Tuesday, December 14, 2010

Pathology continues to move up the agenda

At the beginning of the month I was at a launch event for a new approach to sending pathology samples between UK laboratories conceived by X-Lab, a service that will be hosted by the HIS (http://www.this.nhs.uk/npex). I worked for a medical reference laboratory (Pathology Associates Medical Laboratories (PAML) – www.paml.com) in Washington State that offered a very similar service – essentially a tool that translates the pathology request from one system into a readable and translatable form for any other system (and back again). The concept is similar to that of a telephone exchange.
I mention PAML because they offer a service to hospitals – using CRM to manage client services, using Fedex style logistics to manage pathology sample shipping, etc. Some features of the service could be very beneficial to the UK pathology service– however this will lead me into a comparison between business models that is for another time.

Pathology service savings – now is the time?

With the potential to save huge amounts of cost and increase the quality of service, it has taken a long time for pathology to move to the top of the agenda. We have all known the change is coming, presentations and whispers at two conferences I attended in late-2009 (SBK Pathology Toolkit – Service reconfiguration and implementing change) and late-2008 (Laboratory IT Strategy conference) predicted the change. We’ve all seen the two Carter reviews as well.
It’s one way of saving cost and improving productivity without closing front-end services which could ultimately result in protests and national newspapers front page headlines. At the minimum organisations are starting to pass ideas around about how pathology services can save cost locally (even if at Trust Chief Executive Level), if not already entering into a challenging process of change.

How NPEx and the advent of GP commissioning could impact this

NPEx is a concept that, if used widely enough, could change the shape of the pathology market. Two key examples:

1) Choosing an alternative reference laboratory for specialist reference testing. Laboratory X is charging the Trust £91 per test but the NPEx system states Laboratory Y can offer the same test for £68. This raises a number of interesting questions:
  • Why is it cheaper?
  •  Is the quality of testing going to be as robust as Laboratory X if I switch to Laboratory Y?
2) After the release of the new whitepaper could pathology rise to the top of the agenda for GPs, just as it is for Trust Chief Executives right now? GP work is typically automated and bulk accounting for a high volume at low cost.
  • If information is realised about NHS Trusts cost per test compared to Quest, Serco or TDL how will GP consortia react?
The second point is one that is prominent and non-dependant on the X-Lab system. If private providers take all of the GP work then pathology services within NHS Trusts will not be able to sustain themselves performing the expensive specialist work.

Some key points...

  • As a result NHS Trusts are under pressure to understand their true service costs and make the needed changes to increase quality and productivity throughout; otherwise they may find themselves fighting to keep the GP work from the hands of private providers.
  • The model of delivery has to change. Using paediatric allergy testing as an example – within an SHA region it is most likely being performed in most DGHs and specialist centres. Such a service can be operated from one or two specialist paediatric centres across the region because the work is cold. This will result in:
    • Decreased service cost for DGHs operating the service
      • Reduced cost per test across the test repertoire
    •  Increased service quality for allergy testing
      •  Now only operating in one or two specialist centres
    • A new process that has been implemented
      • Achieving maximum productivity
Some key questions for thought...
  • Can the logistics cope and will this be a telling point for enabling GPs or hospitals to choose where they order a test?
  • If consolidation is to happen will the technology be a stumbling block?
  • How will NHS Trusts actually react to a changing market? 

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