acb news · email: [email protected] mrs louise tilbrook ... bye bye stqa and hello...

ACBNewsACBNewsThe Association for Clinical Biochemistry • Issue 522 • 20th October 2006

Leeds Carter

Road Show

Report

Regions do

Endocrinology

Brighton

Revisited

Consesnus

Units for Drug

Reporting

Leeds Carter

Road Show

Report

Regions do

Endocrinology

Brighton

Revisited

Consensus

Units for Drug

Reporting

October 2006 • ACB News Issue 522 • 3

About ACB News

The monthly magazine

for Clinical Science

The Editor is responsible for the finalcontent. Views expressed are not necessarily those of the ACB. EditorDr Jonathan BergDepartment of Clinical BiochemistryCity HospitalDudley RoadBirmingham B18 7QHTel: 07973-379050/0121-507-5353Fax: 0121-765-4224Email: [email protected]

Associate EditorsMiss Sophie BarnesDepartment of Chemical PathologySt Thomas’ HospitalLondon SE1 7EHEmail: [email protected]

Mrs Louise TilbrookDepartment of Clinical BiochemistryBroomfield HospitalChelmsfordEssex CM1 5ETEmail: [email protected]

Mr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Display Advertising & InsertsPRC AssociatesThe Annexe, Fitznells ManorChessington RoadEwell VillageSurrey KT17 1TFTel: 0208-786-7376 Fax: 0208-786-7262Email: [email protected]

ACB Administrative OfficeAssociation for Clinical Biochemistry130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB ChairmanDr Ian WatsonDepartment of Clinical BiochemistryUniversity Hospital Aintree, Longmoor LaneLiverpool L9 7ALTel: 0151-529-3575 Fax: 0151-529-3310Email: [email protected]

ACB Home Pagehttp://www.ACB.org.ukPrinted by Piggott Black Bear, CambridgeISSN 1461 0337© Association for Clinical Biochemistry 2006

ACBNewsNumber 522 • October 2006

General News 4

Carter Report 6

MRCPath Short Questions 12

Current Topics 14

Focus 2006 Debrief Report 16

A Personal View 20

ACB News Crossword 25

Obituary 27

Situations Vacant 29

Front cover: Speakers and delegates to the first Carter Report Road Show held at the Thackray MedicalMuseum at St James’s University Hospital in Leeds

The Association for ClinicalBiochemistry National MeetingManchester International Convention Centre23rd – 26th April 2007

ocusbeyond the laboratoryƒ

4 • ACB News Issue 522 • October 2006

General News General News General News General News General News

Last Month’s Solution

This Month’s Sudoku

Bye Bye STQA and Hello TAG

In June the farewell annual lunch of the South ThamesQuality Assurance Group was held at the home of Johnand Anne Cook (photo). The 20th Annual Meeting ofthe group will take place on Friday 3rd November atTunbridge Wells and will include presentations oneGFR, IQC, infertility testing, the MHRA equipmentfeedback pilot and historical reminiscences fromprominent past members of the group.

The South Thames Group officially amalgamated withthe North Thames Clinical Chemistry Audit and QAGroup in July, to form the new Thames Audit Group,with Teresa Teal as the new Chair, Helen Aitkenheadremaining as the Secretary and Janina Mazurkiewiczacting as the link person with members in SouthThames. The new group will continue to meet everythree months for individual audit topics. The meetingsare usually held at Great Ormond Street and are open toall members of South and North Thames and Easternregions. Anyone wishing to become actively involved inthe audits should contact Helen Aitkenhead for furtherinformation. Past audit reports can be found on the ACBSouthern Region web-site.

The next audit presentation will be on pre-analyticaltreatment of blood samples on 17th October at GreatOrmond Street. ■

ACB Members who have achieved CSci in September

Mr J J AllisonMr I M BarlowProf D W HoltMr P A Hyde

Dr A E IrvineMr G H Lester

Mr J SlaterMs A L Trewick

Dr AM WallaceDr J M Wardell

Carter Report Carter Report Carter Report Carter Report Carter


ACB Road Shows Lookof CarterReported by Jonathan Berg, Editor

Leeds was certainly an appropriate place for the ACB to hold its firstACB Carter Report Road Show. After all, Pathology services have beenreconfiguring in this Yorkshire city for over 10 years. Do you

remember the national interest in the old Asda food testing laboratories atMorley, just off the M1, when Ian Barnes & Co. converted them into amodern Pathology facility? Many visited Morley to try and convincethemselves that it was not the way forward! However, Morley is still thereand still re-invents itself as the needs of local pathology services evolve.

The ACB has amongst its members both the Department of Health Leadfor Pathology, in the form of Ian Barnes, as well as Professor Chris Price,who was a key member of the Carter Report and who is now to sit on thePilot Site Project Board chaired by Lord Carter. The ACB Road Show formatincluded presentations by Chris and Ian giving the Carter Review Team andDofH views, respectively. Following this Dr Ian Watson, ACB Chairman,looked at the Association’s views on the Report and ways that we could helptake it forward.

Chris started by reminding us of the context of the change processesoccurring in the NHS in relation to the report that was produced. Thisincluded emphasis on:

• Patient choice• Services closer to home• Practice-based commissioning• Standard template contracts• National standards• Contestability• Plurality of providers• Better value for money.

