Introduction
| In this issue ...
· Reports on the CPA one-day conference and inspector training in Italy. · Invitation for applications for EQA pilot scheme funding to be allocated in this financial year, 1999/2000. |
Other
news items ...
· Revised handbook · CPA at IBMS Congress 99 · CPD credits · Reminder to inspectors |
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EQA Scheme Development and Funding David Goldie, Chief Executive (EQA) Historically External Quality Assessment (EQA) scheme development was supported by the Department of Health (DoH). This support took the form of making available limited top-sliced funds each year for which scheme organisers wishing to set up pilot schemes could apply. This mechanism ran successfully for many years although it was always the case that bids totalled more than the funding available and thus the process was always competitive. In 1996 the DoH charged CPA, in EL(96)34 "Oversight of provision of External Quality Assessment Schemes for Pathology Laboratories", with a general responsibility for oversight of EQA schemes in the UK. Part of the remit included assuming responsibility for supporting EQA scheme development. However the DoH declined to continue to make top-sliced funding available and indicated that CPA should raise appropriate funding. How this might be achieved was debated within CPA and it was agreed that, as the ultimate beneficiaries of EQA development are the participating laboratories, the logical way to raise funds would be by way of a modest levy on the annual registration fee paid by accredited laboratories. This was achieved by way of a small increase in fees introduced in April 1997. The CPA(EQA) Committee agreed that it would invite applications for pilot scheme funding on an annual basis by means of an invitation to apply for funding being placed in the house journals of the main professional organisation in Pathology. It was also agreed that advice on areas in which EQA Scheme development might be appropriate would be sought from other bodies notably the Joint Working Group for Quality Assurance (JWG) and that the CPA(EQA) Committee may commission the development of Pilot EQA schemes if no accredited schemes operated in areas deemed to be important. CPA undertook the first round of pilot scheme funding in 1997 when it agreed to support six schemes in Cellular Pathology, Clinical Biochemistry, Genetics and Microbiology. A second round of bids was invited in 1998 and in November it was agreed to support four schemes from the twelve applications submitted. The four schemes supported were for Occult Blood, Cholinesterase investigations, Haemophilia genetics and Haemochromatosis genetics. We are now inviting bids for this year and application forms are available from Central Office. The closing date for completed applications to be received in Central Office is 31 October 1999. The successful applicants will receive funding before the end of the financial year. |
| CPA Trip to
Italy 23-27 February 1999 Jim Murray In October 1998 the Chief Executive and the Executive Manager for CPA (UK) met with Drs Plebani and Dorizzi from the Veneto Region in Italy at the Royal College of Pathologists. The meeting had been arranged to discuss the feasibility of CPA (UK) formally recognising an accreditation programme in a different country, CPA Italy. Following the discussions a group of CPA representatives visited Italy in February 1999 to run a training course for inspectors and to conduct an inspection of a laboratory in Southern Italy. This was the second such visit by a CPA team to Italy as in 1996 a team had run a training course for 30 inspectors (all medical) and also inspected Professor Lippi’s department in Verona. At this time CPA suggested that in order to take the process forward other members of the laboratory professions should be included. This was duly introduced the following year and in 1998 there was a trial inspection of the laboratory in Cremona. 126 letters were sent out to departments in the Veneto region and 25 have now agreed to take part in a pilot study from 1999. As part of the proposal for the Italian team to develop possible joint activity with CPA a team was assembled for a second trip to Italy in February 1999. The high level CPA team consisted of the Chief Executive (Il Supremo), the Executive Manager (Signora Cherubino), Mr John Ward, Dr John Philpott-Howard and Dr Jim Murray. On arrival at Venezia airport the team were escorted to the beautiful walled town of Castelfranco. Its main attraction is the Castelfranco Madonna, a magnificent example of Giorgione’s work in the Duomo. Giorgione’s place in Venetian art is considered equal to Leonardo’s influence in Florence (roughly similar to Cheryl Blair’s influence in Sheffield). After a light lunch we were straight into the inspector training session for the 30 delegates (this time mostly non medical). With amazing foresight the Chief Executive and Executive Manager had prepared translations of their initial presentations since not all delegates spoke BBC English (but then neither did the CPA team). The lectures were therefore delivered in 2 or 3 sentences at a time and then |
immediately
translated into Italian by one of the host team (Marco, Mario and Massimo). The
same format was adopted for the presentations and workshop sessions the
following day, very much along the lines of an inspector training session in the
UK. Against some of the visiting team members’ expectations, this
arrangement worked remarkably well. After a full day’s programme the CPA
team was given 10 minutes to change in their hotel and then transported off to
another hotel 20 miles away in Venice. After dumping bags in another hotel we
were escorted on a moonlight canal trip down the Grand Canal to a marvellous
restaurant near the Rialto Bridge. The Executive Manager could barely contain
her excitement. One of our hosts described his trip to work each morning. He
looks out of his window overlooking the Grand Canal to see when the water-taxi
is arriving then nips out of his front door to hop on the boat and get to work.
