualised care and treatment of patients.

The appropriate use of the examination in the patient pathway optimises the efficiency of the subsequent clinical interventions and treatment regimens. A new development for the working group had been the assigning of a data analyst from the IMS to work with the centres to collect and collate monthly data which illustrates the growing demand on the PET-CT service. Numbers of examinations and average waiting times are now presented to the group who have opportunity to review these, in tandem with the Review of Indications document, and identify and tackle any issues. The PET-CT group review the breakdown of the other indications where PET-CT is used (Figure 3). In addition to reviewing the data, the group informs the commissioners of new developments in the use of PET-CT.


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Figure 3: PET-CT Cancer Indicators that were scanned during 2015-2016

NHS Tayside will be included in the next reporting period.

Detailed activity statistics for 2016-17 PET-CT activity in Scotland were submitted to the Scottish Government finance department to inform the calculation of revenue funding to each centre.

3.3.1 PET-CT: Key Performance Indicators (KPI’s)

The PET-CT working group identified that there was a need to develop a national approach to quality improvement. The group agreed that there was a need to design specific performance standards to assist the group to monitor and oversee the delivery of Scotland’s PET-CT service.


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Six Key Performance Indicators (figure 4) have been endorsed by the PET-CT group. IMS will now extend its data collection to ensure these are reported on to the working group bi-annually, who will develop a programme of quality improvement, targeted to need.

Key Performance Indicators (KPI’s)

1.

Waiting times for Examination

2.

Number of examinations performed

3.

Reporting turnaround time of Examinations

4.

Number of cancelled patients

5.

Change in patient treatment plan

6.

Patient satisfaction

Figure 4: PET-CT 6 Key Performance Indicators

During the period 2018/19 the focus of work will be how the four centres can apply a more uniform approach to recording ‘Did Not Attend (DNA) and cancellation’ data, which is now reflected in the data collection tool. Collaborative working will continue to identify opportunities for improvements in standardisation across key areas such as reporting turnaround. This will potentially lead to establishing an improved universal approach.

3.3.2 PET-CT: Review of Indications Report

A major achievement in PET CT has been the publication of the Review of Indications Report in July 2017, providing guidance on standard investigations for which PET-CT would be indicated. This provides NHS Scotland with the means to ensure an equitable, effective service. This is the evidence base for the service across Scotland and reflects the increasing demand on a finite resource and the need to ensure that referrals were consistent and appropriate across sites.

The work of the group was made possible by continuous support from the Scottish Health Technology Group (SHTG) which conducted reviews of evidence and supported the group in working through the indications for which PET-CT was recommended in the 2016 guidelines by the Royal Colleges of Physicians and Radiology. SHTG also considered whether there was new evidence that should be taken into account.

The collaboration between the PET-CT working group and the SHTG prompted the SHTG to issue advice statements on scoping work that they have progressed in PET-CT such as


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“Is FDG PET-CT clinically and cost-effective in the staging and/or restaging of disease in patients with penile or testicular cancers?”

The advice statement for this topic scoping exercise is available at: http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_010-17.aspx

The PET-CT Review of Indications Review Report was shared with commissioners in NHS Wales, at their request. The report is available on the SCIN website http://www.scin.scot.nhs.uk

It is recognised the ROI will continue to be refreshed by the working group in partnership with SHTG.

3.3.3 PET-CT: Capital Funding Short Life Working Group

The PET-CT Capital Funding Short Life Working Group (PET-CT CF-SLWG) had been convened at the request of the PET-CT working group who identified and recommended a strategic “Once for Scotland” approach should be adopted for capital replacement.

The national approach progressed by the four sites includes ligand production by cyclotrons, together with new developments such as use of Ga68-PSMA (Prostate Specific Membrane Antigen) and other products used in neuroendocrine tumour diagnosis and treatment which can be produced by Gallium generators.

Collaborative working between the four PET-CT centres has led to a better, shared understanding of current and future provision within NHS Scotland. The group provided peer review of a business case of a modest investment (£22K) in the PET-CT service in Aberdeen. NHS Grampian had submitted a business case as the indications for PET-CT had widened from diagnosis and staging, to include assessment of treatment response, restaging, and informing choice of chemotherapeutic regimens. Demand had continued to rise as both the evidence base for the clinical value of PET-CT strengthened and the research applications expanded

Through collaborative planning and sharing of access to equipment across sites, patients have better access to services and opportunity for reduced waiting times; for example, when equipment

http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_010-17.aspx

http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/shtg_advice_statements/advice_statement_010-17.aspx

http://www.scin.scot.nhs.uk/


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in a local centre is being replaced those patients who are happy to travel have been able to access PET-CT scans at another centre.

The work undertaken by the SCIN PET-CT working group has been effective in standardising practise; improved efficiency and accountability within the centres and, particularly through the introduction of the data analyst and the development of QPIs, provided transparency and insight into an evolving high-cost service where demands are increasing.

Figure 5: Predictive model for PET-CT scans from 2015-2025

3.4 NHS Shared Services Imaging Portfolio Board

In 2015 National Services Scotland (NSS) established a Shared Services Health Portfolio Board to take forward the Shared Services Agenda in Diagnostics. SCIN worked collaboratively to progress key pieces of work, initially through the development within the network of a visioning document which set the direction of travel. Further work has included:-.

3.4.1 NHS Shared Services Imaging Portfolio Board: Reporting Radiography

To underpin the implementation of the National Radiology Model, there is a requirement to maximise role utilisation throughout the service. Successful implementation will provide greater flexibility for staff to work across traditional NHS Board boundaries.


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SCIN and NHS Shared Services Programme worked collaboratively to compile a national framework of Radiographer skills which includes:

Standard role profiles

Agreed educational preparation and continuing CPD

Agreed practice supervision requirements

Scope of Practice including standard activity outputs

The guidance was approved by the National Human Resources Directors Group and partners in The Scottish Workforce and Staff Governance Committee (SWAG) secretariat and the NHS Board Chief Executives in August 2017.

3.5 Quality Improvement

The SCIN Quality Improvement (QI) group was established to identify what was the most effective and efficient way to collect a national minimum data set for Radiology.

During the reporting period the Quality Improvement group progressed the following key pieces of work to improve quality within Imaging in NHS Scotland:-

3.5.1 Quality Improvement: Radiology Dashboard

Following initial development by the group, the Radiology Dashboard is being progressed through Public Health Intelligence (PHI) as a programme of work the SRTP has been commissioned to deliver. Dr Raj Burgul (Consultant, NHS Forth Valley Hospital and SCIN QI Subgroup lead) has been invited to provide clinical expertise as the dashboard is implemented throughout NHS Scotland.

