In this issue LTOL Moving On Cardiff Bay Beckons What Will it Be
Transcription
In this issue LTOL Moving On Cardiff Bay Beckons What Will it Be
ACBNews The Association for Clinical Biochemistry & Laboratory Medicine | Issue 621 | January 2015 In this issue LTOL Moving On Cardiff Bay Beckons What Will it Be Like in the 2020s? About ACB News The Editor is responsible for the final content. Views expressed are not necessarily those of the ACB. Editor Dr Jonathan Berg Department of Clinical Biochemistry City Hospital Dudley Road Birmingham B18 7QH Tel: 07792-912163/0121-507-5353 Fax: 0121-507-5290 Email: [email protected] Associate Editors Mrs Sophie Barnes Department of Clinical Biochemistry 12th Floor, Lab Block Charing Cross Hospital Fulham Palace Road London W6 8RF Email: [email protected] Mr Ian Hanning Department of Clinical Biochemistry Hull Royal Infirmary Anlaby Road Hull HU3 2JZ Email: [email protected] Dr Derren Ready Microbial Diseases Eastman Dental Hospital University College London Hospitals (UCLH) 256 Gray’s Inn Road London WC1X 8LD Email: [email protected] Mrs Louise Tilbrook Department of Clinical Biochemistry Broomfield Hospital Chelmsford Essex CM1 5ET Email: [email protected] ACBNews The monthly magazine for clinical science Issue 621 • January 2015 General News page 4 Practice FRCPath Style Calculations page 9 Council Matters page 11 Current Topics page 12 Meeting Reports page 14 Patient Power page 16 Personal View page 18 ACB News Crossword page 23 Situations Vacant Advertising Please contact the ACB Office: Tel: 0207-403-8001 Fax: 0207-403-8006 Email: [email protected] Display Advertising & Inserts PRC Associates Ltd 1st Floor Offices 115 Roebuck Road Chessington Surrey KT9 1JZ Tel: 0208-337-3749 Fax: 0208-337-7346 Email: [email protected] ACB Administrative Office Association for Clinical Biochemistry & Laboratory Medicine 130-132 Tooley Street London SE1 2TU Tel: 0207-403-8001 Fax: 0207-403-8006 Email: [email protected] ACB President Professor Eric Kilpatrick Tel: 01482-607-708 Email: [email protected] Twitter: @ACBPresident ACB Home Page http://www.acb.org.uk Printed by Swan Print Ltd, Bedford ISSN 1461 0337 © Association for Clinical Biochemistry & Laboratory Medicine 2015 Front cover: The LTOL management team celebrate ten years of LTOL-UK Issue 621 | January 2015 | ACB News 4 | General News Top 100 Scientists Celebration At the December Council Meeting awards were presented to the winners of the top 100 Scientists. To identify its list of 100, the Science Council organised a competition around ten different ‘types’ of Scientist roles making valuable contributions across UK society and economy. Each type of role in science draws on a different mix of skills, knowledge and expertise. The ten areas that were judged were explorer, investigator, developer/ translational, service provider/operational, monitor/regulator, entrepreneur, communicator, teacher, business/marketing and policy maker. The ACB nominated individuals in some of the categories of ‘10 types of Scientist’, identifying individuals who are currently engaged with UK science that other Scientists might look to for leadership in their sector or career. Out of the top 100 Scientists the six winners are as follows: Develop-Translational Scientist: ◆ Dr Paul Collinson Monitor-Regulator Scientist: ◆ Dr Catherine Sturgeon Service Provider-Operational Scientist: ◆ Professor Heather Cubie ◆ Professor Christopher Price ◆ Dr John Honour Entrepreneur Scientist: ◆ Dr Jonathan Middle This was a special presentation event reflecting the work of some great Scientists who are part of our thriving association. ■ Cathie Sturgeon, Eric Kilpatrick, John Honour, Chris Price and Jonathan Middle, four of the six ACB Members who made the “Top 100 Scientists” list in 2014 Sudoku This month’s puzzle Last month’s solution ACB News | Issue 621 | January 2015 6 | General News Barnes Quality Review of Pathology It is just a year since the Pathology Quality Assurance Review was published. The review was chaired by Dr Ian Barnes and followed incidents in Pathology that warranted a detailed study of the Quality Assurance framework for Pathology. NHS England is now working along with others to implement the recommendations of the review. Quality systems are increasingly to the forefront of the Pathology Department, especially as the new inspections by UKAS are now taking place. During 2015 ACB News will be looking to promote good practice in quality in the clinical laboratory. Ian Barnes himself is very keen to see greater understanding of the Quality Review, and is concerned that laboratories locally consider the wider aspects of the review. Ian is still busy being asked to speak around the country on his review at meetings and also more locally within Pathology laboratories. As part of this, Ian has recently helped with the production of a series of short training videos. These seek to inform all Pathology staff about the work of the review and how it is being taken forward. Pathology and Trust Board These resources can be used to help increase awareness in pathology of quality and how things are changing in our environment. The first of a series of five videos looking Click on this thumbnail to go to the video from the PDF edition or put the title into YouTube specifically at the Barnes Quality Review is now published. “Barnes Quality Review; Introduction and Governance” sets the scene and then considers the key issues of how Pathology interacts with the organisation in which it is based. The video sees Ian interviewing a Trust Chairman about the role of the Board in Pathology oversight. Dr David Burnett also features in the series and with his huge commitment to clinical laboratory quality systems he will be providing a real foundation of how ISO 15189 can be embedded in Pathology. To