GP consortia will need to ensure pathology commissioning is part of an overall efficiency strategy, says Jag Grewal

Pathology is little understood by many in the health service, and is too often considered a backroom worker. However, it has an undeniably huge impact on patient experience, with 75-80 per cent of medical decisions based on a test result. With so many changes looming for the health service and GPs tasked with commissioning £80bn worth of NHS healthcare, what is the outlook for pathology procurement?

The changes afoot in commissioning are at the forefront of much discussion. Regardless of who is making the decision to commission, opportunities for cost savings remain open through procurement of rationalised pathology services. Although the particulars for pathology and specialist commissioning may not yet be clear, we know the quality, innovation, productivity and prevention (QIPP) initiative will continue, with arguably even greater urgency in the face of budget cuts.

But we must ensure that quality control and an intelligent approach are not sacrificed for quick savings. The structural changes announced in the recent white paper cannot distract attention from the drive to create better services for patients, not just cheaper ones.

Pathology is commissioned in one of two ways: as part of a healthcare-related group, for example as part of a hip replacement, or direct access, for example a blood test for high cholesterol. Direct access procurement is mainly GP led already, and this is where savings and improvements can most quickly be made. With budget responsibility for commissioning passing over to GP consortia in 2012-13, this group will need to feel confident that they are getting the right test, for the right price, while improving value and quality of care.

The health secretary has given commissioning consortia the green light to gain commissioning support, if needed, from primary care trusts, local authorities and independent suppliers. How can commissioners make sure that the pathology service they commission is giving them what they need in terms of finances and patient care?

Pathology is generally bought as part of a block contract, bundled in with wider care pathway costs. To ensure that cost improvements can be made, it is crucial to work with the provider to start unbundling these costs, in order to identify how much of the block consists of pathology.

The most important step in pathology commissioning is to acknowledge that it is not a case of simply ordering a bunch of tests. We must consider how each test commissioned can impact on other areas, too. A commissioner must know the benefits and risks of what is being provided, how it fits into the patient pathway and how this procurement works as part of the overall strategy to cut costs without cutting quality and value.

Effective diagnostics

Intelligent use of diagnostics can deliver personalised healthcare, which improves patient outcomes and avoids unnecessary costs. For instance, when financially tested in just one PCT, the calprotectin diagnostic test, a biochemical test for inflammatory bowel disease, is reported as having the potential to save up to £750,000 each year.

A good service provider will help achieve these sorts of savings. They should be the experts, raising the bar in quality through robust commissioning opportunities. The service chosen should offer knowledge, so that the commissioner has a full understanding of what is on offer. They should be encouraged to buy only the most relevant of tests, with education and training a part of the service.

Diagnostic tests have the potential to reduce waste significantly by allowing treatment to be personalised. For instance, diagnosing the correct HER2 protein status of a breast cancer patient can determine whether treatment with Herceptin, designed to target this protein directly, is worthwhile. At a cost of £20,000 a year, this has the potential to remove the hit-and-miss nature of Herceptin treatment by only giving it to those who will benefit.

Demand more from your pathology provider. Informed commissioning can improve patient experience, can increase efficiency and give better value - lowering costs without compromising on quality. There is a lot more potential in pathology commissioning than just buying tests.

Jag Grewal is the business development director for GSTS Pathology.


GSTS Pathology

Privacy and dignity good practice guide and self-assessment checklist



Originally a 50:50 joint venture between Guy’s and St Thomas’ Foundation Trust and Serco, GSTS has joined forces with King’s College Hospital Foundation Trust. This tripartite joint venture forms the UK’s largest provider of pathology services. The organisation works autonomously but is clinically led.

Improvements delivered by this approach include cervical cancer screening times being halved to under seven days - the legal requirement is 14 - and the average phlebotomy waiting time being reduced from 11 minutes to nine.

Achieved in partnership with a large practice-based commissioning group, improvements have been made to transport services at a local hospital. The daily pick-up, always just once a day despite visiting 95 different GP services, became a tailored service to ensure that a personalised courier picked up tests at the most suitable times for local surgeries.

Tests were processed most efficiently and fewer were left overnight. This led to a drop in the need to retest, which had a positive impact on patient experience.