3.5.2 Quality Improvement: Scottish Imaging Self Assessment Tool (SiSAT)

There have been a number of instances across the British Isles where external agencies have criticised the lack of documentary evidence of quality standards within Radiology services

The SCIN Quality Improvement group developed the Scottish Imaging Self Assessment Tool (SiSAT) in response to this, to provide a comprehensive document that evidences service quality. The SiSAT provides a Quality Scorecard for imaging service using indicators assessing Clinical Performance, Environment, Workload and Workforce, Patient Experience and Safety Characteristics.


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Figure 6: Example Page from the Patient Experience


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The questions in the SiSAT have been weighted in the background according to their relative importance. The questionnaire responses generate a RAG status within the quality fields.

RAG status amber or red prompts development of an action plan to improve the status of imaging departments.

SiSAT will be completed by clinicians and managers responsible for the service in each NHS Board area. The questionnaire and the RAG status are held within each service and are not returned or held centrally. They remain internal documents and are confidential to the service to help identify gaps in quality and provide evidence of quality improvement via the action plans.

The SISAT can also be used to benchmark quality against other centres if managers from both services agree to this action. The resultant document can be submitted, if required, for any external inspection. The SiSAT does not specify that any evidence to support the responses be submitted, however it is expected that supporting evidence is available and could be supplied during an external inspection.

3.5.3 Quality Improvement: DNA and Urgency Codes

Missed outpatient appointments across the NHS in Scotland cost £48 million approximately every year (NHS Health Scotland, 2015). Whilst DNA numbers are recorded, there is no joined up approach to collecting data and displaying it in an accessible fashion.

The Diagnostic Steering Group (DSG) advised SCIN to present the DNA and Urgency Code

Report and its recommendations to the RIS users group. It is anticipated that RIS users group will

progress the report’s recommendations and standardise processes.SCIN will liaise with the RIS

users group to monitor how the recommendations are being progressed.

3.5.4 Quality Improvement: Clinical Decision Software

In the absence of a national system to support clinical decision-making, a priority for SCIN was to explore options for access to information on demand, capacity, referral patterns and variation. This would enable Scotland’s radiology services to work as a “single department”.

Clinical Decision Support Software (CDSS) is an electronic ordering of tests that provides the opportunity to influence clinician referral behaviour. This tool has the potential to direct referrers to the most appropriate evidence-based examinations and allows for audit of referral patterns.

The Quality Improvement Group indentified that there were two acceptable sets of guidelines for a UK market; the RCR guidelines and the European Society of Radiology (ESR) guidelines which are a modified version of the American College of Radiologist guidelines.

SCIN assessed both of these platforms in 2016 and produced a report with recommendations that included the most appropriate CDSS platform to be piloted in NHS Scotland. This was presented to the DSG in July 2017. SCIN’s good work on CDSS has been picked up and is now progressed as a project within SRTP.

3.6 Direct Access to Imaging: Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy

A lack of a defined pathway for patients who presented in Primary Care with an with unidentified suspected malignancy, has led to inequity of access and delay in a referral to the correct treatment


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pathway, with some Boards which providing access to General Practitioners (GP’s) for specific indications and other boards not.

In 2015 SCIN had developed “A Scottish Imaging Pathway for Primary Care Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy”. This was audited in NHS Grampian in 2016 and shown to be effective.

In the summer of 2017, SCIN undertook a survey of all NHS Boards to ascertain how many had implemented the recommendations (Appendix 6).

Of the 14 health boards, there were 6 respondents in total; four of these boards had already accepted GP referral’s prior to the SCIN report; one board indicated that they were unable to accommodate the report’s findings due to capacity issues; the other health board advised that they permitted direct access to GP’s following the publication of the SCIN report.

The data that SCIN collected has been shared with the Ministerial Cancer Performance Delivery Group to enable boards to spread the recommendations from the SCIN Report.

The SCIN Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy Report is available on the network website: http://www.scin.scot.nhs.uk/.

3.7 Seven Day Working in Imaging: Report for the Sustainability and Seven Day Services Taskforce.

The Seven Day working in Imaging Report that SCIN produced for the Scottish Government’s Sustainability & Seven Day Services Taskforce in 2017 outlined the importance of timely accurate imaging services being at the heart of modern healthcare delivery for both primary and secondary care. The report identified that there was variability in the access to emergency imaging across Scotland, both in diagnostic and interventional imaging, out with normal working hours

The group made recommendations on two separate but linked issues with regard to out of hours imaging. The first is the standardisation of emergency imaging tests and procedures which should be accessible on an equitable basis across Scotland and the second was the implementation of 7 day working in Imaging.

In 2017 SCIN issued a survey to the boards to audit the extent to which the recommendationshad been implemented. (Appendix 6).

It is anticipated that the work that SCIN progressed for the Sustainability and Seven Day Services Taskforce will enable the SRTP to progress work in this area.

The SCIN Seven Day Working in Imaging: Report for the Sustainability and Seven Day Services Taskforce is available on the network website: http://www.scin.scot.nhs.uk/.

3.8 Horizon Scanning

The SCIN Horizon Scanning Group was established to identify what forthcoming issues in Radiology SCIN should address on behalf of the Imaging Community and its stakeholders. It also supports and contributes to the NHS Scotland Shared Services agenda.

3.8.1 Horizon Scanning: Are you sitting comfortably?

In 2017 the Healthy Working Lives Poster that was developed through the SCIN Horizon Scanning Group was issued to Imaging Departments to remind staff to look after their physical health in the reporting room. (Appendix 8).




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3.8.2 Horizon Scanning: East Midlands Radiology Service (EMRAD)

The Horizon Scanning Group had identified that a way of providing sustainable, safe, effective patient centre imaging services in NHS Scotland was to explore how resources could be used out with traditional territorial board boundaries. Noting what was occurring in NHS England the SCIN Horizon Scanning Group invited Dr Tim Taylor (Clinical Lead EMRAD) to advise the Network on what EMRAD had achieved.

The SCIN Horizon Scanning Group noted that if a similar project was to be initiated in NHS Scotland new ways of working could significantly improve the clinical care offered within urgent services (such as major trauma and stroke and in regional acute surgical centres), as well as improving the support available to smaller hospitals and outpatient facilities.

A shared technical system in Scotland would allow clinicians to access the complete radiology imaging record for their patients (including scans, reports and clinical opinions), regardless of where they are based, which will help more clinicians provide more care closer to patients’ homes.

As part of its Vanguard5 status EMRAD provided SCIN with the documentation that it had developed.

