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Barnet And Chase Farm Hospitals As ONE of The TWO Processing And

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Barnet And Chase Farm Hospitals As ONE of The TWO Processing And Powered By Docstoc
					  Barnet And Chase Farm Hospitals As ONE of The TWO
  Processing And Screening Site in North Central Strategic
                     Health Authority
Organisational capacity to deliver change

The Barnet and Chase Farm hospitals and North Middlesex hospitals are agreed
partners and have formed a project group to lead the merger of the two pathology
departments in keeping with the concept of pathology modernisation.

In principle the two sites have agreed to work towards a merger of cytology on the
Chase Farm site to provide an efficient, quality cellular pathology service
incorporating new developments such as LBC for the northern section of the Strategic
Health authority with a view to merge the remainder of pathology under a single
management structure.

Partnership of Barnet & Chase Farm Hospitals with North Middlesex hospital will
result in a workload, which is ideal for one LBC processing machine, which will be
run at near capacity to enable efficient, cost effective processing. This will enable the
workload for Barnet, Enfield and Haringey to be processed locally. This is favoured
by the two Trusts’ managements and the PCTs’ as it enables improved local control
and a single common system for the local population. There would also be substantial
advantages in the co-ordination with colposcopy services and the integration of
established MDT meetings.

The Trusts’ management are fully aware of the proposals for LBC for the North
central sector and will assist in any way that will facilitate a cytology screening and
processing centre in a new purpose built pathology block at the Chase Farm site.

At Chase Farm Hospital there is substantial expertise of managing mergers of
cytology laboratories. The cytology department at Chase Farm has seen two previous
mergers (Edgware into Barnet and Barnet into Chase Farm hospital) and this previous
experience will be extremely advantageous in enabling a further merger. The cytology
members of staff at Chase Farm and North Middlesex hospitals are in favour of the
merger so are unlikely to leave.

Barnet and Chase Farm hospitals currently process 40% of the workload for the whole
of North Central Strategic Health Authority. The merged department will have a
combined workload of more than 50% of the sector workload. There is already
therefore the experience and capacity to deal with a large proportion of the workload.
The establishment of a processing and screening centre on this site will enable a
smooth transition to LBC and allow the centralisation of additional workload if
required.

Having two processing centres for the North Central St Health Authority would be
advantageous as it will ensure processing capacity is available in the event of
problems at one site. The two sites could learn from each other and share best
practice.




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Space in existing laboratory

The cytology laboratory at Chase Farm hospital has sufficient space to house one
LBC processing machine and all consumables for the merged department at the Chase
Farm site. The screening room currently has 16 workstations with sufficient space to
accommodate another 6 workstations for the 6 additional screeners from North
Middlesex Hospital. All the screeners have height adjustable benches and new
ergonomic microscopes. Additional space may be required to accommodate extra
A&C staff. There is little extra capacity for the storage of historical slides and files
from North Middlesex hospital. However, the North Middlesex hospital already has
established off-site storage facilities.

If Chase Farm hospital and North Middlesex hospitals implement LBC before the
completion of the new pathology building at the Chase Farm site, the processing for
North Middlesex hospital could be done at Chase Farm and the slides sent back for
reporting until the new building is ready. There is established regular transport links
between the two hospitals so there would not be any additional transport costs. This
would also mean that additional space for A&C staff and storage of historical slides
would not be needed, thus additional funds would NOT be required.

New build planned

A new integrated pathology laboratory is planned to be built by April 2005 on the
Chase Farm site, integrating all the pathology services currently located at Barnet and
Chase Farm hospitals in one purpose built building. The exact dimensions of the
building are currently being discussed and developed. If Chase Farm site is selected to
be one of the two processing and screening sites, then the dimensions of the building
can be adjusted. Trust management are aware of the proposals for LBC and any
adjustment that may be required to the pathology building will be made.

IT network support

There are different IT systems for pathology in all five hospitals within the sector.
Full interfacing of pathology systems with the pathology system would be very costly.
However, it is possible to access to the North Middlesex hospital’s pathology
computer system (ISoft) via the NHS net at Chase Farm hospital. This would allow
North Middlesex staff to log into the ISoft pathology system using their existing user
account. Additional user accounts may be required. Computer departments at Chase
Farm and North Middlesex hospitals are able to facilitate this link at no extra cost
since there is no requirement to provide training. This capability will enable the
screening of smears to continue using existing databases. For operational efficiency
all reporting will need to be migrated on to a single database in the future. This is
common for all options being considered. The advantage of the option is that this
migration can be undertaken in a controlled manner and delayed until required
funding is available.

Barnet, Chase Farm and North Middlesex hospitals are part of the sector wide Video
conferencing network, the funding has been approved and the hospitals will be able to
conduct video conferencing between sites by the end of 2004. This will enable
Pathologists to conduct MDT meetings from the Chase Farm Post Graduate centre



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without having to travel to Barnet hospital or to North Middlesex hospital, saving
travelling time and travel costs.

