Bulletin October 2017 Number 180

President Suzy Lishman signs off with an update on pathology networks and a visit to a pig farm

NHSI pathology networks

Those members working in England will be aware of the recent announcement from NHSI, proposing that pathology services be delivered via 29 networks in order to deliver efficiency savings. This forms part of the implementation of the recommendation of Lord Carter’s 2016  report on operational productivity, which identified pathology as an area where savings could be made.

While support to improve the value of pathology services is welcomed, I have some concerns about how realistic some of the proposals are, particularly without significant investment in workforce, IT, transport and buildings, and the potential detrimental effect on training and research. I issued statements on behalf of the College and the Pathology Alliance raising these concerns. I have subsequently submitted a more detailed response to NHSI and hope that the points raised will be taken into account. I am assured by NHSI that the proposals are a starting point for discussion and not proscriptive, giving Trusts the opportunity to submit alternative plans as long as they follow the principles of networked working and reduction in unwarranted variation.

I, and several members of the Pathology Alliance, sit on the NHSI Pathology Optimisation Delivery Board, which is responsible for implementing Lord Carter’s recommendations. I know that some members feel that the College’s involvement implies endorsement of NHSI’s proposals and that we should withdraw from discussions. My opinion is that active engagement, feeding back members’ views, and highlighting potential pitfalls and possible alternative solutions, is currently the best way to influence the future of pathology services in England. It is my intention to do this for the rest of my presidency. I am grateful to the members of the Pathology Alliance for their unanimous support of this stance.

You will recall that the last two issues of The Bulletin contained a series of articles in which members shared their experience of consolidation and the lessons they had learnt. A compendium of the articles has been compiled and is available on the College website. We have already shared it with MPs and other stakeholders and also hope to circulate it to acute Trust chief executives, CCG and STP leads. You may wish to bring it to the attention of the teams leading on developing the network in your Trust.

GIRFT

Getting it Right First Time (GIRFT) is an England-wide initiative aimed at standardising care across the country to ensure that patients get the test or treatment they need when they need it. First developed in orthopaedics, the programme is now being rolled out across a wide range of medical specialties, including pathology. The GIRFT lead for pathology will have an important role supporting accurate data collection and sharing best practice to reduce variation and improve the value of pathology services.

I had assumed that the pathology GIRFT lead role would be open to appropriately qualified clinical scientists and was surprised to see that the person specification required GMC registration. I was unable to persuade the GIRFT team to change this requirement for pathology but was delighted when they agreed to fund an additional role of Senior Clinical Advisor to work with the Pathology Clinical Lead. This role, which is funded for one day per week, is a great opportunity for a clinical scientist to help shape the future of pathology provision.

Learning from the deceased

Issues relating to the investigation of death and the reduction in avoidable deaths form an important part of the work of the College and its members and it seemed timely to focus on this area in The Bulletin. In this and the January issue you can read the views of a diverse range of authors, from practising pathologists to patient advocates. We already know that some coroners are struggling to provide a timely post-mortem service and have raised this with MPs and the Chief Coroner. We have printed additional copies of this issue so that we can share it with those who will be able to influence how and when resources are invested in death investigation.

Medical examiners

I have been writing about medical examiners for my entire presidency and am disappointed to report that there still isn’t any likelihood of implementation in the near future. Despite there being cross-party support for the initiative, Brexit discussions mean that there is little parliamentary time available for the secondary legislation that is needed. College representatives continue to work with the Department of Health and other stakeholders to prepare as much as possible for the eventual implementation and to align existing learning from deaths initiatives with the medical examiner system. Building on the success of several Trusts that have introduced their own local medical examiner system without additional funding (see Leicester’s experience on pages 228–231), we are planning a national meeting and online resources to help other Trusts develop their own systems. While this won’t deliver all the benefits of the official programme, it will be a significant step in the right direction and will ease implementation when it happens. I remain optimistic that we will get there eventually.

Pathology summer school

The fourth annual Pathology Summer School was held at Guy’s Hospital in London on 18–19 August. Seventy-five medical students from 32 UK medical schools were welcomed to two days of lectures and breakout sessions delivered by an enthusiastic group of consultants and trainees in all pathology specialties. One hundred per cent of students said that they would recommend the Summer School to a friend and 90% said they were more likely to pursue a career in pathology as a result of attending. The event was sponsored by organisations of the Pathology Alliance, and is one of three annual pathology schools for undergraduates now established. Some of the students’ reviews will be published in the January Bulletin and on the website.

