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There is a very good international review comparing the funding and running of pathology systems which has been produced by Price Water House (March 2010) and can be viewed here http://www.hirc.health.gov.au/internet/main/publishing.nsf/Content/20CBB30C457BEB1DCA2576D300822677/$File/PwC_DoHAPathologyReview_180310_FINAL.pdf Overall I would say the review of the German model is fairly favourable. There are a few statements about the way Pathologists are remunerated. The one taken directly from the report relates specifically to Histopathologists (reproduced below). There is no mention made about Chemical Pathologists though, difficult to envisage how their work could be counted as such. BW John Weighted funding: Under the German weighted funding system, the government has a fixed budget for each pathology specialty and each pathologist is paid at the end of a three month period for the proportion of activity they have undertaken in relation to their peers. This model drives efficiency by incentivising pathologists to carry out as many tests as possible within a year as their activity in relation to their peers drives their reimbursement. However, there is a risk that pathologists are not disincentivised from encouraging doctors to request additional, potentially unnecessary tests as their reimbursement is directly related to their activity. In response to this risk, the German Government has introduced caps on pathologists’ activity in any given year and time on any given day. Whilst this is intended to incentivise pathologists to encourage doctors to request the most appropriate and necessary tests, there is also a risk that this approach results in a reduction in efficiency. From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of IAN WATSON Sent: 31 January 2013 13:27 To: [log in to unmask] Subject: Re: "A Step Forward In The Transformation Of Pathology Services" In Germany primary care work and some general hospitals are run by the private sector at the specified costs, however university hospitals, of which there are a significant number, are state run and have higher indicative costs, they also have very different working practices to the UK, this is what my German colleagues tell me; it’s always better to compare apples with apples. As for Carter it’s a busted flush! The savings are being skimmed off and not reinvested; the service that needs to be delivered on a hub and spoke basis makes sense BUT there is no recognition, as we’ve moved on, that we should be delivering a patient focussed service within the clinical pathways, changing completely our service delivery paradigm, yet we are inhibited by the relentless reorganizational churn, most CCGs do not see pathology as an issue, but when you see that the EoE bid excludes phlebotomy, one can only despair at the lack of recognition of pathology as a gateway service! We spend too much time reinforcing the impression of pathology as a discrete entity and not enough selling our value and solutions by example to ensure we are part of the end-to-end clinical pathway. Think you’ll find that recent developments in the marketisation of German laboratories has been around adding value............... Ian D Watson From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of David James Sent: 31 January 2013 13:05 To: [log in to unmask] Subject: Re: "A Step Forward In The Transformation Of Pathology Services" Let’s be a bit controversial – and I am fully aware that I am probably in a minority Why is anyone surprised by this move, we all read the Carter Review and it was quite clear, reconfigure with true hub and spoke models and significant savings in cost to the NHS spend on pathology can be made. How many years ago was it that Carter produced his report, and is that not enough time to deliver? Let’s remember that the 20% saving was expected [and was hopefully to be reinvested but the Bankers put paid to that] and is being taken out of NHS budget, and is supposed to be the starting point before the CIPs I’m sure people would agree that the standard of healthcare in Germany is not lacking, but here are some uncomfortable facts. Average per capita cost of laboratory diagnostics in the UK is about $56 [figure quoted by PWC is actually $70, but they did not take into account blood products] Average cost in Germany is $40……………………….and before everyone starts by saying it’s not comparable as we do it differently, if we accept that they are not comparable, the uncomfortable question left is why does a significantly lower spend on diagnostics still deliver an excellent health service? DJ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Griffiths Paul (RQ3) BCH Sent: 31 January 2013 11:39 To: [log in to unmask]<mailto:[log in to unmask]> Subject: Re: "A Step Forward In The Transformation Of Pathology Services" Dear Colleague, The silence from the profession regarding this issue is deafening! This initiative has the potential to destabilise many pathology departments, taking away upwards of 50% of their workload. They will still be required to provide an acute service for their Trust, including out-of hours. This will subsequently increase their unit costs and brings into serious question the proposed financial benefits, especially when taking into account the costs and difficulties of moving samples around large conurbations. You may have read the anonymous article in the ACB News Sheet on what has happened to the service in the East of England as part of this “transformation” process. The fact that the authors did not feel able to put their names to this article speaks volumes about the nature of the process. Are we, as a profession, happy with what is happening? I would encourage and welcome a debate on this issue. Regards Paul Paul Griffiths Consultant Biochemist Head of Department & Director of Newborn Screening Newborn Screening and Biochemical Genetics Dept. Paediatric Laboratory Medicine Birmingham Children's Hospital Tel +44 (0)121 333 9923 From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay Sent: 30 January 2013 18:45 To: [log in to unmask]<mailto:[log in to unmask]> Subject: "A Step Forward In The Transformation Of Pathology Services" "A Step Forward In The Transformation Of Pathology Services Notices have today been published in the Official Journal for the European Union (OJEU) advertising the three tender opportunities to provide community pathology services for the East and West Midlands. " http://www.strategicprojectseoe.co.uk/uploads/Press%20Release%20(28%20January%2013)%20v6a.pdf Jonathan ------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. 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