Creating the case in need

To provide the strength in access to primary care with the support of secondary care - The hospital into the community is essential for the future of our NHS service and its ongoing sustainability. To make this a reality means you need to find innovative and collaborative ways to deliver healthcare out of the hospital environment – This can be through finding new ways to work collaboratively across NHS providers, system partners, by creatively thinking and looking at digital interventions which effectively and safely increase patient health care outcomes and its capacity for extension in POCT.

The local hospital pathology department’s role

An accredited multidisciplinary pathology diagnostic service at your local hospital laboratory quite often involves providing a service provision for POCT. POCT can be undertaken in clinics, wards, and acute settings within the hospital. The service provided is a robust and quality-led service which is delivered by fully trained and competent staff, ensuring that it meets the clinical requirements as well as the patient’s needs.

Having an established POCT service within your local hospital, a number of questions can be raised as to whether this service also exists in Primary Care, and if so, how is this managed ? Is it comparable to the hospital’s POCT service and does it meet governance and national standards, whilst also adhering to the clinical needs of the patient? This can be identified as the case in need.

Creating a vision

A project in Milton Keynes (MK) was initiated on the basis of the case in need - To reach out to local GP practices in MK with a clear vision:

• Identify and discover POCT devices and services in use across MK GP practices
• Document key strategic recommendations – compliance vs non-compliance, demonstrate good practice and highlight where improvements can be made
• Deliver benefits in patient care in line with national strategies and get it right first time (GIRFT) standards

Creating the method

The project involves conducting a number of audits at key GP practices which have already demonstrated significant findings.

The audits are based on ISO 15189 and ISO 22870 standards alongside MHRA guidelines and national standards when running a robust POCT service.

The  audits would enable the project to outline the current POCT services that are being offered and used within these GP practices. The audits would be baselined against NHS GIRFT, national guidelines, and ISO governance standards, allowing identification of gaps and trends to support the transformation, harmonisation, and compliance, whilst also highlighting any inconsistencies that maybe found within primary care vs secondary care POCT services.

The project vision is also to play a strong focus towards engagement, collaboration, system transformation, digital advancements for electronic patient reporting (EPR) and much more.

Key Recommendations for future implementation 

• Work towards quality assurance – Internal and External Quality Control assessment to ensure reliability of POCT results
• POCT co-ordinator and training lead to support the service and deliver a safe patient care service of excellence 
• Work effectively to reduce NHS pressures in acute secondary care settings by collaborative network partnerships and having the most cost effective service with health inequalities in mind
• Digital transformation, integration, and connectivity for accurate and timely POCT results into GP IT and EPR systems
• Working in partnership to reduce inconsistencies and variation, deliver a quality-led service, and streamline diagnostic access for patients with known and unknown diseases within primary care

Creating the future

The ongoing project in MK has shown clear benefits of working in partnership with your local hospital laboratory and Healthcare Scientists and this is essential for the future sustainability of POCT.  The workforce are able to provide the expertise, knowledge, and skill-sets to understand what is required of a governance compliant led POCT service. Working collaboratively as a multidisciplinary network supporting primary care POCT teams on a range of issues, to include, purchase of appropriate devices, staff training, results interpretation, quality assurance, patient diagnostic pathways and much more.

GP practices in MK agree that recommendations given within the project vision demonstrate how they can work towards delivering safer patient care and continuously improve their standards of excellence. Support was welcomed by GP practices when findings highlighted gaps in practice - “Building networks between primary and secondary care can only be a good thing and you supporting this initiative is very much appreciated” Quote from a local GP practice.

By setting clear visions on what you want to achieve when working collaboratively to strengthen the POCT service on a wider scale, you are able to onboard engagement. This reduces silo working and creates an environment to share best practice and transform the service for growing populations and meet the increasing demand for diagnostics. The community POCT service will give the right test, at the right time, for the right patient.

Rakhee Surti – Point of Care Project Manager – Milton Keynes University Hospital