Healthcare Science National Delivery Plan for Healthcare Science Professionals in Scotland 2014-2017

3. DELIVERING INTEGRATED SERVICES IN THE COMMUNITY: REDUCING COSTS AND IMPROVING OUTCOMES

Shifting the balance of care from acute to primary care locations is critical to enabling NHSScotland to increase quality, reduce costs and meet the increasing demands of an ageing population. Many HCS services rely on large centralised facilities utilising complex and expensive technology. However, a substantial amount of HCS activity takes place in the community, with scope to develop this further.

Point-of-care testing (POCT) is increasingly being used in primary care as an alternative to referring samples to centralised laboratories. While this may offer advantages in immediacy of results for patients, it is generally considerably less cost-effective than laboratory-based testing. Where POCT in vitro diagnostic (IVD) testing is provided, it is essential that it is appropriately quality-controlled. The International Standard (ISO 22870:2006) and MHRA guidance for POCT (Management and Use of IVD Point of Care Test Devices^[2]) both specify HCS staff involvement in the selection and quality-assurance of POCT devices and training. Such activities should be carried out by staff whose training and competence has been recorded: records of staff competency with such devices and procedures are generally poor when compared to laboratory-based counterparts.

A range of physiological measurements is carried out in primary care settings, with increasing use of, for example, 12-lead electrocardiograms. Again, there is concern that lack of appropriate training and competency records for staff performing such tests in the community is leading to inappropriate referrals to secondary care, with ensuing costs and increased anxiety for patients. These tests also involve the use of specialist equipment, requiring specialist input in procurement, maintenance and repair.

HCSs have the skills and expertise to improve the delivery of services in the community. They need to be able to share their expertise with colleagues in primary and community care settings, assure the quality of investigations and safe use of equipment, and reduce inappropriate referrals to secondary care.

In physical sciences and engineering, many equipment-management services are run from medical physics departments. A growing body of evidence suggests that considerable quality improvements and resource savings could be made with better clinical guidelines for equipment use. The increasing use of sophisticated medical devices by a range of professionals, and the consequent risk of inappropriate use, needs to be recognised as a potential threat to patient safety. HCSs can offer support to other professions and training to help avoid problems.

Awareness of the importance of self-management for long-term conditions is growing. Innovations such as the 'My Diabetes My Way'^[3] interactive website encourage patients not just to monitor their own condition, but also access laboratory results and clinic letters about their condition and treatment and contribute to their own health records. There is considerable scope for HCSs in offering interpretation and advice to patients using such services.

Our question is - how can HCSs' involvement in delivering integrated services in the community be improved, thereby reducing costs and improving outcomes?

Our proposals are set out below. Are these the right actions? What else could we do?

3.1 Proposals

• POCT committees in each health board should take responsibility not only for IVD POCT devices, but also for physiological measurement devices in primary care settings.
• The POCT committee should work with the HCS lead to establish and maintain a register of all POCT devices in primary care.
• The HCS lead should work with partners to develop training and competency frameworks for community-based diagnostics.
• HCSs should be appropriately involved (through POCT committees) in equipment selection and maintenance.
• HCS leads should work with the Scottish Government clinical priorities team, multi-morbidities team and patient groups (such as the Scottish Diabetes Group) to determine the extent to which HCS advice would be beneficial to the self-management of long-term conditions.
• HCS leads should work with patient safety colleagues to scope the nature of medical equipment management challenges and potential risks and develop an optimisation strategy to increase patient safety and reduce resource wastage.