The connection that SCIN had made with EMRAD is being progressed through SRTP. This has included SCIN leading the review of EMRAD documentation.

3.8.3 Horizon Scanning: Computed Tomographic Colonsoscopy (CTC)

Bowel cancer is a major public health problem in Scotland. Bowel screening aims to find cancer at an early stage when treatment is likely to be more effective (http://www.healthscotland.scot/health-topics/screening).

In anticipation of changes to Bowel Screening, the SCIN Horizon Scanning group was asked to conduct a scoping exercise on current provision for Colonoscopy for Bowel Screening. A survey was developed and issued to Boards. The audit findings were presented to the Bowel Screening Programme.

A CT Colonography meeting was convened in 2017; participants noted that a major hurdle was the lack of information regarding what patients were from a screening pathway and which were symptomatic. Surgery colleagues noted that this information might be available after all, but that Radiology may not have access to it. The NHS Scotland Bowel Screening Programme is undertaking work to suggest what metrics about screening patients who receive CTC should be collected from all Boards.

3.8.4 Paediatric Workstream

SCIN was approached by Paediatric Radiologists to develop a paediatric workstream which could include:

5 The new care model vanguards are a key element within the NHS England’s Five Year Forward View. They are

partnerships between NHS England, the Care Quality Commission, Health Education England, NHS Improvement, Public Health England and the National Institute for Health and Care Excellence. Vanguard sites take a lead in the development of new care models that act as the blueprints for NHS England moving forward and inspiring the rest of the health and care system.

http://www.healthscotland.scot/health-topics/screening

http://www.healthscotland.scot/health-topics/screening


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Facilitating an event to prioritise what the Paediatric work stream should progress

Dose Optimisation

Waiting times data

Protocol harmonisation

Training/Guidance advise for Specialist Radiographer Reporting

Communication and Engagement

The steering group endorsed SCIN undertaking this programme of work, which will be progressed as part of the 2018/19 workplan.

3.9 Scottish Radiology Transformation Programme (SRTP)

In August 2017 the £3.1 million Business Case that had been developed by the Shared Services Programme was approved by the Board Chief Executives.

SCIN has been invited to provide clinical expertise in the following areas:

Clinical Governance Project Initiation Document

The aim of the Clinical Governance Framework is to ensure that safe processes are in place to support data protection, quality of reporting, reliable arrangements for patient follow up and measure to support peer review, second opinion, discrepancy and MDT management. Dr Fiona Hawke, in her role as Imaging Manager, has led this development.

Radiography workforce

SCIN has met with NES, Scottish Government, and Higher Education Institutions (HEIs) to discuss the requirements for sustainable radiographic workforce for the future


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4. Looking forward to the year ahead SCIN is looking forward to progressing another dynamic programme of activity during 2018/19.

4.1 Education

The first event that SCIN will facilitate is for Paediatric Imaging Clinicians in September. This event will be an opportunity to define what the national challenges are and develop local solutions.

In October SCIN will facilitate its Annual event titled “Developing a workforce to meet future demands”.

4.2 PET-CT

4.2.1 PET-CT Working Group

The IMS will continue to collate and present the PET-CT data to the PET-CT working group. The data will be used to improve the PET-CT service and identify any pressures.

4.2.2 PET-CT KPI’s

The agreed six KPI’s will be analysed by IMS and presented to the PET-CT working group to monitor and improve the quality of service delivered to all NHS Scotland patients.

4.2.3 PET-CT Capital Funding

The finalised PET-CT strategic business case will be presented to the Directors of Finance/Board Chief Executives/Diagnostic Steering Group /National Cancer Strategy Group and the Scottish Government. The PET-CT Working Group will then have a role in ensuring appropriate referral pathways are in place to maximise the return on investment and.

4.2.4 PET-CT Health Board Boundaries

The PET-CT working group will monitor the patient pathways, ensuring capacity is appropriately utilised.

4.2.5 Scottish Imaging Self Assessment Tool (SiSAT)

SiSAT will be presented to the Radiology Managers Group to seek guidance on where the SiSAT should be piloted in NHS Scotland. The tool will be tested in at least 2 NHS Boards; findings will be revised in line with the quality improvement Plan-Do-Study-Act methodology

The SCIN steering group recommended that SiSAT will also be presented to the Scottish Association of Medical Directors who will be asked to endorse the SiSAT prior to submission to Healthcare Improvement Scotland (HIS) in order for it to become a validated quality improvement tool.

4.2.6 Quality Improvement: DNA and Urgency Codes

SCIN will continue to work with the RIS users group to monitor how national DNA and Urgency

Codes processes are being standardised in NHS Scotland.

4.2.7 Demand Optimisation

SCIN will provide clinical expertise as requested by the SRTP to enable the Clinical Decision Support Software and Cross Boundary Reporting streams to continue within the designated timeframe. SCIN will report the progress of this work to the National Demand Optimisation Group.


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4.2.8 Develop an Atlas of Interventional Radiology

SCIN will develop an Atlas of Interventional Radiology procedures that will be presented to the Realistic Medicine Team and the Managed Trauma Network.

4.2.9 Scottish Imaging Pathway for Primary Care Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy”

SCIN will be guided by the work that is being progressed through the Ministerial Cancer Performance Delivery Group to enable boards to spread the uptake of the “Scottish Imaging Pathway for Primary Care Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy”

4.2.10 Develop a sustainable workforce

Collaborative work will continue with National Education Scotland, College of Radiologists, Society and College of Radiographers (SCoR), HEIs SRTP and the Scottish Government to develop a sustainable imaging workforce. This work includes informing the Scottish Government of vacancies, likely impact of retirements and succession planning. Constraints to education such as funding, training time and backfill are also on the agenda for continued discussion

4.2.11 Advanced Practice in Radiography in Scotland

The requirements of advanced practice roles are clearly stated in SCoR documentation as being composed of expert clinical skills; education and training; service assessment and development; audit and research, There are examples of expert clinical skills such as MSK, plain image reporting and also some specific specialised pockets of practice that have developed due to service need. The concern is that these pockets are fragile with little evidence of succession planning. There is a need to identify service requirement for Advanced Practice roles.

SCIN will provide clinical expertise with regards to how these roles should be developed in NHS Scotland.

4.2.12 Communication and Engagement

SCIN will promote the revised network brand on all its communication to the imaging community and its stakeholders. SCIN will continue to ensure that the website is an up to date vehicle of communication and engagement. As part of the networks Quality Improvement Plan the network will have increased interaction with the website by 5% by 31st March 2019.


