Reducing misdiagnosis and helping patients back to work

By Mark Thomas

New imaging technology promises to bring affordable, more detailed 3D imaging to care settings around the world, providing faster and more accurate diagnosis and helping patients get the right care.

Scaphoid fractures are notoriously difficult to diagnose, typically presenting among young men following a fall onto an outstretched hand, car accident or contact sport incident. One of eight small bones that make up the ‘carpal bones’ of the wrist, the scaphoid connects two rows of bones: one closer to the forearm and the other closer to the hand. These fractures can present with wrist or thumb pain but not necessarily any visible deformity or significant loss of motion, leading many incidences to be misdiagnosed as wrist sprains.

The scaphoid bone has an avascular blood supply that means, depending on the location and size of the break, there is a real risk of bone death where blood supply is cut off. This leads to a loss of wrist function and dexterity, which can have significant financial implications for those who rely on their flexibility of wrist movement that the scaphoid supports.

This is why MRI and CT images have become the ‘gold standard’ for diagnosis. However, limited resources and long imaging waiting lists mean clinicians across the UK instead rely on X-rays in the first instance. If a scaphoid fracture is suspected, clinicians will typically request four X-ray views, versus two for other wrist injuries, but even that is not a guarantee that the fracture will show as the scaphoid bone can be easily hidden by other carpal bones in a 2D image.

*Traditional 2D film X-ray radiograph showing broken carpal bone (scaphoid fracture)*

It is easy to understand how scaphoid fractures can be easily missed then, particularly in overstretched A&E departments where there may not be sufficient scanner time or radiology cover to diagnose ‘minor injuries’ quickly. Clinical teams usually adopt a conservative approach therefore: Initially treating the injury as if the bone is fractured, with splinting recommended to protect it from further damage, and a follow-up appointment with the fracture clinic in 7-10 days’ time. By this point, if the patient is still experiencing pain, new X-rays will likely reveal initial bone healing more clearly than the original scaphoid break.

It is a sensible approach but one that ultimately causes several problems:

Firstly, where clinicians are concerned about the possibility of a scaphoid fracture but unable to confirm it during the initial visit, splinting the wrist while awaiting further imaging or specialist review means patients can find themselves unable to work unnecessarily, with significant financial implications due to lost earnings.

Scaphoid fractures are usually slow to heal because tiny blood vessels supplying nutrients to the site are often damaged at the time of injury. This means that even though the results of both surgical and non-surgical interventions are very good following diagnosis, both approaches require considerable time in plaster, with knock-on impacts for patients and their dependents, including inability to drive, work and earn normally. Should surgery ultimately be required, it is easy to see how treatment delays of just a couple of weeks can have a real impact on patients’ lives.

Finally, requiring all patients to attend follow-up appointments in fracture clinic has significant resource implications for a healthcare system already under pressure, not least in terms of clinician time and additional imaging requirements.

Improving diagnosis through next-gen imaging

Accepting all of the above, how then can we improve diagnosis for these patients? How can we prevent patients with sprained wrists taking unnecessary time off work, while supporting those with scaphoid fractures to access faster treatment and limit injury-related loss of earnings?

One potential solution lies in a new imaging technology – already proven in the veterinary industry – which promises to bring affordable, more-detailed 3D imaging to the point of care in hospitals and clinics around the world.

This next-generation technology builds on the foundations of digital tomosynthesis (DT) imaging, which is widely used for breast imaging across the NHS. With traditional DT, a conventional X-ray tube moves through a range of angles to derive 3D data – providing better diagnostic information than 2D X-ray but, restricted by its limited depth resolution capabilities, creating difficulties localising some structures and elements.

Adaptix’s unique 3D X-ray technology ‘sweeps’ in two dimensions, enhancing the Z resolution relative to conventional DT. Images are quickly reconstructed – in under 20 seconds – providing slice-by-slice images that can be analysed extremely quickly. This allows for slice thickness adjustments over regions of interest – a particularly important feature when looking for ‘tricky’ fractures, such as those to the scaphoid bone.

The result? A high-resolution 3D image that provides far greater definition and clarity than 2D X-ray techniques, at a cost and radiation dose similar to traditional X-ray. What is more, the compact design of the technology and low-radiation dose, mean it can be brought directly to the point of patient care – reducing time spent moving between hospital departments and allowing clinicians to obtain imaging ‘in clinic’ if needed.

About the author

Mark Thomas, BSc (Hons), PgC, HCPC Reg., Product Manager, Adaptix

Mark spent the first 10 years of his career working as a Radiographer in human healthcare both in the UK and Australia. Later, he focused on CT, managing the Neuro CT Service in Oxford in his final position. In 2008, Mark joined Toshiba/Canon Medical as a CT Specialist, and spent the next 15 years initially providing training, before managing the UK Clinical CT Team. With a strong team Mark drove the adoption of new technologies pushing clinical boundaries, maintaining high clinical integrity and importantly customer satisfaction. Mark’s background gives him real clarity on the future and opportunity for inclusion of Digital Tomosynthesis Imaging in a modern, forward thinking Imaging Service.

