1. Summary

1.1 The national priority for reducing mortality and morbidity from cardiovascular disease, the resulting expansion in the number of consultant cardiologists, and the reforms of the National Health Service have produced significant changes in delivery of care for cardiac patients and in the relations between district general hospitals (DGH) and the old regional cardiac centres.

1.2 The British Cardiac Society, the Medical Royal Colleges of Physicians of London and Edinburgh, and the Royal College of Physicians and Surgeons of Glasgow established a working group to make recommendations on the most appropriate evolution of these changes to secure high quality care in a cost-effective and professionally rewarding environment. The principal conclusions of the working group were:

i) 

The establishment of new cardiac catheterisation laboratories in DGHs remote from a major cardiac centre should be encouraged provided the workload is adequate to ensure efficient use of the facility.

ii) 

Cardiologists working in districts close to a major centre should be encouraged to catheterise their patients at the centre.

iii) 

Close liaison of the district cardiologist with a cardiac surgeon and interventionist is vitally important.

iv) 

The centres will be required to provide tertiary care for emergency and urgent cases from their traditional catchment area, specialised expertise for the management of rare and difficult cases, and angioplasty. Some centres will also offer complex electrophysiology, and ablation techniques.

v) 

The centres must also provide routine cardiology services for their local district, facilities for cardiac catheterisation for DGH cardiologists, and training for doctors, nurses, technicians, and radiographers.

vi) 

Some centres will be linked with paediatric cardiology and paediatric cardiac surgical units.

vii) 

District cardiac centres will be required to provide a full non-invasive diagnostic service and emergency care for patients referred by general practitioners and hospital colleagues as well as facilities for preventative and rehabilitation cardiology. Arrangements for invasive investigation and treatment of their patients will vary according mainly to the distance from the major centre.

viii) 

Both the major centres and the district cardiac units should participate in training and research.

2. Introduction

2.1 The provision of cardiac and cardiac surgical services continues to fall short of the targets set in 19941 ,2with long waiting lists for elective and urgent cases, and difficulties in transfer of patients for emergency treatment existing in many parts of the country.3 The aging population with coronary heart disease and increasing expectations of and opportunities for treatment are important considerations when assessing needs. 2.2 Specialised cardiac services, closely linked to the provision of surgery have traditionally been provided by the regional or major centres. Staffed by between three and eight consultant cardiologists with a variable complement of clinical and academic training posts, they have aimed to provide comprehensive facilities for invasive and interventional cardiology in addition to non-invasive assessment and diagnosis for between 1 and 2 million people. Not all have offered paediatric cardiology, specialised management of adult patients with congenital heart disease, complex electrophysiology, valvuloplasty or transplantation, and (with the exception of transplantation, which is supra-regionally funded, and paediatric cardiology) these services have developed largely according to the specific interests of the existing consultants. Many centre based cardiologists …