Directory of Diagnostic Services for Commissioning Organisations

1. NHS
CANCER
NHS Improvement
Diagnostics
DIAGNOSTICS
HEART
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NHS Improvement - Diagnostics
Directory of Diagnostic Services
STROKE
for Commissioning Organisations

2. DIRECTORY OF DIAGNOSTIC SERVICES FOR COMMISSIONING ORGANISATIONS
Commissioning safe, effective and efficient diagnostic investigation services is vital to delivering the best of patient care.
DH estimates suggest that around 1 billion diagnostic investigations are carried out in the NHS each year. Diagnostic services are a key component of every clinical
pathway underpinning 80% of all clinical decisions and contributing across the end to end pathway of care.
Technological innovation is changing the way in which diagnostic investigations can be carried out. Accelerating the introduction of these scientific developments
will bring great benefits to patients: the miniaturisation and portability of equipment so tests can be taken to patients; smart technology that improves the
accuracy of diagnostic investigations and their reporting; integrated IT systems delivering images and results rapidly to where they are needed for clinical decision
making will make a difference to our patient’s experience of their healthcare.
To ensure your patients benefit, as commissioners you will want to be confident you are commissioning the best diagnostic services.
This guide brings together in one place information about all of the diagnostic modalities to inform your decisions about commissioning diagnostic services. The
resources have been developed by National Clinical Directors (NCDs) for endoscopy, imaging, pathology and physiological diagnostics in conjunction with NHS
Improvement and the innovative services that they have worked with.
This directory is supported by a companion guide “Top Tips to overcome the challenge of commissioning diagnostic services” which has been produced by NHS
Improvement.
We hope you find it useful.
Dr Ian Barnes, National Clinical Director for Pathology, DH
Prof Erika Denton, National Clinical Director for Imaging, DH
Prof Sue Hill, Chief Scientific Officer and National Clinical Director for Physiological Diagnostics, DH
Dr Roland Valori, National Clinical Director for Endoscopy, DH
Key:
Policy
Service improvement
Case studies
2

3.
CROSS DIAGNOSTICS
Title/author/date of Description Link
publication
The Operating Framework 2012/13 is the second year of the quality and productivity challenge http://www.dh.gov.uk/prod_consum_dh/groups/dh_
for the NHS in England ‐ and the final year of transition to the new commissioning and digitalassets/documents/digitalasset/dh_131428.pdf
2012/13 management system for the NHS. NHS leaders will have to respond to
Department of Health four inter‐related challenges: the need to maintain a continued strong
November 2011 performance on finance and service quality; the need to address the
difficult changes to service provision required to meet the QIPP
challenge in the medium term; the need to complete the transition to
the new delivery system set out in Liberating the NHS; and the urgent
need to ensure that elderly and vulnerable patients receive dignified
and passionate care in every part of the NHS.
First steps towards quality If you are involved at any level in improving health or social care, this http://www.improvement.nhs.uk/diagnostics/Diagnos
improvement: A simple resource will provide the information you need for your first steps ticsHome/Publications.aspx
guide to improving services towards making quality improvements, giving your improvement
NHS Improvement project the best possible chance of success.
December 2011
Bringing Lean to Life Healthcare teams are dedicated and skilled professionals who are http://www.improvement.nhs.uk/LinkClick.aspx?fileti
NHS Improvement under pressure to do their best – but often with inadequate processes. cket=44OglPqPr4k%3d&tabid=56
May 2010 "Bringing Lean to Life" provides a basic introduction and overview of
Lean; the culture, principles and tools to understand, tackle and resolve
issues within healthcare. It is not intended as a complete guide to
implementing Lean as a management system.
Equality for all: Delivering This guide, endorsed by Sir Bruce Keogh, provides case studies and http://www.improvement.nhs.uk/documents/SevenD
safe care – seven days a examples of service delivery models that are being used across the NHS ayWorking.pdf
week to deliver clinical services outside the standard working hours and
NHS Improvement across the weekend period. The forward by a patient provides a very
January 2012 powerful and compelling story to support care 7 days a week.
3

4. The best of clinical pathway Practical examples of delivering benefits to patients, endorsed by NICE http://www.improvement.nhs.uk/documents/bestofcl
redesign and Sir David Nicholson, with examples on the NHS Evidence website. inicalpathwayredesign.pdf
NHS Improvement Whether you are based in a local hospital, GP practice, SHA or clinical
July 2011 network, or in social care there are initiatives that could help you
deliver your own quality and productivity challenges.
4

5.
ENDOSCOPY
Title/author/date of Description Link
publication
Joint Advisory Group on GI The Joint Advisory Group (JAG) Download Centre has a number of www.thejag.org.uk/AboutUs/DownloadCentre.aspx
Endoscopy resources on endoscopy, including information about the Global Rating
Scale (GRS), the JAG Accreditation scheme, national policies and
reports, and information for endoscopy units.
AQP Offers: Community The NHS Supply2Health website provides support for endoscopy units https://www.supply2health.nhs.uk/5QN/Lists/AQPOff
Endoscopy Services applying to provide Any Qualified Provider (AQP) services. ers/DispForm.aspx?ID=5
Rapid review of endoscopy Demand for endoscopy is increasing and it is vital that all units http://www.dh.gov.uk/prod_consum_dh/groups/dh_
services make best use of existing capacity and manage capacity to meet digitalassets/@dh/@en/documents/digitalasset/dh_1
NHS Improvement demand. This document shares some of the learning from 33058.pdf
March 2012 innovative services which can be adopted elsewhere to support
local improvement initiatives.
7 day working: extended Case study: Royal Liverpool and Broadgreen University Hospitals NHS Seven Day Working Case Studies
endoscopy service Trust
NHS Improvement
February 2012
5

6.
GENETICS
Title/author/date of Description Link
publication
Building on our inheritance A report by the Human Gemonics Strategy Group on Genomic http://www.improvement.nhs.uk/diagnostics/Patholo
Department of Health technology in healthcare. gyKeyResources/Other.aspx
January 2012
6

