Welcome to PathUser TM Facilitating Demand Management and Best Practice in Pathology

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Methods of best practice implementation and demand control

Changing requesting or prescribing activity requires a cultural change in practice and must therefore be a medium to long rather than a short term goal. Past evidence suggests that the most likely strategies will use a combination of complementary methods 24:

  • Elaborating good practice standards and guidance is a prerequisite and is currently lacking in pathology.
  • Dr Smellie is co-ordinating a multi-disciplinary national professional group involving the Association of Clinical Pathologists, Royal College of Pathologists, Royal College of General Practitioners, PRODIGY (www.prodigy.nhs.uk), the Association of Clinical Biochemists Association of Medical Microbiologists and the British Society for Haematology, with patient representation from the lay committee of the Royal College of Pathologists. This group is entirely NHS based and is seeking to developing primary care best practice guidance.
  • Electronic ‘intelligent requesting’ (e.g. Anglia ICE system) provides potential for implementing best practice at requesting level. This is being piloted in a study designed by Dr Smellie with the Teespath network in South Durham. It is not without difficulty as progress to embed the technology in GP computer management systems is slow and significant hardware and system upgrades will be required for this to function on a wide scale level. Costs may therefore be high. However this offers considerable potential.
  • Benchmarking has been used successfully as a management tool in pathology laboratories to allow them to compare a range of aspects of laboratory performance and audit change (Newchurch Pathology benchmarking). No benchmarking system however exists for users of pathology. Distributing data captured from laboratory computer systems offers GPs and PCTs a way to examine differences in activity, highlight anomalies and monitor the effects of interventions to improve practice.

Successful uptake and dissemination of any new system to improve practice also requires mechanisms to attract and retain practitioners in the system.