Acute Care, Community Care, Featured, News, Secondary Care April 10, 2025

Embedding social prescribing in secondary care: A toolkit from Barts Health

By Gabriel Blaazer

Barts Health NHS Trust and its partner organisation, Transformation Partners in Health and Care, have released a toolkit detailing their pioneering work embedding social prescribing in secondary care and specialist acute pathways. The toolkit aims to help providers address unmet social needs, improve patient outcomes and reduce demand on acute services, shaping a holistic, prevention-focused model for the future NHS.

Social prescribing attempts to address the social determinants of health. These are the non-medical factors influencing 84 per cent of a person’s total health, with clinical care impacting the remainder. Social determinants of heath include income security and employment, education, housing and food insecurity, or social isolation.

Introduced in England in 2018, it typically involves signposting or referrals to appropriate services, but can also include emotional and mental health support for people experiencing social isolation or low-level mental health issues. Social prescribing is a holistic, person-centred and preventative approach and as such, is a key enabler of the government’s efforts to shift more care into the community and bolster prevention initiatives.

Emerging evidence suggests that social prescribing is an effective, yet low-cost, preventative intervention. However, its implementation has been more frequent in primary and community care, compared to secondary care. In 2023, Barts Health NHS Trust (Barts Health), one of Europe’s largest acute healthcare providers, started implementing social prescribing across multiple pathways, using different integration models to support a whole system approach to prevention and personalised care.

These services, delivered by social prescribers in collaboration with clinical and wider multi-disciplinary teams, support residents with their social needs while aiming to reduce demand on high-pressure services, including cardiovascular (CVD), renal, emergency care, and children and young people’s (CYP) services.

Encouraged by positive outcome data, the Trust and its partner organisation, Transformation Partners in Health and Care (TPHC), have developed a toolkit to help secondary care services embed social prescribing, public health and other community-led prevention initiatives within their specialties and pathways. The toolkit serves as a practical guide and checklist for secondary care providers looking to implement social prescribing and explore integrated, whole-system approaches to prevention.

Addressing unmet needs

While NHS England has established a standard model for embedding social prescribing, this has primarily focused on integration within primary care. In 2023, Barts Hospital’s Endovascular Team, led by Vascular Surgeon Dr Tara Mastracci, identified a high prevalence of unmet social need among patients in the hospital’s cardiovascular pathway – a well-evidenced correlation. Given that CVD disproportionately affects socially deprived populations, Dr Mastracci theorised that integrating social prescribing could benefit those at highest risk, simultaneously alleviating pressure on the pathway and improving patient outcomes.

A key data point supporting the use of social prescribing in secondary care was the gender split between typical users of social prescribing services and those presenting with acute cardiovascular issues. While 84 per cent of patients within cardiovascular pathways were men, 60 per cent of social prescribing users were women. Research has shown that women consult primary care services 32 per cent more frequently than men, suggesting that secondary care could play a central role in engaging men, who might otherwise remain underserved by traditional social prescribing models.

“Overall, we have found that we encounter a different group of patients compared with those who access social prescribing in primary care.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

This reinforced Dr Mastracci’s belief in the merit of social prescribing within secondary care – clearly, more effort was needed to engage men, particularly for CVD patients who could benefit from greater social support.

Building a collaborative approach

Several specialties within the Trust had also identified unmet social needs as a key driver of service demand, and had begun implementing social prescribing programmes within their pathways. However, these initiatives were siloed, staff-led and reliant on temporary funding or fixed grants. To enhance collaboration and sustainability, Dr Mastracci established a multidisciplinary network of staff across primary and secondary care to drive a more integrated and formalised approach.

Finding limited guidance on implementing social prescribing within secondary care, Dr Mastracci’s CVD team set out to develop a replicable model for implementing it as part of secondary care pathways. Keen to apply the same rigorous standards as with a medical intervention, the team partnered with health economists at the University of East London. They incorporated EQ-5D instruments and QALY (quality-adjusted life years) metrics to evaluate the potential impact of social prescribing on both patients and the wider health and care system.

Recognising the need for greater institutional knowledge and community expertise, the team also partnered with the Bromley by Bow Centre (now Bromley by Bow Health), a leading VCSFE (Voluntary, Community, Social, and Faith Enterprise) community health organisation. This collaboration led to the embedding of a social prescriber within the hospital’s heart attack pathway, screening patients entering the pathway for financial or other social needs.

Implementation and outcomes

Once identified, social prescribers provided patients with six to eight support sessions, connecting them to local services and community groups tailored to their specific social needs. Beyond financial deprivation, patients received support for needs including housing, talking therapies, and healthy lifestyle support such as smoking and alcohol cessation, or physical activity and weight management – all of which play key roles in determining a person’s risk of developing CVD-related conditions.

The social prescribers were drawn from diverse backgrounds and communities, to work in collaboration with clinicians and consultants from secondary care, patient advocate groups, VSCFE organisations and others. This multidisciplinary approach facilitated a holistic and patient-centred approach. The experiences and lessons from creating the CVD social prescribing pathway were later used to inform other specialties as they implemented similar services within their pathways.

“We believe strongly in the importance of ‘place’ and thus many of our social prescribers meet patients in the community where they live to engage and provide support.”

Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery, Barts Health

Dr Mastracci acknowledges that it will take years to fully assess the impact of Barts Health’s social prescribing programmes. “We know these target groups are admitted at higher rates than their peers,” Dr Mastracci told ICJ, “but it will take years to evaluate the long-term effects.”

