This webinar recording will provide you with a practical example of delivering echocardiography services from East Sussex Healthcare, a model for delivering ultrasound service from Salisbury NHS Foundation Trust and a national update on the strategy for delivering sustainable echocardiography services from Giancarlo Laura, Programme Manager, 7 Day Hospital Services, NHS England

1. www.england.nhs.uk
Seven Day Hospital
Services Webinar
June 2018
Overcoming the
challenges of delivering
7DS for Echocardiogram
and Ultrasound services
Hosted by:
Sustainable Improvement
NHS England South

2. www.england.nhs.uk
Establishing a Virtual Community for All to
Connect, Share and Learn
• Series of Regional webinars
• Share practical examples – discuss barriers and
generate improvement solutions
• NHS E Specialist Support Team - Sustainable
Improvement
• Work in collaboration with NHS Improvement and the
UEC Programme Board, South Region
7 Day Hospitals – Virtual Community
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3. www.england.nhs.uk
Objectives
This webinar will provide you with:
• A model for delivering ultrasound service at Salisbury NHS
Foundation Trust
• A national update on the strategy for delivering sustainable
echocardiography services
• Practical examples of delivering echocardiography services at
East Sussex Healthcare NHS Trust and Ashford and St.
Peter’s NHS FT and
• An opportunity to ask questions
7 Day Hospitals – Objectives
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4. www.england.nhs.uk
Our Guest Speakers today are
NHS 7 DS access to urgent US at Salisbury General Hospital Claire Gorzanski
Head of Clinical Effectiveness
claire.gorzanski@salisbury.nhs.uk
Echocardiography and 7 day Hospital Services -Giancarlo Laura - Programme
Manager NHS England 7 Day Service
Giancarlo.laura@nhs.net
7 Day ECHO services at East Sussex Hospital -James Wilkinson Assistant
Medical Director
James.wilkinson3@nhs.net
7 Day Ultrasound at Ashford St Peters Hospital David Fluck Medical Director
david.fluck@nhs.net‘
7 Day Hospitals – Guest Speakers
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5. An outstanding experience for every patient
NHS 7 Day Services
Access to urgent
ultrasound
Claire Gorzanski, Head of Clinical Effectiveness
6 June 2018

6. Salisbury District Hospital
pital
• Local DGH –
450 beds
• Regional –
burns &
plastics
• Specialist –
spinal injuries
unit
6

7. Our improvement journey
2013
• Standards – operationally led – no traction
• Relaunched as quality standards – clinical engagement
• Pinned to our vision: “an outstanding experience for every patient”
2014
• Self assessment against the standards
• Workshop – agreed priorities
2016
• Re-assessment against the standards
• Workshop – agreed priorities
• Business as usual – linked the standards to new appointments and service changes

8. Workshop – Dec 2014
• Weekend access to general MRI
• Weekend access to ultrasound
• A solution to the GI bleed rota

9. Workshop – Feb 2016
• Weekend access to MRI – 3 hr radiologist
presence on Saturday & Sunday. Now 9 – 5.30
• Formal GI bleed rota established in Nov 15
with network support – UHS
• 7 day ultrasound access – workforce issue.
Now 8.30 – 12.30 at weekends.

10. Ultrasound service – 2016
• 38,000 scans in 13/14, 43,532 in 15/16,
predicted 49,365 by 16/17.
(ED - 25%, OP - 31%, IP - 8%)
• 10.75 wte sonographers
• Monday – Friday 9 – 5 service
• Emergency cover – on call radiologist
• 6 week targets sustained by regular overtime

11. Ultrasound service - 2018
• Sept 16 - 3 month pilot weekend working
(funded - cost pressures)
• Business case – 2.1 wte sonographer & 1.6
wte assistant funded (£144K) + governance
• Core working day 8.30 – 4.30
• Extended working day 8 – 6 – 7 sonographers
work over 6 weeks, 7th week 8.30 – 4.30, day
off in week to cover the weekend
• Weekend – 8.30 – 12.30 – inpatients (95%
same day), ED emergencies & one OP list – 3
sonographers & 1 assistant
• 99% reported at the time.

12. Ultrasound - learning
• Excellent team leader and team culture
• Engagement & involvement
• Upskilled sonographers
• New appointees - full range of skills
• Governance time funded

13. Impact/benefits
• Extended working day capacity (15%)
without need for extra physical space or
equipment.
• Weekend working capacity by 2236 scans a
year.
• 95% emergency inpts same day scan  delays
& facilitates discharge.
• 6 week target sustained
• Sonographer training & CPD
• Reduced demand for consultant radiologists

14. Challenges - plain sailing

15. June 2018
Echocardiography and
Seven Day Hospital
Services
Giancarlo Laura
Programme Manager, 7 Day Hospital
Services, NHS England

16. Echocardiography is a key element of 7DS
Clinical Standard 5
Seven Day Services Standard 5 (Diagnostics)
• “Hospital inpatients must have scheduled seven-day access to diagnostic
services such as x-ray, ultrasound, computerised tomography (CT), magnetic
resonance imaging (MRI), echocardiography, endoscopy, bronchoscopy and
pathology.”
• Consultant-directed diagnostic tests and completed
reporting will be available seven days a week:
― Within 1 hour for critical patients
― Within 12 hours for urgent patients
― Within 24 hours for non-urgent patients

17. As part of the 7DS Survey, trusts are asked
to provide information on the availability of
diagnostics.
Type of
hospital trust
Number
of trusts
Informal or adhoc
arrangements or no
weekend provision
No weekend provision at all
Primary PCI
centre (pPCI)*
60 45% (27) 7% (4)
Cardiac
surgical
Centres (CSC)*
32 50% (16) 9% (3)
Trusts which
are neither
pPCI or CSC
87 43% (37) 17% (15)
The results from the March/April 2017 survey showed a clear gap in the
formal provision of echocardiography, particularly at weekends.
These results reflect the gaps in provision identified in other surveys e.g.
British Society of Echocardiographers 2016 survey by Picker Institute.

