Right-first-time: raising the bar at NHS Wakefield.

08th February 2017

“If you don’t get it right first time, money is wasted by inefficiencies.” Dr Philip Earnshaw, Wakefield GP, CCG Chair: R4 Today Programme, 8th February 2017.

Who else heard this? The entire Department of Health and all who sail in the good ship NHS, I hope. Dr Earnshaw was talking generally about primary care practice, yet he could easily have been talking about the staggering waste generated by casual NHS and private sector attitudes to a basic diagnostic process, one that is carried out 65m times a year, every year.

Last October I met Professor Tim Briggs, creator of the Department of Health’s Getting It Right First Time Programme (GIRFT). He was unaware that an average 18% (and up to 70%) of urine specimens used for essential diagnoses are unreliable.

The Professor accepted that this could lead to delayed diagnosis and treatment and to avoidable repeat GP visits, which in the current climate our doctors could do without. Unreliable urine samples may also, as cited in this morning’s Today Programme, fail to identify urinary tract infection and prevent an elderly patient from leaving hospital. This last nugget is called “bed-blocking” and is a contemporary hot potato.

Given the insight of those being interviewed on R4’s Today and the £5 million predicted annual saving achieved through collaboration and a right first time policy, it is perhaps no coincidence that the GIRFT Urology Lead is based in Yorkshire, or that the diligent NHS in Wakefield has already identified the problem of unreliable urine samples. Some weeks ago we agreed a date to present and evaluate our solution, Peezy Midstream.

To explain the extent of problem urine specimens, the graphic above shows mixed-growth (contamination) rates across four regions of the UK.

Based on current specimen collection practice, of these 3.9m samples 790,586 patients will not be accurately treated first time. They will most likely be recalled for a second or third appointment, triggering more costly lab tests, healthcare professional time and material resources, including hospital beds.

Furthermore, when no retest is carried out and no accurate result obtained, these patients may be prescribed a broad spectrum antibiotic, against which around 20% of UTI bacteria are already resistant … and we all know where that little problem is going.

A recent debate in the House of Commons points to untreated UTI leading to the highest recorded rates of Chronic UTI, which causes immense suffering and wrecks lives.

The NHS in Wakefield is championing a principle that in any other sector would be implicit; repeated processes lead to unnecessary expenditure. Whilst the NHS has myriad improvements and savings to make, collecting reliable urine specimens should be the least of its problems. Yet its track record around this common area of basic diagnostic medicine is pitiful, albeit inevitable given the procedure has no protocol or established gold standard.

A rare piece of MedTech, Peezy Midstream is designed to reduce the size of its own market, whilst delivering massive cost and time savings to NHS and private providers.

According to Forte Medical’s independent economic model for Peezy Midstream technology, the regions outlined above could collectively enjoy direct savings on retesting of £2.2m and efficiency savings of £79.3m across all aspects of related expenditure. National savings reach £1.2bn.

Dr Phillip Earnshaw has a point: get the basics right … and the rest will follow.

This article first appeared on LinkedIn.