SMVN SUPPORT Grace Cervantes has been appointed as SMVN Programme Support Officer (PSO), replacing Emily Ross who has moved onto pastures new. Grace joined the National Managed Diagnostic

Networks (NMDNs) in 2018 after 17 years within NHS Clinical Governance and is looking forward to working with everyone in this new venture.

One of Grace’s first major projects is to update the SMVN website. Keep checking it for new updates, including availability of the presentations from the SMVN Scientific Day held on 23 May 2019.

Please send articles / news / ideas for future SMVN newsletters to Grace.

Grace.cervantes@nhs.net Tel: 0131 275 7688

National Laboratories Programme (NLP) The NLP has a new website: https://www.labs.scot.nhs.uk/

It aims to keep the NHS Scotland laboratory community, its patients and stakeholders informed of the its work. NLP projects include:

(1) A NATIONAL BLUEPRINT to underpin the laboratory medicine distributed services model.

(2) CONNECTIVITY including the NPEx connection solution and possible national LIMS procurement.

(3) STANDARDISATION to underpin the new LIMS and distributed services.

(4) Delivery of the NATIONAL LABORATORIES INTELLIGENCE & INFORMATION PLATFORM (NLIIP) to resolve current issues of the absence of a standard approach to gathering, reporting and storing laboratories data, within and between NHS Scotland Boards.

In September, the SMVN will hold a standardisation workshop led by the John Mallon (NHS GGC), the network’s representative on the National Standardisation Group. The workshop will develop a plan of action for standardising SOPs (in line with the PHE Standards for Microbiology Investigations) and for identifying data requirements and coding structures for a National LIMS.

The National Managed Diagnostic Networks are on Twitter @NMDNScot

BACKGROUND

TB is the top infectious killer worldwide.

Scotland is a low incidence country for TB but its public health impact is significant.

The confirmatory gold standard culture test takes up to 12 weeks to generate a result.

The smear screening test for TB performs poorly. It is 46-78% sensitive, missing 22-54% of cases.

The smear test is non-specific: 50% of smear positives are not TB.

NHS Scotland is not adhering to guidance to carry out rapid molecular testing for TB / drug resistant TB and is a late adopter of this technology. A case was built by the SMVN to introduce the technology.

SMVN CASE / RECOMMENDATIONS

The SMVN formed a Mycobacterial Services Short Life Working Group (SLWG) to agree the direction and content of an options appraisal / business case which was led by Dr Fiona MacKenzie (SMVN Scientific Manager). The business case evolved through a complex and lengthy governance structure. It was presented, discussed, modified and approved by a large number of groups during its life including the Diagnostic Steering Group (DSG) Advisory Group, the DSG, Laboratory Oversight Board (LOB) Blueprint Sub-Group, NHS Board Directors of Finance and NHS Board Chief Executives. The SMVN Mycobacterial Services SLWG ultimately recommended:

The case for funding was approved and the SMVN has established an Implementation Group to work with National Procurement colleagues, led by Kris Lindsay, to procure the most suitable equipment and consumables.

‘To get to the implementation stage is an accomplishment in itself and the staff involved

should be proud of their achievement.’

DSG 6 June 2019

NICE based triaging of TB specimens to test on a rapid, molecular platform instead of smear testing (applies to c. 38% of NHS Scotland’s c. 30,000 TB samples per year).

All specimens which do not meet NICE triage criteria, and therefore have a low probability of being positive for TB, should continue to be screened by smear.

All specimens, regardless of how they are screened for TB, should be cultured.

The SMVN utilised a published health economic model to ascertain costs of implementing molecular testing for TB in 11 Health Boards which could provide data. The model projected:

Total net cost avoidance / costs savings of £2,586,557 / year (average £215,557 per Health Board, range £26,839 - £659,365). These largely result from identifying TB negative patients earlier, removing them from pre-emptive isola-tion and stopping unnecessary treatment.

Specific costs saved in personal protective equipment (PPE) of £700,068 / year (average £63,643 per Health Board, range £9,009 to £202,394).

SERVICE: The Sco sh Lyme Disease and Tick‐borne infec ons reference laboratory (SLDTRL), Inverness opened its doors during April 2019. Its remit two‐fold: diagnosis and epidemiology. We provide a diagnos c service for Lyme disease but are developing the service to include other ck‐borne infec ons such as Anaplasmosis, Borrelia miyamotoi and louping ill virus with PCR tests now available for Anaplasma phagocytophilum and B. miyamotoi. Secondly, in collabora on with Health Protec on Scotland (HPS), we hope to improve the epidemiological data for the incidence of ck‐borne infec ons in humans and cks and so provide be er public health informa on.

