As genomic testing continues to become embedded in cancer pathways, it is essential that the diagnostic network recognises the expertise across the whole diagnostic workforce and delivers the best possible outcomes for patients by providing clinically relevant turnaround times.
Building on the response to the NHS England Genomic Medicine Service Specification (September 2025), response to the NHS 10-Year workforce plan (21 November 2025), and the forum on Rapid Genomic Testing for Cancer Patients (24 November 2025), the College is progressing a consultation engagement exercise, to develop our professions’ position on the configuration of service and the skills needed to deliver genomic testing services for cancer patients in the UK. This will foster collaboration with patients, governments, service providers, industry, oncologists and other professions, and aid the shaping of service delivery.
Genomic testing in cancer: barriers to quality care
Through recent consultation exercises, College members have identified key challenges in service provision.
Turnaround times remain poor for urgent cancer cases
Only 3% of services who responded to the RCPath 2025 Workforce Census reported always meeting the 14‑day national target for NOLCP genomic testing.1 The biggest reported barriers to meeting these targets were high sample volume and workload (68%), staffing or specialised personnel shortages (64%) and administrative or logistical inefficiencies (51%). These delays can and have compromised timely treatment decisions, patient safety, access to targeted therapies and eligibility for time‑sensitive clinical trials.
Innovation in genomics is advancing far faster than the NHS infrastructure needed to support it.
Services continue to face fragmented reporting pathways, poor IT interoperability and outdated LIMS. About three-quarters (76%) of respondents to the Census report that they still receive paper requests. A modern digital backbone is essential for multimodal diagnostics and for ensuring genomic results are clinically interpretable and accessible across the UK. As AI becomes increasingly capable of analysing and interpreting large‑scale sequencing data, its integration will be vital for improving efficiency. Investment in infrastructure is needed now to realise these gains.
Flexible, patient‑centred genomic testing strategies are needed to reflect the realities of cancer pathways across the NHS.
Many local pathology laboratories have the capability to deliver rapid, clinically targeted next‑generation sequencing (NGS) assays – with small sample inputs and are able to deliver results within clinically useful timeframes. While Whole Genome Sequencing (WGS) at the genomic laboratory hubs offer clear value for complex cases and inherited cancer syndromes, this approach may not meet the varied requirements for optimally treating many tumour types, urgencies or sample constraint. Closer integration of genomics with cellular pathology and haemato‑oncology – for example through improved development of Cellular Pathology Genomic Centres in England – will be key to strengthening both capability and equity across the UK
Restricting the ability of local laboratories to integrate tissue assessment, digital imaging and a few genomic tests within routine pathology, limits not only their diagnostic repertoire in close adjacency to patient care but also the opportunities to flexibly adopt new biomarker assays, maintain clinical trial readiness and update the National test directory. A broad, flexible testing portfolio – local where clinically appropriate and central where necessary – is essential for equitable access and efficient diagnostics.
Workforce challenges continue to limit genomic capacity across the NHS.
Shortages of cellular and molecular pathologists, consultant‑level clinical scientists, bioinformaticians, biomedical scientists and other specialist staff across all services remain a major constraint. National workforce planning supported by standardised workload data are still lacking, making it difficult to plan for future demand. As emerging real‑time diagnostic approaches using NGS and histology expand, success will depend on automation, cost‑effective workflows and a well‑resourced, genomically skilled workforce. Without coordinated investment in training and workforce development – including for pathology and laboratory support staff – centralised genomic medicine risks not only de-skilling scientists and pathologists (making the speciality less attractive) but also becoming a bottleneck in cancer and precision medicine pathways. Current issues with the clinical scientist training processes in molecular pathology amplify these concerns.
Next steps
The College will engage constructively with stakeholders to develop a shared understanding of the challenges and potential solutions to support a system that:
- delivers clinically meaningful turnaround times
- uses the strengths of both local and centralised pathology laboratories
- retains and supports workforce capability and skills
- ensures equitable, high‑quality genomic testing for all cancer patients
- accurately collects workload and workforce data
- liaises with industry to support clinical trials
- supports future innovation
Our aim is clear: a system rooted in collaboration, flexibility and shared expertise — ensuring rapid, accurate and clinically meaningful results for every patient who needs them.
Genomic testing today
Genomic testing across the UK is guided by the Shared Commitments for Genomic Healthcare (2022–2025).
England: Genomic testing is delivered through the NHS Genomic Medicine Service (GMS) via 7 regional Genomic Laboratory Hubs (GLHs), each working to the National Genomic Test Directory. The Directory now includes over 200 cancer testing indications, from small targeted assays to whole genome sequencing (WGS).
Scotland: Genomic testing is delivered through 4 regional laboratories and operate under a Scottish Genomic Test Directory informed by the national, government‑led genomic medicine strategy, Genomics in Scotland: Building Our Future (2024–2029).
Wales: A fully integrated national genomics model centred on a single All Wales Medical Genomics Service (AWMGS) is operated, which includes a national test menu and a single point of access for clinicians.
Northern Ireland: Clinical genomic testing is currently delivered through the Northern Ireland Regional Molecular Diagnostics Service (RMDS). Northern Ireland is at an earlier, but rapidly developing, stage of building a coordinated genomic service.
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