Following an inquiry into Community Diagnostic Centres (CDCs), the All-Party Parliamentary Group for Diagnostics has published its first report, highlighting the clear benefits of the programme with each ICS having at least one CDC site, but also concerns over their placement, workforce and funding.
As part of its inquiry into CDCs, the APPG for Diagnostics held two roundtables in June and July 2023 to investigate the current state and future of the programme. Chair and former health minister Maggie Throup MP led discussion with the support of the joint secretariat, The Royal College of Pathologists and The Royal College of Radiologists. The report, CDCs Unveiled: Challenges & Triumphs An Inquiry into Community Diagnostic Centres shows that NHS England and the government have made strides in delivering the CDC programme, approving 174 CDC sites and opening one in each Integrated Care System (ICS). However, concerns persist about unequal geographic distribution and funding constraints for future expansion.
CDCs are multi-diagnostic facilities created to bolster local diagnostic capacity; enhance patient access, experience and outcomes; alleviate hospital burden; and address regional disparities in healthcare. They provide a range of imaging, endoscopy, physiological science and pathology services.
Initially proposed in Professor Sir Mike Richards’ report, Diagnostics: Recovery and Renewal, CDCs stemmed from the need to separate emergency and elective diagnostics for improved efficiency. Sir Mike Richards’ report also advocated for investments in new service models, equipment, digitisation, and workforce. These topics formed the core focus of the APPG for Diagnostics’ inquiry. CDCs play a key role in achieving the government’s goal of reducing waiting lists by expanding capacity and implementing the NHS Elective Recovery Plan.
Summary of findings
Progress against targets: Analysis of CDC activity reveals a slow pace, with only around 5 million tests conducted since July 2021 against a target of 17 million by 2025. Collaboration with the private sector has expanded services, but persistent high demand and limited capacity pose ongoing challenges, emphasising the need for continuous scrutiny and transparency from NHS England to assess the impact on patient outcomes.
Location of CDCs: Embedding CDCs in the heart of communities, after successful public engagement, improves access to diagnostic services – especially for those less likely to seek healthcare. CDCs are strategically boosting diagnostic capacity in underserved communities, helping to reduce health disparities. However, questions remain over how many CDCs are truly community-based, with 5.2% and 41% of approved CDC sites located on acute hospital and community hospital estates respectively. NHS budget deficits, high upfront costs, and risks with privately renting retail spaces limit CDC placement in community hubs. Overcoming these obstacles is crucial for ICSs to make the "brave" choice of placing CDCs where they can significantly impact community healthcare.
Right tests, checks and scans: CDCs provide essential diagnostic services, encompassing imaging, physiological measurement, and pathology to meet high healthcare demand. Additional services, tailored to meet local needs, have and should be integrated to establish CDCs as true ‘one-stop-shops’ for patients. Unfortunately, a lack of data and research limits the assessment of the programme’s effectiveness in achieving this goal.
Physical and digital infrastructure: Although CDCs are largely equipped with up-to-date machines, crucial for accurate and efficient diagnostic procedures, there are huge gains to be made by innovating the digital infrastructure within CDCs. Digital tools, such as the iRefer tool and NHS App, are vital to streamlining diagnostics, improving efficiency and patient engagement. Unfortunately, despite pilot projects showing significant benefits, challenges in basic infrastructure, data sharing, and inconsistent digital advancements persist, underscoring the need for additional funding for robust digital infrastructure.
Workforce: Ongoing staff shortages, demonstrated by shortfall figures and reports of unmanageable workloads, compounded by insufficient workforce planning and funding, limit CDC effectiveness. Proposed workforce solutions include acute/CDC rotation models, international recruitment, ‘grow your own’ initiatives, and private sector collaboration, each with its own advantages and drawbacks. Ultimately, there is an urgent need to expand the diagnostic workforce in line with growing patient demand.
