UK Laboratories Pushed to Serve Primary Care

National Health Service shifts emphasis to early detection and active intervention

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CEO SUMMARY: At the fifth annual Frontiers in Laboratory Medicine (FiLM) meeting in Birmingham, England, lab administrators and pathologists from the United Kingdom and the United States gathered to share knowledge about innovations in the management of clinical laboratories. The event sold out for the second consecutive year, demonstrating the keen interest in the United Kingdom for improving laboratory testing services.

CLINICAL LABORATORIES in the United Kingdom are responding to significant changes in their nation’s health system.

These issues were a primary theme at the fifth annual Frontiers in Laboratory Medicine (FiLM) meeting, held in Birmingham, England, on January 30-31, 2007. FiLM is a co-production of THE DARK REPORT and the UK’s Association for Clinical Biochemistry and, like the Executive War College, provides information and case studies about management innovations in clinical laboratory and anatomic pathology.

“Our healthcare system is placing a new emphasis on several aspects of care,” noted Michael Hallworth, Ph.D., Consultant Biochemist at Royal Shrewsbury Hospital in Shrewsbury, England. “First, there is an effort to increase early detection and active intervention in primary care settings. As this occurs, providers are seeking to implement the principles of evidence-based medicine.

“Second, programs to improve access and to support patient-centered care are being launched,” he continued. “Laboratories must respond to the evolving needs of primary care clinics and patients.

“Third, efforts have commenced to give both primary care physicians and patients more choices of providers, particularly when it comes to hospital care,” observed Hallworth. “The National Health Service (NHS) is instituting new procedures that make it easier for a patient to select the hospital they prefer—and for the money which pays for that care to follow the patient.

 “Payment By Results”

“Fourth, programs to provide ‘payment by results’ are giving providers extra incentive to improve patient safety and to improve clinical outcomes,” observed Hallworth. “Funding for these ‘payment by results’ programs is substantial and having positive effects.

“Fifth, the NHS plans to create opportunities for private sector participation in our healthcare system,” he added. “The thinking is that private providers can add additional capacity and create competition that will spur everyone to improve.”

Hallworth believes that laboratories in his country will be challenged to adopt and support these system-wide initiatives. “In our country, laboratories are based, for the most part, in hospitals,” he explained. “Currently, these hospital laboratories are the main source of testing for the primary care clinics.

“In recent years, primary care physi- cians have increased their utilization of lab tests as they respond to incentives for early detection and active intervention,” said Hallworth. “However, hospital laboratories haven’t seen a proportional increase in their funding to cover the cost of this additional testing. That’s one example of why changes must come to laboratory medicine in this country.”

Lab Test Utilization

At FiLM, these developments were discussed. One session paired Priscillla Cherry, now President of Laboratory Services at Fairview Health in Minneapolis, Minnesota, with Bob Dredge, Senior Fellow, Financial Management at the University of Keele, in Keele, England. Both speakers explained how laboratory organizations were evaluating ways in which increased testing could support a measurable improvement in clinical outcomes, while simultaneously lowering the overall cost per healthcare encounter.

“However, a key problem we have in the United Kingdom is that the financial accounting systems in use by laboratories and their parent health trusts makes it difficult to get the information needed to accurately assess the cost of care and the associated clinical improvements that result from better use of laboratory testing,” stated Dredge. He is working to develop the accounting systems that could be used by laboratories to do such analyses.

At the same time that the United Kingdom’s healthcare system is pushing for progress in the five areas noted above, a parallel effort is under way in the pathology sector. As used in the U.K., pathology refers to all of laboratory medicine, including clinical laboratory testing and anatomic pathology services.

During the past 18 months, the NHS tasked Lord Carter of Coles to lead an “Independent Pathology Service Review Panel.” This panel issued its report and recommendations in August 2006. (At https://www.dh.gov.uk/PublicationsAndStat istics/Publications/PublicationsPolicyAndG uidance/PublicationsPolicyAndGuidanceAr ticle/fs/en?CONTENT_ID=4137606&chk= J4). At FiLM, members of the Pathology Service Review Panel provided insights and updates to the pilot projects now in the implementation stage.

“One of the important elements of the Review was a recommendation that pathology be funded through its own independent organization,” stated Professor Chris Price, a Panel member. “With the emphasis on primary care, the current funding arrangements for pathology services—usually through the parent hospital—have lacked the flexibility required for laboratories to respond to the evolving needs of primary care clinics.

“Another recommendation was to create pilot projects to demonstrate the effec- tiveness of different operational models of pathology,” continued Price. “For exam- ple, some pilot projects will create consolidated laboratory organizations that integrate laboratory services across several hospitals in an area.”

Lab Test Reimbursement

“However the biggest challenge will be the process of commissioning lab tests [establishing reimbursement levels], as most of the commissioners know little about lab testing,” observed Hallworth. “They are focused on commissioning patient episodes and care pathways. Lab testing is part of those pathways—and often have an important bearing on the ways those care pathways are managed.”

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