play the video simply click on the images on the electronic version of ACB News. Alternatively go onto YouTube and search for: “Barnes Pathology Quality Review: Introduction and Governance”. ■ Ian Barnes explains his review to the “St Elsewhere’s” Pathology Directorate at their annual strategic planning meeting ACB News | Issue 621 | January 2015 General News | 7 ACB Membership Awards 2015 Nominations for this year’s Awards are invited from Regional Committees, together with a citation of about 500 words, outlining the basis of the nomination. The Award must be approved by Council at its meeting in March 2015, and it is important that the Regional representative is able to extol the virtues of the nominee as it is possible that Council members may not know some of the activities of nominated individuals. The three award categories are: Emeritus Member Persons who have been Ordinary Members of the Association for at least ten years and have retired from full-time employment and who have made an exceptional contribution to the objects of the Association may, on the recommendation of Council and by a majority of at least two-thirds of those voting at a General Meeting, be elected Emeritus Members of the Association. Fellow Persons who have been Ordinary or Affiliate Members of the Association for at least ten preceding consecutive years and have retired from full-time employment may, on the recommendation of Council and by a majority of at least two-thirds of those voting at a General Meeting, be elected to the category of Fellow of the Association. The recipients have made a significant contribution to the profession in one or more of the following areas: ◆ Continually led and instigated changes to meet the needs of Clinical Biochemistry and Laboratory Medicine services on behalf of a region or nationally. ◆ Developed exceptional educational and/or training facilities for the profession. ◆ Led in setting up and developing over, a considerable period of time, a well-respected and valued specialised service that had a major impact either within a region or nationally. ◆ Raised the profile of the profession over many years, within the lay or clinical community, either regionally or nationally. Honorary Member Persons who have made a distinguished contribution to Clinical Biochemistry and Laboratory Medicine at international level may, following the recommendation of Council and by a majority of at least two-thirds of those voting at a General Meeting, be elected Honorary Members of the Association. If you would like to propose someone then contact your ACB Regional Secretary. Proposals must be supported by the Regional Committee and the nomination submitted through the Regional Committee at the Council meeting in March 2015. The closing date for nominations received by Council is 2nd February 2015. ■ Issue 621 | January 2015 | ACB News 8 | General News Science on the Bay Gina Sanki, Focus Committee Focus is an event that no ACB Member should miss out on. It is an opportunity to develop our learning, share good practices and look to the future with colleagues. Accompanying this month’s ACB news you will find enclosed your Invitation to Participate. The theme for Focus 2015 in Cardiff is “Breaking Barriers in Laboratory Medicine”. Topics that will be covered include genetics and genomics, porphyria, metabolic muscle disease, haematology, immunology and point of care testing, with the full scientific programme listed in the Invitation to Participate. SpR and Trainees Meeting A satellite meeting for SpRs on Tuesday 9th June 2015, has a programme aimed towards SpRs but is open to everyone. Topics at the satellite meeting include obesity and bariatric surgery, drug analysis and the legal issues this presents. For those at the beginning of their careers in Biochemistry and Microbiology there is the Trainees’ Day being held on Monday 8th June, prior to the main meeting, with the Trainees’ social event held on Sunday 7th June. This provides an excellent occasion to catch up with those who you have previously met during your training and also to make new friends and contacts. The first Award Lecture to be presented at Focus 2015 will be the ACB Foundation Award Lecture by Professor Stephen Halloran MBE on Colorectal Cancer Screening on Tuesday 9th June. Professor Halloran set up the NHS Bowel Cancer Screening Programme’s Southern Hub in 2006. The hub now serves 14.3 million people across the South and, under Professor Halloran’s watch, more than 1,400 bowel cancers have been identified. We look forward to seeing you in Cardiff. Diolch! ■ Come and Contribute to ACB News . . . ACB News is aiming to have some fun in 2015. If you would like to be part of this then do consider contributing. In particular, we are looking for articles that help take clinical laboratory medicine forward. You might want to write about: ◆ Novel ways of improving pathology transport. ◆ Experience of key performance indicators with primary care. ◆ Your first UKAS inspection. ◆ Coping with out-of-hours services with lack of registered staff. You may of course have your own ideas. If you have, do give the Editor a phone call or email. ■ ACB News | Issue 621 | January 2015 Practice FRCPath Style Calculations | 9 Deacon’s Challenge No 164 - Answer A neonate weighing 850 g is admitted to the Neonatal Intensive Care Unit. Following intubation and artificial ventilation, blood gases reveal an arterial blood hydrogen ion concentration of 120 nmol/L and a pCO2 of 6.2 kPa. Estimate the dose of sodium bicarbonate (1.25%) required to reduce the hydrogen ion concentration to 80 nmol/L. You should assume that ventilator settings remain unchanged, and ignore any effects due to changes in plasma volume and peripheral circulation. You should assume also that the total body water in