7.
PATHOLOGY
Title/author/date of Description Link
publication
The Pathology Services A toolkit for commissioners of community pathology services (for http://www.dh.gov.uk/en/Publicationsandstatistics/P
Commissioning Toolkit example direct access) who: ublications/PublicationsPolicyAndGuidance/DH_1343
Department of Health • have undertaken a strategic review of their existing community 85
May 2012 pathology services
• wish to improve service quality, effectiveness, affordability and
value for money.
The toolkit is divided into 3 parts:
1. Provides an overview of the provision of pathology services.
2. Describes each of the 11 steps to commissioning.
3. Includes tools referred to in the 11 steps for example templates.
Atlas of Variation The NHS Atlas of Variation presents a series of maps of variation in http://www.improvement.nhs.uk/diagnostics/Patholo
November 2011 service delivery selected by DH National Clinical Directors and others as gyKeyResources/Other.aspx
being of importance to their clinical specialty. The aim is to put
variations in activity, expenditure, quality, outcome, value, and equity
firmly on the health service agenda for the next decade; and to
stimulate the NHS to both search for unwarranted variation and also to
tackle the causes and drivers of that variation.
Examples from diagnostics services are included.
Quality, Innovation and Pathology is a frequently overlooked area in the NHS but has the http://www.improvement.nhs.uk/diagnostics/Patholo
Pathology potential to unlock up to £500m per year in efficiency savings. Ingrid gyKeyResources/Other.aspx
Health Service Journal Torjesen listens in as some of the most influential makers, managers
16 September 2010 and medical leaders discuss how this can be achieved.
Report of the Second Phase The report of the second phase of the Independent Review of NHS http://www.dh.gov.uk/en/Publicationsandstatistics/P
of the Review of NHS Pathology Services in England, chaired by Lord Carter of Coles. The ublications/PublicationsPolicyAndGuidance/DH_0919
Pathology Services report focuses on three main themes: 85
Department of Health • improving quality and patient safety
December 2008 • improving efficiency
• identifying the mechanisms for delivering change.
The review estimates that significant savings could be made by the NHS
through consolidating pathology services, and makes specific
7

8. recommendations for change. The case for consolidation is based on
activity and cost data collected from a representative sample of NHS
pathology pilot sites in England.
Response to the Report of Response to the recommendations of the Independent Pathology http://www.dh.gov.uk/en/Publicationsandstatistics/P
the Second Phase of the Review chaired by Lord Carter of Coles. ublications/PublicationsPolicyAndGuidance/DH_0919
Independent Review of NHS DH continues to develop its pathology programme, taking forward the 86
Pathology Services in agenda set out in the Independent Review’s report on quality, patient
England safety and efficiency, in the context of the framework set by High
Department of Health Quality Care For All. A key focus of the programme is stakeholder
December 2008 engagement, (including patients) to develop a truly patient‐focused
pathology service that supports personalised, high quality care.
The service will be clinically led and empower patients by giving them
access to information to make choices and manage their care
effectively.
Workforce planning in Commissioned by the DH Chief Scientific Officer's Office, this free tool http://www.dh.gov.uk/en/Publicationsandstatistics/P
pathology toolkit supports workforce planning in pathology. It aims is to: ublications/PublicationsPolicyAndGuidance/DH_0899
Department of Health • log what the scientific workforce currently does in individual 05
October 2008 pathology services
• help managers model changes to the workforce profile when, for
example, demand for tests varies; work is redesigned; competence
requirements are reassessed; or improvements are made in
productivity.
Report of the Review of In September 2005, an Independent Review of Pathology Services http://www.dh.gov.uk/en/Publicationsandstatistics/P
NHS Pathology Services In chaired by Lord Carter of Coles, was set up to advise Ministers, in the ublications/PublicationsPolicyAndGuidance/DH_4137
England context of current resource constraints, on the timeliness, reliability, 606
Department of Health capacity and efficiency of current pathology services in England,
August 2006 benchmarked against international standards and the feasibility of and
benefits arising from wide‐scale service reconfiguration, innovation and
modernisation and involvement of the independent sector. In this
Report, the Review Panel sets out its findings and conclusions, and
makes recommendations for the development and improvement of
pathology services.
The Review concludes that one of the greatest obstacles has been the
lack of good quality useable data about costs, activity and performance
8

9. within NHS pathology services. From the evidence received it is
convinced that there is scope to achieve significant benefits from
further reform of pathology.
Service improvement in This step by step guide demonstrates at each of the five stages of the http://www.improvement.nhs.uk/documents/Blood_
Blood Sciences: How to blood sciences pathway how quality, delivery and efficiency can Sciences.pdf
improve quality, delivery improve services for patients and users of the service. It demonstrates
and efficiency for the need for user engagement and the fundamental need for clinical
laboratory providers and and managerial leadership. It highlights where blood sciences aligns to
their customers four of the five Domains to support the NHS Operating Framework. The
NHS Improvement guide contains case studies and key learning.
January 2013
Service improvement in This improvement guide provides a step by step approach to improving http://www.improvement.nhs.uk/documents/
Microbiology: Why, What microbiology services using Lean Methodology, illustrated with 36 Microbiology_Guide.pdf
and How individual case studies. It describes how improvements can be made in
quality, safety, and productivity, with innovative ways of working.
NHS Improvement Recommendations are made in 3 key areas as a result of work with
clinical teams.
July 2012
Leading the way in blood Article from ‘The Biomedical Scientist’ by Dave Hamer, National Clinical http://www.improvement.nhs.uk/diagnostics/Patholo
sciences Lead for Blood Sciences Service Improvement and Manager of Bolton gyKeyResources/Other.aspx
The Biomedical Scientist NHS Trust Pathology Services. The article describes how the application
October 2011 of Lean methodology has transformed the delivery of blood sciences
services in Bolton.
What a difference a day This guide demonstrates that small improvements at each step of the http://www.improvement.nhs.uk/diagnostics/LinkClic
makes end to end pathway, such as supporting users to deliver effective MDTs, k.aspx?fileticket=yaJNBxk6u%2fA%3d&tabid=113
NHS Improvement redesigning outpatient clinics, and improving the patient experience
January 2011 and outcomes can improve service delivery in pathology.
Learning how to achieve a This step by step improvement guide demonstrates how to reduce the http://www.improvement.nhs.uk/LinkClick.aspx?fileti
seven day turnaround in interval between specimens being taken and results being made cket=2X8saN8rBA8%3d&tabid=56
histopathology available. The impact for patients means a reduction in the period of
NHS Improvement uncertainty and help to ensure that treatment can be started as soon as
November 2010 clinically appropriate. Reducing turnaround times can lead to a redesign
of the whole GI pathway, including redesign of out‐patients clinics and
lengths of stay.
9

