Jeff Seneviratne: Benchmarking Pathology

Report
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
Mapping
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
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
Royal Bolton
Hospital NHS FT
LIMS: Clinisys
Labcentre
Central Manchester
University Hospitals
NHS FT
LIMS: Isoft ILab
Health Protection
Agency at CMFT
LIMS: Isoft ILabTP
Pennine Acute
Hospitals NHS Trust
LIMS: Clinisys
Labcentre
Christie Hospital
Foundation NHS
Trust LIMS
Anglia Ice
results
Anglia Ice
results
Anglia Ice
results
Indigo
Review
results
Salford GP
access to
results from
one lab only
Bolton GP
access to
results from
one lab only
Central Man
GP access
to results
from one lab
only
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
Wigan GP
access to
results from
one lab only
Anglia Ice
results
Indigo
Review
results
Indigo
Review
results
Anglia Ice
results
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
Salford Royal NHS
Foundation Trust
LIMS
Anglia Ice
results
Central Manchester
University Hospitals
NHS Foundation
Trust LIMS
Health Protection
Agency (MMMP) at
CMFT LIMS
Pennine Acute
Hospitals NHS Trust
LIMS
Christie Hospital
Foundation NHS
Trust LIMS
Anglia Ice
results
Anglia Ice
results
Indigo
Review
results
Anglia Ice
results
Results
Portal
Indigo
Review
results
Indigo
Review
results
Anglia Ice
results
Any GP from
any area or
other caregiver
eg Out of hours
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
LIMS
PMIP
DTS
LIMS
Exeter
PMIP
PMIP Converter
Local to National
Clinical users
NPEx
Internet
RBAC
access
N3
Portal
Consolidated
Regional
Pathology
Database
De-identification
Activity
Demand
Benchmarking
Thank you

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