1. Benchmarking Pathology and the Demand on its Service
Jeff Seneviratne, Clinical Lead,
Greater Manchester Pathology Network

2. Hospitals/Laboratories in Greater Manchester

3. GM Pathology Network
Established in late 2005 and formally launched in Spring 2006
Funded originally by DH Pathology Modernisation. Now funded by GM Commissioners
A model for building engagement, trust and respect and facilitating change
Clinical leadership and engagement as a key strength
Network Board made up of key stakeholders across the 10 PCT areas, including clinical directors, managers, the Health Protection Agency and The Royal College.
Accountable to Greater Manchester PCT and Acute Chief Executives and is jointly chaired.
Core management team for the clinically led Network is a 0.5 WTE Clinical Lead, 0.5 WTE Network Director and 1.0 WTE Network Business Manager

4. Early Achievements Investment – Capital funding secured £2m
Developments – HMDS, Cdiff, haemoglobinopathy DNA diagnostics
IMT – GP requesting (reporting), Lab2Lab (NPEx)
Work on standardisation – units, profiles, reference ranges (Harmony)
Work on testing guidelines – CKD, MRSA, Urinalysis
Sharing good practice
NHS Networks New Network of the Year 2007/08
Engagement with Primary Care, Other Networks and wider system.

5. 2010 Carter and QIPP Challenge
Potential savings of £500 million through efficiency gains and by consolidating pathology services
Translated to £25m for Greater Manchester.
Quality improvements
Challenge
The achievement of efficiency savings of 20%
Measurement and improvement of quality by 20%
Sustaining on-site presence of necessary personnel
and services at each Trust
Ensuring sustainability of future pathology services in
Greater Manchester

6. By April 2012, Trusts agreed to:
20% reduction in Primary Care Pathology costs, by August 2012
Further 5% reduction in 2014
Block contract arrangements in the interim
Work with Commissioners and the Network to deliver objective and measurable quality improvements
Work with Commissioners to review appropriateness of activity and implement robust and measurable variable contracts

7. Greater Manchester in 2013-14

8. Further work Framework specification for Primary Care Pathology
Work with emerging Clinical Commissioning Groups and Providers to develop approaches of managing demand and agree a standardised method of measuring activity.
Advice to Greater Manchester Commissioners for decision making about pathology services.
Provision of Pathology Results across patient pathway

9. Development of the Framework Specification
Pathology as a clinical service providing information and advice for diagnosis and treatment, rather than a test results service

10. Activity and Demand How to measure activity How to compare demand
GP Benchmarking/Atlas of Variation

11. Data Collection From labs by practice code
Variation in format & quality
Mapping exercise with KUBS
Multiple local codes
Database of GP activity for selected tests from within GM
st quarter

12. Mapping Alb/Creat ratio Allergy Amylase ANA BNP Ca CA125 CholesterolCK
Coagulation
CRP
Electrophoresis
ESR
FBC
Female androgens
Ferritin Folate FSH fT4 Gamma GT Glucose GTT HbA1c HCG Histology IgE Immunoglobulins Iron LFT LH
Lipids Lithium Malaria Man Diff Microbiology Faeces Micro Gen Micro gut Micro Sputum Micro Urine Micro Wounds Oestradiol Pregnancy Test Progesterone Prolactin Prot/Creat ratio
PSA
PTH
RBC Folate
Rheumatoid factor
Semen
Skin histology
Testosterone
Thyroid Antibodies
Troponin
TSH
U/E
Urate
Virology
Vitamin B12
Vitamin D

14. Comparison of demand by CCG and Practice
Number of requests per 1000 patients

16. FBC

24. Commissioning, not procurement
Contracts
Commissioning, not procurement
Incentives/levers not solely based on activity
Improve appropriateness of testing
Type of contract
Cap and collar, block plus, GM tariff

25. Sharing Pathology Results

26. LIMS in Greater Manchester

27. GM Pathology Results ‘As Is’ State
Christie is currently stand-alone system & not accessible to GPs

28. GM Pathology Results ‘To Be’ State

29. Benefits
Provide access to GPs for all laboratory results requested in secondary or tertiary care
Enable GPs to add results ordered in other settings to their local patient record
Make results available for patients attending A&E & OOH GP Services
Provide universal access to GPs & other care provider for all test results
Provide a complete & safe pathology record accessible across Greater Manchester
Provide access to test results to support the delivery of quality care regardless of where the order originates
Provide universal access to test results across GM to reduce repeat testing.  
Results available on Mobile devices in the future

30. Pilot Project with X-Lab Systems
Exeter
LIMS
PMIP
DTS
LIMS
PMIP
PMIP Converter
Local to National
Clinical users
NPEx
Internet
Portal
RBAC access
Consolidated Regional Pathology Database N3
De-identification
Activity Demand
Benchmarking

31. Thank you