I understand that, on the whole, GPs haven’t had to give a second thought to the price of pathology services. I was a practising GP and know only too well from colleagues that it was often low down on the list of things to scrutinise. We order the tests; the PCT contracts the service provider and pays the bills. A staggering 70-80% of all healthcare decisions involve a pathology investigation, costing the NHS £3bn per annum, with 35–45% of this from primary care. As pathology volumes continue to grow by up to 10% per annum, this is an area that clearly requires attention.
Pathology services review
In 2008 the Carter Report (the review of NHS pathology services in England) highlighted the need for rationalisation of pathology services in the UK, recommending the creation of networks to concentrate specialist services at centres of excellence whilst continuing to provide more general services that require faster turnaround, close to the point of need. By doing so, there would be substantial savings. Except for the fact that back then PCT-based commissioners held the purse strings, the situation and the need to rationalise is no different in 2012.
Why examine pathology service provider?
As we manage more long-term illness for an increasingly ageing population, demand for pathology services will inevitably increase. Furthermore, patients and clinicians have higher expectations about what their healthcare should deliver. Can a test that historically takes 10 days be delivered in three, enabling the clinician to deliver better care to the patient?
What a makes a good pathology service provider?
Patients come first - commissioners need to bear in mind that pathology service providers should always put the patient first. The quality of the service should be beyond question and the turn-around times should match, as far as possible, what the clinician needs and the patient’s expectations. We are seeing an increasing need for faster turnaround time for results as our healthcare system is scrutinised by patients as well as clinicians.
Cost efficiency - A good provider must deliver a cost-effective service, so as demand rises the clinical commissioning group (CCG) does not witness exorbitantly rising costs as well. Are you aware of how much a test costs? Historically GPs have not paid for a pathology test as an individual item or unit. GPs never needed to give it a second thought unless asked to do private work for an insurance company or something similar. In turn, the local lab was not set up to come up with prices and the ability to invoice separately. However, this is about to change. Any service provider should be able to give a detailed break down of the tests they can carry out, the turnaround times and the price whether this is on an item-of-service basis or as a block contract.
Providing additional support and advice - GPs should be able to have reliable access to advice and support when they need it, to assist them in making the right clinical decision. Therefore, a good pathology provider will ensure that prompt advice from consultant pathologists and laboratory scientists is available when the GPs need it.
While there is understandable debate about potential over-ordering of pathology tests, I believe pathology suppliers must be sensitive to the needs of GPs who deal with patients with a vast array of symptoms on a daily basis and who have to ensure that they take every step to exclude serious illness and malignancy, and GPs should not be constrained by the range of tests they can order. Any supplier should respect the view of an experienced medical practitioner whilst being available to advise them if further support is required.
The independent sector – as GPs and CCGs, you need to ask what you currently get from your pathology service provider and what you need from the service in the future. It may well be worth considering providers from the independent sector as well as the NHS, to get what you and your patients need cost-effectively.
Appropriate skills and investment in technology – Good labs use an efficient mix of workforce and modern technology. As the workforce is the most expensive cost to running a lab, clever use of modern technology is enabling test prices to be reduced and turned around faster through the introduction of automation. This releases highly trained staff to concentrate their efforts where they deliver the greatest benefit.
Being part of a network – As mentioned previously, this is something that was identified as an opportunity within the Carter Report. Working within a network of labs allows concentration of expertise and cuts costs. It means that expensive equipment required for the less commonly requested tests is situated at only one or two centres. Local labs can conduct the common tests with a quick turnaround time and the more specialist tests are sent off when they need to be. Within in a properly structured network, clinicians and patients will be unaware of this as they receive consistently high quality results within the turnaround times that they require.
As a GP or CCG, change is happening, and you need to make the change work for you and your patients. Re-assessing your pathology services and ensuring that you are receiving the fastest, most cost-effective service is just one way of ensuring you are ahead.
* Dr Fergus Macpherson is a director of Spire Pathology Services and a former GP.