Labs in United Kingdom Pressured to Change

Healthcare trends push labs to better serve primary care, emergency, and POC

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CEO SUMMARY: Across the United Kingdom, the physical lay-out, instrumentation, and operation of laboratories is very close to that of laboratories in the United States and Canada. The source of most differences is how the healthcare system in the United Kingdom funds clinical services and sets priorities. The latest National Health Service initiative is to have selected pharmacies collect specimens and perform lab tests.

SITE VISITS TO LABORATORIES in the United Kingdom last month provided insights into how U.K. laboratories are responding to pressures to improve the support they provide to primary care clinics, emergency departments, and point of care testing sites. Of particular interest to laboratory administrators and pathologists will be the news that the National Health Service (NHS) is launching a major pilot project to collect specimens and perform laboratory testing in pharmacies. This seems to reinforce similar initiatives in the United States and is a trend which should be watched.

THE DARK REPORT was in England to co-produce and participate in the third annual Frontiers in Laboratory Medicine (FiLM) conference. Held in Birmingham, England on February 1- 2, 2005, it brings together laboratory directors and pathologists to share innovations in laboratory and pathology management.

Following the FiLM program, we had time to journey to London and visit two laboratories. The first site visit was to the laboratory at North Middlesex University Hospital (NMUH). Located in suburbs in the Northern London metropolitan area, this hospital services primarily a working-class and immigrant population. NMUH’s Laboratory Manager, David Ricketts, will be at this year’s Executive War College in New Orleans on May 3-4, 2005 to present a case study.

Site Visits to Two Labs

The second site visit was to The Doctor’s Laboratory. This is one of only two privately-owned laboratory companies in the United Kingdom. It is located in the center of London.

One notable aspect of The Doctor’s Laboratory (TDL) is that it has a lab joint venture with a prestigious academic center hospital. University College London Hospital and TDR recently built an automated laboratory. It had just opened in January 2005, so our site visit came just weeks after it became operational.

There is not much difference in the physical layout and instrumentation of laboratories in the U.K. from those in the United States and Canada. One point of differentiation is that the software products used in the laboratory are mostly from European vendors.

One major difference is the transportation challenges in a metropolitan area like London and the surrounding countryside. It takes a prohibitive amount of time to move specimens by surface vehicles. For this reason, hospitals in each neighborhood are the primary source of laboratory testing for primary care clinics nearby. Specialists tend to practice within hospitals, so their specimens are testing within the hospital lab.

Reference/Esoteric Labs

During the site visits, I asked questions about how reference and esoteric testing is handled in the United Kingdom. In particular, I asked when new assays would become available and how it was decided which laboratory would provide that testing for the country.

It turns out that the United Kingdom doesn’t have well-established sources for new esoteric and reference assays. Instead, if a pathologist in one laboratory has a clinical interest in an assay and begins to run it for the benefit of his hospital and physician staff, news that this test is available at this site gets out to other hospital laboratories.

They can then refer specimens to that laboratory. A transfer price is established and paid by the referring laboratory. In the United Kingdom, regional health trusts establish budgets for each clinical service, like laboratory testing. So it is up to the referring laboratory to make decisions on how much testing to refer to outside laboratories.

There is another consequence to this arrangement. In the United States, many laboratory companies concentrate on developing new assays, educating clinicians about the benefits, and then performing the tests as specimens are referred to their laboratory.

In the United Kingdom, there are many fewer of these “home brew” tests. There are no comparable testing centers to match ARUP Laboratories, Mayo Medical Laboratories, and their peers here in the United States.

Lab Tests In Pharmacies

The demonstration project to put specimen collection and laboratory testing into pharmacies will take place in Manchester, England. Several large pharmacies in Manchester are currently being remodeled to accommodate these services.

The objective behind this project is two-fold. First, the NHS believes it will lead to more efficient delivery of care (read: save money). Second, NHS is responding to patient dissatisfaction about waiting times and poor service within the healthcare system.

In-pharmacy laboratory testing will be designed to allow the patient to accomplish two things on a single visit. In one location, a specimen can be collected and the lab test done on-site. When the results are available, the pharmacist can then adjust the prescription as appropriate.

Integrated Patient Record

One of the requirements to make this type of arrangement successful is an integrated patient record. The lab results most post into that patient’s record and the pharmacist must similarly update the file so the attending physician knows both the test results and any change in the patient’s prescription.

The interest in performing lab tests within a pharmacy is something I consider significant. Every year, I see more examples in the United States of specimen collection and laboratory testing being done within pharmacies.

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