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Clinical Services Committee: Microbiology and Medical Virology

The aim of the Clinical Services Committee is to support infection specialists in their daily work, addressing issues of current concern and importance in the delivery of clinical microbiology, infectious diseases and other infection-related clinical specialties, public health and infection control.

Current topics under discussion include the transformation of pathology, the evolving infection curriculum, KPIs for microbiology laboratories and other infection prevention and control topics.

Clinical Services Secretary MMV (Microbiology and Medical Virology): Dr Natasha Ratnaraja 
See BIA Council page for contact details.
  

Best Practice Standards for the delivery of NHS Infection Services in the United Kingdom

The Best Practice Standards for the delivery of NHS Infection Services in the United Kingdom (version 2) has been developed in collaboration with, and endorsed by, RCP and RCPath. It is envisaged that this document will form a blueprint for infection services. As such, it is a document that is likely to evolve as further evidence comes to light.

 

Clinical Services Committee Position Statement on Pathology Networks, June 2014

The Clinical Services Committee of the British Infection Association represents medical microbiologists in Britain. It contains regional representatives and meets to discuss pertinent current issues.

Infection services are a vital and integral part of all hospitals; they also play an important role in supporting primary care. Thirty five to forty percent of hospital patients are receiving antibiotics every day. Eighty percent of all antibiotic prescriptions take place in Primary care. Infection Services in the forefront of the battle against antimicrobial resistance which is a key national and international priority. Infection Prevention and Control is heavily reliant on the infection service; good infection prevention and infection services improve the quality of patient care.

CSC members and constituents have been involved with the development of infection services following the recommendations of the Carter Review of Pathology services in 2008. The report recommended the creation of pathology networks to address issues of capital under funding, poor infrastructure and staff shortages in various degrees in England. The report suggested that revenue savings of up to 20% could be realized and that these should be reinvested in the service. The devolved nations are also implementing the advice of the report. Infection services have welcomed the opportunity to improve their services but the CSC is aware that this process is not without risk. Some developments have taken place which the CSC is aware have adversely affected the quality of laboratory services and may have had a negative impact on patient care. We would welcome evidence that these changes do realize benefits to patients and realise financial benefits.

In networks where infection specialists have been closely involved in designing and implementing change, progress has been made; fit for purpose IT systems, investment in technology, extended service provision in time and techniques. Many of these have also taken place in the absence of networks. Issues of concern to the CSC have arisen where projects have been rushed and or not closely involved a range of local professional experts. Several recurring themes have emerged. A lack of a common IT system across a network has resulted in difficulties with service delivery including significant reporting errors. In particular, clinicians working in satellite or spoke hospitals are unaware of results that have a direct impact on clinical care. A lack of sufficient transport links between spokes and hubs has resulted in increased turn around times from request to result. Spoke units enjoy a less flexible and nimble service with measurable quality reductions. For example a 7/7 Norovirus testing service in a spoke laboratory site has been lost as a consequence of centralisation. Colleagues working in spoke units report spending a significant amount of time trying to access hub staff to deal with queries on specimens from spoke patients. The direct interaction between consultants and their BMS colleagues represents a significant beneficial addition to the processing of specimens that may have been unrecognized and quantified. We are especially concerned that the soft intelligence which is garnered by working closely with BMS colleagues and scrutinizing reports for validation may be lost; the early emergence of novel antimicrobial resistance patterns or the management of outbreaks are two examples that we cite. Feedback from some colleagues in spoke laboratories is that they have failed to see any benefits post centralization; this includes a lack of financial return as demand management and streamlined testing algorithms have been lost. The CSC is aware that despite reassurances about safeguards for whistleblowers colleagues remain reluctant to make these concerns public.

The CSC is also aware that in a number of potential networks a significant amount of time and effort has been expended only for the venture to collapse as managerial imperatives in the participating hospitals change. This has hugely reduced moral in the wider microbiological community; this is a fragile and extremely valuable commodity that the country can ill afford to lose. The success in tack-ling health care acquired infections and emerging infectious diseases bears testament to the importance of an effective microbiological service.

In conclusion the CSC welcomes the opportunity to develop infection services. However it is concerned that unless safeguards are put in place the hasty implementation of projects will result in a reduced quality of service to patients with attendant risks to the public. These safe guards should include full involvement by all local consultants, a sound single IT system, appropriate transport links between spokes and hubs and communication systems that are able to replicate the efficiency of communication within a self-contained unit. Without these safe guards we would urge colleagues to share their safety concerns with local boards and commissioners.

Service provided by Infection Departments 2013

The Clinical Services Committee(Microbiology) has produced what it considers to be the core and potential extra services that an Infection Service should deliver in various acute and secondary settings.

Please click here to access this document [docx]

Toolkit for Microbiology Laboratories and Networks

The committee has also captured the experiences of colleagues who have been through the process and collected them together to assist other colleagues. A prose form of this has been published in the college Bulletin, the original version can be accessed here (please click) [docx]

 

Infection Diagnostic Services: Learning Experiences of Laboratory Centralisation and Mergers

It is a challenging time for infection services and the re-alignment of laboratories within this. We are keen to garner more information about what has gone well and what has gone less well with the “transformation / networking” of microbiology labs. 
Building on the papers published in the RCPath Bulletin (January 2015) we have put together this questionnaire to monitor progress so far. We would be grateful of your participation and associated feedback in this short survey which we hope will enable us to consider any lessons learned or highlight and review any alternative methods used. Responses are anonymous in all instances.

Click below for:

Analysis of BIA CSC Laboratory Centralisation Questionnaire (Sept 2015) [PDF]

Interactive BIA CSC Laboratory Centralisation Questionnaire [PDF]

Laboratory Centralisation Questionnaire: Interim BIA Member Survey results [PPTX]

BIA CSC Laboratory Centralisation Questionnaire [PDF]

FIS SurveyMonkey version of Laboratory Centralisation Questionnaire