The ThackrayMedical Museum

at St James’sUniversityHospital in

Leeds was thevenue for the

first ACB RoadShow on the

Carter Reportand it’s

implications

Report Carter Report Carter Report Carter Report Carter Report


ks at Implications

Pathology sits in an arena that is full of very different drivers and pressures. Some of the key issues that the Carter team investigated included:

• Pathology impacting on 18-week waits • Unnecessary testing and repeat testing• Delays in reporting results• Excessive capacity and duplication• Slow adoption of new technology• Costs increasing excessively.

These are really non-controversial statements and to put things into context we needto remember some of the features of Pathology today as described by the HealthcareCommission:

• Workload 175 million requests (~ 700 m tests)• Workload increasing at ~ 10% per annum• Workforce ~ 25,000• Productivity increased by 46% over last six years • Expenditure in England ~ £1.8 billion• Including overheads this figure is ~ £2.5 billion• Workforce expenditure is ~ £1.0 billion.

The drivers for change given in the Carter Report included:• Meeting people’s expectations• Re-design to meet expectations• Competitiveness, plurality, commissioning-led • Clinical leadership and business management• Productivity and process management• Information not data to run service effectively• Better use of workforce and technology• Ensure more effective use of pathology services.

One of the first things that Lord Carter was interested to understand at the outset waswhat were the major barriers to change in Pathology. Chris suggested the followingwere important:

• Lack of end-to-end IT connectivity.• Fragmentation of collection services• Poor quality of transport and logistic support • Host Trust management• Host Trust clinicians• Host Trust incentives• Foundation Trusts• Government policies.• Workforce inflexibility.



The key findings of the Carter Report included identifying barriers to change such as:• Undue influence of host Trusts• Absence from planning discussions• Absence of contractual obligation • Poor quality of data and information on service• Variability of service repertoire• No optimisation of configuration• Low level of investment• No incentive to invest• No clinical leadership or business management.

The international benchmarking exercise showed both positive and negative comparisons withEurope and the US with these being interesting observations:

• Lower spend than most countries in Europe and US• Cost per test very competitive in UK• Productivity in England may be lower• Laboratory service more fragmented in England and phlebotomy, transport and IT are the

main culprits• IT connectivity variable (except Kaiser, Sweden)• Impact on patient journey greater in England• Overall service LESS fragmented in England.

England offers a more clinical service and impact on the patient journey is probably greater inthe UK with more clinical involvement in pathology. We need to explain how our service isclinically orientated and point out the benefits of this. The Commonwealth Fund Reportpublished in 2006 shows some very positive comparators including patient safety compared toother countries with, for example, our service scoring much higher than the US in this area.

The key suggestions of the Carter Report included:• Managed pathology networks• Stand alone organisations• National quality specification• Reimbursement strategy/tariff• Introduction of IT connectivity• Clinical leadership and business management• Pilot projects.

A key aim of the pilot studies is to gain much greater agreement on the ways that networks cango forward within a geographical area. The pilot sites and project have the following featuresand aspirations:

• One per Strategic Health Authority and exhibiting a range of economies• Work to a common template• Identify an appropriate network• Identify all activity, costs and resources• Model for network• Benefits and risk analysis• Share and compare• Report to Minister.

Where networks already exist, then work will include looking at how it can be taken forward inthe light of the Carter Report. The report to the Minister on the pilot projects should give theevidence on whether there is money to be saved and propose sensible ways forward.

Report Carter Report Carter Report Carter Report Carter Report


Key issues for Chris included:• Commissioning• Contestability• Choice• Plurality of providers• Ensuring effectiveness of service• Involving the Independent Sector.

Reality Check Kicks in from DofHIan Barnes pointed out that there has to be a reality check on the whole process that goesforward after the publication of the Carter Review. The DofH has been through radical changesand this is a fairly ruthless environment within which policy documents are written to deliverand take forward government policy. Many things at the Department necessarily occur within alegal framework. It is no great surprise that the Carter Report has been doing the rounds inGovernment and it is more than just Lord Warner that will take it forward. Ian sees the Reviewas very positive but we must understand the context. The DofH is currently going throughmajor health reforms including:

• More patient-led choice - demand• Diverse provision - supply• Money following the patient - transaction• System management.

Many things Carter looks at are of course, already being driven forward and are happening. So,we must see the Review within the framework of a whole raft of change processes. Wetherefore do not have a choice to take the bits we like and leave stuff we can not stomach. So,for example, shifting service delivery into Primary Care means resources will be moved and thatis the reality of where the DofH is going.

System reform includes practice-based commissioning, which will include 80% of NHSfunding, with GPs having a lot of power. Primary Care Trusts are reducing down markedly innumber and are gaining new roles. At the level of Strategic Health Authorities we are nowlooking at a marked reduction down to about 10 organisations with strategic planning,performance managment of PCTs and new innovative delivery solutions as key objectives.

Practice-based commissioning rolls out from December 2006 and already outpatientinvestigations are being taken out of secondary care. New innovations include one-stop clinicsand new ways of treating patients, which will include pathology testing.

Interestingly, GPs are interested in all the things that we hold high. They are not obsessedwith point of care testing (POCT), and indeed much of the discussion about POCT has perhapsbeen because people have latched onto it as an idea to take forward without understanding thereality.

The Commercial Directorate is portrayed as a major driver and is pushing the role of theprivate sector provision hard. The role of this group includes negotiating private contracts. Theyhave an interest in Pathology because they see it an area that the private sector could get moreinvolved in. We need to appreciate that the “Independent Sector” need not always be an actualprovider of pathology services directly.

