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Pathology: towards a competence based workforce
IBMS response to the report, Pathology: towards a competence-based workforce.
The Skills for Health report on the Pathology Reprofiling Project is a timely study in view of the changes taking place in pathology and is an interesting piece of work in as far as it goes. The Institute welcomes its openness in respect of the demonstrated benefits and acknowledged limitations as a model for reconfiguring a pathology workforce.
The report clearly shows the benefits to patients and service users of having effective sample transport arrangements in place and electronic ordering communications from all general practitioners and hospital wards/clinics. These should be a fundamental provision, and a commitment to the investment for this to be available to all pathology services would enable the benefits shown by the pilot sites to be replicated elsewhere.
The exercise is valuable for its demonstration that a greater proportion of the routine analytical processes could be undertaken by staff in CF levels 2 - 4 than is currently seen in most laboratories. This naturally liberates more time for senior staff to undertake the quality, training, supervisory and management duties inherent in a laboratory service. In particular, the Institute is pleased with the recognition given to the potential for further CF level 8 role development and also the opportunity for senior staff to make better use of their skills through the devolution of certain duties to lower CF level staff.
The outcomes from the pilot sites showed largely an increase in overall staff numbers through the greater use of level 2 – 4 staff and a reduction in the number of level 6-7 staff. The result was stated to be a potential cost saving at larger hospitals, although not achievable on all sites immediately. What this projection did not take into account was the additional staff that might be needed at CF levels 6 – 8 to undertake those managerial, supervisory and extended roles that were not examined in depth, or at all, in this study. Further work would need to be undertaken to demonstrate whether the projected numbers of level 6 – 7 staff would in fact be sufficient to deliver the increasing need for quality controls and quality management that place demands particularly on senior staff.
The Institute is concerned that the benefits of such an approach to skill mix could be taken out of context. The outcomes of the report rely heavily on the results of staff reprofiling in the areas of sample reception and processing (i.e. basic sample workload) with less consideration given to the elements of quality, training and management and role extension which collectively are the backbone of a laboratory service. Further work must include looking in more detail at these elements that enable service delivery and ultimately, protection of the patient. The key to successful re-profiling is to ensure a skill mix that is fit for purpose and to recognise that that purpose will differ between laboratories as the patient needs differ.
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