X-rays on your high street – a first line of care for the NHS?

Imagine for a moment that patients had the ability to book a test or a scan on any high street of their choosing. All they would need to do is to complete an online questionnaire, that may well access their electronic health record. This would determine the need for the test, or not, and the patient could be then go online to book an appointment at a time and location of their choosing.

It might sound radical. But it’s the sort of thinking that represents a fundamental change needed in how we control access to diagnostics if we are to make transformational changes in outcomes, for example diagnosing cancer at much earlier stages.

For too long have our clinicians been given the unenviable task of being a gatekeeper, rather than having information that enables them to be more confident about choosing the right pathway for their patient. For too long have some of the most disadvantaged people in our society found it to be difficult, if not impossible, to access the right care, sometimes simply because they have not been able to afford the bus fare to hospital.

The key is to utilise technology advances and AI to reduce the unit cost of tests and reporting of results. For example, scanning machines are becoming smaller, less complicated to operate, lower cost and are being coupled to AI algorithms that support decision making in ways we hadn’t imagined even a few years ago.

We are at an inflexion point in the NHS. Are we up for turning high volume pathways on their heads, truly putting the patient first? Are we willing to question how what was thought of as critical estate – outpatients – will be used? Are we ready to control costs by getting it right first time rather than forcing people to queue and be seen at a rate that budget allows?

This will be hugely disruptive to the way many of our staff work. But I truly believe that the 2020s could be the decade in which we radically transform the patient experience, diagnose at much early stages of disease progression, treat at lower cost as a result and deliver much better outcomes for the patient.  This decade should see unit costs, for example costs per scan, of diagnostics radically fall so that we can put them at the frontline of care for patients. We can create the decade of the diagnostic.

Decade of the diagnostic: Changing control

With a mass community testing programme underway to address the ongoing pandemic, there has been a change in public mindset about the role citizens can play in diagnostics, with millions of people taking part.

The conditions are right to push the boundaries away from a parental approach to health services, to trusting the public much more.

I’m a ‘trekkie’ and have long been fascinated by the tricorder, a medical scanning device used on the science fiction series Star Trek. Putting the futuristic technology aspect to one side, some of the principles behind that imaginary mobile scanning tool could inform our model in the present day – getting diagnostics out to people.

There are already apps for carrying out a huge range of activities on your smartphone – including the ability to carry out electrocardiograms, for example. And imaging modalities traditionally found in the hospital are too starting to gain mobility. If we can build on this, then ease of access and the unit cost of diagnostics could move to such a level that we can use community approaches as a first line of care in the NHS.