Disease registers

James FalconerSmith also talked at today's RCPath day on systems, about disease registers for thyroid disease and health registers to coordinate care of those with mental illness. The general health needs of these patients may be poorly looked after, as they fall between the stools of general medicine and psychiatry. Pathology services maybe in a good place to coordinate this.

Pathology could coordinate care of many similar issues, from high risk conditions (eg lithium, DMARD monitoring, post radio iodine) to the complex (eg albuminurua in patients with diabetes, haematuria, MGUS, recurrent UTI).

These things work best when there is willingness from all stakeholders to work together. The thyroid register in Leicester was set up at the request of the endocrinologists. Labs need to be more confident in giving clinical advice.

We still need to grapple with how we commission this 'value add'. A service which is compared on test cost alone will be tempted to strip away expensive 'luxuries'  that are bundled into test contracts. One option might be for commissioners to require services to act on a certain number of system wide problems, with 'bonus' payment linked to delivery of some meaningful purpose focused measurement. For this to work well there needs to be a large degree of trust between commissioner and provider that the latter will act in the best interest of the patient. Otherwise there is a danger that the whole thing descends into management led performance monitoring of proxy measures, with perpetuation of the gaming that goes with this.