Next Steps for East of England
Pathology Services

Issue 1: Aug 2010

Pathologists put Services under the Microscope

Pathology services across the East of England are being transformed over the next two years.

A wide-ranging, innovative and fast-paced regional Transforming Pathology Services project is being co-ordinated by NHS East of England’s Strategic Projects Team (SPT), working closely with local pathologists, NHS providers and commissioners of pathology services.

 Andrew MacPherson, SPT Director said: “This is a project where success is dependent upon an extremely high level of clinical engagement throughout. For that reason, we have established a Project Board to oversee the whole process. This is co-Chaired by a leading local clinician and its membership is made up of senior pathologists and laboratory staff from across the region.

“It is still early days, but already we have seen significant involvement from clinicians at all levels – from active participation in the Project Board, to pathologists and their staff in the field doing ground-breaking work developing potential new models of service delivery and real front-line enthusiasm for agreeing new KPIs”.

“Our clinicians are truly leading the way to shaping a new vision for the future for pathology services”.

(Full details about the Transforming Pathology Services Project Board can be found at www.eoe.nhs.uk/strategicprojects)

Prescription for Change

There have been successive national reviews of the Pathology Service in England over the past 17 years – making it probably one of the most reviewed services in the NHS! The most notable of these, is the Independent Review of NHS Pathology Services in England, chaired by Lord Carter of Coles. 

The Carter report focuses on three main themes:

• Improving quality and patient safety
• Improving efficiency
• Identifying the mechanisms for delivering change.

The Carter review said: “service consolidation is necessary to transform pathology services so that they can respond swiftly to the challenges presented by innovation, system reform across the NHS and reform of the workforce”.

In practice, this would mean that all the hospitals within a Network would have a rapid response laboratory on site to perform the limited range of pathology tests that are required in less than four hours.

However, the bulk of pathology testing (about 80%) for all hospitals and associated GP practices in a Network requires a response within four to 24 hours.These tests would be performed at one or more high throughput laboratories, rather than each hospital undertaking them in their own labs.

Carter concluded that transforming pathology services into Networks offers maximum flexibility, operational and financial efficiency through significant economies of scale, and improvements in quality.

And that’s exactly what the pathologists, laboratory staff, providers and commissioners are working together to achieve in the East of England with the Transforming Pathology Services project.
(More information about the Carter Report can be found at www.eoe.nhs.uk/strategicprojects)

Baseline Readings for Pathology

• The word pathology covers a complex range of activities, performed in a variety of different settings and via a number of different delivery methods.
• Pathology has four main sub disciplines – clinical biochemistry, haematology, histology and microbiology. There are also a number of specialist disciplines including virology, cell cytology, toxicology, genetics and immunology.
• Blood typing for blood transfusions is carried out by Pathology.
• Not all pathology takes place in the lab. In hospitals, haematology and histology pathologists are closely involved in the care of cancer patients and are part of multi disciplinary teams of staff. Pathologists are also part of the ward round teams on critical care units, neonatal units and where patients are receiving TPN (Total Parenteral Nutrition). Consultant Pathologists run out-patient clinics for people with endocrine (hormone) problems or high cholesterol.
• Not all pathology takes place in hospitals. Pathologists also work closely with GPs to help them interpret the results of tests on their patients and to discuss the implications of these for patient care.

Spectrum of Tests for Future Success

The Project Board is determined to engage all stakeholders in developing a range of key performance indicators (KPIs) for the pathology services of the future. As a start, clinicians and laboratory staff across the region were asked to suggest measurable and appropriate KPIs - and they have responded magnificently! 

Dr Stuart Shields, a leading local GP from Peterborough, is a member of the Project Board. He is taking the lead now in working with pathology colleagues and GPs to develop these suggestions into suitable KPIs, which will be used to test accurately the delivery of high quality pathology services throughout the East of England.

Behind the Mask!

Each issue, we will feature a key clinician playing a major role in shaping the future of pathology services in the East of England.

We are kicking off with Hemal, the Transforming Pathology Services project lead and Clinical Adviser to NHS East of England’s Strategic Projects Team:

Dr Hemal Desai MBBS MSc DRCOG MRCGP
Hemal is a practising GP in Urgent Care at Northwick Park Hospital.

He was previously Clinical Adviser to the Commercial Directorate in the Department of Health, where among a broad range of change projects, he led the development of the PCT Procurement Framework to support the delivery of the Equitable Access in Primary Medical Care programme across the UK.

He has successfully supported the delivery of over 300 healthcare purchasing projects through developing support tools, building capability, or as part of a deal execution team.

Hemal can be contacted at hemal.desai@eoe.nhs.uk

The Strategic Projects Team have a clear mandate that Pathology Tranformation in the east of England is both Provider and Commissioner led.

Please let us have your comments and contributions by email pathology.transformation@eoe.nhs.uk or via your board representative.

Andrew MacPherson
Strategic Projects Director