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INTRODUCTION

The purpose of this study was to determine the feasibility of promoting ultrasound scanning in general medical practice across the UK as an additional GP skill.

METHODS

RESULTS

The chart shows the percentage of positive responses received.

CONCLUSION

The introduction of GP USS would require a change in culture, a veritable paradigm shift, but it can be hoped that such a change is not only possible, but desirable, if not inevitable.

• TO CHANGE THE WAY PRIMARY CARE IS DELIVERED

• TO GENERATE SAVINGS FOR THE NHS

• TO INCREASE PATIENT SATISFACTION

• TO RESTORE GP MORALE

The aim is to disrupt the status quo.

ABSTRACT

OBJECTIVES

THE PROCESS

The various stages of the project are illustrated in the diagram.

CONCLUSION

Change is seldom easy, particularly where it affects the culture of an organisation - “the way things are done”.

GPs need to think of ultrasound as the next step beyond the stethoscope in the diagnostic process.

REFERENCES

Blois B (2012); Family Physician Using US for AAA screening; Canadian

Family Physician, March 2012, Vol. 58(3), pp. 172-178

Doddy J (2009); Using Ultrasound in Primary Care; GP (magazine) 5 February

2009

Katz JF and Yucel KE (2011); Letter to the Editor re Point-of-Care

Ultrasonography; The New England Journal of Medicine, 26 May 2011, Vol.

364, pp. 2075-2076

Moore CL and Copel JA (2011); Point-of-Care Ultrasonography; The New

England Journal of Medicine, 24 February 2011, Vol. 363, pp. 749-757

Rubano E, Mehta N, Caputo W, Paladino L and Sinert R (2013); Decent Meta-

Analysis of AAA shows great sensitivity at the bedside; Academy of Emergency

Medicine, February 2013, Vol. 20(2), pp. 128-138

ACKNOWLEDGEMENTS

Fiona Urquhart, my MBA supervisor, whose comments were always

constructive and who saw the potential of this project for service innovation.

Prof Budgie Hussain, who showed me many years ago how ultrasound

scanning can enhance the GPʼs diagnostic process.

Dr Joe Rosenthal, who provided invaluable insights into possibilities for

introducing ultrasound scanning into the medical student curriculum.

CONTACT

Dr David Lukey

Tel.: 077 6969 6612

Email: dvdlukey@aol.com

I. PILOT STUDY

The outcomes are expected to be:

1. A high level of patient satisfaction;

2. An increase in GP morale;

3. Plaudits for the CCG for being innovative.

II. ROLL-OUT TO THE REST OF THE UKIt is expected that the evidence gained from the pilot study will persuade CCGs in England, followed by the rest of the UK, to adopt ultrasound as an additional GP skill.

HIG (Healthcare Innovations Group) Ltd

David Lukey; Kevin Rennie; Miguel Neumann; Lawrence Perry

FACILITATING THE USE OF ULTRASOUND SCANNING IN GENERAL MEDICAL PRACTICE IN THE NATIONAL HEALTH SERVICE

It is gratifying to realise that the choice of scenario planning as the basis for the ultrasound study has this endorsement.

GENERAL REVIEW RELEVANT TO NEW SERVICE DEVELOPMENT

In the following review of the theory related to the introduction of new services, the theory will be linked to the GP ultrasound project at every stage, as theoretical concepts without linkages to real undertakings will ultimately be of little value.

The introduction of any new product or service is bound to encounter resistance, and the eventual success or failure of the venture will depend on whether the combined driving force or the combined opposing force proves to be the stronger.

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This concept of opposing force fields was first postulated by Kurt Lewin as far back as the 1940s and is still frequently referred to by academics in the field of change management. The driving forces are the positive forces for change, while the restraining forces are the obstacles to change. In the GP ultrasound service which is the subject of this survey, the driving forces are anticipated to be the enthusiasm of GPs, GP trainees and medical students, with the possible alliance of academics, while the opposing forces are likely to be radiologists and full-time sonographers who are protective of the status quo, possibly allied to GPs who are reluctant to change or who have not identified a need for such a service.

Closely linked to Kurt Lewinʼs Force Field Analysis is his Model of Change, which is also still the subject of discussion in many business schools.

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Commissioners

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Providers of equipment

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Grönroos (2007) discusses various attempts at determining/measuring the quality of service delivery, notably SERVQUAL, RATER and the ten service quality determinants proposed by Berry et al. (1985). These ten determinants were Reliability , Responsiveness, Competence, Access, Courtesy, Communication, Credibility, Security, Understanding/Knowing the Customer, and Tangibles. There should be no

difficulty relating these ten determinants to the GP ultrasound service proposed in this study, and it should also be clear that customer (patient) satisfaction should be high, as the service should tick most (if not all) of the ten boxes.

In a later publication, Zeithaml et al. (1990) distilled these ten determinants down to five, to create the RATER model, retaining Reliability, Responsiveness, Assurance and Tangibles, and introducing Empathy, which covers previous determinants such as courtesy, communication and understanding. Once again, it should easily comprehensible how GP ultrasound is likely to rank high in patientsʼ perception of general medical service.

SERVQUAL is an instrument based on these five determinants of RATER, augmented bya comparison between the customersʼ expectations of how the service should be delivered and their perception of how it was delivered.

Kang and James (2004) took a critical look at the so-called “Gro ̈nroos model” or European perspective, as opposed to the American perspective. The European perspective is that quality consists of three dimensions - technical, functional and image - and that “image functions as a filter in service quality perception” (p.1 of abstract). They conclude that the

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The investigative

net was spread

wide to include as

many stakeholders

as possible.

It was felt that a

mix of survey

techniques would

deliver the most

credible results.

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