Despite this, early results have been promising, notably within children and young people’s (CYP) diabetes services. Led by Dr Myuri Moorthy, Diabetes Consultant and Clinical Lead for Young Adult Diabetes (YAD) at Barts Health, clinicians in the pathway had noticed a concerning increase in non-adherence to self-management protocols, often linked to concurrent financial and psychosocial issues. The service also saw high numbers of patients not attending appointments (DNAs), largely due to distress, burnout, and the intense mental health toll associated with diabetes.

Poor diabetes self-management is well known to increase the likelihood of complications. This prompted the diabetes team to adopt a co-designed and personalised model, including a multi-disciplinary team of social prescribers, youth workers and a psychologist. The aim of the YAD Social Prescribing Service was to improve patient engagement, reduce DNAs and maximise the impact of each clinical appointment.

Together with service users, the team co-developed a series of interventions, including monthly peer support meetings, a WhatsApp group and a ‘walk and talk’ group, securing funding from NHSE for two and a half years. During this time, the team successfully:

Reduced the DNA rate across the Trust from 39 per cent to 12.5 per cent
Cut diabetes-related hospital admissions of CYP by 36 per cent across all Barts sites
Generated financial savings of an estimated £62,500 per year across the Trust

More outcomes from the prevention initiatives across Barts Health, including economic and demand savings, stronger integrated community networks and improved outcomes and patient experience, can be found on pages 26-30 of the toolkit.

Gaining leadership buy-in

As with many prevention-based interventions, the impact of social prescribing on health and care systems can take years to fully assess. In its paper on integrated neighbourhood teams (within which social prescribers typically sit), The National Association of Primary Care suggests that “savings will be non-cash releasing, but this is not as issue as what is required is capacity and health improvement.” However, this long-term approach does not easily align with NHS funding cycles, which typically require demonstrable return on investment within 12 months.

Currently, all of Barts Health’s social prescribing pathways are funded individually, on an ad hoc basis. The CVD project, for example, was initially funded by NHSE, but is now supported by Barts Charity. To move towards trust-wide funding, TPHC’s Secondary Care Project Manager, Mollie McCormick, emphasises the need to develop:

Robust databases and coding frameworks to accurately track interventions and outcomes over time
Qualitative data collection from patients benefiting from social prescribing, with an emphasis on reduced need for healthcare services and thus cost savings

Bridging the gap between identifying social needs that drive demand and demonstrating short-term cost savings remains a challenge. However, securing the backing and support of senior clinical leadership is critical in building the case for long-term investment.

For social prescribing initiatives to gain trust-wide funding in future, structural changes are needed to prioritise long-term prevention and strengthen outcomes-based commissioning. Different approaches could involve integrated care systems incentivising prevention by:

Setting realistic and appropriate prevention targets for NHS trusts to influence commissioning decisions towards the implementation of personalised care and prevention initiatives
Introducing penalties for avoidable readmissions

These targets could be assessed by monitoring readmission rates for specific condition cohorts or high-demand service areas, ensuring a measurable focus on prevention.

The toolkit: Embedding and Connecting Prevention in Specialist Pathways

Barts Health and TPHC have now published their toolkit, Embedding and Connecting Prevention in Specialist Pathways. Along with background information on the benefits of social prescribing and community-led prevention, the toolkit addresses some of the key systemic barriers that Barts Health encountered while implementing initiatives across various pathways and specialties.

Using case studies and the first-hand insights from patients, social prescribers and clinicians, the toolkit offers practical guidance for those looking to implement community-led prevention approaches, such as social prescribing, in secondary care. It also provides an overview of key Barts Health prevention networks and identifies the leaders driving this work across the Trust. The toolkit offers a valuable resource for anyone working in an acute setting wanting to embed social prescribing into their services or to prioritise the prevention of ill health in NHS Trusts across London and nationally.

Social prescribing: A key enabler of NHS prevention goals

Emerging evidence strongly supports social prescribing as a cost-effective intervention for tackling the wider determinants of health and addressing the often-overlapping health inequalities that contribute to high demand for NHS services.

Further, as the government seeks to move more care from hospitals to communities as part of its ‘three shifts’, initiatives like social prescribing will be increasingly vital. By reducing pressure on secondary care services and helping local systems meet their financial and operational goals, social prescribing plays a crucial role in shaping the future of preventative, person-centred and sustainable healthcare.

Special thanks to Dr Tara Mastracci, Endovascular Lead for Complex Aortic Surgery at Barts Health, and Mollie McCormick, Secondary Care Project Manager at Transformation Partners in Health and Care, for their time and input in developing this article.

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MSE FT deploys AI-powered MyStaff App to boost compliance and efficiency

By Integrated Care Journal

With mounting pressure on nursing staff and increasing emphasis on patient safety protocols, the MyStaff App ensures that every healthcare professional has instant access to the most current clinical guidelines, reducing the risk of outdated information impacting patient care.

An AI-driven document management solution is demonstrating efficiency across NHS frontline services, reducing average document retrieval times from 10 minutes to just 30 seconds and unlocking 140,000 additional hours for patient care at Mid and South Essex NHS Foundation Trust (MSE FT).

The MyStaff App, developed in partnership with Diligram, is a cutting-edge digital governance tool designed to simplify access to over 1,500 policies, procedures, and patient care guidelines. By integrating AI-powered search, real-time updates, and mobile-first design, the app is dramatically improving workflow efficiency, reducing risk, and setting a new benchmark for digital transformation in the NHS.

