There are clear opportunities in pathology services for the NHS to save up to £200 million and step up the improvement of quality, a Nuffield Trust report concludes. Yet progress has been patchy, and an emerging squeeze on staffing risks holding back change.
'The future of pathology services' is based on a review of literature, interviews with leaders across England and an event attended by 60 senior clinicians, managers and policymakers.
Some areas have embraced the centralisation of services, and creation of networks with sites focusing on different things. Although difficult, these are starting to deliver productivity gains. NHS leaders in every area should make it a priority to look into these possibilities.
Standardising the definition and use of tests will unlock great opportunities to provide better care and avoid unnecessary procedures. Programmes like Choosing Wisely, backed by the Royal College of Pathologists, are being rolled out but this should be accelerated and needs more attention from NHS boards.
The national Genomic Medicine Centre network of 13 labs creates enormous potential for this new frontier of medicine. Digital advances are increasingly enabling "point of care" testing, where patients are tested and given results where they are treated, often within general practice. The system needs to realise the value this can create by preventing the need for referrals, even if it is expensive on the spot.
Yet the authors warn that progress in these fields risks being held back by a shortage of doctors, with Royal College of Pathologists figures showing 40 per cent of specialists in the field are over 55 and most of those plan to retire within five years. Financial investment, too, will be needed to support changes.
Report author Sasha Karakusevic, Senior Visiting Fellow at the Nuffield Trust, said:
"Efficiency matters, but there needs to be a strong focus on improving what pathologists deliver to patients and the rest of the NHS. The greatest opportunities will come where pathologists work across the service - advising GPs and hospital colleagues on using tests better, or changing how they work to save time and money elsewhere in the system.
"The status quo of how pathology services are arranged is not an option, but centralisation isn't always the answer either. We need to work carefully to build networks of laboratories that suit the NHS in each area. But what can't happen is that chances to do better are overlooked, nationally or locally, by a narrative of integrated care that forgets the critical and ever more sophisticated role of doctors in laboratories."
Notes to editors
- Pathology is the branch of medicine, typically based in laboratories, which studies and diagnoses disease by examining patients’ tissues, organs and bodily fluids.
- The report forms part of the Nuffield Trust’s work on new models of care and how they can help the NHS to meet the challenges it faces.