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5 Work plan SCIN 2018/19

Objective Number SMART Objective

Linked

Dimensions

of Quality

Planned start

/ end dates

Detailed plan/available

owner

Description of progress towards

meeting objectives Anticipated outcome

RAGB

Status

2018-01

Education and Training

SCIN will facilitate 2 education events

3:4:5 June 2018-December

Programme Manager and Imaging Manager

2 education events will be organised for the Imaging community and its stakeholders

The events will align and contribute to the work that is being progressed in the Scottish Radiology Transformation Programme

G

2018-02

PET-CT Data Collection

The Information Management Service will collate and analysis the data returns from the 4 PET-CT centres

3:4:5:6 April 2018-March 2019

Data Analyst Information Management Service

The data analyst will collate analysis the PET-CT data returns

The PET-CT centres are providing PET-CT to the same clinical indications.

PET-CT trends can be observed and proactively managed

G


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2018-03

PET-CT

KPI’s

The Information Management Service will analysis the agreed 6 KPI’s

1:2:3:4:5:6 April 2018-March 2019

Mrs Alexandra Speirs /Data Analyst Information Management Service

The data analyst will collate analysis the PET-CT data returns

The KPI’s will be used to monitor and improve the quality of service delivered to all NHS Scotland patients.

G

2018-04

PET-CT

Capital Funding

The PET-CT Capital Funding Business case will be finalised.

3:4:5:6 April 2018- March 2019

PET-CT Capital Funding Group

The finalised report will be presented to the Directors of Finance/Board Chief Executives/Diagnostic Steering Group /National Cancer Strategy Group and the Scottish Government

The PET-CT Business will be accepted and endorsed by the Scottish Government as the agreed national strategy for PET-CT

G

2018-05

PET-CT

Health Board Boundaries

The PET-CT working group will monitor the patient pathways with a view of re-drawing these between the PET-CT centre

3:6 April 2018-March 2018

PET-CT Working Group

This will be reviewed at the PET-CT working group meetings

Patient pathways could be redefined to improve access to PET-CT

G


25

2018-06

Scottish Imaging Self Assessment Tool

(SiSAT)

The SiSAT will be piloted in 2 NHS Boards and revised in line with findings

2:3:4 April 2018-March 2019

Dr Fiona Hawke/Alexandra

Speirs/IMS

The SiSAT be presented to the Scottish Association of Medical Directors who will be asked to endorse the SiSAT for it to be accepted by Health Improvement Scotland in order for it to become a validated quality improvement tool.

SiSAT aims to provide a comprehensive document that evidences services quality for NHS Scotland Imaging Boards

G

2018-07

DNA and Urgency Codes

SCIN will continue to work with the RIS users group and monitor how national DNA and Urgency code processes are being standardised in NHS Scotland


Dr Fiona Hawke/Mrs Alexandra Speirs

SCIN is communicating regularly with the RIS users group to ascertain the progress of how the national DNA and Urgency code processes are being standardised in NHS Scotland

DNA and Urgency

Codes are standardised in NHS Scotland

G

2018-08

Demand Optimisation

SCIN will provide clinical expertise as requested by the SRTP in order to enable the Clinical Decision Support Software and Cross Boundary Reporting streams to continue within the designated timeframe.

2:3:4:5:6 April 2018-March 2019

Dr Fiona Hawke SCIN will provide the clinical expertise to the SRTP to enable the SRTP to deliver its programme of activity within its designated time frame

SCIN will report the progress of this work to the National Demand Optimisation Group

The Scottish Radiology Transformation Programme will develop Clinical Decision Support Software and Cross Boundary Reporting

G


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2018-08

Develop an Atlas of Interventional Radiology

SCIN will establish if there is a need to develop an Atlas of Interventional Radiology procedures and if it aligns with the National Atlas of Variation that is being compiled by the Scottish Government.


Mrs Alexandra Speirs

SCIN will establish if the National Trauma Network is compiling an Atlas Interventional Radiology

SCIN will develop an Atlas of Interventional Radiology that can contribute the strategic work that is occurring in the Scottish Government or the Regional Trauma Network

G

2018-10

Scottish Imaging Pathway for Primary Care for Patients with Unidentified Suspected Malignancy

SCIN will work with the Ministerial Cancer Performance Delivery Group to enable Boards to spread the uptake of the Imaging Pathways

3:4:5:6 April 2018-March 2018

SCIN Core Team Data that has been collated by SCIN will be presented to the

Ministerial Cancer Performance Delivery Group

There is equity of access for all patients with suspected malignancy to imaging. G


27

2018-11

Developing a sustainable workforce

SCIN is engaging with the National Education Scotland, College of Radiologists, Society and College of Radiographers, HEIs Scottish Radiology Transformation Programme (SRTP) and the Scottish Government to develop a sustainable Imaging workforce.

3:4:5:6 April 2018-March 2019

Dr Fiona Hawke SCIN will present the work that it is undertaking to the DSG and the SRTP

This work informs the Scottish Government of vacancies, likely impact of retrials and succession planning. Constraints to education such as funding, training time and backfill are also on the agenda for continued discussion

G

2018-12

Advanced Practice in Radiography in Scotland

There is a need to identify service requirement for Advanced Practice roles and to ensure that these roles meet the other pillars of Advanced Practice other than the clinical skill.

SCIN will provide clinical expertise with regards to how these roles should be developed in NHS Scotland.

3:4:5:6 April 2018-March 2019

Dr Fiona Hawke/Society of Radiographers/

Scottish Radiology Transformation Programme

SCIN and the Society of Radiographers will scope what the current practice is for band 5 radiographers How Radiography skills base are built in CT/MR and how the boards succession plan for ultrasound?

SCIN and the Society of Radiographers will be able to advise the Scottish Government of what needs to be implemented to ensure that

Radiographers are sufficiently trained to meet the future demands of health care needs.

G


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RAG status Description

RED (R) The network is unlikely to achieve the objective/standard within the agreed timescale

AMBER (A) There is a risk that the network will not achieve the objective/standard within the agreed timescale, however progress has been made

GREEN (G) The network is on track to achieve the objective/standard within the agreed timescale

BLUE (B) The network has been successful in achieving the network objective/standard to plan

The Institute of Medicine’s six dimensions of quality are central to NHS Scotland’s approach to systems-based healthcare quality improvement, therefore objectives should be linked to these dimensions:

Person-centred: providing care that is responsive to individual personal preferences, needs and values and assuring that patient values

guide all clinical decisions;

Safe: avoiding injuries to patients from healthcare that is intended to help them;

2018-13

Communication and

Engagement

SCIN will promote its refreshed network brand on all of its communication to the Imaging community and its stakeholder

1:3:4:5 April 2018-March 2019

Mrs Alexandra Speirs /SCIN PSO

SCIN will issue quarterly bulletins.