With 90 per cent of the Trust’s 15,000-strong workforce actively using MyStaff App, MSE FT has demonstrated how digital innovation can drive faster, safer, and more streamlined operations across healthcare settings.

Historically, NHS staff have had to navigate outdated, fragmented systems to locate essential documents –leading to wasted time, inconsistent guideline adherence, and increased clinical risk. Before MyStaff App’s implementation, healthcare professionals at MSE FT spent an average of 10 minutes searching for a single document, adding unnecessary delays to decision-making and patient care.

Matthew Hopkins, CEO of MSE FT, explained why the Trust prioritised digital transformation: “One of the biggest inefficiencies in the NHS is time spent navigating multiple systems just to find key policies and clinical guidelines. By using AI to streamline access to critical information, we’re not only saving time but also improving compliance, patient safety, and governance across the Trust.”

Since rolling out MyStaff App in January 2024, staff adoption has risen by 78 per cent, with more than 864 documents accessed every day. These figures highlight a demand for smarter, AI-powered solutions to improve efficiency across NHS frontline services.

MyStaff App’s most significant advantage lies in its advanced AI search functionality, which allows users to retrieve the latest policies and procedures in under 30 seconds. This represents a 95 per cent reduction in search time, drastically minimising interruptions to patient care. The app’s intelligent indexing and natural language processing (NLP) capabilities mean that healthcare professionals can search for information using everyday language, removing the need for complex keyword-based queries.

Describing the impact of instant access to patient information leaflets, Dr Alex Hieatt, Consultant in Emergency Medicine at MSE FT, said: “Having immediate digital access to policies and patient information has transformed the way we work. It reduces delays, ensures patients receive guidance faster, and improves overall safety and efficiency.”

This is particularly valuable in high-pressure environments such as emergency departments, critical care and maternity services, where staff need to make rapid, evidence-based decisions without being slowed down by administrative barriers.

Beyond efficiency, MyStaff App is also enhancing governance and compliance. Before the app’s introduction, guideline compliance at MSE FT stood at 76 per cent. Since adoption, compliance rates have surged to 98 per cent and have remained consistently high for over six months.

Harriet Dobbs, Matron in Antenatal and Postnatal Services, highlighted how digital transformation is reducing clinical variation and improving consistency in patient care: “Having a single source of truth for policies means that when a guideline is updated, every nurse and doctor is working from the most current version. That kind of real-time synchronisation is critical for patient safety and regulatory compliance.”

With real-time audit tracking, MyStaff App allows healthcare leaders to monitor which documents are being accessed, when, and by whom – providing unprecedented visibility into workforce engagement and compliance levels.

As part of the NHS’s £2 billion digital transformation strategy, AI-powered solutions like MyStaff App are playing a crucial role in modernising outdated processes, improving workforce efficiency, and ensuring greater transparency in hospital operations.

Leslie Golding, CEO of Diligram, believes AI-driven automation is the future of NHS digital governance. She commented: “The NHS generates vast amounts of data every day, yet outdated systems mean much of that information is difficult to access or underutilised. MyStaff App is designed to bridge this gap, providing AI-powered automation that makes policy retrieval faster, compliance tracking smarter, and healthcare workflows more efficient.”

Unlike traditional document management systems, MyStaff App is fully optimised for mobile use, ensuring frontline staff can access guidelines from anywhere, at any time—whether on ward rounds, in theatres, or during patient consultations.

The success of MyStaff App at MSE FT has already led to wider adoption, with University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) rolling out the system.

As NHS organisations continue to seek scalable, high-impact digital solutions, MyStaff App’s proven efficiency gains and compliance improvements make it an attractive model for national implementation.

Matthew Hopkins sees MyStaff App as a blueprint for NHS-wide transformation. He said: “One of the biggest inefficiencies in the NHS is time spent navigating multiple systems just to find key policies and clinical guidelines. By using AI to streamline access to critical information, we’re not only saving time but also improving compliance, patient safety, and governance across the Trust.”

With NHS leaders pushing for greater automation, better data management, and AI-enhanced decision-making, MyStaff App is part of a broader shift towards intelligent, integrated digital ecosystems in healthcare.

Key priorities for the next phase of NHS digital transformation include:

Further AI-driven automation to streamline document approval workflows
Integration with wider NHS systems for seamless interoperability
Enhanced analytics to provide Trust leaders with deeper insights into staff engagement and compliance trends

As demand for smarter, AI-powered solutions grows, MyStaff App is proving that real-world digital innovation is possible and already making a measurable impact on NHS frontline efficiency.

Innovative financing: Unlocking the potential of digital health and technology

By Stephen McMillan, Solutions Leader, Europe and UK & Ireland at Philips

With traditional medical equipment financing models becoming unsustainable, flexible financing options are increasingly helping healthcare providers improve their financial efficiency and supporting long-term digital health transformation.

The UK healthcare industry is undergoing a major digital transformation, with innovation already improving care in many areas from reducing waiting times and enabling earlier diagnoses, to delivering better access to care and outcomes for patients. Embracing new technology can help to unlock productivity, giving staff more time to focus on patient care, while also having a positive impact on the planet.

