Debate continues over whether pathology provision across any particular geography would benefit from a closer collaborative model. However, NHS England and Improvement have, for several years, led parallel pathology improvement workstreams through its Getting it Right First Time (GIRFT) and pathology consolidation programmes. The programmes take different approaches and have differing emphases, but both view collaboration and consolidation of pathology services as important objectives:

‘We see the focus of networks as improving quality, sharing knowledge, driving best practice, and bolstering resilience – as well as improving productivity’ (Pathology, GIRFT Programme National Specialty Report, September 2021, p105)

‘By bringing together clinical expertise, pathology services will become more efficient in order to deliver better value, high quality care for patients’ (NHS England » Pathology networks)

Regardless of differing views on the merits of consolidation, it is widely acknowledged that little progress has been made in the reorganisation of NHS pathology over the past decade. There are certainly complex issues that often need untangling but, in our view, careful allocation of responsibilities can side-step many obvious bear-traps.

Consolidation in pathology is often led through one of two strategies: (i) ‘top-down’; with issues of corporate governance, shareholding, and finance taking primacy over planning for operational reconfiguration and improved clinical pathways; or (ii) ‘bottom up’; where Boards task senior pathology staff to present credible option appraisals for change notwithstanding obvious and understandable vested interests. We submit that neither approach alone is likely to get the job done.

In our experience, by placing a clinical vision and improved patient service specification at the forefront of any collaborative proposal, we can both collect support for change and a compass for the various twists and turns that arise throughout a multifaceted process.

Senior executives should be tasked with the establishment of a high-level framework within which operational decisions can be taken and reach agreement on how risks and benefits of any collaborative venture are to be shared. That is, they should decide their preferred corporate form for the arrangement and, in turn, task a future management team to then design and document ‘their’ plan and implement change.

By setting the project framework in advance, the decision-making process can be structured to avoid endless debate and repetition intended to maintain the status quo but – importantly – allows the operational detail to be settled by the experts. A note of caution: the operational detail is important, but should not trump nor be permitted to delay benefits planned for patients nor clinical and quality improvements.

As we have suggested elsewhere, it can be difficult for operational management teams to quantify financial costs and benefits and assess the legal implications of large-scale operational reconfiguration and organisational design. It is common to find it hard to:

  • calculate the likely risks and rewards arising from collaboration and derive a common basis for valuation of stakeholder inputs and costs. In particular, it can be difficult to assess the relative productivity of constituent pathology services and identify a common basis to value income, accommodation, procurement contracts, and the like.
  • match preferred organisational form with long-established NHS clinical and quality governance structures.
  • capture the complete range and scale of economic benefits arising from pathology modernisation rather than focusing overly on leased managed equipment service contracts and associated VAT advantages.

These are all challenges we have seen before, and helped NHS organisations to manage. Please let us know if you would like to have an informal chat about how our approach to building your NHS pathology network might assist your team.