10. First steps in improving Lord Carter’s review of pathology services highlighted the importance http://www.improvement.nhs.uk/LinkClick.as
phlebotomy: The challenge of improving access to phlebotomy. This improvement guide sets out px?fileticket=NeYr5Xcz8xA%3d&tabid=56
to improve quality, the small measurable changes achievable through applying Lean
productivity and patient Methodology that can both improve service quality and delivery, and
experience improve the patient experience.
NHS Improvement
May 2011
ACP News In this issue of the ‘ACP News’, Lesley Wright and Ian Barnes describe http://www.improvement.nhs.uk/diagnostics/Patholo
Autumn 2010 the benefits of using lean methodology to transform pathology services, gyKeyResources/Other.aspx
with examples from MRSA testing and cervical cytology.
Learning from Pathology This publication demonstrates that achievements can be made rapidly, http://www.improvement.nhs.uk/diagnostics/LinkClic
service improvement sites for little or no cost. In his review of pathology services, Lord Carter k.aspx?fileticket=Q04ozDjBYfM%3d&tabid=73
NHS Improvement endorsed the approach implemented by the NHS pathology service
August 2006 improvement team.
Improving histopathology QIPP website: Histopathology case studies http://www.improvement.nhs.uk/qipp/MenuLevel1/D
management: 7‐day iagnosis/Pathology/Histopathology.aspx
turnaround time
May 2012
The role of visual Case study: University Hospital of North Staffordshire NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClic
management in the k.aspx?fileticket=gyyhDFOLiF0%3d&tabid=74
pathology lean
improvement process
NHS Improvement
January 2012
7 day working: 24 hour, Case study: Royal Free Hampstead NHS Trust http://www.improvement.nhs.uk/diagnostics/Patholo
seven day microbiology gyImprovement/Sevendayservices.aspx
services
NHS Improvement
September 2011
Sustaining continuous Case study: Calderdale and Huddersfield NHS Foundation Trust http://www.improvement.nhs.uk/diagnostics/LinkClic
improvement in k.aspx?fileticket=Hf0WgOBYcbY%3d&tabid=74
histopathology ‐ two years
on
10

11. NHS Improvement
January 2010
Re‐designing specimen Case study: University Hospital of North Staffordshire NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClic
transport to smooth k.aspx?fileticket=Kw23vDsZSNE%3d&tabid=74
workflow and improve
productivity
NHS Improvement
January 2010
Kanban systems for Case study: Northampton General Hospital NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClic
material management k.aspx?fileticket=2apXDTMRLKw%3d&tabid=74
October 2008
Workload Level Loading in Case study: Northampton General Hospital NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClic
Specimen Delivery k.aspx?fileticket=MZnaEwCgTb4%3d&tabid=74
October 2008
Improving the immunology Case study: Northampton General Hospital NHS Trust http://www.improvement.nhs.uk/diagnostics/LinkClic
process changes k.aspx?fileticket=2Dvn3rWZ3Yw%3d&tabid=74
October 2008
CYTOLOGY
NHS Cervical Screening Data from 2011 shows a significant improvement in the service the NHS http://www.improvement.nhs.uk/diagnostics/Cytolog
Programme Annual Review Cervical Screening Programme provides to women. The turnaround yKeyResources/Other.aspx
2011 times, and the time from screening to the availability of results, has
NHS Cancer Screening been significantly reduced with 98.6 per cent of cases being reported by
Programmes laboratories within 14 days, compared with 43 per cent five years ago.
Shorter turnaround times mean less anxiety for women, quicker
treatment and a more efficient system.
NHS Cancer Reform This report provides an opportunity to identify major priorities for http://www.improvement.nhs.uk/diagnostics/Cytolog
Strategy Second Annual 2010. yKeyResources/Other.aspx
Report
NHS Cancer Screening
Programmes
December 2009
NHS Cervical Screening The NHS Cervical Screening Programme has set up a pilot scheme with http://www.improvement.nhs.uk/diagnostics/Cytolog
Programme Annual Review NHS Improvement to work towards meeting the two‐week turnaround yKeyResources/Other.aspx
11

12. 2008 time for cytology samples which was promised in the Cancer Reform
NHS Cancer Screening Strategy. A shorter turnaround time will mean less anxiety for the
Programmes patient, quicker treatment and a more efficient system overall.
ScHARR Report ‐ Cervical This report to the NHS Cancer Screening Programme gives an http://www.improvement.nhs.uk/diagnostics/Cytolog
Screening Report assessment of a seven‐day turnaround for the reporting of cervical yKeyResources/Other.aspx
NHS Cancer Screening smear results which focuses upon laboratory practice.
Programmes
February 2006
12

13. Cytology Self‐Assessment This web‐based cytology self‐ assessment tool is an online support for http://www.improvement.nhs.uk/Cytology/assessme
tool all users in the cytology pathway to assess themselves against the key nttool/
NHS Improvement improvements that Phase 1 sites have applied to achieve the 14 day
target. It is designed to be used in conjunction with the Cytology
Improvement Guide launched in November 2009.
Continuous improvement in This improvement guide demonstrates how the cytology pilot sites have http://www.improvement.nhs.uk/LinkClick.aspx?fileti
cytology ‐ sustaining and continued to embed and sustain their improvements throughout the cket=i%2b7gaxF9q%2bs%3d&tabid=56
accelerating improvement cytology pathway. It includes practical examples for reducing
NHS Improvement turnaround times, improving quality, safety and productivity.
September 2010
Cytology Improvement This step by step improvement guide highlights the findings and http://www.improvement.nhs.uk/cytology_guide.pdf
Guide ‐ Achieving a 14 day improvements from the pilot sites who tested how the 14 day
turnaround time in standards can be achieved using Lean Methodology. This practical guide
Cytology is supported by tried and tested case studies across the whole patient
NHS Improvement pathway which all staff involved in the screening pathway can adopt
November 2009 and adapt to meet their local setting.
13

