How successful are the early adopters of the community diagnostic centres?

The creation of Community Diagnostic Centres was recommended following Professor Sir Mike Richards’ review of NHS diagnostics capacity. The minimum requirements for the CDC model archetypes range from simple phlebotomy tests through to more time-consuming gastroscopy and magnetic resonance imaging tests. In October 2021, the Department of Health and Social Care announced that 40 new CDCs would open across England in a range of settings, and in April 2022 it was declared that 73 centres were already open and providing 30,000 additional tests a week. The most recent announcement also set out the aspiration to have 160 CDCs up and running by 2025.

It was not stated exactly what type of tests have been operationalised and included in the 30,000 tests being performed weekly. The absence of granularity here hinders visibility of the scale and complexity of what has already been implemented, and therefore what the real contribution of the CDCs have been so far to increasing diagnostic capacity and facilitating earlier diagnosis. Whilst there will be variance in the type of tests and volume of activity arising out of the CDCs, this equates to only 411 tests per week per CDC. This intimates not all the centres are indeed fully functional in terms of range and volume of tests or utilising the full physical estate available. A recent article published by openDemocracy also casts doubt on the status of the “scores” of CDCs declared to be up and running by health and social care secretary Sajid Javid in Parliament in February 2022, also evidencing significant involvement from the private sector for those CDCs proven to be functional.

Staffing requirements for the CDCs were calculated to be in the region of 6,000 additional staff, however it is questionable as to whether these staff exist as evidenced by the number of unfilled posts across health services in England (recently rising to 110,192). Given the workforce constraints, a long-term workforce strategy is arguably the only real solution to developing a sustainable diagnostic workforce supported by targeted investments.

We contacted the 40 early adopters of the CDC model at integrated care system/place level to establish the maturity of the CDC workforce in terms of strategy, composition, governance arrangements and alignment to elective access hubs and diagnostic training academy developments. Many of the requests were either diverted back to the acute trusts, or to the private sector. Very few organisations confirmed that a workforce strategy existed, with the majority stating that a strategy did not exist or that it was in development, and only a minority of organisations confirmed that they had assigned a lead employer with responsibility for this function. Strategising how staff will be deployed to the CDC model, how they will be developed, flexed, and what governance and legal arrangements will be instilled is clearly of huge importance. It is difficult to see how a piecemeal approach to the staffing of the CDC model would provide both workforce sustainability and flow given the variances in staff terms and conditions, and availability. A lead employer or host organisation approach with centralised recruitment, training, rostering and management of staff is a more effective solution. More so, a system approach to providing a futureproof workforce would be more likely to provide the capacity and capabilities required to realise the vision.

Workforce shortages and skill gaps will continue to undermine diagnostic capacity if this is not addressed with a system lens

What is remarkable is that despite CDC requirements being calculated at 6,000 staff, the responses received show that some of the CDCs had recruited minimal levels of staff with some confirming that no additional staff had been recruited. Most of the responses did however confirm that staff are being rotated between original base and the CDC or “lift and shift”.

Enquiries around the employment status of staff currently working within the CDCs did not deliver clarity in all cases, although a large proportion of organisations demonstrated a high private sector involvement or agency staff usage. Where recruitment of permanent staff had been performed, the majority of those recruited were imaging or administration staff, suggesting that either sufficient diagnostic staff to cover the CDC minimum requirements issued by NHS England existed within the system, or again that a limited range of tests have so far been introduced at this stage.

Additionally, limited evidence of linkage to diagnostic training academies and capacity building developments, such as elective surgical hubs, was seen in the various approaches at this stage.

Many of the CDCs declared as “up and running” are clearly still in the process of developing the required workforce needed to perform the range of tests aligned to local population needs. Workforce shortages and skill gaps will continue to undermine diagnostic capacity if this is not addressed with a system lens.

At Acumentice, we understand the challenge facing providers in meeting the needs of patients waiting for diagnosis, treatment and follow-up care. We also appreciate the importance of understanding the appropriate workforce needs to meet demand in the right place across the end-to-end pathway.

Our partnership approach with organisations aims to support a greater understanding of capacity requirements aligned to current and future demand, facilitated through demand and capacity modelling, skill mix reviews and advice around workforce optimisation.

The creation of strong partnerships and a collaborative approach to workforce planning will be imperative in supporting recovery and ensuring the right strategy is in place to help shape a flexible and futureproof workforce. Such system level workforce strategies will be a key foundation in delivering the CDC vision successfully.