Emphasis on more Pathology in Primary Care is not huge, but includes phlebotomy,anticoagulation clinics and an emphasis on tests such as BNP. Other tests that are being looked atinclude HbA1C and H. pylori and coagulation screening.The Carter Report needs the DofH to work on things such as:

• Commissioning specification and plans• IT connectivity – must fit within current initiatives



• Best practice dissemination• Reimbursement mechanism and the tariff• Technology innovation hubs• Reform of workforce.

Ian pointed out that the indirect costs of Pathology could easily be an additional 40-50% addedonto the current pathology costs.

Ian finished by pointing out that we have an opportunity to take many things in the CarterReport forward as the DofH does not have the resources to look at much of the detail in theReport. Things such as standardisation of results, accreditation, genetics programmes andscreening programmes are all aspects we need to take forward professionally.

View from the ACBIan Watson, ACB Chairman, said that overall the ACB welcomed the Report. Ian asked if weneeded all the laboratories that we currently have, and if they were in the right place withappropriate staffing? Much of the problems in Pathology are due to the pre-and post-analyticalphase and we need to get these aspects sorted.

Workforce is a key issue and staff roles and training needs to reflect changing job functions. Dr Sue Hill, Chief Scientific Officer, does have new initiatives for training of Healthcare Scientists.We can move even further and ask why a professional qualification is required to be a Head ofDepartment or indeed the Pathology Director. Could a manager not take on such roles?

Pilot Site BriefingThe pilot sites met in London on 26th September for their initial briefing. The general impressionfrom that meeting was that people were very positive about networks as a way forward. Ian sawmany activities for the ACB and its members including looking at standardisation, referenceranges and the overall use of the pathology department.

In the discussion that followed it was clear that networks need taking forward and then we aremuch more likely to keep control of our destiny. There was a view expressed that once pathologysees the first major contracts awarded to the private sector then we could see major and quiteswift changes around the country.

The problems with getting all Pathology disciplines to take the Carter Report forward werebriefly discussed. There was certainly some degree of agreement with the view in last month’sACB News editorial that it needs to be a whole Pathology approach that will succeed locally, notjust a group of forward thinking staff from the Biochemistry Department.

Overall this was an informative meeting and it was slightly surprising that there were not morepeople present, though this could be due to the timing of the meeting. Starting a meeting at 5pmwhen many of our modern workforce have family commitments to attend to is certainly not thebest way of filling seats even for something as important as the Carter Report. ■

MRCPath Short Questions MRCPath Short Questions MRCPath Short


Question 68The following results were obtained for two different serum samples:

Sample 1 Sample 2Measured calcium (mmol/L) 1.85 2.52Albumin (g/L) 23 52

Stating any assumptions you make, use these data to derive an expression to “adjust” serumcalcium to a “normal” albumin concentration of 40 g/L.

Deacon’s ChallengeNo. 67 AnswerHow many mL of hydrochloric acid (SG 1.16) are required to prepare 500 mL of 2.5molar hydrochloric acid? The purity of the acid is 32% w/w.

MW hydrochloric acid (HCl) = 1 + 35.5 = 36.5

Therefore weight of pure acid required to make 1 L of 1M HCl = 36.5 g

Weight of pure acid required to make l L of 2.5 M HCl = 36.5 x 2.5 g

Weight of pure acid required to make 500 mL (i.e. 0.5 L) of 2.5 M HCl

= 36.5 x 2.5 x 0.5 g

Since HCl has a purity of 32% w/w, the weight of SG 1.16 HCl required is more than this

i.e. 36.5 x 2.5 x 0.5 x 100 = 36.5 x 2.5 x 0.5 x 100 = 142.6 g% purity 32

Since Density (g/mL) = Weight (g) then, Volume (mL) = Weight (g) Volume (mL) Density (g/mL)

Substitute weight = 142.6 g, density = 1.16 g/mL

Volume = 142.6 = 123 mL (3 sig figs)1.16

Current Topics Current Topics Current Topics Current Topics Current


Consensus Meetingon Units forReporting DrugConcentrationsReported by Dr Ian Watson and Dr Julian Barth

A meeting at theACB offices on30th June 2006and attended byrepresentativesfrom the ACB,RCPath, RCP

(London), NPIS,ACP, FSS,

IATDMCT todiscuss the

mixture of unitscurrently used in

clinical toxicologypractice

The electronic patient record currently being developed by theConnecting for Health programme will enable national access tolocally provided results. The current situation for laboratory data

gives rise to a variation of reference ranges and units, depending on anumber of factors. In the case of drugs and poisons, units consist of amixture of mass and molar units at the judgement of each laboratorydirector. This is confusing and has the potential to lead to clinical error.Since the intention of the electronic patient record is to allow cliniciansaccess to the system even if they are remote from the providinglaboratory, the use of different units offers considerable potential forsignificant clinical error.

The range of units currently in use is a recognised source of delay inproviding advice by the National Poisons Information Service (NPIS)and inappropriately requires them to continually risk manage theirtelephone advisory service (NPIS DATA). There have been at least twofatalities that have been the result of misunderstandings over units fordrugs.

Networking of laboratories with standardisation and consolidation ofTDM and Toxicology services means that uniformity should improve.For this to be effective nationally it is necessary for networks to use thesame units for any given analyte. National or Regional networks fordrug analyses need to adopt a similar approach.

Such policies will be consistent with the proposed NationalLaboratory Handbook.

With these drivers, the lack of laboratory uniformity will becomeclear to those outside the laboratory service and the NPIS. There is a riskthat failure to tackle the obvious contradictions in our current servicewill result in others standardising it for us.

