Using CPA Accreditation to gain a Successful Foothold in the GP Led

Community POCT Market

Tony Cambridge Lead BMS/POCT Co-OrdinatorPOCT Plymouth

Plymouth Hospitals NHS Trust CPA accredited for POCT in External Sites Assurance of quality and safety Potential to provide support for POCT activities through

SLA or legal contract 100 GPs, 5 Community Hospitals, private providers Support for services further afield POCT used instead of the lab so should meet the same

standards

The ConceptPhase 1 Govern existing activity Expand the scope of POCT in the local community

Phase 2 Market services as POCTPlymouth The laboratory has a commercial website

www.clabs.co.uk Dedicated POCT page on the trust website Dedicated email address

plh-tr.POCTPlymouth@nhs.net

Use as a stamp of quality

Phase 3 Market our services beyond the locality Elements include:

EQA management provision of controlled documentatione-Learning and competency packages possibly audit of POCT services equipment evaluation

Acute Trust vs. Community

The Acute Trust POCT activities are widespread Good governance structure Quality and safety monitored Good resources Culture of audit and corrective action

Acute Trust vs.Community

Community Some POCT activity Little governance No evidence of monitoring of results, who would? ?Safe, quality processes? Lack of dedicated resources ?Evidence of audit of POCT processes

Acute Trust vs. Community

The Acute Trust Internal quality control External quality assurance Controlled documentation Training and competency packages Service review Good control over service

Acute Trust vs. Community

Community Little or no EQA Little evidence of IQC performed Documentation absent altogether Training? Competency recorded? No review of service Service fragmented- no control

What is the motivation to expand our activities into the Community?

Identify POCT activities Promote what is available and potential benefits Introduce a governance structure Improve Quality Improve Safety Standardise activities

What is the motivation …..?

Improved outcomes for patients Reduce unnecessary referrals to secondary care Reduce follow up appointments Financial savings Empower patients Patient choice

Communicate with the Community- Thanks to Patricia Lockett Gateshead Health NHS Foundation Trust

Engage with key individuals

Questionnaire Do GPs want to perform tests at the POC? Do CCGs want to introduce POCT?

Who do you talk to? How do you convince them? How can you support their needs? Can be a long, drawn out process

Supporting the Community

Must be able to visit them regularly Provide training and competency Perform regular audit of the service Documentation in place Monitor performance Effective action Good governance

Outcomes Successful buy-in from CCGs Platform for expanding the scope of POCT in the

community More effective service Better outcomes for patients Less strain on secondary care Potential savings within the NHS

What to Focus On? Questionnaire responses

Diagnostic: Focus on tests that rule in/rule out key conditions i.e. BNP, CRP, urinalysis, urine pregnancy testing

Monitoring: Promote tests that can help manage

conditions within the community i.e. D-dimer, HbA1c, glucose, haemoglobin, renal function, cholesterol

Referral: Which tests would reduce referrals to secondary care - all of the above

Which conditions did GPs tell us they would like to manage/diagnose in the community?

Heart failure, IHD, MI, PE, VTE, DVT, ACS, Gout, CKD, PMR, CVD, DM, Hypothyroidism, Ovarian cancer!, chlamydia, infection

Pneumonia vs. LVF vs. COPD Severe or rapidly progressive anaemia AKI, renal function Ectopic pregnancy

What are we concentrating on?

We can’t do it all (not yet)! Not cost effective or clinical justification Start small and build Urinalysis, urine pregnancy testing, Hb, glucose, HbA1c,

INR Potential for cardiac markers Potential for sexual health tests ?Drugs of misuse

Emphasis on governance

Show that the model can work for existing activities Emphasise the value of good clinical governance Help expand the repertoire of tests where

wanted/needed Deal with resistance by explaining the benefits Get the support of your clinical and management leads

Costs

Depends on the service procured Full service, partial or single element Cost based on man hours spent supporting the service

multiplied by an hourly rate determined by the complexity(Atebion model)

Most costs are based on band 2 ATO, but some at band 4 Associate Practitioner

May be an element charged at higher bands

Will it succeed? We hope so… Get on the Pathology agenda Pathology labs meet with the CCGs POCT a major part of pathology provision

We hope to… Generate income to re-invest in the team/service Not a profit making scheme Sign up new users Scale up our activities

Parting Message

POCT has a significant role in the future of Pathology provision

Work together with pathlabs and users

Common goal

IMPROVE PATIENT CARE

Thanks for listening

E: tony.cambridge@nhs.net T: 01752 792294