But for many healthcare providers, the high cost of traditional commercial models makes adopting cutting-edge technology a challenge. In fact, according to the Philips UK Future Health Index, a staggering 92 per cent of healthcare leaders say financial pressures are impacting their ability to deliver timely, high-quality care. Even more concerning, 77 per cent report that these financial strains have forced them to delay, scale back, or even cancel investments in medical equipment and technology – worsening existing bottlenecks and slowing down patient care.

Innovative financing approaches, such as pay-per-use (PPU) and “as-a-service” models, integrated into managed service agreements, give healthcare providers flexible, cost-effective access to technology, without large upfront investments. These models also de-risk investment and can help to enhance productivity, improve financial efficiency, and support long-term digital health sustainability.

Flexibility that adapts to demand

As demand for diagnostic and treatment procedures grows, healthcare providers face squeezed budgets and rising costs. IFRS16 (the International Financial Reporting Standard on Leases) now requires leasing costs to be counted as ‘capital’ on balance sheets, and CDEL (Capital Departmental Expenditure Limit) limits capital spend, even when cash is available. Traditional equipment financing, like leasing, is becoming less sustainable.

This is where flexible financing options such as PPU and “as-a-service” models are transforming how hospitals access and use technology. These models enable hospitals to only pay for what they use, reducing financial risk while ensuring access to the latest innovations. This flexibility helps them scale technology adoption based on patient demand and operational needs, keeping systems up to date and healthcare more adaptable.

Boosting productivity with managed services

Managing complex healthcare technology in-house can be time-consuming and resource intensive. The Future Health Index reports that 80 per cent of healthcare leaders have seen increased incidence of burnout, stress and mental health issues among their staff, with knock-on effects for patient care. A renewed focus on supporting staff is needed.

Managed services offer an alternative approach, where healthcare providers partner with experts to oversee equipment, IT infrastructure, and digital health solutions. This ensures technology runs at peak efficiency, reducing downtime and administrative burdens, freeing up staff to focus on patient care instead of maintenance. At the same time predictable cost structures improve financial planning. Ultimately, managed services can improve productivity, reliability, and performance in healthcare.

Smarter spending through outsourcing

Beyond operational benefits, outsourcing healthcare services can also provide significant tax advantages. Managed services can help hospitals identify and recover VAT from eligible equipment purchases, leading to greater tax efficiencies and improved cash flow.

This financial flexibility means hospitals can maximise use of their budgets, ensure compliance and redirect savings toward critical patient services.

Sustaining technology for the future

Sustainability is becoming a key priority for healthcare providers, and innovative financing can support long-term technology longevity. Lifecycle management solutions will extend the useful life of medical devices and IT systems through proactive upgrades, maintenance, and refurbishments.

This approach not only reduces electronic waste – such as outdated or discarded medical devices and IT equipment – and environmental impact, but also ensures that hospitals are always working with the latest, most efficient technology. By adopting sustainable financing and lifecycle strategies, healthcare organisations can reduce costs, improve operational resilience, and align with NHS net zero goals.

A new approach to healthcare technology

Innovative financing is reshaping how hospitals access and manage technology. Flexible models such as pay-per-use and “as a service”, combined with tax benefits and lifecycle management in managed services, help providers to stay ahead in the digital health revolution – without the financial strain of traditional procurement. At the same time, sustainable technology management ensures long-term value and cost-effectiveness.

By embracing these innovative financing strategies, organisations can boost efficiency, improve patient care, and achieve financial sustainability, ultimately unlocking the full potential of digital health and technology.

This article was kindly supported by Philips

One in four Brits seeking help from A&E due to GP pressures

By Integrated Care Journal

A new nationally representative survey reveals more than one in four Brits (27 per cent) have visited emergency departments because of delays in accessing GP appointments.

New survey data reveals that more than a quarter (27 per cent) of the public have visited A&E recently because the waiting time to access a GP appointment was too long, despite 2024 seeing a record high (370 million) GP appointments delivered.

Conducted by Savanta and commissioned by digital-first healthcare provider Livi, the findings also revealed that delays are leading to worsening of conditions or prolonged recovery, along with increasing costs to the public system based on the cost of a GP consultation versus an A&E attendance.

Regional data reveals that 45 per cent of Londoners who responded to the survey have visited A&E rather than wait to see their GP, while 41 per cent of under-35s reported visiting A&E as an alternative to waiting for a GP appointment.

GPs and clinicians are also feeling the strain of the challenges facing the healthcare system.

Dr Dan Bunstone, Primary Care Network (PCN) clinical director for Warrington Innovation Network and lead GP said: “As GPs, we see first-hand the strain on the system every day. We’re working in a landscape of chronic underfunding for innovation, severe staff shortages, and an ageing population with increasingly complex health needs. Demand is rising, and the resources to meet it simply aren’t there.”

Last month, the Government outlined its priorities for the NHS in 2025 and 2026 – including an objective to improve access to primary care services, and to invest in data and digital to improve productivity in primary care. On 28 February, the Government and BMA also announced a new contract for general practice

The results of this new survey demonstrate how urgently this action is needed, to tackle patient access, GP workload and workforce shortages to avoid pressures and rising costs reaching into other parts of the public system.