Which Units?Mass and molar units are both SI units, with a base unit of volume ofthe litre (L).Molar Units?

The introduction of molar SI units into UK clinical laboratoriesoccurred in the early 1970s. The mole is a valid scientific term as it

Topics Current Topics Current Topics Current Topics Current Topics


expresses the number of molecules [amount of substance] present.Moreover, it enables ready understanding of inter-relationships inrelation to other analytes e.g. sodium, potassium, urea, glucose. Therelationships between drugs, their metabolites, receptors, bindingproteins etc. should be amenable to similar considerations and providebetter insight into the metabolism and function of drugs.

It is fair to say that this potential has not been realised in clinicalpractice.Mass Units?

Mass units present the same information as molar units except that it isnot related to the mass of 12C; for the most of the rest of the World thisis acceptable since reporting in mass units is widespread. As to theliterature, regulatory submissions, reagent information sheets andinternational guidelines are in mass units. If one wishes to interpretresults readily the comparison is easily done, without the need to knowthe relative molecular mass and to perform the necessary calculations.

The ACB/NPIS guidelines in 2002 advised mass units for most drugs.

Consensus ViewAfter presentations for the two options a consensus emerged in thesubsequent discussion. This was:

• There is a need for standard practice in reporting drugs across thecountry.

• Mass units are used in the rest of the world, therefore our practiceand interpretations are inevitably informed by literature in massunits. The majority of laboratories surveyed post ACB/NPISguidelines were already using mass units.

• There are some analytes for which the ACB/NPIS advise molarunits: thyroxine, lithium, methotrexate and iron. Some metals arereported in molar units by SAS laboratories. These should berecognised exceptions.

• The base unit of volume should always be the litre (symbol, L).• All other quantitative drug/poison analyses should be reported in

mass SI units.

Unresolved AreaThe legal reporting units for lead (mg/dL) and alcohol (mg/dL) areinconsistent with the suggestion to standardise on the litre. Shoulddifferent units be used for clinical practice?

Taking this Forward To standardise practice across the UK to ensure patient safety we wouldwish all UK laboratories to adopt the above proposals. We recognise thatsome laboratories would need to change practice. We would particularlywelcome evidence-based views for and against this approach.

Advisory sheets for local use would be prepared.We believe it is imperative that this change be made for patient safety,

and that we as professionals should address this problem, rather thanbeing forced to by regulation.

Please email comments to: [email protected] ■

Focus 2006 Debrief Report Focus 2006 Debrief Report Focus 2006

The Focus 2006 and 2007 Local Organising Committees (LOCs)met at the Hinkley Island Hotel in the Midlands on 28th June forthe annual debrief meeting. Focus 2006 was the first national ACB

meeting that Meeting Makers had been fully involved with, and jointorganisation of the meeting was a new experience for both MeetingMakers and the LOC. Pete Wood, Chairman of the Focus 2006 LOC,reported that feedback from delegates was very positive and thankedMeeting Makers, his fellow committee members, the ACB NationalMeetings Committee and the ACB Office for their contributions tomaking the meeting a great success.

Peter reported that the new online system for the submission andreview of abstracts ran very smoothly and it was therefore decided thatelectronic abstract submission should continue for future Focusmeetings. Despite the venue not being a purpose-built conferencefacility, feedback on the scientific programme was extremely positive.

Brighton Revisited . . .

Focus 2006 DebriefBy Paul Newland, National Meetings Committee

Debrief Report Focus 2006 Debrief Report Focus 2006 Debrief Report

Delegates particularly enjoyed the interactive Grand Round sessionwhere a complicated case of Cushing’s was discussed. The Endocrineand Paediatric sessions were also well received. The jointly organised UK NEQAS sessions worked very well as an integral part of the meeting,and collaboration with UK NEQAS is planned for future Focus meetings.

On the social front, the Corporate Members’ Evening with fish andchips and fairground rides on Brighton Pier was enjoyed by all, and theintroduction of the Caribbean theme for the banquet was embraced,with a significant number of delegates dressing accordingly.Unfortunately, attendance at some of the social events on the Tuesdayevening was not as good as expected due to parallel social eventsorganised by corporate members. This was disappointing for the LOC,as delegates had been turned away from events that were initially fullybooked. This remains a challenge to be addressed by the 2007 LOC.

Overall, the Brighton meeting was a great success. It was recognisedthat despite some inadequacies with the venue, the programme morethan made up for it. The Focus 2007 LOC will take forward thefeedback for next year’s meeting in Manchester. ■

Current Topics Current Topics Current Topics Current Topics Current


The ACB has registered over 50 of its Members for the CharteredScientist status since July and lists of new registrants are givenregularly in the ACB News. Another 50 people had already

obtained chartered status through other organisations. If you applyfor CSci and are accepted now, you will receive CSci registration toDecember 2007 for a single payment.

To be eligible for CSci you must:• Be an active and fully paid up Member of the Association. • Be in one of the following qualifying categories of membership -

Ordinary, Affiliate, Overseas or Retired. Federation, Student andCorporate members are not eligible to apply for CSci.

• Hold a Masters, or equivalent or higher Degree, with a minimumof 4 years experience thereafter.

• Comply with the CPD requirements of the profession.• Comply with the ACB Code of Conduct and apply appropriate

work ethics in all they undertake.

