Community Diagnostic Hubs
Supporting local NHS organisations to plan for the establishment of Community Diagnostic Hubs
In May 2021 UCLPartners conducted a call for national and international examples of community-based diagnostic services to help inform a new model of diagnostic service provision – a recommendation from Prof Mike Richard’s Diagnostics – Recovery and Renewal report.
This call was part of the work NHS England London are undertaking with support from UCLPartners, to inform local NHS organisations in their planning of the establishment of Community Diagnostic Hubs.
We are compiling a summary report based on the evidence and examples from the call, which will be published shortly.
Professor Sir Mike Richards was commissioned by NHS England in 2019 to undertake a review of NHS diagnostics capacity. The independent report, Diagnostics: Recovery and Renewal, recommends transformation of diagnostic services to reduce waiting times and diagnostic backlogs and improve patient access and outcomes.
The establishment of Community Diagnostic Hubs is a key recommendation, with CDHs intended “to provide Covid-19 minimal, highly productive elective diagnostic centres for cancer, cardiac, respiratory and other conditions”.
Community Diagnostic Hubs
It is anticipated that three hubs per million population should be established in the first instance, with mobile services to be considered in some localities.
Based on increasing demand and patient convenience, it is highly likely that as a minimum all CDHs will provide the following tests:
- Imaging: CT, MRI, Ultrasound, Plain X-Ray
- Physiological measurement: Echocardiography (ECHO), Electrocardiogram (ECG), including 24 hour and longer tape recordings of heart rhythm monitoring, ambulatory blood pressure monitoring, oximetry spirometry including reversibility testing for inhaled bronchodilators, Fractional exhaled nitric oxide (FeNO), full lung function tests, blood gas analysis via Point of Care Testing (POCT) and simple field tests (e.g. six min walk test)
- Pathology: phlebotomy, Point of Care Testing, simple biopsies, NT-Pro BNP, urine testing and D-dimer testing
- For larger CDHs only – Endoscopy services including gastroscopy, colonoscopy and flexi sigmoidoscopy
In addition, CDHs may consider:
- Other diagnostics services, for example: mammography, ophthalmology, DEXA scan, antenatal screening, hysteroscopy and colposcopy, cystoscopy, urodynamics, audiology, fibroscan.
- Care at home services could be considered including some diagnostic tests (eg: mobile X-ray) and support for home monitoring (eg: blood pressure and oxygen saturation).
Selection of sites for CDHs should improve equity of access and support inclusion by considering physical, cultural and social needs of different/ diverse population health groups, supporting the NHS Long Term Plan commitment to narrowing health inequalities.
To inform the development of these plans for CDH sites, we are seeking to learn from evidence and exemplar sites nationally and internationally, with a particular focus on the following clinical pathways:
- Cardiorespiratory/ cardiovascular health: including breathlessness, post COVID symptoms, heart failure
- Cancer pathways including unexplained weight loss and screening
- Musculoskeletal conditions
- Urology including diagnosis or exclusion of kidney, bladder or prostate cancer
- Gynaecology including transvaginal screening, menstrual disorders, postmenopausal bleeding, abdominal bloating pelvic mass
- Maternity including antenatal screening
- ENT including otology, ENT imaging, upper airway endoscopy
Health check and Screening Services including abdominal aortic aneurysm (AAA), diabetic eye, cancer screening.