(Dr Murray wondered about a possible transfer to Venice - not as a
haematologist, a taxi-driver would do). Early next morning there was a turbo prop flight from Venice to Bari with a fantastic view of the city of Venice from several thousand feet up as we left. We felt this would be hard to match in Southern Italy and so it proved as we arrived in Bari to dark clouds and heavy rain. Lunch consisted of another gastronomic experience involving octopus, squid and mussels and we were then taken to the Policlinico where we looked through the documentation. This was a little tricky given that none of us could read Italian but we were indebted, as we were throughout this trip, to the efforts of Dr Mario Plebani. The next day we inspected the haematology, clinical chemistry and immunology departments and we were impressed with the hospitality and the courtesy with which we were received. The organisational structure was unusual by UK standards with a high ratio of medical staff to technicians (approximately 1-2) and they clearly worked very effectively together. In fact it was frequently difficult to distinguish between medical and non-medical staff as they worked so closely together at the bench. In Italy there are no national EQA schemes but there are a number of regional schemes. The director of the laboratory Dr Pansini had made exceptional efforts to introduce EQA into his laboratory and had shown great initiative in this area in Puglia. The CPA team met a group of enthusiastic users. The GP in particular was happy with the venepuncture service for his patients though |
interestingly
it is the patient who has to return to the hospital to collect the result at a
pre-arranged time. The meeting with the General Director was an altogether more
formal affair. We were led into a splendid office with several minders in
attendance. The General Director was an imposing figure and he told about his
ambitious rebuilding programme over the next 2 years with figures of 100 billion
lira being quoted (whatever it is it’s a lot). Comparisons with the UK
system were obviously cropping up throughout the visit and we were intrigued to
hear about their annual conference between the hospital management and the local
population. It sounded roughly similar to our community health councils except
the Italian system is much more representative with the local population
attending in large numbers. The hospital in Bari is closely linked with the
University and the strategic aims are jointly discussed so that an effective
service can be delivered.
Considering there are obvious cultural differences between Italy and the UK and considering that there were communication problems because of the language barrier it was very pleasing to see that we could still accomplish a comprehensive inspection programme. We were fortunate in being able to inspect such a good department with motivated staff and they were clearly very anxious to hear our views at the feed-back session at the end of the day. So anxious in fact that they turned up in huge numbers and filled a lecture theatre. As our views were predominantly very favourable we relayed them to the local staff via our interpreter Dr Mario Plebani. At the feed-back sessions in the UK I have seen the host team looking anxious, looking impassive, looking pleased and occasionally somewhat irritated. I have never however seen them reduced to tears (of joy) so CPA achieved another milestone in Italy in February 1999. The final meal in a Bari restaurant that evening before our early morning departure for home was a marvellous affair. The food was wonderful, the language barrier didn’t seem to impede most of the jokes and Anglo-Italian relations have probably never been so good. On reflection was this a worthwhile exercise? I think the answer is a very clear yes. One can see major problems for the Italian enthusiasts of accreditation in view of the lack of a national structure throughout the country but their efforts have been encouraged by the CPA visits and the inspector training sessions. The CPA teams have enjoyed marvellous hospitality and have also learnt a great deal. |
CPA Annual Conference
17 March 1999David Winfield
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The programme of the 1999 CPA Annual Conference was devised
to reflect the changes which are rapidly occurring in pathology and within the
organisation of CPA itself. The large number of delegates who registered
reflected the concerns of all pathology workers who are continually having to
cope with the upheavals which affect not only the disciplines of pathology but
the whole of the NHS.