Simultaneous application for CSci status can be made with new ACBmembership applications. The Science Council consider thatFederation members are eligible to apply for full OrdinaryMembership of the ACB on scientific grounds, but they elect specifically to receive only trade union support through theFederation category and are thus not eligible for CSci registrationthrough the ACB, although they may find they are eligible via otherorganisations of which they are members. Members in the “Retiredcategory” frequently continue working in some form or other, butmust be in a position to maintain the required level of CPD to qualifyto apply for and retain CSci status.

Fast TrackingCurrent Members of the ACB, who comply with the requirementsand were identified from their database record as being potentiallyeligible, can apply for fast-track registration between 1st July 2006and 1st December 2007. After this date only full formal applicationswill be considered. The ACB Office has written to eligible memberswhose data identified them for fast tracking, but this should notdissuade others from downloading the full application forms fromthe ACB website and applying if they feel they meet the requirements.If you consider your database entry could have been incorrect andyou should qualify for fast tracking, please email the ACB office accordingly and we will be pleased to investigate and resolve for you.

The Science Council requires an annual payment for your

Chartered Scientistand the ACBBy Graham Groom

Topics Current Topics Current Topics Current Topics Current Topics


registration while the Licensed Body has to cover the additional administration costs since they are responsible for processing and validating your applications and registration. The total fees listed belowmust be paid by cheque for the initial application unless a Direct Debitalready exists. Renewal fees must then be paid by Direct Debit with, andon top of, the normal ACB subscription fees from January 2007 andonwards.

Initial application £35 This will cover your assessment and registration fees through toDecember of the initial registration year – but to December 2007 forapplications received now.

Annual renewal thereafter £25 This will cover your registration for the period January to December of each subsequent year. ■

A Personal View A Personal View A Personal View A Personal View


The IndependentSector . . . ComingYour Way NowBy Gilbert Wieringa and Martin Myers

This article reflects our experience in the North West of Englandwhere Gilbert has been on secondment to Greater ManchesterPrimary Care Trusts advising on future delivery of laboratory

medicine services and Martin is lead Pathologist for the Cumbria andLancashire Pathology Network. Although a personal view, we hope it isof value to others in responding to up and coming challenges.

There are some large procurements ongoing. As part of the investmentin the NHS, over £750 million has been assigned by DH to buydiagnostics and clinical services in Primary Care with the aim ofreducing hospital admissions. In part, such services will be sourcedfrom established NHS providers, but a substantial proportion will beexpected to be provided by the Independent Sector (IS). Across GreaterManchester, for example, shifts to Primary Care-based services during2007-8 will see PCTs commission about 160,000 IS and 70,000 NHS-led episodes that previously were provided in out-patient settings.In Cumbria and Lancashire it is estimated that up to 170,000 NHS out-patient episodes will be transferred to the IS. Greater ManchesterSHA has termed these services ICATS – Independent Clinical Assessmentand Treatment Services (ICATS). Cumbria and Lancashire SHA haveadopted the term CATS – Capture, Assess and Treat Schemes. They coverservices such as general surgery, trauma/orthopaedics, ENT,rheumatology and possibly gynaecology and urology. It is anticipatedthat a patient will be referred by the GP directly to the ICATS or CATScentres. The diagnostic element, including Imaging and Pathology willbe managed by the IS who will deliver, or commission, in a way thatthey consider appropriate. The scope (and terminology) varies acrossthe country but the principles remain the same:

• Bringing healthcare closer to patients through devolution fromSecondary to Primary Care, in turn to encourage self-management.It is estimated that up to 80% of patients referred to Secondary Careout-patient departments do not require Secondary Care treatment.This attrition rate is seen to put an unnecessary burden onSecondary Care and many of these patients could have completedepisodes in Primary Care.

• Providing patients greater choice of and enhanced access toconveniently placed services.

• Ensuring that a platform emerges for a plurality of NHS and ISproviders.

Gilbert and Martinaim to increaseawareness of

changes ongoing inhealth service

delivery,particularly in

primary care wherea stronger role in

commissioning anddelivering servicescloser to patientsis a central driver

of governmentpolicy



• Delivering the eighteen week maximum journey from decision toreferral to start of treatment.

Timelines Going ForwardThere are two ongoing Department of Health procurements, one fordiagnostics (typically MR and CT) from the IS due to be introduced overlate 2006/early 2007. The other for clinical/diagnostics services come aspackages (such as ICATS and CATS) which are due to start late 2007.

The implications of the changes are considerable. By 2008, there will bea series of new players on the Primary Care landscape who will, in effect,be competing with each other and established NHS providers for a longterm place in healthcare delivery. This plurality of providers is designed tooffer greater and existing providers cannot therefore guarantee thecontinuation of existing workload.

How to Respond?Many commissioners are happy to admit they value guidance on what theyshould be procuring. Many have not had to confront the scope of theservice included under the umbrella of ‘pathology’. Given the pressure onthem to deliver the ongoing procurements, solutions that allow them tomeet their agenda will be especially welcomed. Issues currently to the forefor which they might seek advice include:

• What laboratory medicine services should we place in Primary Care?Should we be using point of care testing more extensively and whatgovernance arrangements need to be established?

• What will you be charging for your service? What is included in thatprice?

• What phlebotomy/transport/Information Management andTechnology (IM&T) will be provided to support the new services?

• Will the health economy be able to maintain a seamless service if thereis more than one provider?

• What are the opportunities for NHS/IS partnership for the services werequire?

• Why is Pathology wrapped in a block contract? Will you be able to‘unbundle’ a cost per test and value a potential contract in thetimescales we have to work to?