Dr Bunstone explained that GPs are delivering more appointments than ever but need alternative solutions to help them to tackle the pressures of long waiting lists and workforce shortages: “Patients deserve timely care, and GPs are constantly looking for ways that allow us to deliver care more effectively and empower our patients. Against all odds we are still delivering more appointments than ever. By embracing digital tools and integrating digital and physical care settings with services across primary and secondary care, we need continued investment in innovative solutions and system-wide coordination.”

Dr Kalle Conneryd Lundgren, Chief Executive Officer at Livi, who commissioned the research, commented on the findings: “The Government needs to act now. These findings confirm what we have long known: the crisis in A&E, hospital backlogs, and ‘corridor care’ all stem from a fundamental failure to provide timely, accessible care in the community. Patients are being left with nowhere else to turn, forcing them into inappropriate care settings and overwhelming an already stretched system and leading to increased costs.

“This isn’t just about more resources, nor is it about capacity. It’s about smarter solutions to boost efficiency and get more patients seen cost effectively. The Government must act now to invest in digital, empower ICSs to scale primary care, and fund proven solutions. By integrating digital and physical care, we can streamline referrals, optimise patient pathways, lower costs and improve access. Working together, we can build a system that works better for both patients and the workforce.”

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New prostate cancer test “cuts biopsies by 50%” in US real-world use

By Integrated Care Journal

Test has demonstrated 94 per cent accuracy in identifying prostate cancer, compared to 55 per cent from traditional PSA tests, along with significant reduction in false positives.

Kearney Urology Center, a specialist clinic in Nebraska, USA, has reported a 50 per cent reduction in biopsies since adopting a new blood test for prostate cancer. The reduction is credited to the adoption of the EpiSwitch^® PSE, which has helped reduce the high number of false positives associated with the standard prostate-specific antigen (PSA) test.

EpiSwitch is the culmination of a ten-year British collaboration between Imperial College, Imperial NHS Trust, University of East Anglia and Oxford Biodynamics, itself a spin off from Oxford University.

There is currently no NHS prostate cancer screening programme in the UK. The UK National Screening committee advises against a national screening programme for prostate cancer due to the low sensitivity of the PSA test; approximately 15 per cent of men who do have prostate cancer do not have a raised PSA level.

Guidance for primary care is provided through the Prostate Cancer Risk Management Programme, and men over 50 (or over 45 for men at higher risk) are eligible to ask for a PSA test from their GP, however GPs are not recommended to proactively engage men in PSA testing, in part due to the test’s low sensitivity and tendency to produce false positive results. As many as three quarters of men with a high PSA do not have cancer. This means a significant number of men undergo the pain and potential side effects of unnecessary biopsies.

EpiSwitch PSE increases the accuracy of the PSA test from 55 per cent to 94 per cent and cuts false positives from 75 per cent to just 7 per cent.

Dr Alexandre Akoulitchev, CSO at Oxford BioDynamics, sad: “Having first demonstrated high accuracy of detection of prostate cancer in the NHS PROSTAGRAM trial in the UK, the EpiSwitch PSE test is today undergoing fast adoption in the US, where it is reimbursed by Medicare and other insurers. PSE leads to a significant reduction of biopsies and overtreatments in the real-world practice of US clinics. There is much value in this test, as recognised by clinical and private health-care institutions in both the US and UK today. Extending access to the general public in the UK would be subject to the NHS and National Screening Committee.”

Dr. Garrett Pohlman, Urologist at Kearney Urology Center, said: “I cannot imagine running my practice without EpiSwitch PSE; it’s a game changer. EpiSwitch increases the accuracy of the PSA test from 55 per cent to 94 per cent and cuts false positives from 3 in 4 to less than 1 in 10. Since adopting this test, I have cut the number of biopsies in half, allowing men who have tested negative for prostate cancer to avoid the pain and potential side effects of an unnecessary intervention.”

EpiSwitch is available privately from Goodbody Clinic and The London Clinic, the private hospital which diagnosed King Charles’ cancer when he was admitted for treatment to his prostate. In the US, the test is reimbursed under its own reimbursement code by several US insurers including Humana, UnitedHealthcare, Medicare and Optum Health. EpiSwitch PSE is not currently available on the NHS.

According to a Prostate Cancer Research report: “This (EpiSwitch) test combines the PSA test with a DNA test, resulting in substantially improved accuracy. Additionally, the test is minimally invasive and has the potential to reduce or eliminate the downsides of the PSA test, such as the high rate of false positives. The timing is ideal to explore innovative screening strategies and consider their benefits to patients, their loved ones and society as a whole.”

Mathias Winkler, Consultant Urologist and Surgeon at Charing Cross Hospital and Imperial College London, added: “The PSA test turns up very few cases of cancer and huge numbers of men are subjected to MRI scans and biopsies, as well as the worry that goes with that, and then it turns out they don’t have cancer.

“PSE is a diagnostic prostate cancer test with unprecedented accuracy. Nine of 10 cancers are found compared to 3 of 10 with PSA alone. Likewise, false-positive results are reduced avoiding unnecessary anxiety and expense.”

Breakthrough infection test to tackle antimicrobial resistance on target for 2025 NHS availability after positive trial results

By Integrated Care Journal

Trial of RNA-based host response analytics technology shows up to 95 per cent accuracy in ruling out lower respiratory tract infection.