14.
IMAGING
Title/author/date of Description Link
publication
Implementing 7 Day A report from the National Imaging Clinical Advisory Group which http://www.dh.gov.uk/prod_consum_dh/groups/dh_
working in Imaging highlights good practice on implementing 7 day working in imaging digitalassets/documents/digitalasset/dh_132083.pdf
Departments: Good Practice departments. It identifies the issues, gives evidence and provides case
Guidance studies resolving these to ensure a patient focussed and consultant
Department of Health delivered service.
January 2012
Exit from the National PACS This contains a wide range of supporting materials to aid Trusts in the http://www.connectingforhealth.nhs.uk/systemsands
Programme local procurement of replacement PACS and RIS systems along with ervices/pacs/beyond
NHS CFH PACS Programme data migration and implementation of these new systems.
Team, 2012
Guidelines for imaging These guidelines for imaging, outlined from Professor Erika Denton, are http://www.improvement.nhs.uk/diagnostics/Radiolo
during a major incident ‐ based on the most recent Clinical Guidelines for Operations (CGOs) gyKeyResources/DHpublications.aspx
Introduction letter published in 2010: RCR guidelines for trauma radiology in severely
Department of Health and injured patients and recent military clinical experience.
Defence Medical Services
June 2011
Imaging guidelines for major This document has been developed jointly by the Defence Medical http://www.improvement.nhs.uk/diagnostics/Radiolo
incidents Services and Department of Health and provides a concise common gyKeyResources/DHpublications.aspx
Department of Health and approach to imaging in the event of a major incident. This forms part of
Defence Medical Services ongoing work to develop emergency preparedness for the NHS and is
June 2011 based on shared learning gained from managing major trauma cases as
part of military operations.
Post mortem imaging These Standard Operating Procedures (SOPs) have been produced to http://www.improvement.nhs.uk/diagnostics/Radiolo
guidelines for mass detail the procedures to be followed in the CT investigation of fatalities gyKeyResources/DHpublications.aspx
casualties in a mass casualty.
Department of Health and
Defence Medical Services
June 2011
14

15. Managing high value This report examines the management of three types of high value http://www.improvement.nhs.uk/diagnostics/Radiolo
equipment in the NHS in equipment in the NHS in England. It covers Magnetic Resonance gyKeyResources/DHpublications.aspx
England Imaging (MRI) and Computed Tomography (CT) scanners, used for
National Audit Office diagnosis, and Linear Accelerator (Linac) machines for cancer
April 2011 treatment. It provides key recommendations; demonstrates
international benchmarking; highlights variation in utilisation; and
explores workforce issues.
Interventional radiology: A report from the National Clinical Imaging Advisory Board provides a http://www.improvement.nhs.uk/diagnostics/Radiolo
Guidance for service summary of the evidence base to show how Interventional Radiology gyKeyResources/Other.aspx#IR
delivery (IR) services can contribute to improved outcomes, safety and
National Clinical Imaging experience. It proposes a framework of options for IR service
Advisory Board: Sponsor DH development to guide providers and commissioners in ensuring
November 2010 appropriate provision for patients.
Interventional radiology: This document contains advice offered by the NHS Clinical Advisory http://www.improvement.nhs.uk/diagnostics/Radiolo
Regional Networks for Groups (CAG) for Major Trauma to their colleagues in the NHS. Strategic gyKeyResources/Other.aspx#IR
Major Trauma Health Authorities (SHAs) declared their intentions to support the
NHS Clinical Advisory establishment of improved regional services for Major Trauma,
Groups Report primarily through the development of regional Trauma Networks in
September 2010 2008. The Revised Operating Framework of June 2010 confirmed that
the expectation that these commitments would be fulfilled, despite the
recent change of Government.
Delivering quality imaging This document describes the structure of services that should be http://www.improvement.nhs.uk/diagnostics/Radiolo
services for children commissioned to support the provision of effective paediatric imaging gyKeyResources/DHpublications.aspx
National Imaging Board services. It was produced jointly by the National Clinical Leads for
March 2010 Imaging and Children and Families. It is intended to inform
commissioners and identify how service providers can offer high
quality, innovative, paediatric imaging services.
PACS and the NHS National This document describes the work done by the NHS CFH PACS http://www.connectingforhealth.nhs.uk/systemsands
Breast Screening Programme to support their NHS National Breast Screening ervices/pacs/projects/breastscreening/index_html
Programme Programme.
NHS CFH PACS Programme
Team, 2010
Introduction to PACS and These documents explain the concept of PACS and how this has http://www.connectingforhealth.nhs.uk/systemsands
15

16. the PACS Programme: revolutionised the management of diagnostic images with the NHS. ervices/pacs/learn
NHS CFH PACS Programme This includes a comparison of operating models before and after the
Team, 2003 ‐ 2010 introduction of PACS, Case Studies and “Frequently Asked Questions”
Interventional radiology: This report has been produced to inform and stimulate discussion http://www.dh.gov.uk/prod_consum_dh/groups/dh_
Improving Quality and about how interventional radiology services can support the QIPP digitalassets/documents/digitalasset/dh_109131.pdf
Outcomes for Patients (Quality, Innovation, Productivity and Prevention).
Department of Health
November 2009
Procurement of CT and MRI The Centre for Evidence based Purchasing developed this document in http://www.improvement.nhs.uk/diagnostics/Radiolo
technologies for stroke response to the national stroke diagnosis initiatives, realising that the gyKeyResources/DHpublications.aspx
imaging services sudden influx of new guidance for stroke imaging services needed
Department of Health analysing and collating into more manageable sources to help business
January 2009 case development and cost‐effective procurement of new CT and MRI
technologies. The aim is to inform imaging providers considering
procurement of either new systems, or upgrading with neuro‐imaging
software packages.
PACS and Voice Recognition This describes the work the national PACS Programme did to support http://www.connectingforhealth.nhs.uk/systemsands
NHS CFH PACS Programme Acute Trusts to implement Voice Recognition software, including a case ervices/pacs/projects/pacsvr/index_html
Team, 2009 study carried out by Leeds Teaching Hospitals NHS Trust.
Implementing the National This guide provides further detail on the recommendations set out in http://www.dh.gov.uk/en/Publicationsandstatistics/P
stroke strategy ‐ An imaging the National Stroke Strategy regarding imaging for transient ischaemic ublications/PublicationsPolicyAndGuidance/DH_0851
guide attack (TIA) and stroke. It sets out best practice and provides guidance 46
Department of Health on how imaging services may develop to provide gold standard TIA and
May 2008 stroke care.
Image and Report Sharing This sets out the advantages of sharing electronic images and http://www.connectingforhealth.nhs.uk/systemsands
NHS CFH PACS Programme summarises various approaches undertaken to achieve this as a series ervices/pacs/projects/imagesharing/index_html
Team, 2008 of side projects to the core national PACS programme.
National Stroke Strategy This national strategy is intended to provide a quality framework to http://www.dh.gov.uk/en/Publicationsandstatistics/P
Department of Health secure improvements to stroke services, to provide guidance and ublications/PublicationsPolicyAndGuidance/DH_0810
December 2007 support to commissioners and strategic health authorities and social 62
care, and inform the expectations of patients and their families by
providing a guide to high quality health and social care services.
Using the OPCS‐4 mapping To generate healthcare resource groupings for payment by results. http://www.improvement.nhs.uk/diagnostics/Radiolo
table from the National gyKeyResources/DHpublications.aspx
16

