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Managed Laboratory Services - the ideal choice for the modern pathology environment

By Robyn Pease, Senior Market Manager - Services, Roche, Burgess Hill.

An established trend

The provision of pathology services in the NHS is increasingly dependent on Managed Laboratory Services (MLS) as more and more Trusts adopt this solution for their diagnostic requirements. The leading provider of innovative MLS to Pathology Departments in the UK, Roche, has witnessed this growing trend, which accounted for around 90% of their new centralised diagnostics business.

Managed services are not a new concept to the NHS. Hospitals and Trusts have been outsourcing non-clinical services, such as catering, cleaning and estate management, for many years. More recently, this trend has moved into the provision of certain clinical services, including pathology.

There are several issues driving this trend in the discipline of pathology, not least the budgetary demands being experienced by Trusts across the nation. These financial pressures have forced laboratories to consider consolidation of services and new ways of realising cost efficiencies, whilst maintaining a quality service. Additional pressure comes from the government's desire to reform the pathology service1,2, encouraging (amongst other things) the formation of pathology networks (offering economies of scale), the rapid adoption of new technology and closer partnerships with industry. Innovative MLS agreements from companies such as Roche can facilitate such change and modernisation within the pathology service, allowing it to be affordable and easily managed.

Tailor-made to fit requirements

No two MLS agreements are the same, since each contract is tailored to the specific needs of individual hospitals or trusts. In short, the laboratory outsources the provision, management and maintenance of analytical equipment and associated products and reagents but, unlike some non-clinical managed services, it is not a complete handing over of responsibility. An MLS is more of a partnership, with the laboratory retaining responsibility for the day to day running of the equipment and interpretation of results.

A common misconception is that an MLS ties the laboratory to a single supplier. This is simply not the case since most MLS providers will incorporate management of third party suppliers to meet the analytical needs of individual laboratories. However, the principle supplier assumes responsibility for this and the laboratory retains the advantage of a single point of contact.

The scope of the contract can vary significantly in terms of the disciplines covered and the services provided within these disciplines. It is typically determined by the original tender specification and may incorporate elements of operational, service and financial management.

Operations

Operational elements may include consultancy on laboratory design and advice on the entire laboratory solution.

Full service management, equipment management and the provision of a fully scalable diagnostic portfolio (including strategic alliances with third party suppliers and system integration/automation) will often be combined in an MLS with other elements such as scheduled technology updates plus information and performance management.

Service

Suppliers, such as Roche, provide initial and on-going training and development of staff, in addition to proactive system maintenance, which may include guaranteed service levels, facilitated by 24/7 technical support and remote diagnostics.

Finance

An MLS offers enhanced control and clarity of costs, allowing improved financial planning, and predictability of future costs. The entire cost of the service, including the leasing of equipment, the provision of consumables, system maintenance and associated third party costs, can be incorporated into a simple unitary charge. Financial risk is transferred to supplier.

All aspects of the service are tracked in regular management/performance reports and discussed openly between the laboratory and the supplier at review meetings, which are held at agreed intervals.

The length of the contract should be sufficient to allow a delivery of service based on a partnership that is developed over time and achieved through an understanding and in-depth knowledge of the laboratory's objectives, working practices and future vision. A typical MLS contract will last for between 5-10 years.

Future proofing

The demand for future testing and resource requirements are not certain, so an MLS should be flexible enough to accommodate changes in workflow, providing appropriate resources to ensure forecast service levels can be met.

In addition, if the contract is to span more than five years, it may be desirable to allow for updates in technology. Requirements for equipment 'refresh' provision is determined at the outset but can usually be varied or altered at any time.

This flexibility to 'future proof' the service provided by the laboratory is one of the major differences between an MLS and capital investment. The MLS option offers laboratories the flexibility to meet current objectives, in addition to adapting to future requirements, with access to the very latest technology developments.

Wide reaching benefits

The advantages of an MLS are experienced not just by the laboratory, but also by the users of the pathology service and the patients themselves.

For the laboratory, an MLS can provide guarantees that they will meet service targets for the duration of the contract. It enhances the relationship with the supplier to ensure that the laboratory gets the very best out of the equipment, improving efficiency and planning. It can be used to achieve an easily managed pathology service across several sites within a trust or locality, facilitating standardisation of equipment and test profiles, and making the movement of staff between sites easier.

For the Trust, since financial and operational risks are transferred to the supplier, it offers the potential to reclaim VAT. It also helps them to meet objectives in terms of result turnaround and patient waiting times.

Users of the pathology service will benefit from a more efficient service that is technologically up to date, ensuring rapid results across an appropriate range of tests. It helps to put the required information quickly and efficiently into the hands of medical staff for them to make timely clinical decisions. Improved efficiencies will also result in cost benefits for service users.

Ultimately, an enhanced pathology service and faster results will help to improve the patient experience, reducing their wait times and ensuring that they receive appropriate care at the earliest opportunity.

First Managed Laboratory Services In Wales

Roche has been operating an MLS for the Cwm Taf NHS Trust for almost two years. Following a robust and competitive procurement process, it was the innovative and flexible approach of Roche that met the aims and objectives of the Cwm Taf Project Team. This was the very first managed laboratory service contract awarded in Wales.

The MLS provides the Trust's clinical biochemistry and haematology departments with excellent analytical instrumentation, considerable analytical capacity and the ability to expand modularity according to service developments and workload increases - a strong platform for future service development. This arrangement has allowed the trust to offer a faster and more efficient pathology service.

"Since the installation of the Roche Modular Analytic platform at the Prince Charles Hospital in Merthyr, we have improved the way we work and are managing our workload more efficiently. Samples are being turned around quicker than before, and we have been able to redeploy staff to other important areas such as point of care testing", comments Laboratory Manager, Doug Proctor.

The MODULAR ANALYTICS and system supplied within the MLS agreement combined Chemistry and Immunoassay testing onto one platform. This immediately provided an enhanced portfolio of in-house laboratory tests (saving money on previously outsourced tests) and reduced time to result in many instances. For example, Troponin tests are now turned around in 1.6 hours (previously 5.4 hours) enabling the laboratory to comply with the All Wales Clinical Biochemistry Audit Group's Guidance of under 2 hours for this test.

The speed of the new system also means that results are available to GPs on the same day, rather than a two day wait, enabling them to change the way they work with patients who now do not have to go to hospital for potentially unnecessary tests.

In addition to the benefits brought to biochemistry analytics efficiencies have also been seen by the Trust's procurement team. "The transfer of all operational and financial risk to Roche is of enormous benefit to us", says Mrs Adele Cahill, Head of Procurement. "We are also able to reclaim VAT on the service, which allows the Trust to directly reinvest the money saved into patient services", she concludes.

For further information about Managed Laboratory Services from Roche, please contact Managed Laboratory Services Marketing on 01444 256000. References:

1.Department of Health (2008), Report of the second phase of the review of NHS Pathology Services in England, 291710

2. Department of Health (2008), NHS Next Stage Review Final Report, High Quality Care For All, CM 7432

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