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BACKGROUNDIn October 2021, NHS England announced the creation of 40 new community diagnostic centres in England. The aims are to create faster, more direct access to diagnostic testing, divert patients from hospital to reduce waiting times and the spread of COVID-19, and tackle the backlog of diagnostic activity created by the pandemic. GPs will be able to refer patients to local centres directly for diagnostic tests and reduce the need for hospital outpatient visits. These centres will purportedly be established closer to people's homes in community hospitals, health centres, repurposed buildings, and even shopping centres, and are planned to be fully operational by March 2022. 1 Further funding for community diagnostic centres was announced in the Chancellor's Autumn Statement, taking the total number of centres to be funded to 100, as well as funding for the purchasing of additional diagnostic equipment such as computerised tomography (CT) and magnetic resonance imaging (MRI) scanners. 2 The drivers for this new initiative stem in part from the NHS Long Term Plan, published in 2019. 3 Professor Sir Mike Richards, the first NHS National Cancer Director, was commissioned by NHS England to undertake an independent review of NHS diagnostic services following publication of the Long Term Plan, and a key recommendation from his report was the establishment of community diagnostic hubs away from acute hospitals that could be delivered in a COVID-19-safe manner as much as possible. The Richards report also recommended separating acute and elective diagnostics, redesigning diagnostic pathways to better utilise triage tests (for example, faecal immunochemical testing), and a significant investment in diagnostic infrastructure and workforce. 4 This intervention from NHS England comes in the context of serious chronic challenges with access to diagnostics.

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A 21-year-old lady was admitted to a hospital with an 8-week history of bloody diarrhoea. She had been diagnosed with ulcerative colitis 2 years previously and had remained in remission until the gradual onset of bloody diarrhoea. Her bowel frequency was 20 times per day and associated with significant abdominal pain and weight loss. She was started on intravenous steroids, topical therapy and anti-tumour necrosis factor therapy; however, this failed to achieve symptom control. Histology of tissue obtained from flexible sigmoidoscopy eventually demonstrated cytomegalovirus (CMV)-associated colitis. Intravenous anti-viral valganciclovir was initiated and the patient made a rapid recovery. This case discusses the differentials for steroid-refractory ulcerative colitis, including the common pitfall of inflammatory bowel disease management and CMV infection. This case also discusses CMV pathophysiology including histological features, appropriate investigations and current management guidelines.