Pathology is not immune to the need for cost savings affecting all areas of the NHS - nor the pressure from GPs for a better service.

NHS East of England has been at the forefront of pushing the case for a radical redesign of services. A variety of options have been looked at – ranging from a single region-wide primary care path hub to some non-urgent secondary and primary care work being grouped together.

Hospitals in the region were concerned about the first of these. If you strip GP-generated work out of many hospital pathology labs, what remains can look unviable.

What is likely to emerge is a series of clusters in which some hospital labs are significantly reduced in size and only handle urgent (“hot”) work for their patients. Some larger hubs will handle the non-urgent work for other hospitals and GPs, as well as their own hot work.

Seven hospitals have put in a bid to the strategic health authority for non-urgent work to be centralised at Addenbrooke’s Hospital in Cambridge and at Ipswich, with the other five sites keeping urgent services.

The SHA says all 18 trusts in the East of England are involved in at least one bid.

But what happens to the “hot” spokes left behind? They get the tough job – limited staffing, yet demands for round-the-clock cover and input into the care of seriously ill patients. Pathologists are concerned about journey times for non-urgent samples – especially in rural areas – and whether the projected £1.2bn savings over 20 years will emerge.

Pathology has been centralising for years, but initiatives like this may be the tipping point leading to a significantly different structure.