Benchmarking Pathology and the Demand on its Service

Jeff Seneviratne, Clinical Lead, Greater Manchester Pathology Network

Hospitals/Laboratories in Greater Manchester

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

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.

2010 Carter and QIPP  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

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

Alb/Creat ratio Allergy Amylase ANA BNP Ca CA125 Cholesterol CK Coagulation CRP Electrophoresis ESR FBC Female androgens Ferritin Folate FSH fT4 Gamma GT Glucose GTT HbA1c HCG Histology IgE Immunoglobulins Iron LFT LH

Mapping

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

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

Salford Royal NHS Foundation Trust LIMS: Isoft ILabTP Anglia Ice results Salford GP access to results from one lab only Royal Bolton Hospital NHS FT LIMS: Clinisys Labcentre Anglia Ice results Bolton GP access to results from one lab only Central Manchester University Hospitals NHS FT LIMS: Isoft ILab Health Protection Agency at CMFT LIMS: Isoft ILabTP Anglia Ice results Central Man GP access to results from one lab only Pennine Acute Hospitals NHS Trust LIMS: Clinisys Labcentre Christie Hospital Foundation NHS Trust LIMS Indigo Review results Pennine GP access to results from one lab only Christie is currently stand-alone system & not accessible to GPs South Man GP access to results from one lab only Stockport GP access to results from one lab only Tameside GP access to results from one lab only Trafford GP access to results from one lab only Anglia Ice results Indigo Review results Indigo Review results Anglia Ice results Wigan GP access to results from one lab only Anglia Ice results 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

GM Pathology Results ‘To Be’ State

Royal Bolton Hospital NHS Foundation Trust LIMS Central Manchester University Hospitals NHS Foundation Trust LIMS Health Protection Agency (MMMP) at CMFT LIMS Salford Royal NHS Foundation Trust LIMS Anglia Ice results Anglia Ice results Indigo Review results Anglia Ice results

Results Portal

Pennine Acute Hospitals NHS Trust LIMS Christie Hospital Foundation NHS Trust LIMS Any GP from any area or other caregiver eg Out of hours Anglia Ice results Indigo Review results Indigo Review results Anglia Ice results Anglia Ice results 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

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

Pilot Project with X-Lab Systems

Clinical users Internet LIMS PMIP LIMS PMIP RBAC access N3 Exeter DTS PMIP Converter Local to National NPEx Portal Consolidated Regional Pathology Database De-identification Activ ity Demand Benchmarking

Thank you