The Imaging Community and its stakeholders are informed of the work that SCIN has undertaken

G


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Effective: providing services based on scientific knowledge;

Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy;

Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location or

socio-economic status; and

Timely: reducing waits and sometimes harmful delays for both those who receive care and those who give care.


30

Appendix 1: Network Governance The SCIN has a Clinical Steering group which consists of Clinical Directors and Managers from across Scotland (15 members). SCIN is accountable to Scottish Government through National Services Division. The Diagnostic Steering Group provides influence and members are key stakeholders for the SCIN.

Network Lead Clinician - Dr Hamish McRitchie

Network Scientific Manager – Dr Fiona Hawke

Programme Manager –Mrs Alexandra Speirs


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Appendix 2: Steering Group Representation

NHS Board Name Job Title

NHS Ayrshire and Arran Mr John Parker Service Manager

NHS Ayrshire and Arran Dr Stephen Cooper Consultant Radiologist

NHS Borders Dr Fiona Hawke SCIN Imaging Manager / Radiographer

NHS Borders Hamish McRitchie SCIN Lead Clinician/ NRIP SME/Consultant Radiologist

NHS Dumfries and Galloway Dr Petr Hrobar Consultant Radiologist/Clinical Director

NHS Dumfries and Galloway Ms Valerie Grierson Service Manager

NHS Fife Jeanette Burdock

NHS Forth Valley) Ms Judy Stein

Service Manager Laboratories, Radiology and The Scottish Centre for Simulation and Human Factors

NHS Forth Valley Dr Paul Kelly Consultant Radiologist (Chair SCIN QI group)

NHS Forth Valley Dr Raj Burgal Consultant Radiologist (SCIN QI Chair)

NHS Grampian Grace Ball Service Manager

NHS Orkney Mr Mike Beach

Radiology Service Manager for NHS Orkney (radiologist input and support from NHS Grampian)

NHS Greater Glasgow and Clyde

Ms Joan Main Service Manager

NHS Greater Glasgow and Clyde

Dr Ross McDuff Consultant Radiologist

NHS Highland Claire MacGillivray

NHS Highland Karen McNicoll Divisional General Manager

NHS Lanarkshire Dr Barbara Macpherson Consultant Radiologist/Clinical Director

NHS Lanarkshire Elaine Connelly Deputy Diagnostic Service Manager

NHS Lothian Mr Clinton Heseltine

NHS Lothian Dr. Fiona Minns Consultant Radiologist, RIE

NHS Lothian/National Imaging Equipment Group

Mr Michael Conroy

NHS Tayside Dr Clare Monaghan Medical Physicist


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NHS Tayside Dr Glen Gardner PET-CT Physicist

NHS Education for Scotland Ms Elaine Figgins Programme Director

National Network Management Service Information Management Service NHS National Services Scotland

Mrs Claire Lawrie Programme Manager

National Network Management Service NHS National Services Scotland

Mrs Liz Blackman Senior Programme Manager

Scottish Radiology Transformation Programme Imaging Portfolio

TBC

NHS National Waiting Times Board

Patricia McKay Service Manager

Scottish Government Tracey McInness Associate Director of NMAHP

Society and College of Radiographers

Ms Maria Murray Professional Officer

Royal College of Radiologists Dr Grant Baxter Chair of the Standing Scottish Committee

Radiology Trainees Dr John Fitzpatrick

Queen Margaret University Mr William Woods Student

Patient Representative Mrs Caroline Green Patient Representative

Patient Representative Mr Colin McGrath Patient Representative


33

Appendix 3: Finance

Figure7: SCIN Finance

The SCIN was allocated a £5,000 budget. Figure 7 illustrates how SCIN spent its financial allocation during the reporting period.


34

Appendix 4: Radiographer-Focused Event Dr Anne Marie Sinclair welcomed delegates and highlighted the Network’s key achievements from her tenure as lead clinician, which included:

Developing protocols for Seven Day Working,

GP Access to Imaging

Procurement of Outsourcing of Imaging,

the development of an Imaging Data Dashboard,

Interventional Radiology recommendations for Scotland

Exploring the benefits of Clinical Decision Software for Imaging and Radiographer

Reporting.

Dr Sinclair introduced delegates to Dr Hamish McRitchie (NHS Borders) who had been appointed as the SCIN as the Lead Clinician.

Dr Raj Burgul, Consultant Radiologist, NHS Forth Valley, presented the work that SCIN had progressed in the area of ‘Clinical Decision Support Software’ (CDSS) for NHS Scotland. Dr Burgul informed the delegates that CDSS would improve accurate imaging requesting that will minimise unnecessary requests, while at that same time provide education regarding imaging referring clinicians.

Dr Dave Caesar, National Clinical Advisor to the Chief Medical Officer, Scottish Government, presented on the work that was being undertaken in Realistic Medicine. The vision for introducing Realistic Medicine is involving the patient in its decision about their care and treatment, which is made possible by clinician’s informing them of what investigation options and treatment is available to them to enable them to make an informed choice about their health and wellbeing.

Dr Caesar welcomed the work that SCIN had undertaken to date in Clinical Decision Software that would improve accurate imaging requesting will minimise unnecessary requests at that same time as providing education regarding imaging referring clinicians as a way of reducing harm and waste and tackling unwarranted variation in imaging to provide a well-functioning and sustainable NHS.

Dr Caesar ended his presentation by inviting delegates to consider how this Realistic Medicine can be progressed in Imaging

Mr Edward Adie, Principle Information Development Manger and Ms Margaret McLeod, Service Manager (NHS Scotland, National Services Scotland Public Health and Intelligence Team (PHI)) demonstrated the imaging dashboard that had been initiated through the SCIN Quality Improvement Group and further progressed through the NHS Scotland Shared Services National Radiology Information and Intelligence Project (NRIIP). Mr Addie demonstrated how the dashboard would work in Boards; the dashboard would provide service based data supporting local performance review of imaging services. This would also” provide, provide benchmarking evidence that would facilitate national, regional and local planning of imaging services.

Dr Brian Montgomery, Director of NHS Scotland’s Shared Services Health Portfolio presented on ‘Cross- Boundary Reporting citing that Scotland’s current radiology model is unsustainable, imaging departments were being challenged to use technology, capability and capacity to their best effect. Dr Montgomery advised that the Boards in NHS Scotland used differing data sets and


35

definitions; there were 5 different RIS systems, a national PACS system and a varied approach to enhanced roles.

