Bulletin April 2017 Number 178

Welcome to issue 178 where, as well as consolidation, we look at the College’s work in Africa, trainees and a knotty ethical issue.

This issue of The Bulletin has as its theme the theory and practice of consolidation of pathology services. We begin with an article from Chris Fourie at NHS Improvement, followed by three accounts of consolidation in action from different parts of the UK. We have encouraged authors to explain what local factors determined the decision to consolidate, how they went about it and what went well (and less well).

With some networks involving commercial partners and others including only NHS providers, it’s clear that no two systems will end up the same. Not surprisingly, IT, transport and communications are recurring ‘must get right’ areas for successful delivery of services. Hopefully the sharing of these experiences will help others thinking of putting a toe in this murky water. We will continue the consolidation theme in July with further reports from pathology networks at various stages of maturity. This is clearly an important topic for all of us, so correspondence is encouraged.

In the last Bulletin, we reported as breaking news the success of the College’s International team at the Times Higher Education Awards. As well as sharing the joy evident on our front cover, you can read more about LabSkills Africa in the International section, and consider taking part or sponsoring the next round of fundraising events. This International section also includes an article from Canada describing the exit competencies in pathology expected from all their medical undergraduates. Since they do not spend time in diagnostic laboratories, it is hoped that development of these competencies will lead to improved use of laboratory tests and better patient management once they qualify. Would this approach add value in the UK? Your reflections are welcomed.

At the launch of our Sudden Unexpected Death in Infancy and Childhood report last autumn, we were asked about investigation of sudden deaths in older children. This issue of The Bulletin features a fascinating article from a paediatric pathology trainee on the establishment of a database detailing findings from all post-mortem examinations performed at Great Ormond Street Hospital. It is also a good reminder of what can be achieved during a period of out-of-programme training.

The article is also a reminder of how much trainees contribute to our work, with a much broader view of the world than I had as a junior doctor. As well as producing the Training section of The Bulletin, which is always excellent and delivered on time without prompting (senior colleagues take note), trainees are always active in public engagement, giving up evenings and weekends to take pathology out to public events. As you will see from the interview with Alice Wort, some also go the extra mile (26 miles to be exact) to raise funds for our international work.

We’re also pleased to include in this issue a contribution from the Ethics Committee, reporting a case in which, for religious reasons, a family took out an injunction to prevent a coroner mandating a conventional post-mortem examination on their elderly relative who had died suddenly. The case resulted in a High Court judgment clarifying when post-mortem imaging might be a permissible alternative to a traditional post-mortem examination in cases where the coroner wishes an examination of the body.

The case raises interesting issues such as who bears the cost of post-mortem imaging. It was also noteworthy that, as part of the investigation, the coroner commissioned an independent review of the medical notes, demonstrating again how a medical examiner type role can help coroners in establishing the cause of death. We welcome any other contributions with an ethical slant.

It is always pleasing to report Fellows’ successes, particularly when a pathologist is recognised by a non-pathological learned society. We heartily congratulate Professor John Gosney from Liverpool on his Lifetime Achievement Award given by the British Thoracic Oncology Group.

Finally, I am sorry to have to tell you that Edward Hulme and Annabel Ries from the publishing team will be leaving to seek new opportunities elsewhere. They have done wonderful work over the years with The Bulletin, annual and other reports, and our professional guidelines. I would like to say a personal thanks to them for all their contributions and for helping me so positively over the last 18 months. We will keep readers posted as new appointments are made.

Dr Lorna Williamson
Bulletin Editor

Lorna.Williamson@rcpath.org