Annex A > Chapter 10 - Outreach Cardiology Clinics > Introduction > The concept of outreach clinics

The concept of outreach clinics

3 Dr Robert Swanton, consultant cardiologist and President of the British Cardiac Society (BCS), told the Inquiry how outreach clinics work in the area in which he practises:

`We send a surgeon out to one of our referring centres every month, to do a sort of joint clinic, and it is very much appreciated by both units. It ensures very good communication and patients like to see their surgeons after the operation, and it works very well. It is time-consuming. It takes essentially a whole day out of the surgeon's or cardiologist's week by the time you have got down there and back again, but it is very valuable.

`I think in time, it will become less important as more of the DGHs [District General Hospitals] have established two cardiologists per hospital. A lot of these cardiologists are single cardiologists in a hospital managing a whole unit on their own with no support. They are people who need the outreach support from London or the big cities.' [1]

4 Dr Ian Baker [2] explained the concept of outreach clinics in his statement. He said:

`"Outreach" clinics were clinics where paediatric cardiac clinicians from Bristol practised away from their base facilities at BRHSC and BRI in facilities of other Health Authorities.

`"Outreach" clinics can be considered as serving: children and parents; referring paediatricians; the development of cardiac services in Bristol; and Health Authorities needing access to paediatric cardiac services.' [3]

5 The 1987 `Annual Report for Paediatric Cardiology and Cardiac Surgery' at Bristol said the following about outreach clinics:

`During the 1970s, joint clinics with the local consultant paediatricians were established throughout the South Western Region ... At the invitation of consultant paediatricians in South Wales, joint clinics were also established in Abergavenny and Newport in 1986 and in Swansea, Carmarthen and Haverford West in 1987. Apart from the obvious benefit of convenience for the families and economy for the host Health Authority, these clinics have an important teaching function for the local Registrars, SHOs and visiting students during their paediatric training in District General Hospitals.' [4]

6 Dr Hyam Joffe, consultant cardiologist, explained the thinking behind Bristol's outreach clinics:

`The peripheral clinic concept was highly successful in fulfilling the following objectives close to the children's homes, instead of the family having to make frequent long trips to Bristol:

• `assessing new non-urgent patients with suspected cardiac abnormalities, referred by consultant paediatricians,
• `maintaining observation on previously diagnosed cases to monitor medication, if required, and to assess further progress,
• `ensuring timely referral for cardiac catheterisation and/or surgical intervention due to evolutionary changes in the nature of the condition,
• `continuing short- and long-term observation on post-operative cases after the initial one or two assessments by the surgeons in Bristol, ...
• `updating paediatricians throughout the region of the latest advances in the ever-changing medical and surgical treatment of cardiac conditions,
• `teaching clinical signs, ECG and chest X-ray features, aspects of basic echocardiography and management of children with cardiac disease to medical students and, especially, GP trainees, paediatric SHOs, registrars and SRs, who frequently joined the clinics.' [5]

7 Mr James Wisheart, consultant cardiac surgeon, explained that:

`These visits to other centres enabled good professional relationships to be established between the referring paediatricians and the cardiological team in Bristol.' [6]

8 Building relationships with local paediatricians was also considered important, as well as fulfilling an educative role. Dr Baker said of referring paediatricians:

`Access to paediatric cardiological and surgical advice and services was achieved through these clinics in the South Western Region and parts of the Wessex Region from 1984.' [7]

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Footnotes

[1] T7 p.53 Dr Swanton

[2] Formerly the District Medical Officer for B&WDHA from July 1984 to October 1991, and subsequently a Consultant in Public Health Medicine for the B&DHA from October 1991 onwards

[3] WIT 0074 0020 Dr Baker

[4] UBHT 0166 0006; `Annual Report for Paediatric Cardiology and Cardiac Surgery', 1987

[5] WIT 0097 0143 - 0144 Dr Joffe

[6] WIT 0120 0069 Mr Wisheart

[7] WIT 0074 0021 Dr Baker