Black Country Pathology Summary of Visit to SW London. Graham Danks

Transcription

1 Black Country Pathology Summary of Visit to SW London Graham Danks

2 Overview A team from BCPS visited SW London who have undergone a successful consolidation exercise. This provided a useful insight into the issues facing such a consolidation exercise. It should be noted that the SW London venture partnership is approximately 75% of the size of the Black Country Pathology venture. Despite being less ambitious than our BCPS considerable savings were made A Project Manager was appointed to oversee matters.

3 In particular Logistics Was a procured service A comprehensive GP Mapping exercise was undertaken as a single workstream including phlebotomy - G.P liaison person being considered The experience was problems with lost samples in the early stages but a track and trace system was introduced and has improved matters. This involves barcode scanning of the sample bags. Logistics workstream are working on such a solution. The Team suggested a baseline level of performance for each site is taken pre and post consolidation included in the BCPS project plan.

4 IT Getting IT and LIMS system correct is crucial Decision taken not to tender LIMS due to time constraints. Retrospectively felt to be a disadvantage. BCPS out to tender for a LIMS In terms of IT a Standard Consolidated Test Catalogue of circa 8,000 lines was prepared and profiles were harmonised across the group 4 months to complete. LTS are due to commence this work for the BCPS. LTS to commence test mapping in next two weeks for the group. Monthly meetings to discuss tests are still ongoing to ensure consistency of advise and clinical comments. BCPS monthly discipline meetings being set up. All disciplines have a validation queue which is subdivided by site included in LIMS OBS. Video conferencing. This is essential for communication between laboratories; it is in use in SWL although digital imaging is lagging behind.

5 Method Consolidation This was one of the largest pieces of work which took up to 5 months facilitated by Project Manager. Work to be undertaken by discipline groups BCPS will need to appoint PM. Abnormal/urgent results requiring immediate action are communicated to the local consultant on the appropriate site. BCPS will replicate this process. Microbiology methodology consolidation proved the greatest challenge but common methods were eventually agreed.

6 Governance There is a Collaborative Board and Governance Committee which appear to work well and include Clinical Leads from the spokes in terms of the latter. Performance Quality Risk and escalations are covered at monthly meetings. Items are discipline as well as site specific which is good practice. BCPS will have its own Board to cover governance. Medical Consultants and Consultant Clinical Scientists remain employed by spokes. There is no alignment of on-call payment and no shared on-call. However the SWL CD receives evidence of appraisals of those holding honorary contracts and there have been no problems with this. BCPS needs to create a better model. There remains confusion on line management and a single structure is preferable.

7 Quality Originally there was 1 Quality Manager Band 8a; there are now 2. BCPS already compliant. One site was using ipassport and the other QPulse both now use Qpulse BCPS would migrate to a single document system. A new QMS was developed for the new network and quality was factored in to all project planning. BCPS quality workstream included in the project plan. Existing QMS were quarantined and a new start date was established BCPS would replicate.

8 Specimen Reception The order-comms uptake is only circa 60-70%. Due to this there is a great deal of re-labelling required Hub has 44 wte Band 2 staff owing to lack of order comms. The spoke sites mainly have Band 3 staff in reception these staff rotate into the labs for other duties. The hub had a pre-sorting area - may not be required if the e- requesting uptake were improved. BCPS would ensure compliance with order comms across all four sites. Walsall and Wolverhampton currently on 90% uptake.

9 Procurement 90% of contracts are now within a consolidated MES. Initially a list of orders across all sites was obtained and consolidated wherever possible this could be done immediately in terms of quality control, training etc. Common requirements can also be jointly procured at reduced cost. This also included fridges and freezers. In terms of charges the cost is usually calculated per reportable test and wastage assumptions of 4% are included: there was an agreement that if the waste factor fell below 4% then savings would be shared with Roche. Procurement was completed in 6-8 months and a 30% savings on the non-pay budget was realised, allowing more flexibility within the staff TOM. Rationalisation number of analysers. SWL are able to take up new tests and/ or kits very swiftly. Procurement of equipment for BCPS to commence in September Goal of single MES by June 2019.

