Central Camden Primary Care Network’s community bowel clinic has been able to reduce waiting times by as much as 74 weeks, thanks to the introduction of new technology that can give a direct visualisation of the anorectal tract.
The Bloomsbury Clinic, part of the PCN, has introduced s digital rectoscope, the LumenEye X1 from SurgEase. It is enabling physicians to look into the rectum – something that is unusual in general practice.
The LumenEye can be operated by a single person, and be comfortably used without sedation or overnight bowel prep with oral laxatives. Crucially, the device’s HD camera delivers high-quality images and video of the lower bowel, helping GPs to spot rectal cancer, and diagnose other bowel issues such as inflammatory bowel disease and haemorrhoids.
It can be hard to distinguish the cause of rectal bleeding because imaging someone’s back passage in general practice is difficult. Guidelines say that if there is an obvious cause for somebody’s rectal bleeding then there is no need for them to be referred. But often a more thorough examination is needed – which usually means a patient being referred to the hospital if they have persistent bleeding.
Dr Ammara Hughes, general practitioner, Bloomsbury Surgery and clinical director, Central Camden PCN, said: “The main advantage of this kit is we can take pictures and save them in a cloud-shaped secure area. So if we see something that looks a bit abnormal, we can save the pictures on the cloud and one of our consultants from the hospital can actually log in and look at it remotely, and tell us whether it’s something that needs to be referred, for example rectal cancer, or nothing to worry about.”
Central Camden PCN has been training up its allied health professionals since last summer to help tackle this backlog. The technology was introduced to the clinic in July 2023 and a consultant spent six months supervising the allied health professionals while they did the procedures, to make sure they were doing everything correctly. They’re now working independently under the guidance of colorectal surgeon, Mr Alexander Von Roon from University College London Hospitals NHS Foundation Trust, which has meant significantly stepping up the volume of patients being seen.
“Our consultant from secondary care has trained our allied professionals to use this device, and he’s trained them how to recognise hemorrhoids and anal fissures – two common conditions which cause bleeding,” explained Hughes. “They’ve also been trained to actually inject the haemorrhoids so that people get treated within the community. And when that’s done it means that we don’t have to refer them into hospital.”
Dr Hughes acknowledges that patients in the local area are currently waiting about 78 weeks for NHS treatment. Using the LumenEye has meant that GPs can safely examine patients with rectal bleeding and be confident they’re not missing anything abnormal. Simultaneously, patients with conditions that are not serious can be treated quickly at the GP surgery.
“When patients are referred to our bowel screening clinic the waiting time is just four weeks,” said Hughes. “We can run a clinic all day where we can see between 12 and 15 patients. Where we see these simple conditions we can actually treat them as well.”
The Central Camden PCN estimates that the community bowel clinic could save North Central London Integrated Care Board almost £250,000 a year, by being able to treat some issues within primary care. Each patient treated in the community delivers an estimated saving of £1,178, and the clinic anticipates it will see over 200 patients by the end of the pilot.