GPs do not always have the opportunity to review sufficient numbers of ECG traces in their own practices to be able to confidently interpret the hundreds of possible variations. As a result, many refer their patients to secondary care for outpatient appointments.

This project came into the NHS Technology Adoption Centre following a large pilot conducted in the North West of England. Broomwell HealthWatch a provider of telemetric ECG interpretation worked with GP practices and established NHS Walk-In Centres to establish 12 lead ECG facilities in community settings. The Centres were recruited with the support of the Lancashire and South Cumbria Cardiac Network.

In Lancashire and Cumbria each location was asked to use the equipment exclusively for the 6 month duration of the pilot and to participate in the audit of the outcomes. Ipsos Mori was asked to gather the findings and produce an independent report.

Broomwell HealthWatch provided the surgeries with telemetric 12 lead ECG machines which are used in an identical manner as conventional machines but which enabled the recording obtained to be transmitted wirelessly along a land based phone line direct to the reading service at Broomwell HealthWatch. This is manned by experienced cardiac physiologists who are able to bring high levels of training and experience to bear to interpret the traces and respond back to the surgeries within 30 minutes. Patients could be segmented into:

• Those within the norm - no further action
• Check patient again after a suitable time interval
• Refer to Cardiology Clinic
• Emergency referral via A&E

There was high degree of acceptance among primary care physicians. Ipsos Mori reported a substantial reduction in the number of referrals to Cardiology Clinics which in itself released capacity within the Acute Trusts.

A comprehensive report was published following the pilot. Cardiac Telemedicine in Primary Care

NTAC's The Technology Implementation Project

Following the work in Lancashire and Cumbria the NHS Technology Adoption Centre worked with several forward thinking GP surgeries and health centres across England to implement the 12-lead ECG with remote interpretation services. By employing a strategy of direct implementation we have examined the issues facing front line staff in real time.

Despite demonstration of high levels of patient and clinician acceptance, and clear benefits to the overall system in various pilot studies, the uptake of the technology has been slow. The technology is seen as problematic to implement despite its proven benefits in terms of Care Closer to Home and accuracy of interpretation due primarily to the issue of 'Silo budgeting'. The purchase and running costs of the devices often devolves to the Primary Care area and Acute Trust's lose income through changes pathways and reduced referrals.

The report into this work is to be published in the autumn of 2011.

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