The conference was opened by Baroness Hayman whose presentation was both thoughtful and well informed, both qualities which have sometimes been lacking from her Tory predecessors. Her stated aims for the current Health Bill are to improve standards of healthcare throughout the profession with self regulation via clinical governance and externally via the Commission for Health Improvement. In many ways the purpose of the Health Bill reflected a widening of the purpose of CPA to raise standards and improve quality throughout the UK Pathology services. CPA had been successful in this and had acquired a high reputation within Government. This had been well illustrated by the ability of CPA to cope with the additional demands of the requirement for all NHS laboratories providing cervical screening to be accredited. The aim of the Health Bill is to avoid unacceptable local variations and ensure that both good practice is recognised but there must also be an openness and ability to learn from events going wrong. Pathologists must take an active role in these developments since they are involved not only with health service provisions but also have a wider involvement in environmental issues, training and I.T. Baroness Hayman highlighted the Government’s worries which closely match those of CPA in that about 20% of laboratories in the UK have still not applied for accreditation. Whilst it is appreciated that some may be working hard to improve their standards to the level required by CPA, the worry remains that some of these laboratories may not be providing an adequate pathology service. With a telling sentence Baroness Hayman stated that if she was still the Chair of a Trust she would not want to hear that her pathology laboratory had not even taken the first stage of registration with CPA. Julietta Patnick of the NHS Cervical Screening Programme spoke on the mandatory accreditation for cervical cytology screening. Although the majority of screening laboratories had provided an adequate service there had been a number of notable and widely publicised problems especially at the Kent and Canterbury laboratories. The |
NHS Cervical
Screening Programme had started in 1995 and initially published sets of
guidelines relevant to good practice within cytology: these are being monitored
and reviewed by quality assurance teams and can thereby enable the Department
of Health to offer reassurance to women that “something is being done”.
Mrs. Patnick also recognised the importance of CPA in providing an independent
assessment that cervical screening laboratories are attaining the standards
required for safe and effective practice. The NHS CSP and CPA have developed
good working links and together they will continue to maintain and improve
cervical screening so that all women can develop confidence in their local
system.
Professor John Lilleyman’s topic for the conference theme of “change” was self-regulation and representation in pathology. To provide a first class service a modern pathology laboratory requires skilled and well qualified scientific and medical staff. They have different but often overlapping roles but ideally work closely together to provide an integrated service. The major groups are medical pathologists, clinical scientists and medical scientists but the importance of MLAs, cytoscreeners, morticians, phlebotomists and secretaries must also be remembered. Self-regulation for medical pathologists now depends upon Calman training programmes with CCST, MRCPath and compulsory CPD. For medical scientists there is state registration through the CPSM whereas for clinical scientists the picture is less clear cut without at present any state regulation. Professional representation of the different groups is also via the RCPath and IBMS although many clinical scientists fall outside these professional bodies. The problems with the existing fragmentation is that squabbles often occur to the detriment of pathology as a whole. In recognition of this the RCPath and IBMS had set up a “Think Tank” with the objective of:- a) The creation of a single source of professional standards of practice. b) The creation of a single institution for defining and assessing professional competence. c) The creation as a single conduit of professional communication with other organisations, with the media and with Government. The initial favoured option presented to the two councils and intended for wider discussion was for a Faculty of Pathology with restructuring of the RCPath. There had been some opposition mainly from Fellows of the RCPath plus a worry that such a |
proposal might
jeopardise the status of the RCPath as a Medical Royal College. The most recent
thought of the “Think Tank” had been a proposal for some sort of joint
council for pathology but Professor Lilleyman hastened to add that it was early
days for this idea.
