ACGS Executive Statement
Dear All
The draft service specification for the redesign of the genetics laboratories in England was published
in January 2015 for consultation. This is welcome progress as there has been an extended period of
uncertainty regarding the future. The specification is far reaching in that it includes both inherited and
acquired disorders, but this was in line with proposals from the ACGS, was present in earlier drafts
and there has already been significant progress to incorporate integration into planning in many areas
where it was not already in place. The plan is to procure Genomics Central Laboratory Hubs (GCLHs)
which will operate as a strategic network, forming the core of an NHS Genomics Laboratory. There
will also be Genomic Local Laboratory Hubs (GLLHs) which will work closely with and be supported by
the GCLHs through a managed network and which will be focussed across a broad range of pathology
services. However in other aspects the service specification is less clear, with no explicit indication as
to the number of GCLHs or GLLHs envisaged nor the population size to be served which would enable
a more informed approach to potential collaborations and aid the development of networks. This
information may or may not be revealed in the eventual tender.
What is also not clear is the potential implication for pathology as a whole. The document "The
forward view into action: planning for 2015/16” provides an indication, directing commissioners to
commission pathology services from Genomic Local Laboratory Hubs, with the 100,000 genomes
project catalysing transformation of the NHS in relation to diagnostics, pathology and functional
genomics.
This is a bold vision, placing genomics at centre stage of pathology and the integration of genetics
and genomics into mainstream pathology is very much to be welcomed and supported. It has the
potential to deliver integrated solutions in the long term for patients through the managed networks,
and has the potential for cost efficiencies associated with rationalisation and centralisation, a
requirement in the challenging financial environment. We have been provided already with some tools
to deliver such an integrated solution; the accredited training and career framework delivered by the
Modernising Scientific Careers programme, the MSc in Genomic Medicine which will make knowledge
of genetics and genomics accessible to relevant NHS staff and the totality of the 100,000 genomes
project which is focussed on providing a legacy to the NHS through service transformation. However
it is vital to note that genetics at present represents a relatively small proportion of referrals to
pathology disciplines and consequently there are significant risks associated with placing genomics at
the heart of such a radical vision. One such risk is the disenfranchisement of existing pathology staff
and their potential disengagement with the process through a perceived diminished role. It must be
recognised by the genetics community that just because genomics is in the title, it does not mean it
will be staffed, or more particularly led, by genetics trained and affiliated staff. In order for this model
to be successful, leaders of the highest quality from all pathology disciplines must be selected who
have the vision for reform and the will to support and develop the model in a cost effective way
which maintains the highest quality for the benefit of patients. Such visionary leadership is vital if we
are to ensure that the pathology disciplines, including genetics, recognises the potential of the
reconfiguration proposals and works to implement them to maximise the already significant
contribution that laboratory services make to patient care.
In this context the ACGS very much welcomes this specification and is keen to engage in the next
steps of this exciting and transformative initiative.
Signed
Ann Dalton, Chair and the Executive Committee, ACGS