What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

As a GP in a rural setting, I am often frustrated by the barriers to my patients accessing the right services in a timely fashion. I have been using point of care ultrasound (POCUS) to aid diagnosis in the community, especially in elderly and housebound patients who find it difficult to travel a 90minute round trip to the local hospital. With simple training I have been able to diagnosis, DVTs, abscesses, joint effusions, gallstones and joint problems, amongst many other conditions, saving resources for my secondary care colleagues, and saving my patients a long round trip, and directing them to the appropriate service from the start.

Efficient use of resources at the primary and secondary care interface is especially important in NI, with the longest waiting times in the UK. The burden on our ambulance service and ED departments exceeds any where else in these islands. GPs can help, however.

What does your project aim to achieve?

My vision is:

• to design a curriculum for primary care POCUS training;
• to assist in provision of ultrasound equipment with remote mentoring functions

This will enable upskilling of GPs, both trainees and qualified doctors, to implement a novel approach to primary care diagnostics in Northern Ireland.

How will the project be delivered?

This is an entirely new concept in Northern Ireland, and still in its infancy in the UK. However, POCUS is used to a greater degree in Western Europe. I have already established links with colleagues in other parts of the UK who are interested in primary care POCUS, and am participating in a research study run by EFSUMB (https://efsumb.org/) on primary care POCUS.

I have spent the last 3 years familiarising myself with many of the ultrasound devices on the market, and trialling implementations of them in my own practice in a safe and effective way, and have also started reaching out to GPs in NI who may be interested in developing their skills, or who have previous secondary care ultrasound experience.

I am investigating the possibility of using reconditioned ex-hospital equipment, or of re-using loaned items for initial training periods, in order to reduce cost and help prevent electrical waste.

How is your project going to share learning?

The concept of POCUS is fairly radical in NI and UK – non-specialists using novel handheld and portable equipment, outside of a hospital setting, to answer clear, binary yes/no questions of patients’ examination findings, as an aid to existing clinical examinations, to help prevent inappropriate referrals, direct patients to the correct resources first time, and to upskill GPs, helping retain and encourage a specialty which is currently struggling to regain its mojo.

There is a trickle-down effect, not just of the ultrasound technology, but of the skills and lessons learned from ED and Respiratory colleagues who use similar techniques, and now incorporate them in their curricula. If we can build a simple core set of diagnostic scenarios, with simple yes/no questions asked of our ultrasound findings, then we can encourage both GPs, but also our secondary care colleagues that this is a legitimate resource, and eminently scaleable UK-wide.