Benchmarking Pathology and the Demand on its Service

Jeff Seneviratne, Clinical Lead, Greater Manchester Pathology Network

Hospitals/Laboratories in Greater Manchester

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

GM Pathology Network

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.

Early Achievements

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

2010 Carter and QIPPPotential savings of £500 million through efficiency gains and by

consolidating pathology services

Translated to £25m for Greater Manchester.

Quality improvements

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

Greater Manchester in 2013-14

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

Development of the Framework Specification

Pathology as a clinical service providing information and advice for diagnosis and treatment, rather than a test results service

Activity and Demand

• How to measure activity• How to compare demand

• GP Benchmarking/Atlas of Variation

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

– 2011-12– 2012-13– 2013-14 1st quarter

MappingFerritinFolateFSHfT4Gamma GTGlucoseGTTHbA1cHCGHistologyIgEImmunoglobulinsIronLFTLH

LipidsLithiumMalariaMan DiffMicrobiology FaecesMicro GenMicro gutMicro SputumMicro UrineMicro WoundsOestradiolPregnancy TestProgesteroneProlactinProt/Creat ratio

Alb/Creat ratioAllergyAmylaseANABNPCaCA125CholesterolCKCoagulationCRPElectrophoresisESRFBCFemale androgens

PSAPTHRBC FolateRheumatoid factorSemenSkin histologyTestosteroneThyroid AntibodiesTroponinTSHU/EUrateVirologyVitamin B12Vitamin D

Comparison of demand by CCG and Practice

Number of requests per 1000 patients

FBC

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

Sharing Pathology Results

LIMS in Greater Manchester

GM Pathology Results ‘As Is’ State

Royal Bolton Hospital NHS FT

LIMS: Clinisys Labcentre

Central Manchester University Hospitals

NHS FT LIMS: Isoft ILab

Christie Hospital Foundation NHS

Trust LIMS

Health Protection Agency at CMFT

LIMS: Isoft ILabTP

Pennine Acute Hospitals NHS Trust

LIMS: Clinisys Labcentre

Salford Royal NHS Foundation Trust

LIMS: Isoft ILabTP

University Hospital of South Manchester

NHS FT LIMS: Isoft ILabTP

Stockport NHS Foundation Trust

LIMS: Isoft ILabTP

Tameside Hospital NHS FT

LIMS: Isoft ILabTP

Trafford Healthcare NHS Trust

LIMS: Isoft ILabTP

Wrightington, Wigan & Leigh NHS FT LIMS: Clinisys

Labcentre

Salford GP access to

results from one lab only

Anglia Ice results

Anglia Ice results

Anglia Ice results

Anglia Ice results

Anglia Ice results

Anglia Ice results

Indigo Review results

Indigo Review results

Indigo Review results

Pennine GP access to

results from one lab only

South Man GP access to results

from one lab only

Wigan GP access to

results from one lab only

Trafford GP access to

results from one lab only

Tameside GP access to results

from one lab only

Stockport GP access to results

from one lab only

Central Man GP access to results

from one lab only

Bolton GP access to

results from one lab only

Christie is currently stand-alone system & not accessible to GPs

GM Pathology Results‘To Be’ State

Results Portal

Royal Bolton Hospital NHS

Foundation Trust LIMS

Central Manchester University Hospitals

NHS Foundation Trust LIMS

Christie Hospital Foundation NHS

Trust LIMS

Health Protection Agency (MMMP) at

CMFT LIMS

Pennine Acute Hospitals NHS Trust

LIMS

Salford Royal NHS Foundation Trust

LIMS University Hospital

of South Manchester NHS Foundation

Trust LIMS

Stockport NHS Foundation Trust

LIMS

Tameside Hospital NHS Foundation

Trust LIMS

Trafford Healthcare NHS Trust LIMS

Wrightington, Wigan and Leigh NHS

Foundation Trust LIMS

Any GP from any area or

other caregiver eg Out of hours

Anglia Ice results

Anglia Ice results

Anglia Ice results

Anglia Ice results

Anglia Ice results

Anglia Ice results

Indigo Review results

Indigo Review results

Indigo Review results

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

LIMS

LIMS

Exeter

PMIP Converter

NPEx

Consolidated Regional

Pathology Database

Internet

N3

Portal

Activity Demand

Benchmarking

PMIP

PMIP

DTS

De-identification

Local to NationalClinical users

RBAC access

Pilot Project with X-Lab Systems

Thank you