17. Interim Clinical Imaging
Procedure Codes
Department of Health
Towards best practice in This document draws together best practice in Interventional http://www.improvement.nhs.uk/documents/IR_Guid
Interventional Radiology Radiology (IR), highlighting the findings from visits to IR services at the e.pdf
NHS Improvement 24 proposed major trauma centres in England during 2011/12. This
June 2012 record of their major findings provides a definitive read for trust chief
executives and commissioners to help better inform IR service redesign.
It contains a collection of case studies for clinical teams in trauma and
non trauma services to adopt and adapt to deliver safe and effective
services for patients.
Interventional radiology: This follow‐up article looks more closely at the three Accelerated Stroke 'How to implement best practice in stroke and TIA
How to implement best Improvement (ASI) measures that relate directly to radiology. It outlines imaging'
practice in stroke and TIA examples of best practice introduced by Trusts across England to meet
imaging these targets and provides patients with the best possible outcomes.
Synergy News
November 2011
Interventional radiology: The article describes the improvement approaches to supporting Stroke 'The Challenge for Radiology Imaging for Stroke and
The Challenge for Radiology Imaging. Strokes are the third biggest cause of death and the leading TIA’s'
Imaging for Stroke and TIA’s cause of disability in the UK, with more than 110,000 people per annum
Synergy News suffering an initial stroke. Three key themes are highlighted:
September 2011 1. Why do we have to image 50% within an hour?
2. What is the role of perfusion imaging?
3. Why urgently undertake carotid imaging if surgery is not happening
in a timely manner?
17

18. A Guide to achieving This guide is a follow up to the document ‘Why treat stroke and TIAs as http://www.improvement.nhs.uk/diagnostics/Radiolo
changes in imaging services emergencies?’ It has been produced to highlight how changes in gyKeyResources/tabid/63/Default.aspx
to support new stroke imaging services have been achieved by Trusts across the country to
pathways deliver improvements in services to stroke patients and to support
NHS Improvement improved outcomes and patient experiences. It contains a number of
May 2011 case studies for clinical teams to adopt and adapt to their local services.
The role of teleradiology in This document describes how teleradiology can address variations in http://www.improvement.nhs.uk/diagnostics/Radiolo
supporting the delivery of local reporting capacity whilst providing patient centred and locally gyKeyResources/DHpublications.aspx
diagnostic imaging services driven services.
Department of Health
April 2011
Why treat stroke and This publication highlights why treating strokes and Transient Ischemic http://www.improvement.nhs.uk/LinkClick.aspx?fileti
transient ischaemic attacks Attacks (TIAs) as emergencies can reduce mortality; reduce length of cket=TGB0QZ9zZ4A%3d&tabid=56
(TIAs) as emergencies? stay; improve functional recovery and minimise residual disability, thus
NHS Improvement increasing the chance of a return to independent living.
June 2010
Radiology Reporting Times This best practice guidance has been developed and endorsed by the http://www.improvement.nhs.uk/diagnostics/LinkClic
Best Practice Guidance National Imaging Board to define best practice for the reporting of k.aspx?fileticket=e8lkz6rOyzY%3d&tabid=63
NHS Improvement images. It is based on the practical experience of some imaging
September 2008 departments in delivering high quality and effective patient‐centred
services. It outlines the key role played by imaging services supporting
the whole patient pathway by providing the reporting of images in a
timely manner. This timely delivery is also key to the delivery of the
NHS priorities for Cancer, Heart and Stroke Management.
Service Improvement for This signposting document aims summarising service improvement http://www.improvement.nhs.uk/diagnostics/LinkClic
Radiologists knowledge and experience for UK Radiologists. This document includes k.aspx?fileticket=bVz9WgBaan4%3d&tabid=63
descriptions of underlying principles with specific examples. Endorsed
NHS Improvement by the British Institute of Radiology, it contains specific appendices of
Radiology Success factors for each of the key imaging modalities. See
November 2007 below
Radiology Success Factors This appendix supports the Service Improvement for Radiologist http://www.improvement.nhs.uk/diagnostics/LinkClic
document. Generic Success Factors are described which contribute to k.aspx?fileticket=T3f6CZ%2fMIig%3d&tabid=63
NHS Improvement improving radiology data; administrative; clinical working practices; skill
18

19. November 2007 mix; support services.
PACS – Service PACS has a very pivotal and extensive role to play in the delivery of http://www.improvement.nhs.uk/diagnostics/LinkClic
improvement and benefits imaging services. It lies at the heart of modernisation of the NHS IT k.aspx?fileticket=n3CfL6XrWCY%3d&tabid=63
realisation infrastructure, and is linked to service improvement, advancing
NHS Modernisation agency technology and a changing and developing workforce. This document
May 2005 demonstrates the impact that PACS supported by process redesign can
have across the wider healthcare community. It describes the potential
for non imaging digital images (such as ECG, endoscopy and
dermatology) to use the infrastructure of the PACS architecture. The
benefits of linking all digital images for the patient record will inevitably
increase the efficiency of the healthcare system as a whole.
Radiology service The appendices included with this toolkit are designed to give teams a http://www.improvement.nhs.uk/diagnostics/Radiolo
improvement toolkit – guide basic template to support data collection. They are designed to assist gyKeyResources/Archive.aspx
to redesign teams in reducing the set up time to start on such a project. However,
NHS modernisation Agency you may wish to adapt the documentation to suit your local
June 2003 circumstances.
7 day working: a seven day Case study: University Hospitals of Leicester NHS Trust http://www.improvement.nhs.uk/SevenDayWorking/
service for the assessment SevenDayWorkingCaseStudies/tabid/219/Default.aspx
and treatment of transient
ischaemic attack
NHS Improvement
September 2011
7 day consultant radiology Case study: Gloucester Hospitals NHS Trust http://www.improvement.nhs.uk/SevenDayWorking/
service SevenDayWorkingCaseStudies/tabid/219/Default.aspx
NHS Improvement
September 2011
19