Access to the ISoft system will allow access to historical data at North Middlesex
hospital, this along with existing access to Open Exeter would allow appropriate
management to be suggested for smear reports.
Chase Farm’s cytology department has put in a bid to purchase Cyres computer
software that can incorporate extracts of histology and cytology results from both
computer systems into one database. This would allow the production of all the
statistics required by the screening program including KC61. Additionally laboratory
failsafe could also be done through Cyres.

Staffing levels

There are adequate staffing levels at both Barnet & Chase Farm and North Middlesex
Hospitals to manage the current workload. Both sites have very good turnaround
times and meet all national guidelines. Both sites currently enjoy good recruitment
and retention of both technical and clerical staff. In addition both sites have an active
training programme for trainee cyto-screeners to ensure future capacity. There is a
requirement for additional consultant due to unfilled post, but both sites are currently
actively recruiting.
The current combined staffing available for cervical cytology is:

     Staff group                        Establishment      In-post (wte)
                                            (wte)
     Trainee cytoscreeners/BMS                2                   2
     Cytoscreeners                          11.82              10.82
     Checkers                                 5                   5
     Support staff (MLA)                      4                   4
     Advanced Practitioners                   1                   1
     Consultants                              1                   1
     A&C staff                               9.06               9.06

A workload of 60,000 per year would require 10 WTE primary screeners. The
combined technical members of staff from Chase Farm and North Middlesex
hospitals would be sufficient to carryout primary screening, quality control and
management of gynaecological cytology and well as other laboratory procedures such
as preparing and screening of non-gynaecological cytology specimens, administration
and training etc.

Assuming 15% of the total workload is referred to the Pathologists, the workload
would require 1.5 WTE of Pathologists / Advanced Practitioners (AP) to deal with the
gynaecological workload. A further 0.75 WTE would be required for Non-gynae
cytology and HBPC/MDT meetings etc. The AP and consultants from Chase Farm
and North Middlesex hospitals will be able to provide adequate pathologist / AP cover
for the this workload.

Two International Fellows will be starting on 1st July and 1st August 2004 at Chase
Farm hospital.




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Education

Barnet and Chase Farm Hospitals have 2 SPRs and 1 trainee BMS. North Middlesex
hospital have 1 SPR at and 2 trainee BMS. The consultant pathologist capacity of the
combined laboratory will be will be sufficient to provide high quality training. There
is also an active recruitment and training programme in place for trainee
cytoscreeners/ Biomedical scientists, supported by the NCLWDC. This will ensure
the availability of trained screening staff in the future.

Advanced Practitioner training will also be offered to the appropriate candidates.

Chase Farm and North Middlesex hospitals have Health Professions council
accreditation for training trainee BMSs’. All staff are supported and encouraged to
participate in continuing professional development.

Chase Farm hospital has SurePath system on a trial basis, preparing LBC slides on
selected colposcopy cases. Majority of screeners will receive training to screen LBC
preparations by SurePath. There is a 10-headed microscope in cytology seminar room
to discuss cases.

Formal training for all screeners and pathologists/Advanced BMS Practitioners at
Chase Farm hospital and North Middlesex hospital will be carried out at Northwick
Park hospital. The Cost of training to be funded from central funds passed to PCTs’ in
2004/5.

Financial

Pay

The combined staffing establishments of Barnet & Chase Farm hospital and North
Middlesex is sufficient to manage the combined workload of these departments by
conventional methods. Any additional pay costs will be those associated with the
change to LBC.

There will be additional pay requirement to manage the transition from current
systems to LBC. This will be required to manage the workload while the staff are on
LBC training courses and harmonising the pay awards between the two hospitals.

Both hospital sites currently attract the same level of London Weighting.

It is possible that there will be additional manpower requirements for un-associated
changes in guidelines and ancillary tests such as HPV testing. These will be related to
additional fail-safe and audit requirements particularly due to changes in colposcopy
systems.

Non-pay

Training costs for BMS and cytoscreeners will NOT increase since the cytology
training and update courses at the regional cytology training school are free. Also the
training cost for consultant pathologists and SPRs is NOT envisaged to increase.



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    Additional space for A&C staff and storage space for files and slides from North
    Middlesex hospital would be required. This is currently being investigated. However,
    if Chase Farm hospital processes LBC samples only for North Middlesex Hospital
    and sends the slides back for reporting until the new pathology building is ready, then
    there would NOT be any need for additional space.

    Chase Farm is to purchase Cyres software, which will produce all the laboratory statistics.
    Non-Staff costs

    Additional funds to pay for the consumables would need to be funded by PCT’s (see
    below). It is anticipated that there will be efficiency savings in the laboratory once the
    screeners and pathologists / AP are confident in reporting with the LBC preparations.
    This may take over a year. Also there will be savings from the introduction of the call
    recall system. However this will take at least three years to be realised and the savings
    will vary depending on whether the PCT currently operate a 3 or 5 years recall.