The responses to such issues may be significant determinants in winningcontracts. Added value, unique elements that an established service mightbe able to provide, needs to be exploited. Examples will include:

• Understanding of local geography and demographics.• Having an established infrastructure - build, IM&T links, staff,

expertise, quality, CPA accreditation.• Speed of service.• Cost of service.• Track record e.g. past working with the PCT, strength of GP/user

satisfaction, successful roll-out of enhanced Primary Care-basedservices such as anticoagulation, glucose meters support,transport/phlebotomy.



• Respected links with other service providers.• Access to analytical and advisory services 24 hours a day.• Flexibility in response to issues – particularly pre-and post-analytical

issues that may be outside the immediate scope of laboratorymedicine.

• Understanding of, and willingness to develop clinical pathways andprotocols for new services.

Moving ForwardOur views are based on our own experience in the North West, but theseare certainly going to be of relevance elsewhere:

• Recognise the strengths and weaknesses of the current service inrelation to the demands that PCTs will be making in the future.

• Source additional expertise, as necessary, to develop business plans.This may be Trust accountants, PCT commissioning teams, IS partners.

• Consider joint working with other disciplines, particularly otherdiagnostics services such as Radiology, in developing a package ofservices. Avoid Silo working at all levels, from Directorate to largegeographical areas.

• Consider whether liaison should be on an individual or a networkbasis.

• Consider how current PCT and SHA reconfigurations may lead to areconfiguration of local delivery plans.

Finally, arm yourself with the Carter Report’s excellent vision of what is aLaboratory Medicine service. The vision is one that should be included inthe longer-term strategy of any laboratory bidding to be at the forefront ofcommissioning cost effective services. To this end, the current round ofprocurements may provide the platform and catalyst for achieving thatvision. ■

ACB News Crossword ACB News Crossword ACB News Crossword


ACB News Crossword

Crossword set by RugosaAcross 6 Describe what followed a close finish (7)7 Expecting direction (7)9 Impenetrable hideaway in Kent? (5)10 Conductor upset Director-General raring to go (9)11 Function opposing deforestation? (7)13 Said to be Ransen’s organic compounds (6)15 Try home cystic treatment and study cell reactions (13)19 Eliot initially took census of supernatural beings (6)20 Head of Honda mistakenly erases last vehicles (7)23 Prediction of extraordinary progression without

doubt (9)24 Judges one of our workplaces (5)26 Sets chloride/iodide question followed by urea and

electrolytes (7)27 Unusual disease from tick bite gives Oxford graduate a

haematological problem (7)Down 1 Decide the pattern of stresses in a soprano descant (4)2 Potential nidation phase after damaging unilateral Iran

withdrawal (6)3 First part of business strategic analysis by

Crammer? (9)4/16 Bulletins taken so uncertainly, nevertheless helping

patients understand investigations (3,5,6,2)5 Weaving of silk remote? How far away? (10)6 Describes spoke and tyre (6)7 Wounded in Slovenia (4)8 Agrees about lubricant (6)12 Your outdated ludicrous remark and bull implicating

chemistry heads makes one ill! (10)14 An Austen title contains such exceptionally overstated

promotions it makes one breathless (9)16 See 417/18 A subject with a maths problem shows an abnormal

reaction to the environment (6,6)21 Walker offers loss leader in translucent resin (6)22 Ancient god exists again (4)

25 Orange light gas (4)

Answers to Last Month’s CrosswordAcross: 1 Lady-love, 5 Borsch, 10 Bluer, 11 Ethanol, 12 Relic, 13 Leasehold, 14 Splenomegaly, 18 Antidiabetic, 21 Nathaniel, 23 Ethic,24 Israeli, 25 Lemur, 26 Ersatz, 27 Irish Sea

Down: 1 Livery, 2 Dabble, 3 Launch pad, 4 Viral hepatitis, 6 Ochre, 7 Syncopal, 8 Holidays, 9 Hepatocellular, 15 Epidermis, 16 Jaundice, 17 Statures, 19 Charts, 20 Sclera, 22 Alert

Keep sane at coffee time with the ACB News Crossword. Always relating to the science and practice ofClinical Chemistry, you will never cease to be astounded by the convoluted mind of the ACB NewsCrossword compiler.

Prizes for your department: The first five correct solutions to appear on the ACB News fax machine(Fax: 0121-765-4224) will receive a copy of the new educational Calcium Cases CD-ROM by AubreyBlumsohn, Christina Gray, Neil McConnell, John O’Connor, Anne Pollock & Roy Sherwood and whichretails at over £50. Please state clearly the name and address of the Department that is entering the competition.

Remember that ACB News appears first as a PDF on www.ACB.org.uk around the 7th of each month.

Engaging

EndocrinologyHilton Hotel, Newport, South Wales

16th-17th November 2006

ACB Wales Region Autumn Meeting

16th November 200610.00 Registration 10-30-11.15 Gut Hormones

Dr Carel le Roux11.15-12.00 Clinical Utility of Testosterone Measurement

Dr Mushmi Biswas 12.00-12.45 Analytical Aspects of Testosterone Measurements

Dr Mike Diver12.45-13.45 Lunch13.45-14.30 Clinical Utility of Growth Hormone Measurments

Dr John Gregory14.30-15.15 Analytical aspects of GH, IFG1 and IGF-BP3 measurement

