“Progress and Challenges”

Ken BarrNetwork Director

Merseyside & Cheshire Pathology QIPP Network

MCPN Pathology Network

9 Trusts on 14 sites

3 x Acute FT, 4 x Specialist FT, 2 x Acute

Population served ~1.7m

5.7m requests per annum with 25.8m tests

1,030 staff

£64m direct budget spend 2009/10

~12,400 sq m lab space currently in use

QIPP savings target = £14m

Pathology Network: Full Merseyside and CheshirePopulation Served ~ 2.4m

Network Progress

Vision:

“To provide an efficient and effective Pathology service that is patient focused and clinically led, delivering measurable quality and performance

that is continually improving”

Establish a singly managed Pathology organisation

Consolidate and re-design services using a hub & spoke model, supporting

community and primary services to keep patients as close to home as possible

Through clinical leadership reduce inappropriate variation in tests and results via

standardisation of operating processes and protocols, using evidence-based best

practice

Invest in IT connectivity to improve access to information to support patients/NHS

staff with the right services at the right time in the right place

Establish a single Pathology Integrated Board to manage and deliver pathology

services in the most efficient and effective manner to save £14m by 2014/15

Outline Business Case

Single managed network with single identity/employer

Remove historic organisational barriers and deliver services to population/GPs

‘Carter consolidated model’ – hub and spoke concept

Flexibility to reuse/rent space as available and affordable

Explore options for single business structure

NHS host, social enterprise, JV

Centralise multi-discipline, automated, non-urgent testing

Improve standardisation, quality, efficiency based on agreed TAT

Centralise specialist and sub-specialist services

Cost benefit analysis to include access to peer support, R&D, training, MDTs etc.

Clinically led integrated services

Respond to population/patient needs - improve access & patient experience

Increased efficiency

Reduce direct spend from £64m to £50m over four years (>20%)

Challenges: Pathology Information Systems

7 different types of LIMS in MCPN - some integrated to PAS systems

Cost issues – need migration plan funded via overall efficiencies

Keep track of referred test and samples within and outside the network

Procure same analytical equipment – avoid risk of poor standardisation

Many interfaces required, order comms/reporting, GP messaging, cytology

recall, GUM, cancer registry, infection control etc.

Operational – report printing, management, finance, audit, R&D

Many supporting IT systems – document management, supplies, asset

register, risk register, QC information

POCT connectivity, order and result comms to community/primary sectors

Transport

• Key to making the network viable – Pathology specific

• May require temperature regulated vehicles on longer routes

• May utilise motorcycles couriers on shorter routes

• Needs to be flexible, based on “zones” + ad-hoc collections

• IT tracking, specimen numbers, collection times, management

• Specialist companies are already in use – need scaling up

ensure VFM via formal specification and tender

Biochemistry – Spoke Tests

Alanine transaminase (ALT)AlbuminAlkaline phosphataseAmmoniaAmylaseAspartate transaminaseBilirubin (total and conjugated)Blood gases and lactate (use ward-based instruments)BicarbonateCalcium[Cortisol]Carboxyhaemoglobin (ward)ChlorideC-reactive proteinCreatine kinaseCreatinineDigoxinEthanol (alcohol)GlucoseHuman chorionic gonadotrophin[Iron]

LithiumMagnesiumOsmolalityParacetamolPhosphateSalicylate[TFTs]Total protein[Transferrin]TroponinUrateUreaCSFGlucoseTotal proteinXanthochromia screenUrineCreatinineOsmolalityPotassiumPBGSodium

Copyright of Kent & Medway Pathology Network

Haematology ~ 3m tests

Urgent FBC and coagulationRoutine FBC and

coagulationFull Blood Transfusion

serviceESR GFST

Sickle screensMalaria investigations

B12 & Folate Hb Profile

G6PD Immunophenotyping

Bone Marrow Asp CSF Cytospin CytochemistryThrombophilia

LUPUS Factor assays (exc FVIII)

Plasma Heparin (Xa) HIT screen

Platelet AggregrationsMTHFR, Leiden, PTGM

HUB (60%)

SPOKE (40%)

Urgent FBC and ESR Urgent coagulation

Full Blood Transfusion serviceSickle screens

Malaria investigations

Copyright Kent & Medway Pathology Network

Next Steps

Develop OBC/Service Spec with external management support

by March 2011

CEO decision on business model/delivery method

by April 2011

Estate ‘hub’ option appraisal

Commence consolidation during 2011/12

Meaningful consultation/communication with staff and stakeholders

To commence November now CEOs have approved OBC work

Project team to develop and deliver implementation plan 2011-2015

April 2011