STRUCTURE: The south west London primary care trust cluster is looking to centralise the procurement of pathology services as part of a wider review of care.

The PCT cluster, which commissions from five hospital trusts, said the clinically led Better Services, Better Value review exercise would examine care pathways across its £2.2bn health economy.

Merton GP Howard Freeman, who is leading the review, told a press conference last week there was scope for centralising pathology services in the region and new technology meant not all trusts needed to have a laboratory on site.

Tests performed by pathology labs on most patients are paid for as part of the tariff but trusts make additional income from referrals for testing from GPs.

One of the acutes in the area, Croydon Health Services Trust, received income from referrals to its biochemistry, haematology, histology, cytology and microbiology/virology services totalling £4.8m in 2010-11, against a turnover of £227m.

Pathology labs are also part of maintaining 24 hour services like accident and emergency.

A hospital chief executive from outside the south west London cluster told HSJ: “Most hospitals have sunk very large costs into their labs to maintain the required standards, costs which would be lost if these were simply closed.

“These labs also generate income, contributing to corporate overheads. Every service removed from a hospital results in the remaining services becoming more expensive because of the loss of the contribution to overheads.

“In time and with new technology, it may be possible to do these tests without needing a full lab, but we’re not there yet,” they added.

The south west London cluster consists of Wandsworth, Kingston, Sutton and Merton, Croydon and Richmond PCTs.

A national review of pathology services by Lord Carter of Coles in 2008 concluded that £250m-£500m could be saved every year in England though consolidating services.