Following reviewing the current service provision of imaging in NHS Scotland Dr Montgomery informed the delegates that it was essential that an affordable and sustainable Imaging provision in Scotland was reached that was reactive to development, enhanced recruitment and retention and was able to address Board-level constraints. Cross-Boundary Reporting had been identified as an approach that could be implemented to provide a solution to the issues that were imaging in Scotland was experiencing.

Cross-Boundary Reporting “A suitably skilled and qualified practitioner in any location in Scotland is able to view radiological films and accompanying clinical information on a patient in any (other) location in Scotland and provide a report which contributes to the safe, effective and efficient clinical management of that patient”.

Dr Montgomery informed the delegates that NHS Shared Services Radiology Portfolio Board were working towards securing a national ‘Once for Scotland’ approach to imaging in line with the National Clinical Strategy , Health and Social care Delivery Plan, Realising Realistic Medicine, NHS Scotland Healthcare Quality Strategy.

Mr Clinton Heseltine, Chief Radiographer/ Radiology Service Manager, presented on Cross-Boundary reporting from a Radiographer perspective that was occurring as part of the South East Regional Radiology In sourcing Solution (SERRIS) project. SERRIS had been designed to deliver a Radiology network Solution for South-East Scotland which transcends fixed Health Board boundaries. The nationwide Picture Archiving and Communication System (PACS) enabled Imaging Reporters in Board A to view images acquired in Board B, across the country. For ‘Reporting Radiographers’ the work would be managed by the SERRIS manager with local line management approval. It was anticipated that Radiographers would be able to report 15 episodes per hour and they would be paid for the hours worked according to AfC terms and conditions.

Dr Jonathan McConnell, Consultant Radiographer, NHS Greater Glasgow & Clyde presented the work that had been progressed through NHS Scotland Shared Services Radiology Programme and SCIN to outline a National Framework for Reporting Radiographers.

Ms Morag Stout, Consultant Sonographer, NHS Greater Glasgow & Clyde, presented on the 21st Century Challenges for Sonography. Ms Stout advised that the role of Sonographers to provide a safe and high quality ultrasound service became the norm in the last 15 years; this role had previously been undertaken as part of the Consultant Radiologist role. A 21st century Sonographer was expected to perform and report most ultrasound examinations. Current challenges were highlighted as; waiting time targets increasing, increased number of speciality scans, RSI, training, recruitment and retention of staff as well as finical constraints. An effective robust governance structure was required to support the Sonography role as well as ongoing training that included promoting the Sonography speciality, and encompassed leadership, mentorship and support for the profession.

Dr Judith Anderson, Consultant Radiologist, NHS Lothian, presented on the role of a 21st century Radiologist, noting the skills and competencies required were; to have a good foundation in medical practise to be able to detect abnormalities in the image they were reporting, practise safely and effectively and to ensure that a treatment and /or management plan could be provided to the referring clinician for the patient, in addition to having good communication skills, be able to work in an Multi-Disciplinary Team (MDT).

http://www.gov.scot/Resource/0049/00494144.pdf



http://www.gov.scot/Resource/Doc/311667/0098354.pdf


36

Dr Anderson informed delegated that a 21st Radiologist must be able to provide answers to clinical questions for example in the early detection of cancer, incidental/unsuspected findings, as well as providing clinical expertise that informs the patient diagnosis and subsequent treatment. Dr Anderson noted that junior doctors were exposed less to the clinical environment and would more often request an imaging test to supplement their clinical judgment. Senior doctors have moved into sub specialties which has diluted the experienced generalist. This has resulted in the Radiologist having to fill the gap with opinions and recommendations focussed on patient management. Dr Anderson concluded her presentation by asking delegates to not dismiss or devalue the role of the Radiologist as their skills and expertise cannot be easily matched or replaced within the clinical environment.

Ms Sarah Zycinski (Radiographer Student; Glasgow Caledonian University) presented on the role of the 21st century Radiographer. Ms Zycinski described the history of Radiography and how the Radiography role had developed due to the increasing demand of imaging that had promoted government policy to enhance the skills of Radiographers. Ms Zycinski noted how policies supported the role extension of the assistant and advanced practitioners within the NHS and concluded her presentation by advising that the 21st century Radiographer would be a practitioner who would exhibit ‘teamwork,’ ‘leadership,’ and ‘patient focused’ qualities to enable them to meet the changing needs of the NHS.

Ms Elaine Figgins, Associate Director for Allied Health Professionals, NES, presented on behalf of Ms Tracy MacInnes from Scottish Government on the vision for 21st century Radiographers, Allied Health Professionals (AHP’s) will work in partnership with the people of Scotland to enable them to live healthy, active and independent lives by supporting personal outcomes for health and wellbeing.

The vision was defined as:

Huge opportunity to evolve the workforce

Optimising care pathways - MSK

Need to build up our evidence across modalities of impact

Working in partnership – MDT’s

Allow radiographers the freedom to further develop

Consultant radiographer non clinical role

4 tier structure part of practice – educational component

Evolve distributed model of leadership across MDT’s

Dr Fiona Hawke National Imaging Manger, NHS Borders, presented the NHS Flying Start learning programme for newly qualified Radiographers/ allied health professionals.

Dr Hawke advised that this NES programme is a preceptorship initiative which supports newly qualified staffs learning and development in the first year post graduation. However as this is a generic AHP programme it is quite difficult to fit radiography in to the suggested activities on the programme website. In NHS Borders, Flying Start is planned as a Project based programme with the outcome of a services based improvement product and a publication in a peer reviewed professional journal. The units of Flying Start, such as communication, research in practice, team working etc are all met from within the projects. The new graduate has the benefit of improving practice at an early stage in their career and also has the respect of having their work published


37

early in their career- certainly a benefit for the CV as well as building confidence during their first year of practice in NHS Scotland, poster examples of these projects were available in the hall on the day

Ms Maria Murray presented on Advance Practice Accreditation for Radiographers. The college of Radiographers defined an Advance Practitioner as “an individual who has significantly developed their role and who consequently has additional clinical expertise in a defined area of practice, accompanied by deep underpinning, evidence based knowledge related to that expertise.” “They make appropriate clinical decisions related to their enhanced level of practice, directly impacting on the patient care pathway.”

Ms Murray noted that by 2021 there was an expectation that all advanced practitioners must hold or be working towards a full Master’s degree, whilst Consultant Radiographers must hold or be working towards a Doctorate by 2021.Ms Murray advised the delegates to contact her if they had any further questions regarding accreditation.