DIAGNOSTIC TESTING

Lyme disease:

Serum: 2 er tes ng on serum sam‐ple: posi ve or equivocal EIA con‐firmed by IgG and IgM immunoblots

Serum/CSF: Both samples MUST be taken on same day to test by EIA for neuroborreliosis. Used to calculate an body index and interpreted with cytology/ biochemistry of CSF and clinical presenta on

Anaplasma/B. miyamotoi:

EDTA whole blood: PCR on whole blood taken within 4 weeks of onset of symptoms

PCR is available for tes ng on skin biopsy, joint fluid and other samples as discussed with SLDTRL (01463 704206)

Further details found on the HPS website: h ps://www.hps.scot.nhs.uk/

web‐resources‐container/sco sh‐lyme‐disease‐and‐ ck‐borne‐infec ons‐reference‐laboratory‐user‐manual/

Thanks to all our users for their inval‐uable help and coopera on!

EPIDEMIOLOGY

There were 232 cases of Lyme disease diagnosed serologically in 2018. However, since erythema migrans is diagnos c of Lyme disease, there were a further 244 seronega ve erythema migrans cases making a total of 476 cases iden fied at the reference lab in 2018!

Tick collec on and tes ng is an unusual role for an NHS reference laboratory but it is crucial to understand the epidemiology of ck‐borne disease and may provide an early warning for emerging diseases. PCR will be performed on cks collected from humans to iden fy what pathogens are being carried and where in Scotland they can be found.

THE WEE BEASTIES

Ticks should not put you off enjoying the wonderful Sco sh green spaces! Instead be aware. Remove cks as quickly as possible a er being out even checking yourself whilst out walking. Informa on on ck removal and what to do if bi en by a ck is available on the HPS website:

h ps://www.hps.scot.nhs.uk/a‐to‐z‐of‐topics/lyme‐disease/

or the NHS Inform website:

h ps://www.nhsinform.scot/healthy‐living/outdoor‐health/bugs‐and‐germs/avoiding‐bugs‐and‐germs‐outdoors

Different sizes of ck stages

Larval stage

Nymphal stage Unfed adults

In June 2018, the Diagnostic Steering Group (DSG) convened a subgroup to explore workforce planning issues is laboratory diagnostics. This was in response to:-

A number of risks to future service sustainability, raised by diagnostic disciplines in response to a range of workforce issues, including immediate pressures in cytology services, consultant shortages and a lack of flexibility in the current training approach.

The workforce transformation ambition in the National Delivery Plan for Healthcare Science.

Pay protection issues following the implementation of agenda for change.

Predicted number of retirals in the near future.

A lack of progress with issues raised in the DSG’s 2013 workforce paper.

A group was convened, chaired by Dr David Stirling, Director of Healthcare Science, NHS National Services Scotland (NSS). There was broad representation, including each laboratory discipline represented within the DSG structures, the Scottish Government, NHS Education for Scotland (NES) and staff side. SMVN was represented by Dr Tom Gillespie and Dr Lyndsey Batchelor. The group was supported by DSG secretariat and met on five occasions.

A major data gathering exercise was undertaken in order to ensure recommendations were based on accurate information. The Information Management Service (IMS) would like to thank all lab staff who worked with them to ensure a full and accurate picture of current staffing levels.

The data demonstrated a significant difference between the workforce data published by PHI and that collected. It also provided the first accurate, holistic picture of medical and scientific laboratory workforce.

The group are currently finalising a report on their work which will be made available through the SMVN. Draft findings are as follows:-

The group has concluded that NHS Scotland is facing a significant crisis in its laboratory workforce which will have an impact throughout the patient journey. A solution is required which addresses the problem holistically, delivering a sustainable service through a meaningful union of scientific and medical workforces.

This work noted that the data on which workforce planning in labs has been based to date does not provide an accurate picture of staffing levels and there is a need to address how figures are recorded going forward.

The group reviewed the recommendations from the 2013 DSG Workforce Planning report and noted that, in the absence of a delivery vehicle, work was not progressed. The group concluded the need for ongoing governance, functioning as a subgroup of DSG, appropriately supported to oversee the implementation of the emergent recommendations.

The work of the Scottish Pathology Network (SPAN) in progressing a training school for BMS Dissection was highlighted as a significant achievement in transforming roles that were traditionally medical. The group concluded the need for further exploration of similar initiatives in all disciplines to negate the reliance on medical roles and ensure a multi-professional approach to service sustainability.

Fundamentally, the group concluded that a different approach to workforce planning and design is needed. This must include imaginative approaches to training and transformative roles, ensuring that NHS Scotland can build a workforce capable of delivering a sustainable service model.

The DSG Workforce Planning Subgroup made the following recommendations for NHS Scotland’s laboratory workforce:-

1. Systematic data collection should continue through the NMDNs, informed by their specialty-specific expertise and supported by their Information Management Service.

2. Work with Public Health Intelligence to improve the quality of their laboratory workforce data and ensure that any publication of their data acknowledges its limitations in service planning.

3. Workforce planning should be carried out

within each board/region to determine the optimal workforce profile for the future service model.

4. Support Networks to progress their workforce workstreams, with particular support for transformational roles and the development of advance practise roles.

