Introduction

Hywel Dda University Health Board have been considering the impact of projected demand and capacity implications of the First Line Faecal Immunochemical Testing (FIT) within the bowel screening programme in order to assess the impact from:

• Increased uptake of the test due to changes in the administration of the test
• Changes to the sensitivity of the test and what level an individual would be invited for a diagnostic procedure
• The lowering of the age to which an individual is sent a test

As part of this we have reviewed the current capacity across the Health Board, currently we are meeting the requirement to offer a procedure date within 2 weeks of undertaking the Screening Practitioner (SP) assessment appointment.

Next steps

We are now working to identify the Demand and Capacity required to deliver the service based on the increased uptake of 6.4% due to the implementation of FIT.  It is expected that Hywel Dda’s activity will increase by 115 patients during 19/20 and a further 236 during 20/21.  During 19/20 we will be able to manage the increase by establishing an additional BSW weekly list at PPH, during this time we will be reviewing our workforce and capacity to deliver the increases required from 20/21 onwards. 

To undertake this review a local project team is being developed who will work together to implement and manage any changes in practice, we hope to work with our Primary Care colleagues to support early diagnosis through FIT testing by general practitioners.

The group will include:

· Clinical champions

· Service manager for Endoscopy

· SNM for Endoscopy

· Specialist Screening Practitioner Lead

· Programme Manager for Bowel Screening Wales

· Management sponsor

· Laboratory manager and consultant clinical scientist

· GP cluster leads

· Gastroenterology team

· Information technology department lead

· Clinical audit facilitator

· Finance business partner

Future Plans

In addition to the above the Health Board is also pursuing a Business Case for the development of new endoscopy facilities for Prince Phillip Hospital (PPH), this will allow us to create additional capacity, for BSW increased uptake and the growing demand for diagnostic testing. 

Further capacity considered would be the expansion of the bi-weekly list at Bronglais General Hospital (BGH) to a weekly list, Withybush General Hospital (WGH) also has the capacity to increase the number of lists delivered for BSW.

Currently we have 2 Nurse Endoscopists in training for the Health Board who are due to qualify in December 2018, these posts have been progressed as a contingency to managing the increased demand for routine endoscopy, to allow for Clinician capacity for the more complex Endoscopy, including BSW screening. 

The IMTP being developed within Scheduled Care includes an aspiration to increase staffing numbers within the Endoscopy service to ensure all units are working at full capacity, this could include 3 session days and / or 6 day working. 

The Health Board is fully engaged in the National Programme for Endoscopy and continues to work on a regional basis with ABMU, across both the BSW programme and diagnostic endoscopy.