Our regional PACS network and insource reporting pool enable member Trusts to access a wide area network of specialists willing to carry out additional paid work. Clearer backlogs and enhanced access to expertise within the NHS reduces the need for more expensive private outsourcing.

Why reinvent the wheel?

NHS Trusts are often unable to meet the needs of fast growing radiology services due to the large shortfall in supply vs demand in the United Kingdom. This has led to the widespread use of private outsourced reporting services. Ironically it is frequently NHS radiologists who carry out this service in their own homes, paid by the outsourcing company who also take a middle man fee.

By creating our own NHS insource reporting network we are able to provide a framework to carry out the same activity for additional remuneration without a privately owned middle man. This allows us to deliver a cost saving to participating NHS Trusts whilst offering the reporter a more attractive fee schedule.

Benefits of YIC-insource

• Cost saving against private outsourcing
• Familiarity of worker pool
• Quality assurance of in-network specialists
• Oversight of area reporting by Special Interest Groups
• Zero capital investment in infrastructure
• Centralised business process management
• Home Workstations provided at zero cost, which can also be used for on-call and Trust work

Infrastructure for insourcing

Considerable investment in infrastructure, manpower and time is required in the creation of an insource network. Our network represents the sum of several YIC Masterplan milestones which contribute to a robust network framework in which our member Trusts can transparently interoperate.

• Regional Cloud Index and Patient LifeTimeline
• Technical infrastructure to work remotely (Workstations, Networking and Software)
• Cross Network Governance
• Rules of Engagement for reporters
• Regional Tariff System
• Building of a Core Network Management Team
• Robust Assurance System for reporters
• Regional Radiology Events and Learning (REALM) Process

Making use of Insourcing

The insource network is open to all active YIC member Trusts in good standing.

Radiology services who have a need for additional reporting capacity may nominate work to be pushed to the regional insource reporting pool but always retain control over which work is forwarded. In addition they may also request reporting by assigned specialists or the general credentialled worker pool.

Studies may be forwarded to the insource pool in a number of ways

• Manually for a batch of identified work assigned to the regional pool
• Automatically based on rules created for studies on local PACS

Charging

Trusts are charged for work carried out by the insource service based on the Regional Tariff System. The system offers flexibility to incentivise work by increasing complexity by band if there is a specific focussed need.

Trusts will be cross-charged for activity carried out each month, which will be tracked by the YIC who will provide a simple summary of activity and payments to be made between provider Trusts.

Reporters will be reimbursed monthly for non-contractual work carried out via the Insource Network. They will receive a remittance notice showing a summary of activity, description of each item and the tariff band and remuneration awarded. The process is automated in co-operation with each Trust payroll and is remunerated as part of your monthly salary via the NHS PAYE scheme. Payments are non-pensionable.

NICIP coding

The importance of accurate coding using the NICIP system within your Radiology Information System (RIS) cannot be overemphasised enough. This is the mechanism by which YIC will identify which activity has been carried out and apply the appropriate charge coding to calculate

• Cost to Trust
• Fee paid to reporter

Inaccuracies in NICIP coding may lead to unexpected reimbursements. However, this is something which we will be using our Central Business Intelligence Unit to heuristically survey and adapt to standardisation as the network matures.

A complete lookup table of NICIP code mappings per described radiology activity will be published as part of the tariff system

Network Governance

The primary care site of a patient holds the responsibility for governance around the standard of care a patient receives. This rule also holds true for diagnostic imaging executed by or on behalf of the Trust but reported by an outside agency (either insource or outsource reported). In practice, this means that complaints and incidents arising for a patient are investigated within the Trust holding responsibility for the relevant care episode.

We also have some additional guidance around the investigation of Serious untoward events in imaging arising from work carried out in the insource network.

Whilst it is the responsibility of a Trust to carry out investigatory work, YIC does strongly encourage peer feedback to the parties involved in a constructive and educational manner. We also have a peer learning mechanism with a regional Radiology Events and Learning Meeting to ensure that the lessons learned from events are shared for improvement.