As good as new

Community hospitals are finding a new lease of life as DTCs. Carol Lewis reports on an intriguing turn of events

New life is being breathed into community hospitals as increasing numbers expand and convert themselves into diagnostic and treatment centres.Though DTCs were originally conceived as units based on acute sites, a new generation of centres are showing that primary care or community-based units are a successful and popular alternative.

Community Hospitals Association chair Dr Phil Moore says this is in line with the government's proposals in Keeping the NHS local - a new direction of travel.Dr Moore adds that these DTCs are an excellent example of community hospitals adapting to the changing healthcare scene where there are more remote specialist centres, better technology and more GPs and nurses with specialist skills.

Currently there are four primary care DTCs in the Department of Health's national programme, in Hampshire, east London, Derbyshire and Manchester.Between them, the DoH estimates they will carry out an additional 11,000 consultations, procedures and operations a year for the NHS.

The first primary care DTC opened last year at Chase Hospital in Bordon, by North Hampshire PCT.But as project director Lisa Briggs explains, this DTC is not confined to the hospital - it also holds clinics in local GP surgeries.'The beauty of primary care treatment centres is that It is not necessarily about one building; you can have a virtual DTC spread over several GP practices as well as the community hospital.'

Services provided at the Hampshire DTC include: scoping services, pre-operative assessment, vascular assessment, rapid access x-rays and pathology services, medical assessment and pain management.

Much of the work is carried out by GPs and nurses with special interests.Two scoping clinics are currently held in GP surgeries and it is hoped chronic pain management clinics will also soon move into general practice.Meanwhile, the vascular assessment service is run by a specialist nurse practitioner using telemedicine back-up to the local acute centre eight miles away.

These services are popular with local patients and with consultants.

'Patients have told us that they prefer to come to a primary care setting where It is less intimidating.They also like the services being provided closer to home, added to which they are not sat waiting in such long queues, 'explains Ms Briggs.

Though the formation of services around GPs with special interests creates an additional layer between primary and secondary care for PCTs to manage, it brings its own rewards in staff recruitment - doctors relish the chance to develop their career pathways.

Erewash PCT in Derbyshire has taken a slightly different approach.

Instead of employing GPs with special interests, it is running a consultant-led operation at Ilkeston Community Hospital.

Clinical services manager Lynne Walshaw explains that the new services added to the hospital in its conversion to a DTC included new operating theatres and recovery facilities; endoscopy suites; echocardiography; breast augmentation; urology; and ophthalmology services.Day-case surgery and clinics are carried out by consultants from the local acute centre.

Ms Walshaw says the transition from community hospital to community DTC has been fairly easy, with consultants enjoying working there and patients happy that they do not have to travel to the acute centre.

Though the DoH says it is not looking to recruit any more community DTCs into the national programme, PCTs are already lining up to expand community hospitals and build new treatment centres.

Two PCTs In Hertfordshire - Hertsmere and South East Hertfordshire - have been inspired by Ilkeston to produce ambitious plans for a 'triangle of care'with community DTCs based around three local community hospitals.Each offers a core range of services, including x-rays, echocardiography, minor surgery, out-of-hours primary care, chiropody, physiotherapy, phlebotomy and a few local specialties provided by both GPs with special interests and consultant-led outreach clinics.

The advantages of having several sites are that staff can be shared and clinical networks developed across 'the triangle', explains Stephen Wells, director of health improvement and modernisation at Hertsmere PCT.

At Potters Bar Community Hospital, there are already 21 intermediate care beds and a community intermediate care team which is integrated with social services, GP direct access to x-ray and ultrasound and a phlebotomy service.Future plans include a second operating theatre for a one-stop day-case cataract service and an endoscopy suite.

At Cheshunt Community Hospital there will be a community paramedic and minor injuries service, an NHS Direct 'hub', echocardiography and audiology, and at the new Hertford County Hospital, orthopaedic triage, ultrasound and a wide range of diagnostic services.

Mr Wells and colleagues are particularly enthusiastic about the proposed cataract service, to be run in conjunction with Moorfields Eye Hospital in London.He says it could cut the number of visits made by local patients from eight to three - assessment, surgery and follow-up.

Mr Wells says: 'This is all about enhancing community hospitals and bringing care away from acute centres to where people live.One of the key messages from patients is that they want local access to services and they do not want to have to travel long distances. It is also about redesigning referral pathways and eliminating some of the steps, so patients have fewer visits and shorter waiting lists.'

Totally different yet equally ambitious are plans by Bristol South and West PCT to build a community DTC alongside an independent sector treatment centre and new local authority leisure facilities.

Project director Ben Bennett explains that it is a major push to move services away from the city centre.'There are exciting opportunities for urban regeneration here.This will be a new centre and we want to deinstitutionalise it.We are talking with the local authorities about building leisure and sports facilities alongside, which could be used for rehabilitation, 'he says.

The community DTC would provide intermediate care centred on a minor injuries unit, day surgery, endoscopy and rehabilitation facilities.There would also be specialist outpatient clinics run by consultants, GPs with special interests and nurses.

The community DTC would also have a walk-in centre on site - something Mr Bennett says the government has expressed an interest in and is set to recommend to centres elsewhere.

'Community DTCs bring the range of services closer to the people who use them. It brings specialist, primary and secondary services together in one place - bridging the gap between general practice and acute hospitals. It also takes the pressure off the acute hospitals and leaves them to get on with what they are best at.And you can design the service exactly how it will best suit your site and your patients, 'he says.

Further information

Stephen Wells is a speaker at the HSJ conference 'Practical solutions to reducing outpatient waiting times - a primary care focus to an acute problem', on 23 October.

www. hsj. co. uk/waitingtimes

NHS Estates information www. diagnosticandtreatmentcentres. com

Department of Health policy and guidance www. doh. gov. uk/diagnosisandtreatmentcentres

Key points

Diagnostic and treatment centres are providing a boost to community hospitals through improved technology and specialist skills.

The first primary care DTC was opened by North Hampshire PCT last year.

Plans in Bristol include a community DTC alongside an independent sector treatment centre and local authority leisure facilities.