neonates is 80% of body mass, due to an expansion of extracellular fluid volume compared to adults, and is evenly distributed between intra- and extracellular compartments. FRCPath, Autumn 2013 The hydrogen ion concentration (in nmol/L), multiplied by the bicarbonate concentration (in mmol/L) and divided by the pCO2(in kPa) is always constant at 180: 180 [H+] [HCO3–] = pCO2 To calculate the initial bicarbonate concentration substitute: [H+] so that 180 = 120 nmol/L and pCO2 = 6.2 kPa = 120[HCO3–] 6.2 [HCO3–] = 180 x 6.2 = 9.3 mmol/L 120 Similarly substitute [H+] = 80 nmol/L in order to calculate the final plasma bicarbonate concentration (assume pCO2 is still 6.2 kPa since the ventilator settings remain unchanged): 180 = [HCO3–] 80[HCO3–] 6.2 = 180 x 6.2 80 = 14.0 mmol/L Therefore administration of bicarbonate has increased the plasma bicarbonate concentration by 14.0 – 9.3 = 4.7 mmol/L A smaller amount of bicarbonate has been consumed in reducing the [H+] from 120 to 80 nmol/L. i.e. 40 nmol/L of hydrogen ions have been neutralized by the administered bicarbonate. Therefore another 40 nmol/L = 0.00004 mmol/L are needed, which is small enough to be ignored. Assuming administered HCO3– remains in the ECF and is not metabolized: Change in HCO3– (mmol/L) = Amount of NaHCO3 given (mmol) ECF vol (L) Issue 621 | January 2015 | ACB News 10 | Practice FRCPath Style Calculations ECF vol (L) 4.7 = = Body wt (Kg) x % body water x Proportion of water in ECF = 0.85 x 80 x 1 100 2 = 0.34 L Amount of HCO3– needed (mmol) 0.34 Amount of HCO3– needed = 4.7 x 0.34 = 1.60 mmol Calculate concentration of sodium bicarbonate solution (1.25%) in mmol/L: MW NaHCO3– = 23 + 1 + 12 + (3 x 16) = 84 Therefore [HCO3–] = 1.25 x 10 x 1000 84 = 149 mmol/L Volume needed (L) = Amount needed (mmol) Concentration (mmol/L) = 1.60 = 0.0107 L i.e. 10.7 149 Question 165 An inherited metabolic disease is due to a gain in function of enzyme X. The erythrocyte activity of X was measured in 100 normal subjects and 100 patients with the disease. The 95% confidence limits of the two groups are: Unaffected: Diseased: 89 – 901 IU/L red cells 830 – 5260 IU/L red cells The data from the unaffected group showed a normal Gaussian distribution. However, the data from the diseased group were markedly skewed but a simple logarithmic transformation produced a reasonable Gaussian distribution. It is proposed to use the assay of X in erythrocytes as a screening test for the disease. Calculate the decision level which will result in a sensitivity of 95%. What specificity will this achieve? Two tailed z-distribution: P(%) 10 5 z 1.65 1.96 2 2.33 1 2.58 0.2 3.09 0.1 3.29 FRCPath, Spring 2014 ACB News | Issue 621 | January 2015 Council Matters | 11 The 2014 Awards Went to . . . At a recent Council Meeting the Annual ACB Awards Ceremony was held. These Awards are designed to recognise Ordinary Members of the Association who have made a significant contribution to the work of the Association and have retired from full time working. There are three awards, Emeritus, Fellow and Honorary. The nominations for these Awards come from each of the regions and are recommended by ACB Council and by a majority of at least two thirds of those voting at a general meeting. The awards for this year are as follows: the Association for at least ten years and have retired from full-time employment and who have made an exceptional contribution to the objects of the Association: ◆ Dr Keith Griffiths, Wales ◆ Mrs Ruth Lapworth, Southern ◆ Dr Nigel Lawson, Trent Northern & Yorkshire Fellow Members Persons who have been Ordinary or Affiliate Members of the Association for at least ten preceding consecutive years and have retired from full-time employment: Honorary Members Persons who have made a distinguished contribution to Clinical Biochemistry and/or Laboratory Medicine at international level: ◆ Dr Penny Clark, West Midlands ◆ Mr Martyn Egerton, Southern ◆ Ms Roberta Goodall, South West & ◆ Mr Mike Hallworth, West Midlands ◆ Dr Ian Watson, North West ◆ Dr Geoff Beckett, Scotland ◆ Dr Charles Van Heyningen, North West ◆ Mr Gethin Roberts, Wales ◆ Mr Colin Samuell, Southern Emeritus Members Persons who have been Ordinary Members of Our congratulations go to all recipients of these Awards. ■ Wessex Issue 621 | January 2015 | ACB News 12 | Current Topics Demonstrating Personal Proficiency in Pathology Professor Eric Kilpatrick, ACB President and Dr Bernie Croal Chair, RCPath SAC on Clinical Biochemistry The ACB and the Royal College of Pathologists have released a draft document for consultation on the topic of demonstrating personal proficiency with a deadline for responses of 30th January 2015 (http://www.acb.org.uk/whatwesay/acb_newsp age/2014/12/10/demonstrating-personalproficiency-in-pathology). All members of the ACB received the document by email and it has been included in the College consultations page. This current article is intended to give an overview of the purpose and aims of the document. pathology results and providing clinical advice should be registered with current External Quality Assessment (EQA) individual assessment schemes and demonstrate regular participation. Since the report publication, NHS England has established an Oversight Group to supervise the implementation of all the Quality Review recommendations and the Professional Bodies, including the ACB, have been tasked with helping deliver many of them, including the one related to individual assessment. Why Demonstrate Personal Proficiency? In recommending the need for individual (or personal) EQA, Ian Barnes, as the Chair of the Review, did not specifically associate personal proficiency solely with participation in individual EQA. This is certainly in keeping with the view of the document currently out for consultation which emphasises that