Ms Elaine Figgins, Associate Director for Allied Health Professionals (AHPs), NES, presented the resources that were available to AHP’s from NES. This included the AHP Careers Fellowship that focused on the Active Living Improvement Living Improvement Programme (AILIP). Applications were being sought from AHP’s that were maximising the contribution that AHP’s will make to the health and well-being of the population of Scotland, building on the AHP National Delivery plan 2012-2015.


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Appendix 5: PET-CT KPI’s (April 2017-November 2017) KPI 1 - Waiting times for examinations

Scottish Government introduced waiting time standards of six weeks for four diagnostic Radiological Examinations. Patients who are referred to Imaging with a suspicion of cancer, treatment should commence within 62 days. (Imaging should be delivered within 2 weeks of referral where possible)

The national average waiting time for a PET-CT examination for the period Apr 2017 – Nov 2017 was 15 days.

Presenter

0 2 4 6 8 10 12 14 16 18 20

Average per Centre (Apr 17 - Nov 17)

Tayside 13

Lothian 18

Grampian 16

Glasgow 14

KPI 1: Waiting Times for Examination

0 5 10 15 20 25

Apr-17

May-17

Jun-17

Jul-17

Aug-17

Sep-17

Oct-17

Nov-17

No. of Days

Data

Co

lle

cti

on

Pe

rio

d

KPI 1: Monthly Average Waiting Times for Examination

Tayside

Lothian

Grampian

Glasgow


39

32%

29%

32%

7%

Grampian - Oesophageal & Upper GI PET-CT Study

Upstaged

Downstaged

No Change

Excluded

KPI 2 Number of examinations performed

P

I KPI 5: Change in treatment plan

Two independent studies for upper GI cancers were undertaken by Dr Jack Straiton (Grampian) and Dr Dilip Patel (Lothian) respectively, to ascertain whether PET-CT imaging was effective in changing the treatment plan for patients. The findings from the studies are detailed hereafter.

Summary: - 61% of patients had their staging changed, either upstage or downstage. This is vitally important as radical treatment for oesophageal cancer is a difficult undertaking in terms of morbidity. PET/CT is shown to be ideally placed to help guide clinicians and patients in decision making regarding radical and hopefully curative therapies. It is also useful for problem solving for follow up patients post therapy where CT imaging is equivocal.

Source - Study carried out by Dr Jack Straiton, Grampian Health Board, based on 31 patients undergoing a PET/CT examination for upper GI carcinoma, January to March 2017.

52%

15%

23%

10%

KPI 2: Average % of Scans per Centre (Apr 17 - Nov 17)

Glasgow

Grampian

Lothian

Tayside


40

22%

14% 64%

Lothian - Oesophageal & Upper GI PET-CT Study

Upstaged (palliative care option only)

Redically Treatable (palliative care - other reasons)

Treatable (radical radiotherapy/surgery)

Summary: - PET/CT altered staging in 22 patients who were upstaged (22%) and these patients were treated palliatively rather than radically. PET-CT is a very useful tool in identifying patients with undetected disease not seen on CT, allowing appropriate therapy to be instituted and avoiding futile surgery.

Source - Study carried out by Dr Dilip Patel, Lothian Health Board, based on 100 patients with oesophageal cancer who were referred for PET/CT and were considered suitable for consideration for either radical radiotherapy or surgery based on endoscopy, CT staging and physical fitness.


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Appendix 6: Direct Access to Imaging Survey

There were 6 respondents in total, out of the 14 NHS Boards 4 Boards responded with varying feedback. The 4 responding Boards are detailed in figure A.

Respondents were requested to detail if their Board/ Hospital permitted direct GP access for CT prior to the SCIN recommendation. NHS Borders, Forth Valley and a site in Lothian advised that they did accept GP imaging referrals prior to the SCIN report. Two other sites in NHS Lothian and a site in NHS Grampian cited that they did not previously accept direct access GP referrals for CT.

Figure A: NHS Board Respondents to the SCIN Survey

Out of the sites that advised they previously did not accept direct access GP referrals for CT NHS, Grampian was the only Board that has permitted direct access GP referrals following the SCIN report. Both sites in NHS Lothian advised that they could not currently accommodate this change due to capacity issues.

Of the four sites that accept direct access GP referrals for CT it was cited that there was no adverse effects on the Board CT waiting times.

Sites in NHS Borders, Grampian and Lothian advised that they had audit data that they would be able to share with SCIN

The Boards who participated in the post implementation audit provided additional comment with regards to the recommendations:

NHS Forth Valley: “Forth Valley already had the suggested system in place. However the SCIN project has ensured fair and equitable access across NHS Scotland.”

NHS Lothian: “We have recognised pathways for specific cancers-I suspect this GP access will address a need for a pathway for patients with weight loss.”

NHS Lothian “is supportive of the concept, but concerned about the impact on capacity if inundated with referrals. Data from Grampian suggests there won't be a deluge of requests.

NHS Lothian: “We are hopefully about to secure funding for a 3 month pilot.”

NHS Lothian: “Direct access is for CT Head scans only, not body scanning”

NHS Grampian: “Volume remains low. GP find it a very useful resource prior to onward referral.”

The report for Direct Access GP referrals for CT in imaging in Scotland outlines the importance direct access for GPs to CT scanning of chest/abdomen/pelvis for this group of patients which


42

could enable a cancer diagnosis to be made directly from primary care and aid more appropriate onward secondary care referral.

The aim of the questionnaire that SCIN shared around the Boards was to understand the current ‘as is’ state of practice if direct access GP referrals for CT throughout Scotland, in addition to having a baseline for which the degree of the recommendations outlined in the SCIN “Direct Access to CT of Chest/Abdomen/Pelvis for Patients with Unidentified Suspected Malignancy” report have been undertaken.

The Boards that responded provided useful feedback on the recommendations that SCIN made. However due to the limitations of the number of NHS Boards that engaged and provided responses to the survey, SCIN was unable to draw accurate conclusions from the data as evidence of change cannot be measured with a response rate of 28.6%.

The recommendations in the Report are being taken forward by the Ministerial Cancer

Performance Delivery Group to establish if any health boards have implemented the pathway

since the 2017 audit


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Appendix 7: Seven Day Access to Imaging Services The aim of the SCIN audit questionnaire that was issued to the Boards was to understand the current ‘as is’ state of imaging throughout Scotland, in order to establish the degree to which the recommendations outlined in the SCIN seven day working report have been undertaken.

