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The PM Challenge

10th April 2006

10042006_physicalexam1.jpgWith waits hitting three years in some areas, physiological measurement (PM) capacity is stretched to breaking point, and may be the biggest challenge in meeting the 18-week waiting target. Alison Moore in the HSJ looks at strategies to ease the pressure.

Physiological measurement covers everything from vascular to sleep monitoring, respiratory services, urodynamics, hearing tests and heart monitoring, in total about 100 separate tests. Many trusts will have extensive teams involved in them, but others are less common and more complex and may be dependent on just one member of staff. There is a huge gap between the capacity required and the capacity on the ground.

In order to hit the 18 weeks, many managers believe waits of no more than three weeks in diagnostics will be needed, including PM; but some SHA areas are understood to have waits of three years for services.

Department of Health chief scientific officer and national clinical lead for PM, Professor Sue Hill, is chairing a leadership group set up to look at the area. It is developing a programme to identify bottlenecks that could impact on the 18-week target, and also looking at a service framework.

From the New Year, trusts will need to file details of waits in seven areas to the Department of Health.

For many areas, a mapping exercise is the first step to solving the problems, and meeting the interim target of no waits for diagnostics longer than 13 weeks by March 2007.

The services which have done most to reform themselves seem to be those which link into national priorities or service frameworks, such as coronary heart disease. Demands for some tests - such as those used in heart failure - is increasing.

Moving some work out of NHS secondary care into the community is one option - and has already happened with some services.

'It's imperative that pathways involving the use of PM diagnostics are developed in conjunction with the primary and secondary sectors and all the relevant members of the delivery team,' warns Professor Hill.

Buying excess capacity from the independent sector can offer another solution. Some PM work, such as ECGs, is included in the second wave of diagnostics procurement. But some of the rarer tests are hard to source in the independent sector.

Developing extended roles and skill mix is also seen as one way forward although there are limits to what it can achieve.

Often the picture is muddled by lack of planning, says the HSJ. There may be people in training but no funding for the jobs they would occupy once they complete this.

High-level sign-up to changes is necessary, but in the SHA areas with good information and plans for change this has been achieved. The challenge for all SHAs will be ensuring the lessons of those pockets of good practice identified are then spread across all PM tests.

Sue Hill, the Department of Health chief scientific officer and national clinical lead for physiological measurement says there are a number of steps trusts should take to ease their way towards the 18-week target reports the HSJ:

- Identify PM services, who delivers them and the scale of the challenge.

- Understand patient flows, pathways and referrals. Look at equipment use, hours of operation and processes to improve productivity.

- Establish data collection and waiting-list management.

- Map current workforce and consider skill mix and other options.

- Assess likely impact of new technology and explore new delivery models.

- Set up a PM group to share experiences and solutions, and adopt a common approach.

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