individual EQA schemes can only ever be a part of demonstrating personal proficiency and that there are many other ways in which safe practice can also be proven. These include (but are not limited to): continued CPD; evidence of innovating and improving service quality, either as an individual, as a leader and/or as part of a team; demonstrating valued teaching or training supervision; feedback from colleagues, other staff and service users (ideally as part of a 360° appraisal); and recording compliments and complaints. It is self-evident that maintaining proficiency in the job we do as clinical scientists or medics is our professional duty which is why UK registration bodies such as the HCPC and the GMC make it an explicit requirement for continued practise. In this respect, most Pathology staff already take part in appraisal and participate in schemes which demonstrate their continuing professional development. Also, as part of their usual work, they are central to improving the quality of service to patients. Why Now? Although most laboratory staff already have the means of demonstrating their own proficiency, the Pathology Quality Assurance Review (PQAR) (http://www.england.nhs.uk/ publications/ind-rev/) published in January 2014 advised that demonstrating proficiency should become more formalised through the development of methodologies which would give a fair and accurate indication of an individual’s competence to practise. As part of this, the Review recommended that all practising individuals responsible for reporting ACB News | Issue 621 | January 2015 The Professional Body Response Challenges There are challenges in implementing the draft document which include how interpretative EQA schemes will be able to adapt to meet the recommendations of the PQAR and how having proficiency questioned might affect individuals. Current Topics | 13 The interpretative comments EQA scheme organisers recognise that the schemes in their current forms will not be able to fulfil the role envisaged by the PQAR, not least because of capacity issues if everyone eligible applied at once. Also, these schemes focus mainly on education rather than assessment, with laboratories frequently submitting joint responses. It means that the system itself will have to evolve to provide individual assessment of the necessary while excluding an obligation to have wide knowledge of the obscure. Of course, this is further complicated by the fact that there are also many sub-specialists in our profession who will need to be catered for. With regard to discussing the adequacy of personal proficiency, it is suggested that the most appropriate setting should be the locally based appraisal system. While this form of discussion is already part of appraisal and revalidation for medical staff, it is appreciated that it may mean a change to the way in which clinical scientists undergo this process. The document makes it clear that the appraisal discussion should continue to be supportive, concentrating on identifying the individual’s development needs rather than being regarded as potentially punitive. The Future It seems better for the profession to lead on how personal proficiency should be assessed rather than it be imposed in what could be a more imperfect manner. It is therefore important that the draft document is given careful consideration and that ACB Members respond to the consultation with any suggestions as to how it might be improved. ■ Issue 621 | January 2015 | ACB News 14 | Meeting Reports Early Detection of Disease Dr Sally Thirkettle, Cwm Taf UHB This year the ACB Wales Autumn Regional and Audit Meeting found us in Newport, with a focus on early detection of disease being a major function of the laboratory, to facilitate appropriate and timely patient management First to take to the stage was Dr Rachel Brixey, Trainee Clinical Scientist, Cardiff and Vale University Health Board. Rachel presented two fascinating and informative cases of kidney stones, one of which was in a young girl that had sadly caused irreparable kidney damage, really highlighting the importance of quick diagnosis and treatment. Next up was Gareth Davies, Clinical Scientist with WEQAS, who told us of the latest developments in the generation of an EQA Scheme for POCT creatinine. This test could be used in secondary care as a screen for renal damage before commencing a patient on a regime of nephrotoxic drugs for example. Great progress has been made on this, and the next step is to put the scheme forward for UKAS accreditation. To conclude this set of short presentations Sarah Tennant, Clinical Scientist, Cardiff and Vale University Health Board, presented a review of the effect of changing cortisol assays, from the Siemens Centaur to the Abbot Architect, in 2010. Sarah carried out this review in conjunction with the paediatric endocrine team as concerns were initially raised about over-investigating patients secondary to lower results being reported with the new assay. However, this was not found to be the case, and clinicians were more considered when requesting the test, only requesting it when there were good clinical grounds to do so. ACB News | Issue 621 | January 2015 L-R: Rachel Brixey, Sarah Tennant, John Tovey and Gareth Davies First prize for the Trainee members presentation went to Sarah Tennant, but due to the high quality of all the talks Dr Rachel Brixey and Gareth Davies also won a prize! Congratulations to you all. AKI is Common, Costly and Poorly Managed The trainee talks were followed by an excellent presentation by Dr Edmund Lamb, Consultant Clinical Scientist, East Kent Hospitals University NHS Foundation Trust. Dr Lamb demonstrated how we can use biological variation within individuals to better understand the markers used to diagnose kidney disease. Dr Lamb highlighted