London Calling

This year The London Clinic celebrates 75 years of independent medical treatment to the public. Fundamental to this service has been its Pathology Department, as Laboratory News discovered when it spoke to Paul Apps recently.

Paul Apps, deputy director of clinical services at The London Clinic, is responsible for a range of clinical departments there including Pathology, Radiology, Cardiology, Physiotherapy, Pharmacy, Health Screening and Dietetics.

Q/ Paul, could you give a little general background history on The London Clinic itself?

A/ “The London Clinic was established in 1932 by a group of Harley Street doctors and actually pre-dates the formation of the NHS. It has since become one of the UK's leading independent hospitals treating approximately 20,000 inpatients and 125,000 outpatients each year. Situated in the heart of London’s medical community, it is a fully equipped acute facility that has earned an international reputation for the provision of clinical excellence. Holding full healthcare accreditation and with “Investor In People” status, the Clinic attracts UK and international patients wishing to access the very best facilities that private healthcare can offer. In addition to routine surgery and medicine the Clinic provides extended specialist clinical teams and support services such as critical care, radiology, pathology and physiotherapy The main hospital site spans Harley Street itself, with additional consulting rooms also in Harley Street plus a new outpatient centre at Devonshire Place.”

Q/What about pathology services at the Clinic, when were they first established?

A/ “We have actually had a laboratory on site here at the Clinic since the day the building opened  in 1932 and so have provided 75 years of continuous diagnostic services to our users. Today pathology is an important part of the Clinic and maintains a high profile here by providing the hospital with a comprehensive diagnostic services in Biochemistry, Haematology, Blood Transfusion, Histopathology, Cytology and Microbiology on a 24/7 basis. Each discipline, which now also includes a new Stem Cell Laboratory, is led by expert pathologists in their field and all procedures are performed by biomedical scientists registered with the Health Professions Council (HPC). The laboratory incorporates a sophisticated quality-management system to ensure investigation procedures are performed to the highest possible standard. We also participate in National External Quality Assurance Schemes (NEQAS) as well as undergoing strict internal quality assurance and audit programmes.”
 
Q/Has the general layout of the laboratory changed much over the years?

A/ “When I first took charge in 1997 the laboratory had not been altered since the early 1960s. We were in urgent need of modernisation and refurbishment of the existing areas and so following a space analysis exercise by a firm of leading London architects, construction of the new pathology centre began in 1998 and was completed the following year. The Centre, which subsequently won an International Design Effectiveness Award, was carefully planned into 5 floors of the existing building to make the most effective use of the limited space available and we quickly saw immediate benefits. We can now deliver 90% of routine test results within one hour and this has allowed us to increase our capacity by around 15%. Also the new facilities have enabled us to streamline our pathology service, carry out a greater range of tests in-house for the benefit of our patients and offer new services to consultants and GPs in the area, thereby rivalling anything an NHS laboratory can provide. Our histopathology department for instance processes the caseload of 13 consultant histopathologists and to assist their workflow we have introduced both telepathology and remote authorisation systems.”

Q/ What does the current workforce in the laboratory comprise of, have you experienced any recruitment and retention difficulties for instance?

A/ “We currently employ a total pathology staff of 40 ‘WTE’s at including state registered biomedical scientists and MLA support staff.  We remunerate our staff very well and so once we do acquire them they tend to stay with us. We pay salaries which are on average around 10% higher than NHS equivalents, with a simplified staffing structure which allows the discretion to advance staff up the scale and provide private medical insurance, free life insurance and an interest free travel loan. We also employ overseas laboratory staff, particularly from Australia, New Zealand and South Africa, the advantage being that they tend to be multi-disciplinary trained with the broad practical knowledge and skills required to work at the bench.”

Q/What about staff training issues and CPD now that the HPC has made this a mandatory requirement for state registration, is this a problem area for you?

A/ “No quite the opposite, we invest considerably in both time and money to ensure our pathology staff fulfil their CPD requirements. All are encouraged to attend various external meetings and courses where appropriate, I have a very substantial training budget to encourage this and it is very rare that I turn down a legitimate request.”

Q/How have other current issues such as new legislation, Agenda for Change (AfC) and the Carter Review of pathology services impacted on you in the private sector?

A/ “Keeping up with the increasing legislation and accreditation issues are just as problematic for us as they are in the NHS. It’s a bit like the high-jump – you get over and then they put the bar up again! Independent laboratories in hospitals such as ourselves not only get subjected to the scrutiny of CPA but also get inspected by the Healthcare Commission, although generally their standards are very much in line with CPA. Additionally the recent Human Tissue Act had considerable implications for our stem cell freezing activity and of course we had to apply for a license to continue this activity. AfC however didn’t really impact on us in the independent sector. As for the Carter Review, I agree with many of its recommendations. The hub and spoke approach is the right way to go but there needs to be significant investment in pathology if we are to see centralised facilities.”

Q/ Procurement of laboratory equipment and analysers can often be a problem for NHS pathology laboratories, what are your experiences of this in the private sector?

A/ “We believe here in using the best equipment at the cutting edge of technology. We are very much user-driven, and as such will perform an evaluation of what is on the market, following which we make a recommendation to the board backed up with a sound business case, and invariably this is then very quickly rubber stamped with the minimum of red tape. We wouldn’t necessarily opt for the best deals on the market, but instead choose the equipment that most suits our needs. There is also a general ongoing rolling programme of replacing equipment, analysers and other laboratory hardware.”

Q/Is there much competition for pathology work from other independent sector rivals?

A/ “There is very strong competition on the high street from several other private pathology providers which I consider to be a healthy state of affairs. As a result we have managed to successfully expand our service and to market it externally. Additionally many of our competitors have diversified into other areas such as clinical trials, drugs testing and veterinary work, but we stick to what we do best here, namely providing high quality clinical pathology testing. We have therefore continued to see an increased demand for pathology – virtually across the board in all disciplines. We decided to bring our immunology and auto-immune serology in-house in 2005, which had previously been referred to external laboratories. We managed to acquire a small amount of additional laboratory space and set up the service and have never looked back.”

Q/ What recent changes have you seen at the Clinic and what future plans are there in the pipeline for the pathology department?

A/ “Our new outpatient diagnostic centre opened in October 2006, although there are no actually laboratory facilities on this site there is a phlebotomy service along with radiology and cardiology. The concept is that the unit can provide a “one-stop” shop that clinicians can refer their patients to for all their diagnostic investigations. A new Cancer Centre is also under construction and due for completion in summer 2009 which will provide approximately 70 additional beds and a radiotherapy department with two linear accelerators. Unfortunately for us, to create space for this we must vacate our existing pathology premises. We have therefore identified a new location on Harley Street which will involve a new build with pathology taking over the whole of the basement there.  All the existing pathology services will relocate there, with urgent samples, blood banking and out-of -hours services provided from a satellite laboratory located within the new Cancer Centre. Having the new laboratory on a single floor however will facilitate streamlining of the service and further integration of the disciplines. There will be a “blood sciences” laboratory using the latest tracking systems and incorporating a lean laboratory design element.  All this is due for completion in late 2009, but hopefully this will be the last laboratory at The London Clinic that I personally will ever have to design!”