A conversation with Richard Dulcamara, NHS Partnerships Lead - Bleepa

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A conversation with Richard Dulcamara, NHS Partnerships Lead

Richard explains why creating and delivering the right digital infrastructure to support one stop shops for community diagnostics is such a complex yet rewarding process. He also shares his thoughts on how the NHS can transform the way it provides care in a sustainable way.

Community diagnostic centres are a great opportunity for the NHS to innovate in the way that care is provided. While these hubs are key to alleviating care backlogs right now, the health service needs to create a sustainable future for diagnostics. Otherwise we’re going to keep seeing bottlenecks, and these backlogs will build up once again. So I think this is a great opportunity for the NHS, and that’s why we’re investing in being part of that future.”

Richard Dulcamara, NHS Partnerships Lead

Could you tell us a little about your professional background and what led you to join Feedback Medical?

To start with the second part of that question, a great part of what motivated me to come to Feedback Medical was my own experience as a user of the NHS. Sadly, like quite a few people across the country, my family have had a few experiences that left me asking myself questions.

Why was my father passed from service to service over many years before getting the diagnosis he needed? Why was my two-year-old daughter’s emergency department experience so poor? Given where we are with advances in digital infrastructure and communications, why does the NHS still experience problems in being able to provide efficient and effectively coordinated care?

I began my career working in the medical devices industry, covering sales for a pretty large global company, before doing some strategy work for them. That gave me a great understanding of how clinicians work on the ground, how NHS services are commissioned and how patients move throughout the system.

From there I joined a tech company called Advise Inc which created the price benchmarking tool used by the health service in its procurement practices. It was a fantastic environment that taught me a great deal. After a few years NHS Digital then decided to move this capability in-house, so I moved on to start my own business, which is where I got a real appreciation for tech. It allowed me to dive into the worlds of coding and product and user experience.

I then brought all this experience back into the world of health, which led me nicely to joining Feedback Medical in October 2023.

Feedback Medical is investing heavily in the community diagnostic centre programme. What was the organisation’s rationale for focusing on working with CDCs?

We invested heavily in that programme for two key reasons. Firstly, we agree that this is very much what’s needed for patients. Following Sir Mike Richards’ review of how the health service provides diagnostics, the idea to create a network of hubs that provide the x-rays, ultrasounds, blood tests and organ function tests closer to where people live clearly marks an effective way to help reduce the 7.5 million care backlog.

Secondly, our product Bleepa lends itself perfectly to what the CDC programme is trying to achieve, as it alleviates a lot of the problems the centres are facing around connectivity and communication. Imagine you are trying to set up one of these centres to increase capacity for tests from your local primary care providers, acute trusts and district general hospitals. There’s a plethora of different NHS systems you need to connect to in order to accept referrals, perform the tests and then communicate their outcomes back to the care providers across a whole region. That’s exactly what Bleepa facilitates. So greater alignment with CDCs and the networks in which they operate fitted perfectly with our strategy.

On a broader point, these diagnostic centres are a great opportunity for the NHS to innovate in the way that care is provided. While these hubs are key to alleviating care backlogs right now, the health service needs to create a sustainable future for diagnostics. Otherwise, we’re going to keep seeing bottlenecks, and these backlogs will build up once again. So I think this is a great opportunity for the NHS, and that’s why we’re investing in being part of that future.

What lessons has Feedback Medical drawn from the partnerships it has forged with CDCs during pilot initiatives so far?

The first thing we’ve learned is that no centre or region is the same. While every single service is obviously focusing on its distinct population health needs. But understanding the wider context is vital. You have to learn what’s going on in the wider region and the wider pressures these regions are facing.

Right now, the integrated care boards (ICBs) that are responsible for commissioning and outcomes in their individual geographies have direct control over the CDCs until March 2025. From that point the management of the centres will be fully handed over to provider trusts. That’s the background to any implementation of digital infrastructure. So what we have seen is the vital necessity of effective stakeholder management as part of making such a big change.

There are sometimes as many as 40 different stakeholders, starting with the programme director or manager at the ICB level, through to the digital and IT teams at trust level who need to do their due diligence on our software and then schedule in the time to carry out the necessary system integrations to make the pilot a success.

At this stage of the process the key thing that any serious technology company working with the health service needs to understand is there is no one decision maker. Each stakeholder needs to give their stamp of approval before anything can go ahead. That’s why it’s a very complex process.

Finally, what we have seen from our CDC partnership work is that you need the support and ‘buy-in’ from GPs. As the traditional gatekeepers of many care pathways, primary care is hugely influential in the success or failure of new ways of delivering diagnostic services.

The CDC programme is all about creating symptom-based pathways, where the centres become one-stop shops for diagnostics. That’s why it’s important that GPs are on board and don’t continue to send patients off for outpatient appointments. So we have really focused on working to get engagement with them.

Finally, what would you like to see from national leaders in order for community diagnostic centres to cement their future within the health and care system?

Given that the initiative is, relatively speaking, still in its infancy, there is no standard blueprint for what a CDC should do. But with the right backing from central government and the NHS nationally over time those symptom-based pathways I talked about earlier will develop and mature in their own way. When that happens, different areas will be able to provide a more advanced one-stop shop for diagnostic services in the community.

That would mean better outcomes for somebody like my dad – who spent years going from one outpatient appointment to another, from one place to another and from one kind of diagnostic test to another.

When I talk about the need for national leaders to ‘back’ the CDCs I’m also talking about changing certain financial incentives. Right now an inpatient diagnostic test carries a slightly higher tariff payment than, say, the same test in a community setting. So right now, if you’re the financial director of a trust, you’ll be wanting to make sure that your organisation’s inpatient diagnostic services are at full capacity before sending patients off to a CDC. So, in order for patients to always be sent to the right place for best outcomes, those financial incentives need to be tweaked.

As we prepare to embark on another round of CDC pilot schemes across Buckinghamshire, Oxfordshire and Berkshire West, we’ll be applying everything we’ve learned up to this point to better connect clinicians and healthcare settings. We’ll be keen to update everyone on progress soon!


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