the significant range of inter- and intra-individual variation, in both health and disease, which has a direct impact on the key analytes used to determine renal function. This impacts on how clinicians should interpret results and highlights the need to be cautious in diagnosing patients solely using standard reference ranges. The afternoon session was divided into two: consisting of three audit presentations recently carried out in Wales, followed by a presentation given by Dr Richard Body, Meeting Reports | 15 Consultant in Emergency Medicine at Manchester Royal Infirmary. The first audit was presented by Miss Gina Sanki, Clinical Scientist, Cwm Taf Health Board, on Acute Kidney Injury (AKI). AKI is currently a priority in the NHS due to it being common, costly, often poorly managed and avoidable. The aim of this audit was to determine whether AKI is being identified and managed appropriately in secondary care at North Cwm Taf. 45% of cases were not recognised as being AKI, leading to the development of a strategy to improve AKI identification which has now been implemented across Cwm Taf University Health Board. Following this, Avril Wayte, Consultant Clinical Scientist, Betsi Cadwaladr University Health Board, and Annette Thomas, Consultant Clinical Scientist, WEQAS, presented on troponin. Avril Wayte presented results of an audit aimed to investigate the potential differences between analytical platforms and protocols used for measuring and reporting troponin concentrations across Wales, and facilitate standardisation across the principality. Clinicians View on Sensitive Troponin However, the results demonstrated that a range of troponin assays are still being used with some way still to go until all labs standardise their assays. Annette Thomas assessed the current performance of troponin assays in Wales by determining the level of intra- and inter-laboratory variation at different concentrations of troponin. It was demonstrated that whilst the assays currently in use are clinically useable, some showed less variability than others. Collectively, these three audits provided a valuable insight into the current practices used in early diagnosis of AKI and MI. To draw a fantastic day of great quality talks to a close, Dr Richard Body gave an engaging and energetic talk on the clinician’s perspective on the clinical utility of high sensitivity troponin testing. Dr Body Festive ACB Trainees welcome event, post ACB Wales Meeting with Gina Sanki, Rachel Brixey, Sally Thirkettle, Daniella Nice, Leanne Kelly, Sarah Tennant, Jonathan Howe and Elizabeth Palmer highlighted the need for sensitive and specific biomarkers for acute coronary syndrome, due to the variability in clinical symptoms, but emphasised that they must be used with care as a positive test result is not necessarily diagnostic of an acute myocardial infarction. However, exciting new data showed that under certain situations AMI could be ruled out in 3 hours, preventing unnecessary hospital stays for patients. In addition, an algorithm combining clinical observations with biochemical analysis for determining the probability that patients are having an MI is being trialled, so there will likely be new developments to watch out for in the future! I would like to take this opportunity to thank Dr Angharad Shore and Mr Gareth Davies for organising such an informative day. I and all those present gained new knowledge and understanding from this meeting and provided considerable scope for reflection on current practice within the laboratory. May I thank Miss Gina Sanki for organising an opportunity for the new STP Trainees in Wales to meet after the meeting and to the ACB for providing the refreshments for the evening. ■ Issue 621 | January 2015 | ACB News 16 | Patient Power Lab Tests Online-UK into Second Decade Ten Years of Lab Tests Online-UK: Launching the Champion Role, Technical and Editorial Update This has been an exciting year for Lab Tests Online-UK. We celebrated our ten year anniversary at EuroLabFocus. A speech from UK Board Chair Dr Danielle Freedman provided an overview of Lab Tests Online and planned future activities. The celebration was well attended including patient representative Dr Patricia Wilkie OBE and GP Dr Amir Hannan. A video of the speech can be seen via our homepage (www.labtestsonline.org.uk). If you are reading the electronic version of ACB News just click anywhere on this page to go to the video. Could you be a Lab Tests Online-UK Champion? As part of our celebrations we have launched a champion role to promote the website to patients and healthcare professionals to ensure its place as the recommended website for laboratory medicine information in the UK. Champions can sign up via http://www.labtestsonline.org.uk/show-your- support/ to receive a champions pack which includes our facts and figures, a prepared powerpoint presentation to be used and edited as the Champion wishes and examples of our newly revised literature including leaflets and posters. There is also an opportunity to sign up for our e-newsletter to be kept up to date with the activities of Lab Tests Online-UK and the board members, as well as request leaflets and posters for your local area. For more information on our champion role please contact Rebecca Leyland, Champion Manager, ([email protected]). Technical Report: Site Visitors The website has continued to receive around 150,000 hits per month, second only to the US when compared to other countries. The majority of users (~80%) coming to the site arrive via Google. Our reliance on Google search ranking presents a challenge because the site is in constant competition with others to reach our target audience. The risks of this dependence were made abundantly clear to us recently when a Google search algorithm update dropped