With the changes imposed on pathology services over the past few years, most pathology workers feel hard done by: once they had heard Dr. Ian Barnes’ talk about the changes he has had to manage in Leeds/Bradford over the past few years they immediately felt better since here was change on a grand scale. The initial developments were a merger of the pathology services of Leeds General Infirmary and Bradford Royal with the opening of an off site facility in 1998. Dr. Barnes outlined the rationale for this major development but also highlighted the problems including the isolation of laboratory staff from other colleagues within the hospitals. We should all appreciate that staff morale is as important as cost effectiveness. A subsequent development is the merging of the two Trusts in Leeds to also incorporate the pathology services of St. James’ Hospital. Both professional and cultural differences between merging laboratories have the potential to cause future problems and active management at an early stage is the only way to prevent long term problems. The first of the afternoon sessions was Dr. Jane Beaumont from the United Kingdom Accreditation Service (UKAS) talking on the co-operation which had developed between UKAS and CPA and their joint involvement with European accreditation agencies. The mention of European involvement in pathology accreditation tends to produce an ennui amongst pathologists but Dr. Beaumont skillfully avoided this by an interesting presentation which initially stressed the importance of the joint ‘Statement of Intent’ which had been agreed between the Boards of CPA and UKAS. UKAS is the body with overall responsibility for recognising accreditation schemes and the importance of the Statement of Intent is in allowing recognition of common aims of the two organisations, in providing confidence in the services of medical laboratories in the UK and to seek improvements in the quality and standard of work. The other aspect of the statement is in co-operation with regards to European accreditation. UKAS is a member of the European co-operation for Accreditation (EA) and will participate in the European committee on certification issues. There is also an important role for CPA participating in the committee considering accreditation in laboratory medicine. cont... |
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cont... A place in Europe is an important step for the long term future of CPA. The final presentation was by Dr. David Burnett in which he described the changing world of standards and asked the question as to whether CPA should lead the way. For some time there has been an awareness within CPA that the current standards written at the time of CPA’s inception in 1992 have lasted well but there is now a requirement for change. Laboratory practice is changing and there are a number of guides and standards either published or in preparation. CPA must assess these and should seek to operate in conformity with ISO/IEC Guide 58. Dr. Burnett described the work of the CPA revision group which he chairs and which has the task of writing new standards and grouping them in a logical manner. CPA and those involved with it have always demonstrated their flexibility and willingness to embrace new developments in pathology and the introduction of the new standards will be extensively discussed in a series of workshops. The overall conclusion from the day’s meeting was that CPA over the past few years has developed into a highly professional organisation, well respected by Government and with strong lines to other accrediting bodies. Despite these strengths CPA needs to evolve and grow and adapt to the changes arising in health care and laboratory services. The importance of the annual conference is for those interested in CPA to attend and learn of current developments within pathology but also there is a need for CPA officers to hear the delegates’ opinions, good or bad, on the way CPA works at present and how the organisation progresses in the future. The CPA annual conference will be held as usual in London on 15 March 2000. Anyone wishing to register now should contact CPA Office. The registration fee has been maintained at £95. |
Accreditation Handbook The CPA standards have been in use now since 1992 and have gradually evolved over the years. We have made some changes to the handbook and the new edition (version 7.0) will be available at the end of August. All registered departments and inspectors will receive a copy. The handbook will in future be a “controlled document” and each copy issued will be numbered. In this way we shall be able to update the handbook on an on-going basis. CPA Stand at IBMS Congress The IBMS Congress will be held at the International Convention Centre in Birmingham, from 21-23 September 1999. The CPA stand will be sited in the registration area - Stand R3. If you are attending the Congress and would like information on our plans to further revise the CPA standards, please come and talk to us. CPD Credits The Royal College of Pathologists had agreed to allocate one CPD credit for each visit undertaken by CPA inspectors. In response to feedback received from CPA, the Royal College have now agreed to increase the credit allocation to 3 CPD credits per visit. This takes effect immediately. Reminder to Inspectors Following the Board decision to include some of the more specialised disciplines in the accreditation process, we issued a questionnaire to all CPA inspectors. This is a reminder for those of you who have not yet returned to Central Office the questionnaire regarding your ability to inspect molecular biology and/or semen analysis. Christmas/New Year Holidays The CPA Office will be closed from 25 December 1999 to 2 January 2000. Normal office hours will be resumed on Monday 3 January 2000.
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Diary Dates |
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20 October 1999
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CPA(EQA) Inspector Training Session - London
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