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In your consultant interview, you may get asked questions on developing or setting up a new service. To the uninitiated, it may be as simple as get a person to do that task. Essentially, setting a new service requires an understanding of components of the service. It should be done in steps. This is an opportunity for you to bring in your awareness of improvement models.

Unfortunately it is not just that. Any service requires three key elements:

  • Money: You need to pay staff that is providing the service as well as to buy equipment necessary.
  • Manpower: Skilled people to run and manage the service
  • Material: Office equipment, medical supplies and maintenance

You should have been exposed to service development. This may have either been discussed in the governance or departmental meetings. If you are not aware of the concept, speak to the service manager or a consultant in your department.

Pause and think what happens before and after you see a patient in clinic or in ward or when they require a procedure? Let us look at the process (please note this is not an exhaustive list):

•          Patient referred (ED/GP)

•          Reference reviewed: accepted/rejected

•          Communicate to the referring source

•          Appointment to be booked: Letter created, printed and posted

•          Text to the patient by admin/OPD team

•          Transport booked by admin (GP or hospital)

•          Patient visit clinic  (need transport, parking)

•          Sign post/reception to direct to OPD

•           OPD clerk

•          To check in

•          Get notes from medical record

•          Record the outcome after clinic consultation

•          Clinic Nurse

•          Checks  vitals and record in notes

•          Clinician: See patients, dictate letters, request investigations (blood/imaging)

•          Patient gets to phlebotomy service: need to book at phlebotomy reception

•          Phlebotomist take blood/urine sample, samples sent to lab

•          Porter: Move patient between areas, take samples from phlebotomy to lab

•          Laboratory: Admin /clerk receive sample and log them

•          Lab technician: Does test, generate report, 

•          Call responsible team for abnormal results

•          Consultant in biochemistry approve tests results

•          Request received in radiology: Admin team prints out requests from clinician

•          Radiology consultant approve request

•          Admin book appointment for investigation: Clerk print and sent appointment

•          Radiologist: Approve request, Report investigation, Participate in relevant MDT

•          Secretary: Types letter/print and post, Receive calls from GP , patients, relatives, other services, Liaise with relevant clinicians,  Cancel clinic when clinician away

Patient journey from referral to visit

As seen from above, setting up a new service requires a lot to be considered.  It is not just getting a clinician and a nurse to get patient seen. It has implications on work load of many others and that need to be considered as it has job planning issues. For example, when new service is set up, it requires imaging and hence more radiological tests are ordered that require reporting.

A new service should be set up with a thought out process. Five steps model* proposed by NHS England simplify the process for service improvement. Similar approach can be adapted to set up new service.  

Foremost in the process is to convince the key players (stakeholders/budget holders, buyers, your colleagues) to justify why this is needed. You should have evidence of poor performance due to lack of it or problems (patient satisfaction poor outcomes, datix data). Even GIRFT recommendations can be useful. Change in guidelines? NCEPOD recommendations? Use all you have to justify whey? There should be a buy in from the ultimate user: primary care providers and/or integrated care boards (ICBs). Don’t forget the funding and income matrix. It would be easy to set up it creates revenue and requires minimal investment or uses existing resources.

Do incorporate robust governance to keep the service safe, write SOP (standard operating procedure for service) and relevant guideline and circulate. Once launched service need advertising and that requires trust communication team and service managers to liaise with the ICBs.

You may meet resistance when a new service is proposed. This could be for various reasons. Think why the project is objected to and come up with convincing rationale or back off. Do not give up though and keep collecting data that convinced you originally that a need existed and start again.

Be a realist. Recognise your abilities. 

When answering such questions, ensure that you have assessed the needs and understand its implications (financial, work load implications and impact on job planning). Do involve others (colleagues, managers) to ensure the idea is viable, sustainable and the department agrees with the vision. Look at the governance aspect , do risk benefit analysis, get feedback from users (patients GP etc). 

identify what you need (take example given above) to deliver safe and efficient service with regular feedback and safety whilst minimising risks and wasted resources (money, manpower and material). Regularly review performance and improvise as needed (PDSA cycle of change). 

Don’t forget to give example of something you have set up or seen how it was done and what was your learning. Can you replicate it? 

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