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100k Genomes Project• In December 2012 the Prime Minister announced a programme of Whole Genome Sequencing as part of the UK

Government’s Life Sciences Strategy. • The principal objective is to sequence 100,000 genomes from participants with cancer, rare disorders, and infectious

diseases, and to link the sequence data to a standardised data set of diagnosis treatment and outcomes. • A world-leading programme in the use of genomics and genetic technologies for participant benefit within the NHS.

Integral to this and the adoption of the complete functional genomics pathway from genome sequencing and DNA through to products as metabolites and biomarkers, will be the development of new capability and capacity for genomic medicine within the NHS and the transformation of care delivery.

• A major driver in ensuring that genomic medicine becomes main stream in the NHS in line with the move towards predicting and preventing disease, and more precisely diagnosing disease and personalising treatment.

• The Department of Health has established Genomics England … is procuring entities with NHS Genomic Medicine Centre Status to harness the capability and capacity of the NHS across England to contribute to the Project between 2015 and 2017. They will be centres that drive excellence in genomic medicine by providing high fidelity clinical data alongside the highest quality samples and feedback of results to participants.

• The overall aims of the Project, as set out in the Genomics England Protocol, are to:• Increase discovery of pathogenic variants for rare disease and cancer;• Accelerate the uptake of genomic medicine in the NHS;• Stimulate and enhance UK industry and investment; and• Increase public knowledge and support for genomic medicine.

• Specifically the Project will focus on rare diseases and cancer.

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Wave 2 GMC• Application to become a Wave 2 NHS Genomic Medicine Centre

(GMC) requires centres to explain how they will meet the service specification (revised version anticipated late January/early February) for an NHS GMC and their mobilisation plan for starting activity by mid to late 2015, including all contributing partner organisations. This includes the ability to meet Genomics England’s requirements for: • recruitment of eligible patients with cancer or rare inherited diseases; • obtaining appropriate consent and blood and/or tumour samples from these patients; • capture of clinical information in a co-ordinated way; • transfer of samples and linked data to the Genomics England Central Biorepository; • interpretation of genomic data and feedback of findings to patients within clinical care

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West of England GMC Partnership

Annex A Governance

Structure

Partnership BoardAHSN, BSU, CCGs, GHFT, NBT, patient association, RUH, UHB,

UOB, UWE, WAHT, AWP

Working GroupsCancer, Commercial & Contract, Consent &Communication, Education and Training,

Information and Informatics , Laboratory, Rare DiseaseNOTE: a separate PPI group is not proposed as PPI will underpin all of the working groups

The membership of the West of England GMC Partnership Board comprises 17 or more organisations. All of these have expressed commitment to securing a successful outcome to the Wave 2 designation process, led by Genomics England, (GE) which offers the potential for a GMC to be established in the West of England.

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Processes and WoE GMC bid

Figure 4: Simplified ‘Clinical Workflows’ for Greater Manchester NW GMC for Rare diseases.

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PATIENT IDENTIFICATION

PATIENT CONSENT

TAKE SAMPLE

TRANSPORT SAMPLE

PROCESS BLOOD SAMPLE

EXTRACT DNA FROM BLOOD

MOLECULAR PATHOLOGY AND DNA EXTRACTION FROM TUMOUR

DISPATCH SAMPLES TO GE BIOREPOSITORY

WGS AND POST-ANNOTATION VALIDATION TESTING

RETURN RESULTS TO PATIENT

DELIVER CARE (TRANSFORMATION AND IMPROVED OUTCOMES

AWP, GFHT, NBT, RUH, WHAT, UHB

AWP, GFHT, NBT, RUH, WAHT

PATHWAY COMPONENT ORGANISATIONS INVOLVED WORKFORCE AFFECTED LEAD WORKING GROUP FOCUS

SPECIFICATION REF

As above. On a hospital site or is GP practice involved?

As above by usual transport systems

Bristol Genetics Laboratory NBT

Bristol Genetics Laboratory NBT

Bristol Genetics Laboratory NBT

Bristol Genetics Laboratory NBT

Validation –BGL NBT

AWP, GFHT, NBT, RUH, WHAT-

AWP, GFHT, NBT, RUH, WHAT, CCG & NHSE Commissioners

Rare disease clinicians, oncologists, clinical geneticists and genetic counsellors

RD & Cancer, informatics, education

3.1

RD & Cancer, Consent & Communication

As above + clinic staff

Phlebotomists, clinic staff, GP practices

3.1.2

RD & Cancer, informatics, education

3.3.1 & 3.3.2

RD & Cancer, laboratory As above + transport and receiving staff

As above

As above

AWP, GFHT, NBT, RUH, WHAT, CCG & NHSE Commissioners

Recruiting clinicians and clinical genetics UHB

As above

BGL NBT

RD & Cancer, consent & communication, education

Laboratory

Laboratory

Laboratory

Laboratory

Laboratory

RD & Cancer, consent & communication, education& informatics

3.2.6 & 3..4.1

3.3.3

3.3.4

3.3.5

3.3.8

3.3.9

BGL staff

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Haematology SSG and WoE GMCRecruitment of patients, return of results

• No indication of dedicated staff for approach/consent• Model needs to be developed around existing clinical teams & research infrastructure• No evidence of additional resource

– In Manchester “Dedicated Biobank Technicians embedded within NHS Trusts has ensured maximum patient recruitment … single point of consent creates massive efficiencies and assists busy clinical staff who may not have time to consent for this type of study.”

• Specific consent for use of their samples for whole genome sequencing and their clinical data being made available to the Genome England project and their partners for the purposes of improving the diagnostics and treatment of included conditions, and to be invited to take part in future relevant studies.

• Unclear yet how these bits will work in WoE– ?Lead organisation will be responsible for ensuring that WoE sites have the relevant approved

versions of the information sheets and consent. Appropriate contact details of both local staff and lead organisation staff will be provided to facilitate any queries or requests for further information from potential participants.

– ?To ensure that potential participants are fully informed about the study, invitation packs (containing approved versions of the information sheet and consent forms) will be provided

– ?Other key points that will be covered include the nature of feedback of pertinent and incidental findings, including a discussion about the likelihood of finding any clinically relevant results and the potential time-frame in which they would become available.