20. 7 day radiology service Case study: Salisbury NHS Foundation http://www.improvement.nhs.uk/SevenDayWorking/
NHS Improvement SevenDayWorkingCaseStudies/tabid/219/Default.aspx
September 2011
CT case studies Direct pathway from ambulance to CT scan: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Royal Bournemouth Hospital ( 2011) gyCaseStudies.aspx
2011 and 2009 Training radiographers to perform CT heads:
‐ The Great Western Hospital NHS Foundation Trust (2011)
24 hour CT imaging for patients suspected of having a minor stroke:
‐ Countess of Chester Hospital NHS Foundation Trust (2009)
Providing a comprehensive stroke imaging service:
‐ Salford Royal Hospital NHS Foundation Trust
Improving access for patients ‐ 24 hours a day, 7 days a week CT
service:
‐ Hull and East Yorkshire Hospitals NHS Trust
24 hour CT imaging for suspected stroke patients:
‐ Chesterfield Royal Hospital
Implementation of radiographer for CT head reporting for stroke:
‐ Kingston Hospital NHS Trust
Introducing a radiology access unit:
‐ Portsmouth Hospitals NHS Trust
Reducing waiting times and improving booking:
‐ Portsmouth Hospitals NHS Trust
Providing immediate access to CT head scans for stroke patients:
‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay
Providing a 24/7 service to support stroke and emergency care patients:
‐ St Helens and Knowsley Teaching Hospital NHS Trust
CT & MRI case studies MRI training plan to support seven day working : http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Blackpool Victoria Hospital (2011) gyCaseStudies.aspx
2011 and 2009 Improving scanner utilisation in MRI by 25%:
‐ North Staffordshire NHS Foundation Trust (2011)
Streamlining paediatric sedation process:
‐ Great Ormond Street Hospital for Children NHS Trust (2009)
Implementing NICE stroke guidelines:
‐ Central Manchester Foundation NHS Trust (2009)
20

21. All Modalities case studies Reducing reporting turnaround times: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Barts and The London NHS Trust gyCaseStudies.aspx
2009 Reducing waiting times for outpatients:
‐ Hinchingbrooke Hospital NHS Trust
Implementing a 3 session day:
‐ Mayday Healthcare NHS Trust
Improving access and booking to reduce waiting times:
‐ Worcestershire Acute Hospitals NHS Trust
Improving inpatient turnaround times:
‐ South Devon Healthcare NHS Foundation Trust ‐Torbay
Implementing a 7 day service:
‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay
Improving reporting turnaround times:
‐ St Helen's and Knowsley Teaching Hospitals NHS Trust
Booking case studies Introducing direct booking: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Portsmouth Hospitals NHS Trust gyCaseStudies.aspx
2009 Implementing direct booking in CT and Ultrasound:
‐ Bromley Hospital NHS Trust
Implementing booking using a call centre:
‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay
Fluoroscopy case studies Improving access to the hysterosalpingogram service: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ University Hospitals of Leicester NHS Trust gyCaseStudies.aspx
2009 Reduction in waiting times for hysterosalpingograms:
‐ Princess Alexandra NHS Trust
Interventional case studies Improving patient safety: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement, 2009 ‐ Luton and Dunstable NHS Foundation Trust gyCaseStudies.aspx
Nuclear medicine case Redesigning the department and improving patient flow: http://www.improvement.nhs.uk/diagnostics/Radiolo
studies ‐ Calderdale and Huddersfield NHS Foundation Trust gyCaseStudies.aspx
NHS Improvement, 2009
Plain film case studies Improving the flow for orthopaedics patients: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement, 2009 ‐ Bolton Hospital NHS Trust gyCaseStudies.aspx
21

22. Reporting case studies Improving reporting turnaround times: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ St Helens and Knowsley Teaching Hospitals NHS Trust gyCaseStudies.aspx
2009 Improving reporting turnaround times:
‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay
Theatres case studies Training theatre staff to screen during spinal surgery: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Dorset County Hospital NHS Foundation Trust gyCaseStudies.aspx
2009
Ultrasound case studies Creating a one stop haematuria clinic: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Blackpool Fylde and Wyre NHS Foundation Trust gyCaseStudies.aspx
2009 Expansion of ultrasound in primary care:
‐ Blackpool Fylde and Wyre Hospitals Foundation Trust
Rapid access to carotid doppler imaging for TIAs:
‐ University Hospitals of Leicester NHS Trust
Improving the urology patient pathway:
‐ Luton and Dunstable NHS Foundation Trust
Reducing waiting times and improving quality:
‐ Blackpool Fylde & Wyre Hospitals Foundation Trust
Reducing waiting times for musculoskeletal patients:
‐ South Devon Healthcare NHS Foundation Trust ‐ Torbay
Other case studies Maintaining zero infection rates: http://www.improvement.nhs.uk/diagnostics/Radiolo
NHS Improvement ‐ Princess Alexandra NHS Trust gyCaseStudies.aspx
2009 Achieving 18 weeks target:
‐ Queen Marys Hospital ‐ Sidcup
22