Dr Gwen Wark15.15-15.45 Tea15.45-17.00 Bayer Award

17th November 200609.00-09.45 Parathyroid Hormones

tbc09.45-10.30 Thyroid Hormones and Autoantibodies

Dr David Sinclair10.30-11.00 Coffee11.00-11.45 Macro hormones

Dr Mike Fahie-Wilson11.45-12.30 Interesting Endocrine Cases

Newport Endocrinology Team12.30-13.30 Lunch13.30-15.30 AWCBAG

to follow the All Wales Clinical Biochemistry Audit Group Meeting

Residential Rate (includes 1 night accommodation & conference dinner) £190

Day Delegate: Thursday - £50. Friday - £40

For further information please contact Catherine Bailey onE-mail: [email protected] or Tel: 01633-234500

Obituary Obituary Obituary Obituary Obituary Obituary Obituary


Dick Richardson was born in Smethwick on September 23rd1926, and went to school at Holly Lodge Boys School. Hegrew up during a difficult period of the last century and this

certainly affected his higher education opportunities, beginning hisstudies for an External London degree in Chemistry at theBirmingham Central Technical College at the end of the SecondWorld War, graduating in 1947. He went on to be elected a Fellowof the Royal Society of Chemistry in 1962 and he was one of thefirst to be awarded the Mastership in Clinical Biochemistry in 1967.

Dick initially trained as a precious metal chemist with JohnsonMatthey in Birmingham. However, his early career as a chemist wasinterrupted when he contracted tuberculosis and spent two years ina sanatorium. He then joined the National Health Service as aLaboratory Technician at Dudley Road Hospital in Birmingham,moving on to train as a hospital Biochemist. It was at Dudley Roadthat he met his future wife, Shirley. He subsequently moved to theCoventry and Warwickshire Hospital in Coventry where he was tospend over 25 years as Head of the Biochemistry Department,retiring in 1989.

Local EQA PioneerDick’s early training as a precious metal chemist made him aformidable analyst and throughout his career he strove to advancethe quality of the analytical techniques used in the hospitallaboratory. He was a strong advocate in the setting up of a networkof laboratory collaborations in the West Midlands Region, the“quadrants”, with the initial objective of improving the quality ofanalysis within- and between-laboratories. He was the firstOrganiser of a local EQA Scheme, which pre-dated the setting up ofNEQAS in Birmingham by several years. He circulated samples ofpooled serum every fortnight, with hand drawn graphs of theresults posted back in the intervening weeks. In his own quadrant,which also included East Birmingham (now Heartlands), SuttonColdfield, Warwick, Rugby and Nuneaton hospital laboratories, heencouraged collaborative work on standardising the preparation ofreagents for the dye binding methods for serum albumin,

A Modest andPrivate Man ofCoventryRichard William Richardson

Obituary Obituary Obituary Obituary Obituary Obituary Obituary


significantly reducing the inter-laboratory variation of results. Thisinter-laboratory collaboration, a feature of the West Midlands region as awhole, extended in later years to other aspects of laboratory practiceincluding education and training, another aspect of which he was astrong advocate.

An interest in analysis of human material naturally leads on to issuesrelated to biological variation and Dick published a number of papers inthe area, becoming particularly interested in techniques for establishingrobust reference ranges from data derived from patients attending forblood tests. This culminated in the publication of his book “Handbookof Non-pathologic Variations in Human Blood Constituents” after hisretirement.

Dick’s career as a Clinical Biochemist was heavily influenced by hisexperiences as a young man, his early training and by his own beliefs.His education had been interrupted by the Second World War and hehad to work hard to obtain a degree. This experience was reflected inthe strong support he gave to all of his staff in their career advancement.Over the period of his career he helped a large number of Biochemistsand Biomedical Scientists to obtain higher degrees, always being willingto listen and give advice on a wide range of subjects. The careers of alarge number of laboratory staff have been greatly influenced by hisearly encouragement. Dick was also a committed socialist. He was amember of the Labour Party for many years, holding several offices inthe Coventry Branch. He continued with his health interests, serving onthe local Community Health Council after his retirement, as well asworking with the Bond Hospital Charity and the Socialist MedicalSociety.

Baggies FanIn many ways Dick was a very quiet, modest and private man, and fewreally knew the person of “Mr R” - as he was known by most peoplewith whom he worked. Except perhaps at Christmas parties, where hewas a regular attendee, because he was an ardent West BromwichAlbion supporter… a fact that everybody at the party would be aware ofby the end of the evening as a result of a loud chant, which he wasreadily persuaded to share.

All of those who worked in any way with him will have benefitedfrom his help and insight, as well as appreciating his gentlemanlyapproach. Many will continue to use what they learned from him intheir working practice, and possibly their private lives, for many years tocome. That is a measure of the man.

Dick Richardson died on April 29th 2006. He is survived by his wife,Shirley, son and daughter, Catherine and William, and fourgrandchildren. We trust that they will treasure their memories of Dick,as much as those who worked with him as colleagues and friends. ■

CPP

Vacant Situations Vacant Situations Vacant Situations Vacant


Product Manager Hospital Blood Glucose Testing

Nova Biomedical is a leading provider of advanced blood gas, electrolyte and chemistry analyzers for use inboth critical care and laboratory testing. We have recently introduced the new StatStrip™ hospital glucosetest strip and meter that features advanced multi-well strip technology, creating a new class of analyticaltesting performance for hospital glucose testing at the point of care.

