Guidance for planning, designing, and implementing community diagnostic centers in England

On September 2, 2024, NHS England published guidance for planning, designing, and implementing Community diagnostic centers (CDCs). The national CDC Program is in its third year and has approved 170 CDC sites across England (165 are fully operational). CDCs deliver additional, digitally connected diagnostic capacity, providing diagnostic tests in community settings, enabling an accurate and fast diagnosis on various clinical pathways.

This guidance sets out the next steps and best practices for integrated care systems in developing CDCs, including commissioning, governance, engagement, regulatory and accreditation requirements, digital connectivity, workforce, and pathway development.

The guidance sets minimum requirements for core diagnostic tests that CDC must provide permanently, including the following:

• Imaging - CT, MRI, ultrasound, plain X-ray;
• Pathology – phlebotomy, NT-proBNP, Point of care testing (POCT) including for some of the following: eGFR, pro-BNP test, anticoagulation change of dose, C-reactive protein, hCG pregnancy test, urinalysis;
• Physiological science - 12-lead electrocardiography (ECG), ambulatory ECG monitoring (for example, Holter, patch monitor), ambulatory blood pressure monitoring, trans-thoracic echocardiogram, spot check pulse oximetry, POCT capillary blood gas assessment, fractional exhaled nitric oxide (FeNO), spirometry with bronchodilator response, full lung function tests, sleep studies (multichannel home recordings), CO monitoring;
• Endoscopy (large CDCs only) – gastroscopy (trans-nasal endoscopy or oral esophago-gastro duodenoscopy), colonoscopy, flexible sigmoidoscopy.

The guidance also specifies the tests suitable for CDC delivery in addition to the national minimum requirement, for example, mammography, DEXA scan, dermoscopy, elastography (e.g., Fibroscan), CT colonography, simple outpatient biopsies (skin, breast), colon capsule endoscopy, sponge on a string, cystoscopy, flexible cystoscopy, hysteroscopy, colposcopy. This is a non-exhaustive list, and systems are encouraged to provide additional tests from CDCs where these are deemed appropriate and a priority locally and can be supported by local funding. Screening services can also be considered if agreed upon and funded locally by screening commissioners.

The document also lists some tests that are considered clinically unsuitable for delivery in a CDC setting, for example, endoscopic retrograde cholangiopancreatography (ERCP), complex interventional procedures including biopsies of internal organs, bronchoscopy and endobronchial ultrasound (EBUS), complex sleep studies that include electroencephalography (EEG) monitoring, needle electromyography (EMG).

Local commissioners (Integrated Care Boards, ICBs) are required to commission their CDCs using the NHS Standard Contract. However, they can select the most appropriate commissioning and contracting model to meet local needs. The CDC Program is working closely with the NHS England Costing and Pricing team to refine the finance model for CDC activity. In 2024/25, the CDC Costing and Pricing team will progress a review of all collected cost per test data to inform 2025/26 proposed system uplift payments and, potentially, also future ICB baseline allocation adjustments from 2025/26.

See the full details here.

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