23.
CANCER
Title/author/date of Description Link
publication
National Awareness and The National Awareness and Early Diagnosis Initiative (NAEDI), http://www.cancerresearchuk.org/cancer‐
Early Diagnosis Initiative arising from the Cancer Reform Strategy, aims to achieve improved info/spotcancerearly/naedi/
(NAEDI) outcomes for people with cancer through earlier diagnosis. The
website contains information and resources for health professionals.
Website: www.naedi.org.uk
National Cancer Intelligence The National Cancer Intelligence Network website contains http://www.ncin.org.uk/publications/data_briefings/rout
Network: Routes to information and resources for health professionals. The NCIN is a es_to_diagnosis.aspx
Diagnosis UK‐wide initiative, working to drive improvements in standards of
NCIN cancer care and clinical outcomes by improving and using the
information collected about cancer patients for analysis, publication
and research.
Website: www.ncin.org.uk
PCT Profiles for Cancer The PCT Profiles for Cancer have been produced by the National http://www.ncin.org.uk/cancer_information_tools/profil
2011/12; 2012/13 Cancer Intelligence Network and give information about 26 key es/pctprofiles.aspx
NCIN indicators relating to cancer services for every Primary Care Trust in
England. These profiles provide comparative information for
benchmarking and reviewing variations at a PCT level. They are
intended to help Primary Care Trusts think about clinical practice
and service delivery in cancer and, in particular, early detection and
diagnosis. They are not for the purpose of performance
management and there are no 'right or wrong' answers.
Website: www.ncin.org.uk
General Practice Profiles for The General Practice Profiles for Cancer have been produced by the http://www.ncin.org.uk/cancer_information_tools/profil
Cancer National Cancer Intelligence Network (NCIN) and give information es/gp_profiles.aspx
NCIN about key indicators relating to cancer services for most GP practices
July 2012 in England. They are intended to help GP practices think about the
services they offer to their patients, in particular those services
related to recognising symptoms and diagnosing cancer earlier.
Website: www.ncin.org.uk
23

24. Direct access to diagnostic A best practice referral pathways document for GPs for direct access http://www.dh.gov.uk/prod_consum_dh/groups/dh_digi
tests for cancer: Best to diagnostic tests for cancer. The four pathways focus on non‐ talassets/@dh/@en/documents/digitalasset/dh_133511.
Practice Guide for General obstetric ultrasound to support the diagnosis of ovarian cancer; pdf
Practitioners chest x‐ray to support the diagnosis of lung cancer; flexible
Department of Health sigmoidoscopy to support the diagnosis of colorectal cancer; and
April 2012 brain MRI to support the diagnosis of brain cancer.
The Characteristics of an This document sets out the characteristics of an effective MDT as http://www.improvement.nhs.uk/diagnostics/PathologyK
effective MDT identified by the responses of over 2000 MDT members to a survey eyResources/Other.aspx
National Cancer Action in early 2009 about MDT working. It also takes into account
Team additional views expressed at six workshops held in May 2009 and
February 2010 the outputs from ad hoc meetings with stakeholders. These
characteristics will form the foundation on which the National
Cancer Action Team’s (NCAT) MDT development work programme
will build and may evolve over time.
Website: www.ncin.org.uk
Best practice diagnostic These guidelines define, and bring together in one place, the key http://www.associationofbreastsurgery.org.uk/media/45
guidelines for patients clinical and process markers of quality for the multidisciplinary 85/best_practice_diagnostic_guidelines_for_patients_pr
presenting with breast diagnostic team to promote both quality and efficiency. They will be esenting_with_breast_symptoms.pdf
symptoms vital in ensuring that all breast cancer patients receive high quality,
November 2010 joined up care. They are as vital a guide for the GP practice as they
are for the hospital specialist.
Supporting direct access to Best practice pathways for diagnostic imaging teams. This guide http://www.improvement.nhs.uk/documents/Diagnostic_I
diagnostic imaging for covers the ‘best practice’ process for direct referral by GP’s to 3 maging_Cancer.pdf
cancer specific diagnostic imaging tests where ovarian, lung or brain cancer
November 2012 may be suspected but urgent GP referral (2 week wait) is not
applicable.
24

25.
PHYSIOLOGICAL DIAGNOSTICS
Title/author/date of Description Link
publication
IQIPS Improving Quality in Physiological Diagnostics Services. The IQIPS www.rcplondon.ac.uk/projects/iqips
programme is professionally led and aims to improve service quality,
care and safety for patients undergoing physiological diagnostics
investigations and treatments. The process of self assessment,
improvement and accreditation gives national recognition to the service
with a badge of quality.
What is Physiological A guide to the tests and procedures conducted by physiological http://www.improvement.nhs.uk/physiologydiagnosti
Measurement? diagnostics services including audiology, cardiac physiology, GI cs/documents/WhatisPhysiologicalMeasurement.pdf
Department of Health physiology, neurophysiology, ophthalmic and vision science,
May 2007 respiratory and sleep physiology, urodynamics and vascular
science.
Audiology
Provision of Adult Balance This good practice guide provides practical evidence based advice http://www.dh.gov.uk/prod_consum_dh/groups/dh_
Services – a Good Practice on how to improve people’s access to, and experience of, balance digitalassets/documents/digitalasset/dh_093861.pdf
Guide services. It suggests how to reduce waste and unnecessary steps
Department of Health in care so people with balance problems receive high quality
January 2009
specialist services as quickly as possible.
Provision of Services for This good practice guide provides practical evidence based advice http://www.dh.gov.uk/prod_consum_dh/groups/dh_
Adults with Tinnitus – a on how to improve people’s access to, and experience of, tinnitus digitalassets/documents/digitalasset/dh_093810.pdf
Good Practice Guide services. It suggests how to reduce waste and unnecessary steps
Department of Health in care so people with tinnitus problems receive high quality
January 2009
specialist services as quickly as possible.
Transforming Services for This good practice guide aims to support local services in ensuring http://www.dh.gov.uk/prod_consum_dh/groups/dh_
Children with Hearing that children with hearing difficulty have improved access to high digitalassets/@dh/@en/documents/digitalasset/dh_0
Difficulty and their Families quality hearing services delivered as close to the child’s home as 88676.pdf
Department of Health possible with rapid access to more specialist expertise when
December 2008
needed. The early detection, assessment and management of
25