UK medtech company, Presymptom Health, has announced positive results from a clinical trial aiming to tackle antimicrobial resistance. The trial, called PRECISiON, was designed to assess the performance of Presymptom Health’s technology in the management of infection and sepsis in patients presenting to emergency departments with respiratory infection.

Accurate infection diagnosis, by identifying patients who don’t require antibiotics, is crucial to saving lives and to tackling antimicrobial resistance, which has been labelled a global emergency by UK government health officials. Failure to address the problem of antibiotic resistance could result in an estimated 10 million deaths per year globally by 2050 and could cost the global economy £66 trillion.

As part of the PRECISiON clinical trial, which was conducted between May 2021 and April 2024 at Portsmouth Hospitals University NHS Trust and eight other NHS sites, Presymptom Health assessed the performance of its InfectiClear^® diagnostic product. Early results show the InfectiClear® diagnostic product may have >95 per cent accuracy at ruling out lower respiratory tract infection, a significant improvement over standard of care.

The core of the InfectiClear® technology lies in RNA-based host response analytics, which examines the body’s response to an infection rather than attempting to detect the pathogen directly – a method that sets it apart from marketed tests available in the UK today. This approach provides an early, highly sensitive signal for infection or sepsis and avoids the delays and inaccuracies often seen with traditional tests, which can lead to unnecessary or incorrect treatments. These tests are platform agnostic, and will over time be offered on multiple different NHS PCR platforms, which were widely deployed during the COVID pandemic and are now often under-utilised.

“Antimicrobial resistance is a global crisis. If it’s not addressed, it will kill more people than cancer does today by 2050.”

Dr Iain Miller, CEO, Presymptom Health

Once ongoing validation work is complete and the product made available in the NHS, starting in 2025, this will enable clinicians to rule out infections earlier, and avoid unnecessary prescription of antibiotics in patients presenting with non-infectious inflammatory symptoms, such as fever and elevated heart rate or breathing. Such symptoms are not necessarily signs of active infection, and existing blood tests are not specific enough to diagnose infection or sepsis.

Further analysis of the trial results is ongoing, and full results will be announced later in 2025.

Dr Iain Miller, CEO of Presymptom Health, said: “Identifying the presence, or lack of, infection at the earliest possible opportunity is crucial to tackling the crisis. Current methods to detect infection are slow and inaccurate, leading to antibiotics being prescribed when they really don’t need to be. In fact, 20-70 per cent of the UK’s annual 35 million antibiotic prescriptions are unnecessary or inappropriate, depending on the clinical setting.

“This clinical trial, when combined with data from other NHS trials, was crucial to further evidencing the efficacy of the technology. It has also enabled us to collect vital data around infection from the 484 patients that took part. We are now looking to raise further funding to help us get this lifesaving technology into the NHS as a UKCA-accredited product in 2025 and to deliver further clinical trials across the NHS and overseas.”

Host response analytics: a new way to detect infection

Presymptom Health was established to exploit IP developed by scientists working at the UK Defence Science & Technologies Laboratory (Dstl), initially researching how to tackle biological threat infection, such as anthrax, plague and ebola. Ploughshare – the company that converts technology research created by government organisations into civilian applications – identified the innovation as having potential societal impact and spun it out from the UK Ministry of Defence in 2019.

Dr Paul Schmidt, Consultant at Portsmouth Hospitals University Trust and lead researcher for the study, said: “This study offered a fantastic opportunity to see how this leading-edge technology for recognising infection and sepsis, developed by UK Dstl scientists combining machine learning and molecular technologies, could benefit NHS patients. I am excited to continue to work with Presymptom Health to unlock the huge potential of this technology”

Dr Schmidt led the collaborative development of the study design, working with Presymptom Health on behalf of Portsmouth Hospitals NHS Trust, the NHS Sponsor of the study.

Presymptom Health is developing a unique portfolio of blood tests powered by machine learning that accurately detect infection and sepsis up to three days before current standard of care. The technology has been trained on a dataset of blood samples collected over 15 years, encompassing thousands of cases, including patients who went on to develop infections and sepsis.

Earlier this year Presymptom Health was selected as one of only eight companies to be part of the Innovative Devices Access Pathway (IDAP) – a government initiative to bring new medical technologies to the National Health Service (NHS) to help with unmet medical needs.

Presymptom Health to launch a further clinical trial

Presymptom Health plans to run a follow-on 350-patient trial in 2025 to assess the accuracy and utility of InfectiClear® in patients with symptoms of respiratory and other infections. It is hoped that the results from this trial, named Precision 2, would help drive adoption at scale across the NHS. The trial is being designed with inputs under the IDAP program from the NHS, the Medicines and Healthcare products Regulatory Agency, and NICE.

Optimising medication management: lessons from an NHS Trust

By Hardeep Bagga

Hardeep Bagga, Director of Pharmacy at University Hospitals Coventry and Warwickshire NHS Trust, discusses how best to manage the implementation of new technology following the success of digitalising pharmacy services.

University Hospitals Coventry and Warwickshire (UHCW) NHS Trust is one of the largest acute teaching Trusts in the UK, comprising University Hospital in Coventry and the Hospital of St Cross in Rugby, and working in partnership with Warwick University Medical School and Coventry University. It has more than 10,000 staff and delivers services across the West Midlands region. This includes hosting region-wide services such as the Coventry and Warwickshire Pathology Network and Bowel Cancer Screening programme.