our average Google search ranking well beyond the first page of results. The impact was devastating – a 50% reduction in hit rate almost overnight. We have been able to work with our colleagues in the US to address this issue but the message to us was clear – we cannot rely solely on Google referrals to ensure patients have access to our information. GP System Suppliers Patient and GP input in LTOL is increasingly important ACB News | Issue 621 | January 2015 The difficulties with website traffic have been a key motivator for Lab Tests Online-UK to work with other website providers, such as NHS Choices, and with GP system suppliers to embed direct links to Lab Tests Online-UK within their products. Our aim is to provide hyperlinks directly to information about specific laboratory tests when and where Patient Power | 17 from GP record systems. Working with third parties is going to become increasingly important as more software tools come onto the market with functionality to collect and display patient results. We would encourage any members who come across any such products that we may not be aware of to get in touch with Stuart Jones, (Technical Lead) [email protected] so we can consider working with the supplier to help improve experience for their users. The free Lab Tests Online mobile app continues to attract users with us recently passing 10,000 downloads. UK Editorial Team Danielle leading the celebrations patients need them. This work has become particularly relevant with the NHS England announcement that all patients in England should be given access to their electronic health record by April 2015. Our recent work with GP (and third party) system suppliers has been particularly fruitful. We now have test-specific links embedded against patient results within TPP’s SystmOne patient portal and we are working with INPS and eMIS to do the same with their portal applications. We are also working with third parties, such as HealthFabric, to embed links in their personal care planning tool, which also collects results The UK site continues to be extremely grateful to all of its editors, who voluntarily edit the pages of Lab Tests Online-UK, to ensure that the content is factually correct, consistent with UK practice and national guidelines, and written in a style that is appropriate for patients. Over recent years, the pool of editors has grown, and editors span all disciplines of laboratory medicine. The team are always keen to welcome new editors, in particular from the more specialist areas such as genetics, cytogenetics and molecular testing. Any keen GPs would also be welcomed. Please contact Dr Sally Stock (Managing Editor) [email protected] for more information. ■ Issue 621 | January 2015 | ACB News 18 | Personal View Clinical Biochemistry into the 2020s Jonathan Berg, Birmingham The organisers of a recent conference gave me a challenge, asking me to speak to 200 people on what we might all be experiencing in the 2020s. For some of us of a certain age life may well have moved on, certainly the free bus pass beckons for me not long into the next decade. Well straight after a coffee break can be good for audience participation with the question: “What three things would you most like to sort out in your clinical science laboratory?”. However, there was complete silence. No matter I had already asked my Pathology team what they thought and had come prepared with my own shortlist of pathology conundrums. My own Pathology team answered this question at the start of a recent management meeting. Their comments are probably reflective of the aspirations of the rest of the country. Here are key things to address for the 2020s: Pathology History – Learn from the Past We have lots in common in our pathology laboratories. During the time of huge growth in the 1970s and ’80s new technology including mechanisation, automation and IT were key to coping with demand. Of equal value was the drive and determination of individuals who had foresight and determination to take laboratory medicine forward for patient benefit. In my own discipline and locality I know the pioneering names Whithead, Sammons, Gaddie, Green and Broughton but living in Scotland I might equally say Morgan, Whitby, King and Percy-Robb. The lack of such a pool of determined, scientific and strategic thinkers in recent times has allowed an overindulgence of central managerial influence. Of course this is Aspirations Tell It Straight . . . GP samples spun down within 4 hours and overcome high potassium artefacts forever Will we ever get there? Poor quality samples from GPs are a continuing disgrace. No more lost samples Where do they all go? What about the racks of “orphan” samples we all have on our benches with no names on? Specialist services in a falling market We have done well in my own laboratory. It takes real determination at present to keep specialist services alive when everyone is trying to restrict what they spend on “send-aways”. More Twitter followers for @FitPathLab and @cityassays! No-one admits to using Twitter in our environment. We have found it incredibly powerful for getting our message out to people we did not even know existed. Seriously though communication is key to future success in Pathology. Jonathan’s key things to get right for the 2020s! ACB News | Issue 621 | January 2015 Personal View | 19 Aspirations of Pathology Sideways View . . . Reasonable financial target please not impossible CIPs We have always met our CIP, but taking 9.5% out of the budget in one year is too much! Appropriate levels of skilled staff We are all fighting each other for trained BMS staff at present. Demographics are against us. Home grown staff is clearly the one and only way forward. Assess savings across healthcare economy not just Pathology Will it ever happen! Service