This page contains information on the transfer of services to the Hub. This information is relevant to Bromley-based GPs only.
Following the successful repatriation of Bromley GP pathology services back to Synnovis, we are now planning the transfer of your services from laboratories at the Princess Royal University Hospital (PRUH) to our new hub laboratory at Blackfriars.
This webpage describes the changes you can expect to see when the transfer takes place on a date to be confirmed in November - we expect to be in a position to share the exact transfer date later this week. This information has clinical relevance, therefore we ask that you please take the time to read this newsletter and share its contents with other colleagues where relevant.
Clinical impact of migration of services to the Hub
Historically, GPs across south east London have been served by different laboratories in different hospitals. This has meant that reference ranges, critical phoning limits and test profiles differed depending on which hospital or site your samples were sent to. As a result, there was no overall consistency across the region.
When Bromley GP services transfer to the Hub, it willl mean that all boroughs across SEL will be serviced from one place. This provides the opportunity both to harmonise reference ranges, profiles and protocols for all GP practices, and to align consistently with best practice guidance from the Royal College of Pathologists, GIRFT and NICE.
Immediately following transfer, there will be several changes for you to be aware of, including:
- Reference range changes for chemistry and haematology
- Changes to nutristasis - test profiles and names, references ranges, critical phoning limits and updates to automated comments and reflex rules
- Changes to some test profiles
Chemistry and Haematology reference range changes
The change in biochemistry instrumentation will result in changes to some tests and reference ranges. Whilst most of these changes are insignificant, a small number could have a direct impact on patient diagnosis and management compared with the previous PRUH arrangements.
Haematology reference ranges have already been harmonised for all GP users.
You can find a full summary of chemistry and haematology reference range changes here.
Changes to reference ranges for routine haemostasis
As part of the ongoing commitment to harmonising our GP services, we’ve made some changes to the routine haemostasis testing service.
The reference ranges for core haemostasis assays have been reviewed and harmonised, as we are now using the same methodology across all Synnovis laboratories. These changes have been discussed and approved by laboratory haematology consultants and scientific staff.
You can find a full summary of changes online here
Changes to test profiles
There will be no change to Renal, Bone or Lipid profiles for Bromley GP Users.
In accordance with advice from strategic clinical leads, the Renal + Urea profile will no longer be available as a combined test. The standard renal profile (Sodium, Potassium, Creatinine and eGFR) continues to be available, with Urea orderable as a standalone test. Both can be requested from the tQuest main page. This is consistent with all five other south east London boroughs.
There are some assays where we have also changed methodology:
Transferrin
Transferrin will now be measured (reported in g/L) instead of total iron binding capacity (TIBC). Transferrin saturation (TSat) will still be calculated but using the transferrin measurement instead of the TIBC calculation. This will be a significant improvement as results will no longer be overestimated as seen when using TIBC.
Albumin
Albumin will now be measured using the bromocresol purple (BCP) method, which does not overestimate albumin compared with the previous bromocresol green (BCG). As such there is a negative bias of 20% compared to the previous method. Adjusted calcium will be unaffected due to a change in the equation used to calculate this following the move to BCP for albumin measurement.
Nutristasis changes
The Nutristasis unit provides analysis of endogenous vitamins in body fluids. As part of transitioning to the Hub, there are changes to nutristasis reference ranges, critical phoning limits, test profiles and names, automated comments and reflect rules. You can find a full summary of the Nutristasis changes online here.
Catalogue Changes
Existing test catalogues have been reviewed and when GP practices in Bromley transfer to the Hub, all our service users across primary and community care in south east London will be using the same testing catalogue.
You will still access the Bromley tQuest catalogue you previously used in the same way, which will enable you to request tests and print the correct forms as before. However, the list of available tests will not be the same.
Changes you can expect to see include:
- Changes in terminology, although the test itself fundamentally remains the same.
- Changes to tests within some core profiles e.g. liver tests, with tests displayed as part of the profile name.
- Access to additional tests you couldn’t order previously.
- The discontinuation of more specialist tests where the latest clinical practice shows that other patient pathways are more clinically appropriate.
The new harmonised catalogue is available online, along with a summary of the Bromley specific changes.
It is important to note that catalogue changes will take place as clinical services transfer to the Hub, and therefore you will not see all of the new tests immediately after the Bromley blood sciences work moves. Changes to Virology and Reference Services are currently planned to happen throughout the first quarter of 2025 with the same phased approach that was taken for Blood Sciences, and we will share information about these nearer the time.
Amendments to tQuest
As part of the catalogue harmonisation, we will need to standardise the common orderables (the main page tick boxes) which are currently different for all four catalogues. This has been done in conjunction with ICB, PCN and practice leads across all six boroughs (including clinical representatives from Bromley) and will be shared before it is implemented to allow you to familiarise yourself with the new layout.
Given the differences across the previous tQuest versions, there will inevitably be some changes for each GP cohort. The most significant change for Bromley GPs will be that we have based the new layout on the most commonly requested tests rather than alphabetical order.