Regional and international visits

After successful trips to Belfast and Glasgow in May, it was a pleasure to visit Cardiff in July. The day started with the Wales Regional Council (WRC) meeting, where I talked to Council members and learnt more about the issues challenging the profession in Wales. I then had a chance to talk to trainees, listening to their concerns and answering their questions. The highlight of the day was the informative and inspirational symposium organised by WRC Chair Dr Esther Youd. You can read more about this on page 257.

I also enjoyed the European Congress of Pathology (ECP) in Amsterdam at the beginning of September. I spoke at two sessions, about public engagement and BMS reporting. I last spoke at the ECP about the College’s public engagement programme in 2014. This year, several delegates spoke about how, following the 2014 talk, they had adapted College resources and ideas to develop their own International Pathology Day events. The session on BMS reporting was a controversial one and sparked heated debate. No other European country has a programme like the RCPath/IBMS one, but several have pathologist assistant roles. It was nice to meet many College members at the meeting, as well as international colleagues.

All-Party Parliamentary Group on Laboratory Medicine

The College, as a member of the Pathology Alliance, is involved in the development of an All-Party Parliamentary Group (APPG) on Laboratory Medicine to increase the specialty’s profile with parliamentarians and promote discussion of important pathology-related topics. I attend several of these groups, including those relating to cancer, personalised medicine and life sciences, but having our own group will allow us to determine the agenda and engage more effectively with our colleagues in Westminster. We are currently in the process of inviting MPs and peers to join the group and will keep you updated on its progress. 

Women in Medicine exhibition

To mark the 100th anniversary of the Medical Women’s Federation and 500th anniversary of the Royal College of Physicians, a touring exhibition has been developed to highlight the lives of pioneering women in the different medical specialties as well as some contemporary role models. The exhibition opened at the Royal College of Physicians on 2 October and will tour other colleges and meetings over the next year. The College will be celebrating the contribution of women in pathology on its website.

National Pathology Week

The theme for this year’s National Pathology Week (NPW) is ‘Pathology in the community’, focusing on working closely with local schools, charities and other organisations to demonstrate to the local population how pathology affects their healthcare. As always, the College has developed promotional materials and resources to help make holding an event as easy as possible. Please see the website for details of how to register your event, request materials and access resources. If you use social media, please promote NPW using #NPW2017.

Antimicrobial stewardship

On page 248 you can read about how microbiologists are tackling antimicrobial resistance to try to promote judicious use of antibiotics and optimise patient outcomes. The same principles apply to animal health, as I found on a recent visit to a pig farm. Along with a coach-load of senior medical leaders, I heard from experts about the contribution that food production makes to global warming and how the use of antibiotics in animals differs around the world. I was impressed by the measures being taken on the pig farm to minimise the use of antibiotics and grateful to the team there for taking the time to show us round.

Election results

I hope by now you will have seen the results of the elections for College officers and Council members. Many thanks to everyone who stood for election and the members who voted. I am delighted that the new Vice Presidents, from the AGM on 16 November, will be Dr Rachael Liebmann, Professor Shelley Heard and Dr Tim Littlewood, who will be responsible for the Communications, Learning and Professionalism areas of College work, respectively. Dr Lance Sandle, current Vice President, has been elected Registrar. Assistant Registrar Avril Wayte and Treasurer Dr David Cassidy have one year of their current terms left to serve and, along with current officers Rachael and Lance, will provide some continuity and corporate memory. I am particularly pleased that this experienced team draws expertise from histopathology, microbiology, haematology and clinical biochemistry, as well as a clinical scientist perspective, representing the majority of College members. 

6 Alie Street

The new College premises at 6 Alie Street in east London are shooting up, with the skeleton of six floors already in place. I was recently given a guided tour of the site, and it’s wonderful to see the architects’ designs starting to take shape. It’s easy to tell how light and spacious the new building will be and it was great to walk round the main lecture theatre and appreciate the facilities that will soon be available for members. My visit was filmed; you can see the video on the College website.

And finally …

This is my last Bulletin column as president. It has been an honour to serve in the role and I am grateful to the thousands of members who have helped make my term of office so enjoyable. I would particularly like to thank members of College Council (pictured on the cover) and Trustee Board, who have supported me on this amazing journey and have delivered a phenomenal amount of work for the benefit of patients. The College staff have been a joy to work with, translating our sometimes confused and contradictory decisions into actions. Although I know she won’t need it, I wish my successor Jo Martin all the luck in the world and hope that she finds the role as exciting, fulfilling and fun as I have done. I leave the College in safe hands and wish it, and you, all the very best for the future.

Dr Suzy Lishman
Suzy.lishman@rcpath.org