    The figures quotes below are inclusive of VAT. The cost per test includes lease costs
    of machines over 5 years, additional consumables and reagents required for
    processing LBC.

    Workload for the Two hospitals

                                         Workload          Projected number of
                      Hospital            2003/4             cases with 2.0%
                                                             Inadequate rate

                  Chase Farm               48,864                 44,099


                  North Middlesex          17,707                 15,793


    Additional cost of processing LBC specimens Per Annum

                                                              Cytyc                    Cytyc
                                     SurePath            1xT2000, 1xT3000            2 x T2000

Additional staff required           £38,000                       £0                 £24,000
                              1.5 BMS1 + LW + on                                 1.5 MLA +LW +
                                     costs                                           on costs

Equipment lease                    £17,625 inc                   £0                     £0
                                    (SurePath             (Included in cost      (Included in cost
                             £15,000+VAT/machine)             per test)              per test)

Consumables + Reagents        £197,044 inc SurePath         £310,346 inc            £280,085inc
                                 £2.80+VAT/test           (£4.41+VAT/test)       (£3.98+VAT/test)

Total cost of equipment,           £252,669 inc             £310,346 inc           £304,085 inc
reagents and additional
staffing

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       Note.
       The above figures assume that the entire workload of NC St HA is processed
       using the same technology. SurePath discounts tests >50,000pa, if workload is
       less than this, the consumable costs increases by £1 per test.

       The Cytyc quote is based on 5-year lease of equipment and assuming that
       whole of London will use Cytyc. If only NC St HA uses Cytyc then the cost
       per test is increased to £4.50 +VAT based on workload of 116,000.

Transport for staff

Chase Farm hospital has good bus service to Enfield and has car parking free of
charge to members of staff.

The number of staff at Chase Farm hospital are more than double that of North
Middlesex hospital, therefore TUPE of staff costs i.e. protected travel expense for
minimum 4 years, will need only be given to staff moving from North Middlesex to
Chase Farm, staff already at Chase Farm hospital will be unaffected thus reducing
costs. For a number of North Middlesex hospital staff there will be no additional
travelling requirement and therefore NO additional expense.

Transport for samples

Individual surgeries would send the LBC vials in the same manner as cervical smears,
via existing hospital van collection system to Chase Farm or North Middlesex
hospitals. Vials could also be posted directly to Chase Farm Hospital.

Specimens received at North Middlesex can be batched and sent to Chase Farm using
the regular transport vans between Chase Farm and North Middlesex hospitals at least
daily. Therefore NO extra transport cost of LBC specimens is envisaged.

       Note
       LBC vials are suitable for postage via the normal postal service as long as they
       are appropriately packaged in compliance with the packaging instruction 650
       and the requirements of UN3373

Partners

North Middlesex Hospital is an agreed partner for the merging of cytology department
with Chase Farm Hospital with the possibility of merger of the whole pathology
departments at a later stage.

PCTs would prefer their workload to be processed and screened in their locality so
reducing transport of specimens and clinical governance issues. Barnet & Chase Farm
Hospital already screens more than one-third of the sector’s workload so a relatively
small number of specimens will have additional transport arrangements and these are
largely already in place.

The Cytology department at Chase Farm serves colposcopy departments at Barnet and
Chase Farm hospitals, facilitating incorporation of work from another colposcopy
service. The colposcopy department at North Middlesex hospital could collaborate


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readily with Chase Farm rather then a hospital in the south of the sector as the
cytology laboratory at Chase Farm hospital would be more accessible to them.

Administration capacity and capability

Current establishment of A&C staff of Barnet & Chase Farm hospital and North
Middlesex hospital is 9.06 WTE, which with 1 additional A&C member of staff
(funded by NMH in accordance with their QA report) will be sufficient to manage the
administration of the joint workload.

Additional PCT manpower or IT infrastructure to manage the Open Exeter system
would not be required.

HPV testing

Pilot sites are evaluating HPV DNA testing on LBC samples on selected cases such as
low-grade abnormalities and will need NICE approval before being implemented in
the cervical screening programme. The aim is to only do colposcopy on patients with
high-risk HPV infection, thus reduce the number of patients seen in colposcopy.
Currently the method of choice for doing HPV DNA testing is the product from
Digene.

It is anticipated that once HPV DNA testing is introduced in the cervical screening
programme, it can be done at the Chase Farm site in either the microbiology
department or the cytology department (in the same manor as the pilot sites) and
participate in any EQA schemes for HPV DNA testing. It is not possible to estimate
the cost of implementation since NICE has not published any guidance on its’ use.




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