line reporting is not the answer. More IT and better Pathology transport True, but expensive. Views of the Pathology Directorate a vital ingredient but the focus on networking and consolidation can, if we are not careful, rather miss the point. Our future success will be founded on providing relevant laboratory medicine to patients, not amazingly efficient U&Es of little end-user value. We need to remember that not that long ago the day’s work in a busy clinical laboratory could all be written into a diary! On my birthday in the laboratory in West Bromwich just 10 samples were analysed, all written into a desk diary! taxpayers money and NHS effort has been wasted on failed projects. There are one or two areas of the country where major changes have been made, including involvement with the private sector and we will be able to observe how these experiments pan out. Letts day to a page diary with Hallam Street Hospital biochemistry results for 1956 all neatly entered Clear Strategy Well we have our feet on the ground in my Pathology Department. Key components of our own strategy are: ◆ Do the basics well. ◆ Innovate with IT and work on the basics and continuous quality improvement. ◆ Develop new tests of relevance to our own patients that are also of interest to others. ◆ Continue with the direct to public services. These will always be a work in progress but many of the ways we are moving forward can be positioned under one of these aspirations. Much comes along to influence strategy and of these tendering is important to get right. Certainly with GP tendering there are no great success stories. If you look from Sussex, Hampshire to the Midlands huge amounts of Issue 621 | January 2015 | ACB News 20 | Personal View Get the Basics Right . . . Not That Easy! Timely and relevant tests About having correct procedures in place but also commitment of all in the process. Helpful support and advice The friction between the “duty biochemist” role and the developmental section leader is ever present in my laboratory. Relevant POCT Not a panacea to everything and needs a lot of central control to do well. Extend use of IT: Test intervention, harmonisation, sample tracking, etc Use IT to increase efficiency and effectiveness, not create more mess for the end user. Communicate with and involve staff Sort of what SWBH is known for, but on our staff questionnaire communications always scores badly. Key things we continually work on In my own department we had several tenders live at any one time all through 2014. Recent examples include a tender for Cytology in 2013 which, when won by a neighbour, meant the closure of our service and twenty staff leaving our employment. Specialist services can be undermined by tendering and this is particularly the case in Toxicology, where partnering with just one or two Mental Health Trusts can be very risky if re-tendering takes place every three years. Innovation & Entrepreneurship Not a way many have chosen in recent times and not for the faint hearted during times of healthcare austerity. You need to have a vision and be able to back a 50/50 idea. When you know you are right then sometimes time is required for the rest of the world to catch up. Entrepreneurial services such as TPMT and Infliximab being examples, albeit at different stages of maturity, of the long-term approach. Being in the right place at the right time is more than a “fluke”. The SWBH legal highs service presently being used by labs across the country demonstrates another angle of ensuring our services address clinically relevant issues. Our young people killing themselves by taking in these horrendous substances is certainly relevant and this has put us into the ACB News | Issue 621 | January 2015 forefront of a huge clinical and political issue in 2014. I could write a whole article about entrepreneurial Pathology next time ACB News lacks material, but really the key is that you either understand it or you don’t. Clinical scientists in my laboratory mainly understand this. Some of what we do is highly intuitive, especially where new ideas transfer to a service for others. Pathology has been ignoring marketing communications to its detriment for far too long and it is very clear that most Pathology Laboratories still do not “get it”. With Whom We Work Understanding who we actually work for into the future and something of their direction of travel is essential. Many of our parent Trusts are focussed on a short-term balanced budget and this can override sensible medium and longer term strategies. You need to change your approach during such times, working on different ways of achieving fundamental objectives. Those around who we interact with, such as CCGs and other provider Trusts, also need to be understood. So, when the CCG negotiates a block contract with your Trust for everything including Pathology we need to understand the impact. If your local Mental Health services provider is just Personal View | 21 about to lose their main contract for provision of alcohol and drug addiction there are consequences. Healthcare sectors such as Mental Health are changing fast and impacts on local and national services can be predicted if you have someone at the top of your Pathology organisation looking at the politics. For us successful working with CCGs is more of the following: ◆ Pathology work is moving into ◆ ◆ ◆ ◆ Community and funding from CCGs must reflect the cost of doing the work. Discuss individual services at a senior level. Marketing communication needs much more emphasis. GP transport needs continual improvement. Produce KPIs for your GP service by interacting with your CCG even though you do not have to! CCGs really do appreciate direct talks with senior staff and it is essential you meet the GP leads and interact with them. We