The South West London Acute Provider Collaborative (SWL APC) Diagnostics Programme team implemented a range of activities to improve diagnostic services across their system.
1. Successful initiatives to clear diagnostics backlog and reduce clinical risks associated with delayed diagnosis
A comprehensive strategy was implemented across each of the trusts experiencing challenging performance across diagnostic modalities (imaging, echocardiography, and endoscopy):
a) Maximising productivity and utilisation - this included changing administrative working patterns to enhance booking efficiency, adjusting radiologist job planning to achieve reporting turnaround time targets, and expanding capacity through six/seven day working.
b) Waiting list validation - The implementation of echocardiography waiting list administrative and clinical validation processes enabled the service leads and booking teams to book patients and manage the backlog more effectively. As a result, performance significantly improved with a higher proportion of patients being seen within six weeks of referral. Overall, South West London Integrated Care Board (ICB) performance also improved, with the ICB moving from lowest performance across London to second position.
c) Collaborative working - the acute providers in South West London have supported each other through mutual aid initiatives resulting in the delivery of over 1600 echocardiography tests, 1000 Magnetic Resonance Imaging (MRI) scans, 357 colonoscopy procedures and 150 Non-Obstetric Ultrasound Scans (NOUS). This collaborative approach has significantly improved diagnostic performance across the system, with six-week performance improving from 20% in June 2020 to 89% in 2025.
2. Community Diagnostic Centres
The roll-out and implementation of the Community Diagnostic Centres (CDC) programme has been successful in significantly increasing diagnostic capacity across South West London (SWL). Since 2021 the Acute Provider Collaborative (APC) has worked to implement four new CDCs, in locations closer to more deprived areas of the system. Three of the four SWL CDCs are fully operationalised, with the fourth CDC scheduled for June 2025. This has brought more revenue and capital funding to the sector, enabling them to increase their capacity and resources both in terms of equipment, rooms and staff.
The CDCs have delivered a total of 726,000 additional scans/tests between 2021 and 2025; this represents 26% of the total diagnostics tests delivered since 2021/22 (2.8m scans and tests). This equates to 46% of the total CDC activity across London.
The SWL CDCs have reached the national standard for productivity for the number of scans completed and did not attend rates have reduced through regular reminder calls and messages to patients. As a result, utilisation has improved, and there are opportunities to build on this further.
Through the CDC programme, the additional equipment the provider collaborative acquired includes:
- Five CT scanners
- Three MRI scanners
- 13 ultrasound scanners
- Three endoscopy stacks
- Six echocardiography machines
3. Additional Capital Funding
All four acute trusts have been supported to secure additional capital funding, which has enabled teams to procure additional equipment to support service delivery. The programme has have been very successful in securing record levels of capital funding as follows: c.£1.4m funding to upgrade x-ray equipment and enable AI software for MRIs, and £3m to establish additional space for bowel cancer screening and to purchase endoscopy stacks.
4. Enhancing productivity, releasing efficiency and workforce development
The South West London Imaging Network, which is a key component of the diagnostics programme, has been striving to enhance productivity across imaging services through the implementation of new technologies and upgrading of equipment. This has resulted in the delivery of approximately 6000 additional MRI scans (April 23-October 24) and 6287 x-ray tests (April 24-December 24).
The programme, in partnership with the acute trusts, has been seeking to acquire better value on a range of external contracts. This includes image acquisition contracts for relocatable scanners and image reporting outsourcing contracts. Through the collaborative effort this has resulted in a cost saving of approximately £0.8m in 24/25, and £1.5m annually.
The services experience shortages in trained diagnostic staff (including radiologists, pathologists and endoscopists) which has been impacting on service delivery. The collaborative has been working through initiatives to enable SWL to become an attractive place to work, which include targeted international recruitment, training programmes, developing innovative ways of working through skill-mixing and shared roles.
The imaging network has recently piloted an Imaging Training Academy, and through the training academy they have delivered over 400 hours of ultrasound training and multiple study days (dental, modality introduction, image interpretation, leadership, induction and preceptorship).
They have also been working in collaboration with colleagues in South East London to secure £100k funding for a practice educator post to train echocardiographs and have secured training resources (£138k) to support clinical endoscopist training.
5. Digitalisation
The collaborative has initiated a digital transformation programme to improve connectivity across the four acute trusts. This includes implementing a single Radiology Information System (RIS) which enables the teams to monitor workloads and support the workforce. Additionally, they have rolled out 76 workstations to their reporting radiologists and radiographers, facilitating home reporting which they hope will enhance productivity and job satisfaction.