Ordering a test not in the new catalogue
In the event that you need a test which is not available on the new catalogue, you can request it using the existing manual request process. The request form can be downloaded from the tQuest information page on the Synnovis website at https://www.synnovis.co.uk/tquest-synnovis-pathology and it is also available on your DXS system.
Please be aware that as always, any manual requests may be subject to a clinical review and approval process. Should you wish to discuss an off-catalogue request with one of the clinical teams, please contact Synnovis customer services synnovis.customerservices@nhs.net who will put you in touch with the appropriate team
Changes to Cholesterol result reporting as part of harmonisation
As per recent NICE guidelines on cardiovascular disease: risk assessment and reduction, including lipid modification (Dec-2023), we will report lipid profiles with the following interpretive comments to aid in the management of high-risk patients.
LDL: Aim for 2.0 mmol/L or lower for patients with established cardiovascular disease, history of stroke/TIA or peripheral arterial disease.
Non-HDL: Aim for 2.6 mmol/L or lower for patients with established cardiovascular disease, history of stroke/TIA or peripheral arterial disease.
In addition, total cholesterol and triglycerides will flag high at >7.5 mmol/L and >20 mmol/L respectively.
Please note that we will no longer be reporting reference ranges for cholesterol/lipid profiles.
UKAS Accreditation
For a short time, the tests undertaken at the hub will be ‘unaccredited’ while UKAS undertakes the necessary checks and assurances required to confirm that hub arrangements are operating in accordance with ISO15189. This is perfectly normal when services transfer to a new setting. We are well underway with the accreditation process, which takes several months as we have to work within UKAS timeframes, and will keep you up-to-speed with progress.
In the meantime, all existing Synnovis quality processes for hospital-based services, such as rigorous in-house verification testing, internal quality control and quality assurance, are in place for all tests carried out at the hub, meaning you can be assured that high standards are being observed whilst accreditation is underway.
The UKAS status of the laboratory processing your sample will be indicated on your test results report.
Logistics and collection changes
In preparation for the transfer of services to the Hub, some of our courier routes have been reviewed and updated.
Changes to the collection schedules and access to the logistics route can be found online.
Our customer service team can help with logistics and collection queries – please see contact details below.
Requesting changes to Pathology services facilities
Pathology services in south-east London are delivered by Synnovis LLP on behalf of the King’s College Hospital and Guy’s & St. Thomas’ NHS Foundation Trusts (the Trusts) under contract to the Integrated Care Board (ICB).
Requests for additions or changes to the tQuest system, the test catalogue, sample collection routes or any other similar items must be done via a Change Control Enquiry form. The application requires support from both the ICB and PBU prior to being forwarded to Synnovis to confirm if it is possible, the cost and timeframes. Synnovis will then submit the proposal to fulfil the request for the PBU and ICB to approve prior to implementation.
You can access the form online, alongside the relevant contact details for escalation.
Compatible blood tube types
Please note that the tubes used to collect samples need to be compatible with instrumentation used at the hub laboratory.
EDTA (full blood count samples)
Please use 13x75mm tubes for EDTA samples, like the BD ones shown below. Greiner equivalent tubes are also acceptable. EDTA tubes that are too tall cannot be processed automatically and could break.
Serum samples
To ensure we have a sufficient sample quantity to process, please use 13x100mm tubes for serum samples like the BD ones shown below. Greiner equivalent tubes are also acceptable.
Label printing and positioning
We currently need to reprint the barcode labels on as many as 3 in every 10 blood tubes we receive from primary care because they are faded or difficult to read. Poor quality printed labels cannot be scanned or tracked by instruments within the laboratory. Incorrectly positioned labels are also unreadable.
We know that blood tube labels are often applied by phlebotomy clinics outside of the practice surgery, but we’d appreciate your support in ensuring that labels printed within your practice when tests are ordered are of high quality and aligned correctly on the paper. We are working with phlebotomy clinics and other services to ask for their help too.
Please help us to expedite your samples as quickly as possible by ensuring that all relevant practice staff are aware they need to:
1. Check that printed barcodes are clearly readable and not faded in any way. Check toner and printer ink levels and top them up if needed. Please also make sure the print doesn’t rub off the paper when you touch it.
2. Taking care of the label after printing. It would help us if you could ask your patients to look after the label before they attend their phlebotomy appointment, as fading or damage to the label can sometimes occur at this point.
3. Check that labels are properly aligned in the peel off section on the bottom right-hand side of the form and include all printed information. If not, you will need to reprint the form. Unfortunately, we cannot accept sample bottle labels that do not contain all of the required patient information as per our Sample Acceptance Policy.
4. If applicable, ensure that labels featuring barcodes are correctly placed onto phlebotomy tubes in straight alignment, so the barcode is positioned along the length of the tube, not wrapped around it.
Last updated: 18/10/2024
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