are currently setting up meetings to put in place KPIs similar to those in a failed GP tender, which some may consider make a rod for our own back but others can observe as very astute and actually ISO 15189 compliant. Pathology Finance For the last eight years I have delivered the Cost Improvement Programme (CIP), for a year or so rebadged as Transformation Saving Plan (TSP). In 2005 we had to find 4.5% of our budget and for the last three years it has been 8%. This has been difficult and has included a lot of skill mix changes, loss of staff and also efficiency of non-staff areas of the budget. There comes a time when if cost pressures money is not put in on the other side of the equation the Pathology Director has to say “We cannot deliver a safe and fit for purpose Pathology service and make these savings”. Automation solutions have not delivered staff savings and downtime can be a real issue Issue 621 | January 2015 | ACB News 22 | Personal View Getting out with Glen on the GP transport run gives a real insight into how we interact with community services Equipment Let us be very candid, we pretty much get the equipment offer that the big diagnostic providers think we should have. A year or so ago you struggled to see anything other than track based approaches in response to tendering in Blood Sciences. However, the huge issues with the implementation of this technology and the lack of the promised manpower efficiencies make us question if this is the future. One thing is certain, relying on just one diagnostic supplier for our main platforms can cause real pain when a method is withdrawn overnight. Managed service contracts never seem to work out as attractive in practice as on paper and of course this VAT loophole may be on borrowed time. Pathology People The right mix of staff with appropriate skills to take our service forward is vital. Why on earth we cannot employ staff on a probationary contract I do not know. Bank workers have been key to keeping many services going, and we have some excellent staff employed now on long term contracts who started on the ‘bank’. Sickness records in the NHS including Pathology would not be tolerated in the Private Sector but we have Public Sector HR policies. Having been fortunate enough to have taken <5 days sick in 36 years in the NHS, I struggle when I see young, fit and healthy staff who have had five or more episodes of short term sickness in a year – usually just ACB News | Issue 621 | January 2015 under the sickness review barrier. Retaining good staff is really key to the 2020s but being able to ’let go’ those who really do not want to commit to our environment is also important. Skilled and highly trained BMS staff are our backbone. I have considerable issues with the need to have an IBMS registered Biomedical Science degrees to enter the profession. I know the IBMS say this is the HCPC who demand this … but what a crazy thing that people who have excellent science degrees are told they have to pretty much do a whole new degree to progress to registered status. The change to out of hours payments is another disaster area. Whatever one thinks about previous pay rates we are in a supply and demand arena which is exacerbated by out of hours enhanced pay differences between laboratories. So, these are some of the things I see as important heading towards the 2020s. The key thing for me has been the realisation of a conversation when I interviewed Professor Gemmel Morgan and a young trainee some years ago. We were driving back to Glasgow Airport after a convivial breakfast. Gemmel asked me what I wanted to achieve in Clinical Biochemistry in the final phase of my career. My reply was easy; “To have some scientifically based fun and make a difference to patient care”. Well I have certainly had the fun and we continually work on the second! ■ Crossword | 23 ACB News Crossword Set by Rugosa Well done to those that sent in an entry. The Editor apologises for a couple of errors in the clues. However, this did not appear to detract with the usual suspects still managing to get an entry in to claim their just reward. This month we revert to our normal, though anonymous, cruciverbalist along with some more sideways looks at Pathology. 22 Cook attains our state of being able to hold no more (10) 25 Liked nothing about abnormal healing of incision (6) 26 Mathematical function of surgeon? (8) 27 Doctor treats middle-age youth leader to plan (8) 28 Belief there is no law about holy water (6) Across 1 Pale person upset old-fashioned England (6) 5 Treatment of ulcers containing aluminium are nostrums (4-4) 9 Thoroughly eliminated possibility without me (2,6) 10 Is of help when love affairs generate no offer (6) 11 Feign truce about apparatus (10) 12 13 16 17 19 21 Down 2 Make surgical incision exceptionally clean (5) 3 Desist out of disinterest, becoming inactive (5) 4 It avoided wild variation describing relation to a gland (7) 5 Laboratory growth last month in successful treatment (7) 6 Enter silver amalgam for use in reaction (7) 7 Kind of stimulant used in French capital (9) 8 Ill-use lab? Make soothing sounds! (9) 14 Corrupt venal unit having one active site (9) Distressing xeroderma but 15 Monoclonal antibody producer (9) no order for test (4) 18 One reused scattered remains (7) French neurologist corrected 19 Lacking energy for work – strange – unchastened, sat out (8) hankering about fortified wine Tasty scrap to eat or hear (6) turning up (7) Flexible part of gun carriage (6) 20 Resolved an ester isomer (7) Former sort of cherry-red 23 React about suspicion (5) train (8) 24 Bouquet from our first party; Travel slowly - intoxicated we hear you are next (5) wandering not noticed (4) Last month’s solution Issue 621 | January 2015 | ACB News
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