18. In response to this challenge, a 7 day
Echocardiography Sub-Group was
established
• 10 objectives covering workforce options, training,
data modelling and IT solutions.
• Produce a set of recommendations for improving
echocardiography provision for emergency and
urgent admissions by 2020
• Implementation plan which sets out what will be
achieved, by when and identifies the lead
organisation(s) for the action.
• A set of good practice examples – available to
professional bodies and trusts

19. The Group’s ten objectives were developed to
provide short, medium and long term solutions
Objective
INFLUENCECURRENT
POSTSANDSKILLS
1 Add cardiac physiologists to the national shortage occupation list and
increase overseas recruitment
2 Systematically utilise recruitment and retention premia (RRPs) for substantive
cardiac physiology posts
3 All cardiology consultant posts should include out of hours responsibilities
4 Trusts to retain existing cardiac physiologists about to retire
DEVELOP
OPPORTUNIT
IESFORNEW
WAYSOF
WORKING
5 Review existing provision and demand within trusts and remodel existing
provision within trusts
6 Develop out-of-hours cardiovascular provision at network or regional level
INCREASE
ECHOCARDIOGRAPHER
WORKFORCE
CAPACITY
7 Develop an overarching training plan to increase echocardiographer numbers
8 Extend skilled workforce able deliver level one emergency echo
9 Increase the numbers of clinical scientists/cardiac physiologists to deliver
level two echo
10 Develop apprenticeships for cardiac physiologists able to carry out level two
echo

20. The Sub-Group has developed a set of
proposals, which will be presented to the
7DS Delivery Group
• To support short term workforce capacity, the Group has distributed
guidance on recruitment and retention premia and overseas recruitment
through the BSE and SCST.
• Workforce modelling is being undertaken to gauge the nature of the
workforce needed to deliver echocardiography with new service models
and technology.
• An overarching training plan is being developed to help tackle the
workforce shortfall and support urgent and emergency echo provision.
• Level 1 echo accreditation is being supported to build urgent echo
workforce capacity in professions other than cardiac physiology.
• NHS Digital are prioritising digital solutions for echocardiography to
support greater network provision.

21. 7 Day Services
Echocardiography
James Wilkinson Assistant Medical
Director

22. 7 Day Services - Echocardiography
Current Service
• Two acute sites: Eastbourne DGH and Conquest Hospital
• PAMI service – hot site alternates weekly
• Consultant on call for cardiology 24/7 at one site but only on
alternate weeks at the other (when on for PAMI)
• SpR on call (pacing rota) at one site
• Cardiac technicians work only in office hours
• Scope for Fast scans in A&E AMU (ED doctors working
towards BSE accreditation)

23. 7 Day Services - Echocardiography
Access to Urgent Echo
In office hours Cardiac Registrar
Cardiac Technicians
Cardiologist on call
Out of hours Cardiac Registrar
Cardiologist on call
U/S trained ED consultants can identify effusions but not
always available on site.

24. 7 Day Services - Echocardiography
Challenges
• 24/7 cardiac registrar cover only at one site.
• Cardiology trainees not all echo-accredited by BSE
• Cardiac technicians
- recruitment difficulties
- service dependent on locums
- additional on call would create a risk to recruitment and
retention of highly skilled, scarce staff.
• A&E/AMU staff with echo experience not always present.
Individuals working towards BSE accreditation.

25. 7-DAY ULTRASOUND
DR DAVID FLUCK
MEDICAL DIRECTOR AND CONSULTANT
CARDIOLOGIST

26. General Ultrasound – 7 days
 Monday to Friday 0800 – 1930 routine access
for inpatients (Sonographers and Radiologists)
 Saturday and Sunday 0900 – 1700 routine
access for inpatients (Sonographers)
 U/S request out of hours
 if clinically appropriate wait until 0800
 if urgent diagnosis required and another modality can
give diagnosis then this may be performed
 if urgent and another modality not suitable, on-call
interventional radiologist performs scan

27. 7 day Echocardiography
 Monday – Friday (0800 – 1700) staffed by cardiac
physiologist
 Saturday and Sunday (0900 – 1400) staffed by cardiac
physiologist
 Out of Hours Echo service provided by Consultant
Cardiologist (occasionally SpR)
 Challenges:
 Recruitment of Echocardiographers is challenging, even with
15% retention and recruitment incentive now offered. This is
compounded by Home Office restrictions around recruiting from
abroad
 There is an increase in complex IP echo requests and
inadequate staff/BSE compliant rooms to accommodate

28. www.england.nhs.uk
7 Day Hospitals – Advice and support
For advice and support, contact the Sustainable
Improvement Team
Sue Cottle, Programme Lead sue.cottle@nhs.net
Wendy Keating, Senior Improvement Manager wendy.keating@nhs.net
Lou James, Improvement Facilitator lou.james1@nhs.net
Thelma Daly, Improvement Manager thelma.daly@nhs.net
Suzanne Cullen, Improvement Manager suzanne.cullen@nhs.net
For general information vivrichards@nhs.net
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29. www.england.nhs.uk
•
For more information: Contact: vivrichards@nhs.net
For other 7 day service resources:
https://improvement.nhs.uk/resources/seven-day-services/#resources
https://www.england.nhs.uk/seven-day-hospital-services/
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