The Network is one of the first and largest in the UK to take a ‘holistic’ view of pathology services by providing high-level clinical and managerial advice on key service planning issues and strategic decisions. The concept of Networks was actively promoted in the National Review of Pathology Services, Pathology – The Essential Service (2004) and is anticipated to be reaffirmed in the latest Independent Review for the DH by Lord Carter of Coles.  

Greater Manchester has a population of 2.5 million, with 10 PCT areas and 16 hospitals providing pathology services.  The Greater Manchester Pathology Network was established in late 2005 and formally launched in Spring 2006. Over the past two and a half years this has proven to be a model for building engagement, trust and respect and a powerful way of facilitating change.  It has enabled barriers to be broken down between primary, secondary and tertiary care, focusing solutions on patient care pathways rather than organisations.

The aims are to:

• Provide profile and identity, coherent and collective strength
• Ensure national policies and strategies and can be effectively delivered locally
• Provide expertise and knowledge for commissioning pathways and service development
• Ensure standards, clinical governance, quality, sharing best practice and consistency
• Ensure effective communications at all levels and across all sectors, disciplines and geography
• Ensure all workforce, training and education issues are integral and built in
• Develop performance management arrangements to measure delivery
• Ensure effective and constructive patient and public involvement
• Develop appropriate infrastructure to ensure delivery, IM&T, Transport etc.

The Network aims to deliver high quality patient centred pathology services – access to appropriate services at the right time and in the right setting. Through better equity of access, faster results reporting, improved accuracy rates there will be less inappropriate testing and retesting and an increase in evidence-based testing and interpretation. This should all lead to fewer admissions and improved patient diagnosis closer to home.  The Network has a key role in the facilitation of end to end services.

The Network has a formal constitution including clear terms of reference and accountability arrangements set out in the structure.

The Board is made up of key stakeholders across the 10 PCT areas of Greater Manchester including clinical directors, laboratory managers and the Health Protection Agency. 

The Board is accountable to Greater Manchester PCT and Acute Chief Executives and is jointly chaired by Mike Burrows, Chief Executive, Salford PCT and Andrew Foster, Chief Executive, Wrightington, Wigan and Leigh Hospitals NHS Trust. This is unique nationally and facilitates true organisational engagement for the patient journey.   The local Process for Investment and Reform affords the Network an influential role, providing professional advice to commissioners of services.

The core management team for the clinically led Network is made up of the two Chief Executives, two Clinical Leads who share 5 sessions, Mr Jeff Seneviratne and Professor Keith Hyde and the Network Director, Neil Jenkinson and Support Officer, Rachel Pearson.

There are 6 Network Advisory Groups (NAGs) for the main disciplines, Clinical Biochemistry, Haematology, Microbiology, Immunology, Histopathology and  Cytology. 

The theme of many of the work streams is the facilitation service improvement and redesign across the conurbation and key work includes:

• Harmonisation of reference ranges, standardisation of units, standardisation of profiles, costing and pricing of tests,
• Investigation and interpretative guidelines, demand management and implementation of NICE guidelines around new tests, development of policies to implement Human Tissue Act.
• TB service specification, standards & contact tracing, guidelines for effective screening and management of MRSA and C Difficile, and non-specific Virology testing undertaken in the community.
• Directory of services, audit of referred tests, harmonisation and rationalisation of laboratory services. Development of lab to lab IT links to support test referral.
• Standardisation of good practice and protocols, reconfiguration of services to support the delivery of cancer targets and a wide ranging service review of capacity in Cytology to meet QA standards.
• Coordination of Advanced Biomedical Scientists training and training for Community/PCT led anti-coagulation clinic testing,
• Audit Activities,
• Share knowledge & good practice between laboratories

Work streams have been developed in line with the key drivers from the Carter Review namely, point of care testing, procurement, workforce, IM&T, transport and communications. 

• Point of Care Testing – raise profile, agree quality standards, standardisation, governance, connectivity, build relationships with commissioners.
• Procurement - effective purchasing, supply chain review, tendering & procurement
• Workforce - planning/development, training & education, local workforce issues, agenda for change
• IM&T - GP order Communications, Laboratory to Laboratory links, IM&T developments, shared infrastructure.
• Transport – logistics, collection services, transportation services
• Communications - raising profile, marketing to commissioners/providers, communications strategy, website development

Key achievements:

Supporting service developments

• Haemoglobinopathy – molecular diagnostics service to be provided locally – worked with NW specialist collaborative commissioning team to secure funding
• HER2 - A model of treatment across GM – samples from women with breast cancer tested to see if Herceptin a suitable treatment.
• Haematological Malignancy Diagnostics (HMD) – improving cancer pathway – working with the Greater Manchester and Cheshire Cancer Network. 
• Molecular diagnostics
• Immunology – future model across NW – working with NW specialist collaborative commissioning team
• Clostridium Difficile – development of a regional typing service supported by capital investment secured by the Network.

Standardisation – to improve patient management

• Units of measurement
• Profiles of tests
• Reference ranges

IT Connectivity – the Network secured £1m capital investment for the following projects:

• GP Order Communications – this will enable GPs to request tests electronically – this is a high proportion of many laboratories’ workload and will reduce repeat requesting and help guide appropriate investigations
• Lab to Lab links – this will enable labs to refer work electronically, enabling better patient management and avoidance of repeat testing through improved turnaround times as well as avoiding duplicate data entry which removes the potential for errors.  This is pioneering work as the first project using open standards in the UK.
•  IT System to support the Haematological Malignancy Diagnostics (HMD)  service

Network Tariff

Testing guidelines

• Chronic Kidney Disease – implementation was developed in consultation with the Greater Manchester and East Cheshire Renal Network which led to a more standardised approach to follow up investigations
• MRSA – informed by audit against DH guidelines
• Urinalysis – improved demand management by guidance on appropriate use

Participation in Phase 2 of Modernising Pathology Through Action Learning.  4 sets in Greater Manchester:

• Point of Care Testing
• Phlebotomy Services
• Lean/6 Sigma
• Mortuary Services

More about the Department of Health Pathology Action Learning Programme (link to external site)