Diagnostic technologies 

Point of care testing (POCT)

POCT is defined as any analytical test performed for a patient by a healthcare professional outside a conventional laboratory setting. This could be in a GP practice, A&E or a community setting, like in a patient's home.  

A wide variety of NHS staff can perform point of care tests, including laboratory professionals, paramedics, radiologists, doctors, nurses, and other healthcare professionals. The results from point of care testing can be acted upon immediately supporting the rapid assessment and treatment of patients.

Where are Point of care testing (POCT) currently being used in the NHS?

In hospitals, POCT is being used in places like intensive care and emergency medicine, for tests such as blood gas analysis, where very rapid results are required.

In primary care, POCT provides convenient on-site testing for urine electrolytes (to check the body's electrolyte balance), blood glucose (to check whether blood glucose is within normal range), C-reactive protein (to check for the presence of inflammation), and other markers. There are also specific tests for blood clotting (D-dimer testing) and heart failure (NT-PRO BNP).

An example of POCT – CRP (C-reactive protein) test

Unnecessary antibiotic prescriptions are a significant factor in causing antimicrobial resistance (AMR). However, rapid diagnostic testing can help clinicians make more informed decisions about the prescription of antibiotics, helping to reduce unnecessary prescribing. One such diganostic tool is the C-reactive protein (CRP) test that can be used to assist clinical decision making as to whether an individual with symptoms of a respiratory tract infection (RTI) needs an antibiotic. Evidence from trials using CRP tests have shown to reduce antibiotic prescribing by 22-26% for respiratory tract infections (RTIs)[1] and 22% for chronic obstructive pulmonary disease (COPD)[2].

The College has joined other organisations calling for the development and adoption of rapid diagnostics including urgently adopting point of care testing to tackle antimicrobial resistance and support antimicrobial stewardship. Read more here: College joins coalition in signing consensus statement on tackling antimicrobial resistance (AMR) (rcpath.org)

Community Diagnostic Centres (CDCs)

CDCs are centres that provide patients with a broad range of diagnostic tests nearer to home without the need to attend a hospital.

Many of the CDC tests focus on imaging, however pathology tests are also provided. Some of the pathology tests at CDCs include phlebotomy (blood testing) which include, NT-PRO BNP (a test for heart failure), D-dimer testing (a test for blood clotting) other point of care testing and simple biopsies and urine testing.  

There is a clear opportunity for further pathology testing to be provided at CDCs. There also needs to be more data on CDC services to understand what tests are being offered and where, to ensure they are meeting all healthcare needs and successfully supporting patient pathways.

The College would like to see more data on CDC services and activites including data on blood and other pathology testing to be able to evaluate the CDC programme fully and ensure it continues to meet patient needs. [3]

What we need to deliver diagnostic services closer to patients

Funding

Properly costed financial resources to support POCT.

The NHS is experiencing increasing pressures and POCT, which enables fast-track decision making, could reduce this pressure. However, there is a lack of joined up funding for these initiatives which can lead to POCT bypassing NHS procedures, leading to the use of POCT products that have not been configured or evaluated properly.

Quality assurance

Central pathology laboratories must have oversight of POCT, including training, delivery, and maintenance of POCT services. The reporting of results and POCT must be accredited by the UK Accreditation Service (UKAS).

Plugging these gaps will smooth procurement processes for POCT while also ensuring e patient safety.

An increased and skilled diagnostic workforce 

Growing the laboratory workforce and equipping them with effective training and support is vital to deliver all elements of diagnostic services.

The Royal College of Pathologists has developed the National Strategic Guidance for at Point of Need Testing that advises on minimum standards to ensure appropriate testing.

Modern IT systems

The NHS needs specific IT software that allows POCT to communicate with the main laboratory. This is because POCT results should be securely recorded and added to the patient’s medical record.

Looking to the future, AI powered devices that can read and report results are likely to become more available, and these should be assessed as part of the evaluation of the POCT device, the test and where it takes place.[4]

References