5. Work with SG, Professional Bodies and NHS Education Scotland to:-

Explore possibilities for a cohesive approach to run-through training programmes, and training support for the R&R setting.

Explore a flexible approach to the use of training budgets, including use of medical training budgets in training other specialties to support consultants.

Consider redesigning the geographic distribution of medical trainees to ensure it offers optimal training opportunities.

SMVN Meeting Dates, 2019 quarter 4 SMVN Operational Group 6 September

SMVN Standardisation Group 11 September

SMVN Steering Group 19 September

SMVN AST / AMR Group 24 October

DSG Advisory Group 4 November (topic of the meeting = SMVN) DSG 5 December (topic of the meeting = SMVN)

SMVN Steering Group 12 December

SMVN Members based in Health Board laboratories may ask their Laboratory Manger / Clinical lead for information on any of these meetings or log onto the members’ area of the SMVN website for further information.

An microbial resistant bacterium

Janet Young, NHS Greater Glasgow & Clyde (GG&C) Microbiology Service Manager retired from the service on 31st July 2019. Janet has worked all her career in NHS GG&C, firstly at Glasgow Royal Infirmary (GRI) then followed by Yorkhill Hospital for Sick Children and finally at the Southern General Hospital, Glasgow.

In 2009 Janet was appointed as the Microbiology Site Manager for the Southern General Hospital and was heavily involved in the merger between the two Microbiology Laboratories at Yorkhill and the Southern General when the laboratory service was amalgamated into the new laboratory building at the Laboratory Medicine/FM Building at QEUH.

In 2014 Janet was appointed to the post of NHS GG&C Microbiology Service Manager with operational responsibility for the GG&C Microbiology service provided by GRI, QEUH and the Royal Alexandra Hospital, Paisley (RAH).

In 2017 NHS GG&C decided to introduce WASP/WASPLab automated robotic technology into GG&C Microbiology with two fully operational

systems installed at GRI and QEUH. Janet was

instrumental in the management of this project and was fully involved in the extensive work to ensure that the new WASPLab technology was fully embedded into both departments. Janet personally overseen the WASPLab discovery sessions, were a series of interactive, educational and fun seminars were used to prepare the staff for the change prior to implementation.

Janet has been a firm supporter of the work of the SMVN and specifically the AST and SMOG groups and her considerable experience will be missed to the profession. We would like to wish Janet all the best for her future in her retirement.

JANET YOUNG - RETIRAL

A series of roadshows is underway highlighting the work of the diagnostic networks, shared services, demand optimisation and the Diagnostic Steering Group (DSG). So far these have taken place at various diagnostic network events and at NHS Ayrshire & Arran, Dumfries & Galloway, Fife, Forth Valley, Grampian, Great Glasgow & Clyde and Lanarkshire. Laboratory staff have been given the opportunity to meet network representatives and ask questions.

The remaining roadshow events in 2019 will take place as follows:

NHS Western Isles: 27 August 2019NHS Western Isles: 27 August 2019

(NHS Orkney, Shetland, Tayside (NHS Orkney, Shetland, Tayside -- dates to be confirmed)dates to be confirmed)

ROADSHOWS

Dr Vhairi Bateman is a consultant in Infectious Diseases & Medical Microbiology and antimicrobial team chair at NHS Grampian.

Vhairi is a strong supporter of the Antibiotic Guardian campaign led by Public Health England in collaboration with UK devolved administrations and professional bodies. She and her team won the Community Communications award at the recent Antibiotic Guardian annual UK-wide awards. Specifically, they were recognised for spreading the word about antimicrobial resistance amongst football supporters at Aberdeen FC events.

Vhairi also set up a challenge during last year's Antimicrobial Awareness Week saying, “The more NHS Grampian staff who joined me in sign-ing up to Antibiotic Guardian, the further I would run. More than 100 signed up, so I found myself committed to completing a half-marathon”. She will be joined at the Simplyhealth Great Ab-erdeen Run on Sunday 25 August by nine NHS colleagues. Some will line up with her on the half-marathon start line while others are taking on the 10k.

“As well as raising awareness, we're all fund-raising for one of the few charities supporting new drug development — Antibiotic Research UK.

We would be delighted to grow our team so if there are any other NHS Grampian staff who'd like to join us, please do get in touch."

Vhairi came fairly late to running after being punished for taking too long to complete a school cross-country course. "The teacher con-cluded I must have been skiving and I received my first — and last — punishment. This left me with a lingering hatred for running!

"But I've now given it another go, and by the end of last year had successfully finished a Couch to 5k programme.

"Since then I've completed a 10k race and I train when time allows. I'm very lucky to work with some much more experienced runners and they've been offering lots of great advice."

The Great Aberdeen Run event includes a family run open to everyone over the age of three, as well as the 10k and half-marathon. Runners will take in the sights of Union Street out to the coast where they can enjoy views across the North Sea. There will be bands playing at the event along with members of the public cheering on participants along the route.