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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 - PowerPoint PPT Presentation
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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