In 2018, the Trust launched an ambitious target to begin a journey of digitising their medicines management systems, starting with a Trust-wide implementation of Automated Dispensing Systems to drive safe and legislative compliance with storage. At the time, medication storage was time and operationally intensive on pharmacy and nursing teams. The Trust was on a journey to establish Electronic Patient Records (EPR), and it was agreed that a solution was needed to bring together both challenges; improving medicines storage and security to fully leverage the power of a hospital EPR system.

Initially, we had to present a business case within the Trust, which included recognising the external and internal scrutiny required to ensure we had robust medicines storage; assessment of security, nurse-led audit work, as well as acknowledging the impact of medicines handling on Time to Care. A number of enthusiasts supportive of the programme were recruited from ICT, Nursing, Pharmacy and Estates teams.

Following a competitive tender process, we made the decision to partner with Omnicell UK, who provide advanced automation, data intelligence and professional services, in order to transform operational efficiency and improve patient experience in hospitals.

Omnicell initially worked with us on our first stage installation, which included introducing more than 70 Automated Dispensing Cabinets (ADCs) on wards, in theatres and clinics. Such was the scale of the operation that at the time, it was one of the largest and fastest European rollouts.

Unbeknown to us at the time of committing to the project, but we were inadvertently helping to prepare ourselves for the biggest healthcare challenge the NHS has ever witnessed – the Covid-19 pandemic. Since implementation, the Trust has improved management of medicines during shortages, taken waste out of operational delivery of the supply of medicines, informed teams around medicines safety during temperature deviations, and is now progressing towards closed-loop medicines administration.

Project and installation highlights include the following:

All wards and departments have automated dispensing systems for medication storage (72 units in total), including two in pharmacy for controlled drugs and after-hours support.
Medication Safety Officers (MSO) used a live view to track high demand, essential treatment medicines throughout Covid and beyond.
Temperature monitoring gives an overview of real time temperature of all stock areas to support informed decision-making during temperature deviations.
Digital ordering by automated dispensing systems has reduced nurse time handling medicines by using pharmacy team time saved from ordering medicines redeployed to fill cabinets instead of nurses.
Increasing breadth of stock holding as top up occurs thrice or more weekly, rather than just weekly, across the Trust.

Such was the success of the project, that over the entire pandemic, the wards never ran out of stock of essential Covid treatments by utilising this technology.

Essential elements in the change management process

An effective and well thought out change management process was crucial in gaining buy-in from internal stakeholders and in particular, the nursing team who would be day-to-day users and large beneficiaries of the new technology.

The Pharmacy team at University Hospitals Coventry and Warwickshire NHS Trust (9th from left: Hardeep Bagga)

Valuable best practice lessons can be taken from trusts such as ours, to help support the successful adoption of technologies across the healthcare sector. First and foremost, this includes the need to have a solid change management plan in place to drive employee engagement – employees have to be part of the planning as much as the execution.

Adaptations to technology also tend to go more smoothly when applied from the ‘bottom up’. This can be done by assigning and engaging ‘change champions’ or representatives within different departments. The key overriding factor remains: be the lead on the timeline and rules of the technology, but let your employees decide how to run the show.

A good way to start, as we did at UHCW, was to encourage internal stakeholders to make a list of their wishes and goals from the project at the outset. This was supported by a clear communication and adaptation strategy which emphasised the value and usage of digitalising and automating pharmacy services, and the impact this would have on internal teams, as well as our patients. This helped to ensure the implementation process went smoothly and served to remind us all of the end goal when at times, the project ate into our time or we hit a bump in the road.

It’s important to work closely with your technology partners to ensure effective communication. Omnicell was key to understanding our workflow, mapping this out to ensure systems benefited the way we work, as well as providing ongoing education and training. As partners on the project, the post ‘go live’ support, which included floor walking and handholding for ‘live day’ and the week afterwards, was imperative.

The project is by no means complete and currently we are working towards a key milestone which will be to link the ADCs and our robotic dispensing system to Oracle-Cerner. This will mean that our patient record system will provide a live/real-time view of what’s stocked in cabinets, as well as streamlining workflow and retrieving medications. All with enhanced security and removing process waste to support closed-loop administration.

More recently…

Further enhancing the Trust’s technology adoption, we recently installed two large dispensing robots in pharmacy – Tom and Jerry – with a joint capacity to hold more than 50,000 packs of medication. Importantly, they have allowed for the automation of nearly two million medication transactions which were previously ‘hand-picked’. The time saved allowed a skill mix change within the department, releasing time for Medicines Management Assistants (MMAs). As a result, MMAs are now working directly on wards, and utilising automated cabinets to improve patients’ medication journeys. Dedicated medicines returns units have helped drive the better use of medication and recycling of stock medication at a ward level. The impact has been staggering, saving large amounts in waste prevention.

In addition, all ward stock medication top-ups are now fully automated; the ward ADC sends a message to the robots at 6am and all ward boxes are picked and packed by the robots before the staff come into work. This process previously required manual picking and an accuracy check by another senior colleague, but is now fully automated.

The Pharmacy team last year celebrated winning the CEO Team Award at the Trust’s Outstanding Service and Care Awards (OSCAs), which is positive recognition of its digital transformation.

Find out more about the new MES initiative: Omnicell.co.uk or email: Sales-aa@Omnicell.com