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The editorial by di Martino and colleagues1 asks whether there is a role for point-of care ultrasound in UK primary care (GP PoC-US), and we agree with the authors that the time is right to explore and develop its use.
Quite apart from the advantages that an early practice-based scan can bring, many scans are requested on patients who are frail, for whom a trip to the local hospital can be a major undertaking. We are also aware of individuals living in residential care who have missed imaging appointments because of the failure of complex transport arrangements.
The skills to carry out a safe ultrasound can be acquired by training, supervision, and practice, and form part of the training of some specialists. GPs, given our vital role in early diagnosis across multiple clinical disciplines, and the varied community settings in which we work, stand to benefit at least as much.
We have set up a GP PoC-US training programme in Somerset, through a collaboration between the Radiology Department at Yeovil District Hospital and the GP practices who were involved in the Symphony Vanguard project (now collectively known as Symphony Healthcare Services).
We chose four initial scans to learn, for their relative simplicity, and their clinical utility: DVTs, bladder scans (for retention and residual volume), abdominal scans for ascites, and chest ultrasound for pleural effusions. We adopted the Royal College of Radiologists’ training guidelines, with logbooks to record scanning experience. A portable ultrasound machine was acquired and configured to be able to upload images to the hospital PACS server. Training has been delivered by a consultant sonographer and his team, with direct teaching, observing scans, scanning under supervision, and training in reporting.
We are now also working with the local palliative care team to develop a community paracentesis service.
We hope, through a process of audit and reflection, to contribute to the evidence that GP PoC-US is effective, safe, and of benefit to our community. One day it could be the ‘new normal’.
- © British Journal of General Practice 2021
