More than half of the 29 proposed pathology networks comprising acute and specialist NHS trusts have yet to agree on a model to reconfigure their laboratory services, eight months after the initial deadline passed.

Data released by NHS Improvement this week showed 16 networks have not yet agreed on a model with all member trusts.

Last September, all acute trusts were told to form networks and “formally agree” a partnership or outsourcing model for their pathology services by January 2018.

NHSI emphasised that a majority of the trusts have agreed a model, which it said showed “excellent progress”. However, many of these trusts are in networks which are not agreed overall.

The regulator has published a progress report on its pathology programme, which aims to deliver £200m in savings by 2021 through a wide ranging overhaul of laboratories across England.

While 103 of the 148 acute and specialist trusts have signed up to their network’s proposed model, only 13 of the networks have secured agreement from all member trusts.

In six of the 16 networks that are yet to agree a model, only one trust has not confirmed agreement. In five networks, none of the trusts have agreed a model.

Some trusts which have not yet agreed with their network’s model are starting, or in the middle of, a procurement process which will determine the model they choose. Other trusts have not yet agreed, but also not contested NHSI’s plans.

A few networks whose trusts are all in agreement, such as Lancashire, are yet to decide how to implement the changes. Others, such as South East London and Dorset and Hampshire have published network wide tenders for new services. 

NHSI has proposed that networks design a “hub and spoke” model, where hubs (often the largest trust in the network) run complex and high volume tests, and spokes (the remaining trusts) deal with laboratory services essential to the hospitals’ operation.

A third of the networks are expected to be “fully operational” by the end of the financial year, according to NHSI’s efficiency director Jeremy Marlow.

One in five networks are operational today, he said.

The biggest network where fewest trusts have reached agreement is in the East Midlands, where only two of nine trusts across Lincolnshire, Nottinghamshire, Derbyshire, and Leicestershire have agreed on plans. 

The Cheshire and Merseyside network includes 12 trusts, five of which have not yet agreed. The biggest network that has secured agreement from all member trusts is in the North East, which features nine trusts across Durham, Tyne and Wear, Northumberland and Cumbria. 

In 2017-18, trusts reported making £33.6m of savings within pathology services, while another £30m has been identified among trusts’ cost improvement plans for 2018-19, according to the report.

Mr Marlow said networks that are making progress are reporting larger savings opportunities than previously estimated by NHSI.

“While not yet fully implemented, this nevertheless stands as evidence that the whole NHS can work collaboratively in the interests of patients and taxpayers,” Mr Marlow added.

NHSI’s report also showed that 16 specialist trusts have been placed in networks with their acute neighbours.

Five of these trusts (Alder Hey Children’s Foundation Trust, Royal Marsden FT, Birmingham Women’s and Children’s FT, Royal Orthopaedic Hospital FT, and Papworth Hospital FT) have not agreed a model with their proposed network.

Regulator urges trusts to use pathology staff more efficiently

NHS trusts could save nearly £80m in the “short term” by using their pathology staff more efficiently, NHSI’s report said.

The regulator said “advanced roles enable services to deliver faster turnaround times at a lower pay cost”.

It is encouraging trusts to undertake skill mix reviews of its pathology staff.

Around £50m could be saved through better staff utilisation in trusts with below average work rate, while another £29m could be saved if all trusts achieve staff efficiency levels in line with the top quarter of trusts.

The data behind these projections has been collected from trusts and fed into NHSI’s “model hospital” data system.

NHSI said centres identified as “spokes” should start the transition to deliver the new model, including putting in place training, recruitment, operating and procurement strategies.

The “hub” sites should “support preparatory work to consolidate any testing activity that can be moved in advance of further networking”, NHSI’s report said.