We are currently seeking a Product Manager who will assume primary responsibility for expansion ofStatStrip™ sales in the UK. In this multi-faceted position, you will interface with Nova field salesrepresentatives and appropriate laboratory and medical staff at major UK hospital Trusts to develop prospectsand convert them into sales. In the context of the sales process, you will coordinate performance of on-siteapplication studies for StatStrip™ products and present performance data to various buying influences andprospective customers. You will also be responsible for after-sale customer training and validation support.In addition, you will support scientific marketing evaluations conducted in conjunction with Nova’sscientific affairs group to ensure that clinical evaluations are conducted in adherence with prescribedprotocols. The qualified candidate will have strong familiarity with the clinical laboratory includingmanagement and/or point of care testing experience. Diagnostics industry or hospital related salesexperience would be beneficial. Experience with bedside glucose monitors and blood gas systems, a generalunderstanding of statistical data, and expertise with Microsoft Excel are also important. Travel within andoutside the assigned sales region will be required.

Please reply to: HR Department, Nova Biomedical UK, C5 Evans Business Centre, Deeside Industrial Park, Deeside, Flintshire CH5 2JZ. Tel 01244 287087. Email: [email protected]

Closing date for receipt of applications: 10th November 2006

Situations Vacant Situations Vacant Situations Vacant Situations


HAMMERSMITH HOSPITALS (NHS) TRUST

DIRECTORATE OF CANCER SERVICES

& CLINICAL HAEMATOLOGY

Principal Clinical

BiochemistTumour Marker Laboratory

Salary Band 8b £46,676 - £56,371 Salary Band 8c £55,019 - £66,518 88b without MRCPath or PhD progressing to 8c whenacquired or 8c with these at appointment

Whether you are an experienced clinical scientist with a specialinterest in immunodiagnostics or a younger member of theprofession wishing to develop such a special interest then thiscould be the opportunity you have been waiting for!

You will develop your career alongside the clinicalbiochemist with responsibility for the Tumour Marker Service,within the Division of Clinical Chemistry at Charing CrossHospital, which forms part of Hammersmith Hospitals (NHS)Trust. This internationally recognised service hosts aSupraregional Tumour Marker Assay Laboratory, works in closecollaboration with the Supraregional Clinical Service forChoriocarcinoma and Hydatidiform Mole and providesextensive assay services to external clients in the NHS andPrivate Sector. The medium term goal of this appointment isto gain sufficient experience to take over management of thespeciality pending retirement of the current postholder.

The Hammersmith Hospitals NHS Trust manages a PathologyNetwork comprising Charing Cross and HammersmithHospitals together with Chelsea and Westminster, Ealing andWest Middlesex University Hospitals operating through ServiceLevel Agreements. The successful applicant has therefore all thepotential advantages of developing a career within one of thelargest and most comprehensive clinical chemistry services inLondon.

Automated “core” laboratories are present at each site andcentralised across sites is a broad range of specialities essentialto a major centre of excellence for service, teaching andresearch. These include Andrology, Endocrinology, Metabolic/HPLC, Paediatric Biochemistry, Point of Care testing, SpecialProteins and Trace Elements. Endocrinology is a major specialityproviding IVF, Supraregional Assay and Tumour Marker services.A new Laboratory Information system financed from thePathology Modernisation fund was installed in 2003.

MRCPath or PhD is highly desirable although not essentialbut it is expected that applicants without these qualificationswill have a defined interest in research and development,register for PhD and work towards MRCPath commensuratewith a career in a Division allied to Imperial College Faculty ofMedicine.

Potential candidates should call the recruitment help line on 0870-770-2360 for application details quoting reference No C/238.

Further information may be obtained from Mr HughMitchell, Principal Clinical Biochemist (Tel: 020-8846-1415)or Professor Michael Seckl, Director of the ChoriocarcinomaService (Tel: 020-8846-1421). Short-listed candidates will beinvited to visit the laboratory prior to interview.

Closing date for applications will be Friday 10th Novemberand interviews will be held on the 28/29th November.

To advertise your vacancycontact:

ACB Administrative Office130-132 Tooley Street

London SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006

Email: [email protected]

Deadline: 26th of the month prior to the month of publication

Training Posts: When applying for such posts you shouldensure that appropriate supervision and training supportwill be available to enable you to proceed towards state

registration and the MRCPath examinations. For advice, contact your Regional Tutor.

The editor reserves the right to amend or reject advertisements deemed unacceptable to the Association.

Advertising rates are available on request

Consultant Clinical

ScientistBand 8D £55,469 - £73,281 per annum

(Hours: 37.5 per week)

East Lancashire Hospitals NHS Trust includes Burnley General andthe Royal Blackburn Hospital and provides a comprehensive range of

services to a population of 510,000. The Pathology service isworking towards unification but is currently delivered from twosites. The exact configuration, however, may change as the recent

clinical service review proposals evolve. There have been recent majorPFI developments on both sites with new laboratories at the Royal

Blackburn Hospital and proposals exist for upgrading the laboratoryat Burnley General Hospital.

New major analysers have been procured to enable harmonization ofservices across sites and there is a new common IT system.

You will join a team of two other Consultant Clinical Biochemistsand your duties will be based on the Burnley site in the first

instance, although it is expected that there will be flexibility androtation according to the needs of the service. To succeed you will bea Member of the Royal College of Pathologists, with excellent team

working skills and a proven scientific and professional record.For further information and to arrange a visit to the Department

please contact the Head of Department, Mr T F Dyer Tel: 01254-734362 or Dr E J Hindle Tel: 01254-734153.

To apply log onto www.jobs.nhs.uk quoting reference number 435-B248-06.

It is strongly recommended that you complete and return yourapplication as soon as possible.

Closing date: 10th November 2006

acb news · email: [email protected] mrs louise tilbrook ... bye bye stqa and hello...

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