26. hearing problems in children is key to their personal, educational
and social achievement.
Transforming Adult Hearing Improving access and reducing waits in adult hearing services http://www.thebsa.org.uk/index.php?option=com_co
Services for Patients with requires those services to be transformed applying all the tools ntent&view=article&id=100&Itemid=71
Hearing Difficulty and techniques in service improvement and redesign. This good
Department of Health practice guide provides practical evidence based advice to
June 2007
provide quicker access to assessment and treatment and to
improve the patient experience of hearing services.
Shaping the future: This guide shows how applying Lean principles can improve http://www.improvement.nhs.uk/audiology/documen
Strengthening the evidence service quality and patient experience while increasing service ts/Shaping_the_Future.pdf
to transform audiology productivity in audiology. The principles outlined can be adapted
services to inform service redesign in local environments.
NHS Improvement
March 2011
Pushing the boundaries: This guide outlines a range of practical examples to support http://www.improvement.nhs.uk/LinkClick.aspx?fileti
Evidence to support the clinical teams to deliver improvements in quality and the cket=zRsxjLXTeCw%3d&tabid=56
delivery of good practice productivity of audiology services. The examples outlined cover a
guide range of clinical audiology pathways which include tinnitus,
NHS Improvement
balance, and children’s hearing as well as age related hearing
July 2010
loss.
Cardiac Physiology
Transforming Cardiac This good practice guide provides practical evidence based advice http://www.nwlcn.co.uk/18weeks/cardiologygoodpra
Diagnostic Services to on how to improve people’s access to, and experience of, cardiac ctice060718weeksjune07.pdf
Deliver 18 weeks – a Good services. It suggests how to reduce waste and unnecessary steps
Practice Guide in care so people with cardiac problems receive high quality
Department of Health
specialist services as quickly as possible.
June 2007
18 Week ‐ Focus on Cardiac Focus on cardiac diagnostics is a project of the Heart http://www.improvement.nhs.uk/physiologydiagnosti
Diagnostics Improvement Programme which focused on reducing the waiting cs/documents/Cardiac_Diagnostics_Summary.pdf
NHS Improvement times for all non‐invasive cardiac diagnostics. This document
2008 draws together information on good practice, advice on
commissioning, workforce requirements, technology and
innovation and service improvements in cardiac diagnostics
26

27. services.
Neurophysiology
Transforming Clinical This good practice guide provides practical evidence based advice http://www.improvement.nhs.uk/physiologydiagnosti
Neurophysiology Diagnostic on how to improve people’s access to, and experience of, cs/documents/Neurophysiology%20good%20practice
Services to Deliver 18 neurophysiology services. It suggests how to reduce waste and _260907.pdf
weeks – a Good Practice unnecessary steps in care so people with neurophysiology
Guide
problems receive high quality specialist services as quickly as
Department of Health
possible.
August 2007
Respiratory and Sleep
Physiology
The NHS Atlas of Variation This Atlas outlines the extent of the variation in clinical activity http://www.rightcare.nhs.uk/index.php/atlas/respirat
in Healthcare for and outcomes in respiratory services. It demonstrates the scope orydisease/
Respiratory Disease clinicians and commissioners have to improve outcomes by
Right Care ensuring that all patients receive the quality of care that is
September 2012
delivered in the best performing localities.
COPD Commissioning Tool The Chronic Obstructive Pulmonary Disease (COPD) http://www.dh.gov.uk/health/2012/08/copd‐toolkit/
Kit Commissioning Toolkit aims to make it easier to commission
Department of Health better outcomes for people with COPD by bringing together
August 2012 information about the clinical, financial and commercial aspects
of commissioning.
Transforming Respiratory This good practice guide provides practical evidence based advice http://www.improvement.nhs.uk/physiologydiagnosti
and Sleep Diagnostic on how to improve people’s access to, and experience of, cs/documents/RespiratoryGoodPractice_060209.pdf
Services – a Good Practice respiratory and sleep services. It suggests how to reduce waste
Guide and unnecessary steps in care so people with respiratory and
Department of Health
sleep problems receive high quality specialist services as quickly
February 2009
as possible.
Pulmonary Rehabilitation This guide provides support for the local implementation of NICE clinical http://www.nice.org.uk/media/63F/4D/PulmonaryRe
Service for Patients with guidelines through commissioning, and is a resource to help health habCommissioningGuide.pdf
COPD professionals in England to commission an effective pulmonary
Commissioning Guide rehabilitation service for patients with chronic obstructive pulmonary
NICE disease (COPD).
December 2006 This guide should be read in conjunction with the following NICE quality
27

28. standard:
http://publications.nice.org.uk/chronic‐obstructive‐pulmonary‐disease‐
quality‐standard‐qs10
Vascular Science
The Provision for Services This good practice guide provides practical evidence based advice www.vascularsociety.org.uk/library/vascular‐society‐
for Patients with Vascular on how to improve people’s access to, and experience of, publications.html
Disease 2012 vascular services. It suggests how to reduce waste and
The Vascular Society unnecessary steps in care so people with vascular problems
February 2012
receive high quality specialist services as quickly as possible.
Service specifications Evidence based service specifications, produced by the SVT Professional http://www.svtgbi.org.uk/resources/service‐
The Society for Vascular Standards Committee and are intended to be a source of guidance to specifications/
Technology of Great Britain anyone running, setting up or commissioning a vascular ultrasound
and Ireland service.
August 2010
Lesley Wright
NHS Improvement Director
Email: lesley.wright@nhsiq.nhs.uk
Fiona Thow
NHS Improvement Director
Email: fiona.thow@nhsiq.nhs.uk
21 March 2013
28

29. NHS
CANCER
NHS Improvement
DIAGNOSTICS
HEART
NHS Improvement
NHS Improvement’s strength and expertise lies in practical service improvement. It has over a decade of
experience in clinical patient pathway redesign in cancer, diagnostics, heart, lung and stroke and
demonstrates some of the most leading edge improvement work in England which supports improved
LUNG patient experience and outcomes.
Working closely with the Department of Health, trusts, clinical networks, other health sector partners,
professional bodies and charities, over the past year it has tested, implemented, sustained and spread
quantifiable improvements with over 250 sites across the country as well as providing an improvement
STROKE
tool to over 2,400 GP practices.
NHS Improvement
3rd Floor | St John’s House | East Street | Leicester | LE1 6NB
Telephone: 0116 222 5184 | Fax: 0116 222 5101
www.improvement.nhs.uk
Delivering tomorrow’s
improvement agenda
for the NHS