There were 12 respondents in total, out of the 14 NHS Boards 7 Boards responded with varying feedback

The audit questionnaire was broken down in to three question areas:

Emergency Radiology

Paediatric Radiology

Interventional Radiology Figure B: NHS Board Respondents to the SCIN Survey

Recommendations for a Quality Emergency Radiology Service (Adult)

It is recommended that that the following studies should be available when they will materially alter patient management before the next normal working period. All acute receiving hospitals should have agreed patient transfer arrangements in place to access these procedures if they are not available on site.

Of 12 respondents 11 advised that their hospital admitted emergency adult patients.

Of the 11 sites that admitted emergency adult patients their capabilities were as such:

Are adult Imaging services available 24/7 including: Yes No

CT Head including CTA/CTV 7 4

CT Neck /cervical spine 11

CT Neck /cervical spine 9 2

CT Thorax/Abdomen/Pelvis 9 2

CT Pulmonary Angiogram 9 2

CT Angiogram for haemorrhage/ischaemia 10 1

Poly trauma CT 9 2

CT KUB 9 2

MRI for Spinal Cord Compression 1 10

Renal ultrasound for obstruction/ sepsis 8 3

General abdominal/pelvic ultrasound 9 2

Respondents were then asked; in addition to the above studies were the following studies available during day time at weekends.

Studies available day time at weekends Yes No

General abdominal/pelvic ultrasound 9 2

DVT ultrasound 9 2

Recommendations for a Quality Emergency Radiology Service (Paediatric)


44

It is recommended that all acute secondary receiving hospitals which receive paediatric patients should have imaging facilities to scan patients and agreed image and/or patient transfer arrangements in place to access these procedures in a tertiary centre if they are not available on site.

Local scanning on the receiving site is recommended. If there is no local expertise to report the images, these images should be transferred to the agreed tertiary centre for reporting. Protocols should be put in place to enable the safe scanning of paediatric patients on the secondary site and the onward timely reporting of the images.

Out of the 12 respondents 6 received paediatric patients and 6 did not. Of the 6 who did receive paediatric patients 2 centres were a specialised tertiary paediatric hospital

Of the 4 sites that were not specialised tertiary paediatric hospitals their capabilities were as such:

Are the following paediatric imaging services available 24/7 in your centre? Yes No

CT head +/- contrast 4

CT Neck /cervical spine 3 1

Abdominal ultrasound 2 2

Where both NHS Lothian and NHS Orkney advised “No” above that they did not have paediatric imaging services available 24/7 at their centre.

The following arrangements are made:

NHS Lothian- Most Paediatric Imaging would be performed in RHSC Edinburgh

NHS Orkney- Patients are flown to ARI Aberdeen

Of the remaining 2 sites who advised that they were a specialised tertiary paediatric hospital their capabilities were as such:

Are the following paediatric imaging services available 24/7 in your centre?

Yes No

Pneumatic reduction of intussusception 2

Upper GI contrast for malrotation 2

Remote viewing and reporting capacity of imaging from other centres 2

Respondents were then asked; in addition to the above services were the following paediatric services available during day time at weekends.

Services available day time at weekends Yes No

Chest and abdominal drainage 1 1

Nephrostomy 1 1

Upper and lower GI contrast studies 2

MRI brain and spine 2

Cranial ultrasound 1 1


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Recommendations for a Quality Emergency Radiology Service (Adult Interventional)

All acute receiving hospitals should have agreed patient transfer arrangements in place to access these procedures if they are not available on site.

Out of the 12 respondents, 4 sites advised that they had a 24/7 staffed interventional service.

Of the 4 sites identified as having 24/7 staffed interventional service, the following capabilities are in place.

NHS Board Haemorrhage control

Nephrostomy for sepsis

Please detail agreed transfer arrangements if applicable.

NHS Lanarkshire

Yes - onsite imaging


Current service until 10. PM and at weekends sixth cons approved: planned reintroduction of full service in 2017

NHS Highland



Image acquisition out of hours is by on call radiographers, reporting is done by one of interventional radiologists working unofficial on call rota. If Interventional Radiology not available then patients would be transferred to nearest available centre (usually ARI)

NHS Grampian



NHS Lothian Yes - onsite imaging


Of the sites that identified as having 24/7 interventional capability it was then detailed additionally if the following procedures were available during day time at weekends?

Abscess drainage for sepsis – all 4 sites had capability to carry out this procedure.

Colonic Stenting for untreatable bowel obstruction 2 sites had capability to carry out this

procedure

NHS Lothian advised that Colonic Stenting was available at the Western General

Hospital within the Board

NHS Highland advised that Colonic Stenting will be done if one of the interventional

radiologists is available or is scheduled to be on call.


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Of the 8 sites that identified as not having a 24/7 staffed interventional service the following capabilities are in place:

NHS Board Transfer arrangements for Haemorrhage control out of hours?

Transfer arrangements for Nephrostomy for sepsis out of hours?


NHS Tayside

Yes Yes Transfer to Ninewells

NHS Lanarkshire

No No

NHS Lanarkshire

No No

NHS Borders

Yes Yes Patients will be transferred to the care of the relevant specialty in NHS Lothian following clinical referral.

NHS Orkney

Yes Yes Patients are transferred to ARI after consultation with the ARI team

NHS Lothian

Yes Yes Agreed transfer policy would be too RIE for Haemorrhage Control and WGH for Nephrostomy.

NHS Lothian

Yes No Haemorrhage control would be done at RIE, the WGH provides a 7 day service for Nephrostomies, but it is not fully funded and many cases out of hours are supported by Theatre team rather than radiology team.

NHS Lothian

Yes No Nephrostomies would be done 24/7; if it was a child the type of haemorrhage would depend on whether the child was managed within theatres at RHSC, RIE or DCN.


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Of the sites that identified as not having 24/7 interventional capability it was then detailed additionally if the following procedures were available during day time at weekends?

NHS Board Colonic Stenting for untreatable bowel obstruction

Abscess drainage for sepsis


NHS Tayside

No No Patient who require colonic stenting will be transferred to Ninewells - we have no nurse support Abscess drainage occasionally possible in PRI but difficult due to very limited radiographic staffing and no assistants

NHS Lanarkshire

Yes Yes

NHS Lanarkshire

No Yes

NHS Borders

Yes Yes

NHS Orkney

No No Patients will be transferred after discussion with appropriate ARI team

NHS Lothian

No Yes Colonic stenting would be done at Western General Hospital, Edinburgh

NHS Lothian

Yes Yes

NHS Lothian

No Yes “We don't currently do Bowel stenting on Paeds Most Paediatric Imaging would be performed in RHSC Edinburgh”


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Appendix 8: SCIN Horizon Scanning Poster

scottish clinical imaging network (scin ) 2017-2018 annual

Documents