10 Staffing Staffing numbers were exchanged for comparison purposes Whilst rotation between hub and spokes is aspirational most staff at ESL sites preferred to stay there BCPS would prefer to rotate staff to allow access to specialist testing better for career development. JDs are generic for all grades and have been shared and passed to our HR Leads. Interviews were undertaken by panels including neutral members. Due to change of role choices and natural wastage there were virtually no redundancies ( only 2 across the entire network). The TOM did change over time but the non-pay savings which exceeded expectations enabled flexibility in this. A Training Officer was appointed with associated training budget Not included in BCPS plans. SWL advised that need to consider training status as an individual lab or as a whole Need to consider how and where registration & specialist portfolios will be done A real issue/concern was the recruitment of staff for haematology/blood transfusion. Now going to Portugal to recruit.

11 Cellular Pathology 3 partner trusts only 2 consolidated Cellular pathology at the hub. Kingston retained its own Cell Path Lab MDT support is at present a mixture of travel and video link. The 100K Genome Project is only supported for St Georges. Vacuum system not used. A lack of frozen section facility at the spokes compromises efficiency. BCPS have provisioned for this service at the spokes. BCPS centralising Cellular Pathology with MDT support for each site. Frozen sections and andrology to be delivered from each site.

12 Blood Sciences Chemistry at the Hub site process circa 6000 tubes per day. Haematology at the Hub site process 3000 FBC counts per day Total haem/chemistry samples at the spoke 650 Clinical Haematology lies outside of SWL Pathology Roche MES across the group Volumes equate to 75% of BCPS Immunology tested all samples. This was recognised as an inefficient model and Igs were not tested on the track. Given these inefficiencies this is not a service to replicate. BCPS to migrate to common equipment MES linked to LIMS and create one single service. Discipline workstreams to agree immunology model.

13 Transfusion Each Hub & spoke site had a dedicated BT manager 8a. They also acted as a deputy to the spoke manager BT manager, day to day management of BT, MHRA requirements, updates QMS Continued to use old LIMS for transfusion no data transfer. Each site has a dedicated band 7, who also participates in the out of hours Performs Group/saves, antibody screening, DCT, antibody identification, issuing blood and components. FMH screens. There are 10 staff that work 24/7 shift pattern for haem/bt. BCPS will migrate data and move to a single LIMS. Services will remain as is on each site.

14 Bone Marrow & Film Reporting This at the time was left out of scope. Bone marrow slides are processed and stained at either the hub or spoke. These slides are then reported by the clinician looking after the patient. Trephines are all sent to the hub to be processed and reported by the histopathologists/mdt There are no current plans for reporting BM via Digital Morphology Cellavision is in situ but not used. BCPS workstreams to develop local model.

15 Haemaglobinopathies etc Due to the many pathways, this was originally left out of scope Samples arriving from GP s, community booking bloods and antenatal clinics Workstreams are in place to establish a new service. Reporting any complicated cases interpreted by Consultant at hub BCPS workstreams to develop local model.

16 Microbiology No lab at spokes. All blood cultures are performed at Hub. BCPS model places these at the spoke with exception of SWB. BCPS will offer an overnight blood culture service. BCPS will house blood culture machines on the spoke sites with the exception of MMH. 17 Micro consultants CD estimated 6.5 wte lab related. No integration of clinical work or on-call All CSF to the hub. PCR method is offered. No alignment of infection control or antibiotic policies. Team working could be improved Spoke consultants can visit hub site but rarely do so. Medical Directors to ratify the working model following discussions with the Microbiology consultants.

17 Overall None of the staff who were engaged would go back to the old ways of working Some issues were experienced with frequency of night and weekend duties at the spokes SWL had achieved huge savings and were able to introduce new tests quickly Communication is vital and a regular communication newsletter is essential. Need to get transport and I.T right!

18 Information Escalation SWLP Partnership Board Programme Governance Chaired by SWLP Chairman Governance / strategy/ accountability Meeting monthly - ToR s & minutes Implementation Working Group Drives programme delivery Track programme progress Attended by all workstream leads Manage programme risks/issues Led by SWLP Managing Director meeting weekly Accountability Strategic Direction Assurance Oversee Delivery SWLP Partnership Board Managing Director Implementation Working Group Programme Workstreams Programme delivery responsibilities Progress implementation plans & escalate risks/issues. Led by nominated workstream Leads Meeting via the working groups monthly Manage Delivery Managing Director Programme Workstreams Programme Team Transition Groups Subject specific to inform programme workstreams Led by relevant staff that provide appropriate expertise Deliver the implementation plans and escalate issues and risks to the appropriate workstream leads Transition Groups Programme Team Manage and coordinate the overall programme delivery Maintaining the Programme Plan and track progress against key milestones PMO activities and support