Benchmarking Pathology and the Demand on its Service

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

12. Mapping Alb/Creat ratio Allergy Amylase ANA BNP Ca CA125 Cholesterol CK Coagulation CRP Electrophoresis ESR FBC Female androgens PSA PTH RBC Folate Rheumatoid factor Semen Skin histology Testosterone Thyroid Antibodies Troponin TSH U/E Urate Virology Vitamin B12 Vitamin D 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

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

16. FBC

24. 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 PMIP LIMS PMIP Converter Local to National Clinical users NPEx Internet Portal Consolidated Regional Pathology Database RBAC access N3 De-identification Activity Demand Benchmarking

31. Thank you