fit –nice guidance published meet the president care · 2017-07-31 · meet the president . . ....

In this issue

FIT – NICEGuidancePublished

Meet thePresident

BIVDA

Focus 2018

Health &Care ProfessionsTribunalService

CSO Bulletin

Innovationand BestPractice

FlexibleWorking

TraineeElectives –from London to SouthAfrica

The Association for Clinical Biochemistry & Laboratory Medicine | Issue 648 | August 2017

ACBNews

About ACB NewsThe Editor is responsible for the finalcontent; advertisers are responsible for thecontent of adverts. Views expressed are not necessarily those of the ACB.

Lead EditorMr Ian HanningDepartment of Clinical BiochemistryHull Royal InfirmaryAnlaby RoadHull HU3 2JZEmail: [email protected]

Associate Editors Mrs Sophie BarnesDepartment of Clinical Biochemistry12th Floor, Lab BlockCharing Cross HospitalFulham Palace RoadLondon W6 8RFEmail: [email protected]

Dr Gina Frederick Pathology Laboratory, Level 5Royal Derby HospitalUttoxeter RoadDerby DE22 3NEEmail: [email protected]

Dr Derren Ready Public Health England National Infection ServiceMicrobiology Reference Services61 Colindale AvenueLondon NW9 5EQ Email: [email protected]

Situations Vacant AdvertisingPlease contact the ACB Office:Tel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

Display Advertising & InsertsPRC Associates Ltd1st Floor Offices115 Roebuck RoadChessingtonSurrey KT9 1JZTel: 0208-337-3749 Fax: 0208-337-7346Email: [email protected]

ACB Administrative OfficeAssociation for Clinical Biochemistry & Laboratory Medicine130-132 Tooley StreetLondon SE1 2TUTel: 0207-403-8001 Fax: 0207-403-8006Email: [email protected]

ACB PresidentProfessor Ian YoungTel: 028-9063-2743Email: [email protected]: @ACBPresident

ACB Home Pagehttp://www.acb.org.uk

Printed by Swan Print Ltd, BedfordISSN 1461 0337© Association for Clinical Biochemistry &Laboratory Medicine 2017

ACBNews

General News page 4

Microbiology News page 17

Practice FRCPath Style Calculations page 18

Current Topics page 20

Trainee News page 30

Meeting Reports page 34

Future Meetings page 41

BIVDA News page 43

ACB News Crossword page 45

Situations Vacant page 46

Issue 648 • August 2017

The monthly magazine for clinical science

Issue 648 | August 2017 | ACB News

Front cover: ManchesterMetropolitan University, venuefor Focus 2018. See you there!

SudokuThis month’s puzzle

Last month’s solution

4 | General News


STOP PRESSThe final Diagnostics Guidance on Quantitative Faecal Immunochemical Tests (FIT) toguide referral for colorectal cancer in Primary Care was published on Wednesday 26th July2017 as the ACB News went to press. The recommendations include use of particular FIT methods ‘to guide referral for

suspected colorectal cancer in people without rectal bleeding who have unexplainedsymptoms but do not meet the criteria for a suspected cancer pathway referral outlinedin NICE’s guideline on suspected cancer’ (ie NG-12). In other words testing is recommended for the patient groups within recommendation1.3.4 of NG-12. A cut-off of 10 µg/g faeces is recommended. The articles on pages 20 to 23have been commissioned to coincide with the launch of this important guidance. Laboratories need to be aware of this guidance, as FIT is being discussed within Cancer

Alliances, NHS England Clinical Networks, Commissioning Groups to name but three! As Ian Godber’s article illustrates, this is of relevance across the UK. The final Report fromNICE can be found at: https://www.nice.org.uk/guidance/dg30 �

Focus 2018

Focus 2018, our National ScientificMeeting, will be held on 6th-8th June 2018 at the Manchester MetropolitanUniversity – please note this in yourdiaries! (OK, so you probably don’t have a2018 diary, yet!). Key members of theOrganising Committee Members are: Mike Hallworth: Chair, OrganisingCommittee; Chris Chaloner: Chair, ScientificCommittee; Sarah Robinson: Vice-Chair,Organising Committee; Secretariat: ACB Office ([email protected]). Further information will be available

soon. We look forward to seeing you inManchester. �

Meet the President . . .Professor Ian YoungIt was a great honour totake over the position ofACB President at this year’sAGM, and I am lookingforward to the challenge ofrepresenting ourprofessions in difficulttimes. My predecessor,Gwyn, was an excellentPresident and will continueto work closely with me forthe next year in the past-President role. The ACB News Editor has

kindly asked me to write ashort article introducingmyself – always a difficulttask! I joined the ACBapproximately 30 years agoas a Trainee ChemicalPathologist, and have beenan active memberthroughout my career. I was Chair of the ACBScientific Committee for anumber of years, beforejoining the ScientificDivision of the IFCC, where Ibecame vice-Chair and thenChair for a period of sixyears up to the end of 2016. In my day job, I have been

a clinical academic andConsultant ChemicalPathologist in Belfastthroughout most of mycareer. I was appointed asProfessor of MedicalBiochemistry at Queen’sUniversity Belfast in the late1990s, and subsequentlybecame Professor of

Medicine, a position which Istill hold. My clinical andresearch interests havebeen mainly in lipids,nutrition, and oxidativestress, and I have publishedalmost 400 papers andreview articles in theseareas. My University andclinical commitments havenow significantly reduced,and my time is mainly spentas Deputy Medical Directorin Belfast Health and SocialCare Trust, and ChiefScientific Advisor/Directorof Health and Social CareResearch and Developmentfor the Northern IrelandDepartment of Health.However, I continue to seepatients and to provideclinical advice.Apart from the ACB,

I have a number of otherexternal roles, in particular

as a member of the UKScientific AdvisoryCommittee on Nutrition,Associate Editor for ClinicalChemistry, Chair of the UK NEQAS ClinicalChemistry Steering Groups,member of ScientificAdvisory Boards for NIBSCand LGC, and member ofJCGM Working Group 2 (all abbreviations can beGoogled!).In my personal life, I am

particularly interested inliterary fiction/bookcollecting, andcontemporary art (especially urban art), topics I am always happy tochat about! I am looking forward very

much to the next two yearsas President of theAssociation. There will bemany important issues toaddress, but in particular Ihope to promote initiativesto maximise membership ofthe Association in allrelevant branches oflaboratory medicine, and toensure that leadership rolesin the Association reflectthe demographics of ourmembership and that activeconsideration is given toequality issues in all aspects of the Association’swork. �

6 | General News


8 | General News


Clinical Chemistry by David White, Nigel Lawson, Paul Masters and Daniel McLaughlinPublished by Garland Science, Taylor &Francis Group, 2017ISBN 9780815365105587 pages, including index

I found this new book refreshing, in thatthe chapters were obviously written de novo, rather than updating the textfrom previous editions. Thus aspects suchas high sensitivity troponin, brainnatriuretic peptide, acute kidney injury(AKI), estimated glomerular filtration rate,the use of enzymatic creatinine assays, themeasurement of CSF xanthochromia andthe use of tandem mass spectrometry are included. Also included is very usefulbackground information on glycatedhaemoglobin (HbA1c) measurementsincluding standardisation with the nowhistorical cross-over period for the ‘new’versus ‘old’ units, use (and limitations) ofHbA1c in the diagnosis of diabetes.Reference is made to the original DiabetesControl and Complications Trial (DCCT)and the UK Prospective Diabetes Study(UKPDS). At the time, these were landmarkstudies demonstrating the benefits ofgood glycaemic control and, probablymore important, the effects of poorglycaemic control.The book is divided into 25 chapters,

each with useful side-headings, coveringthe subject in a very comprehensivemanner; topics are well-referenced in theindex. The text is inter-spaced with veryrelevant ‘clinical practice points’,‘analytical practice points’ and clinicalcases. For example, there is a usefulreminder that TSH may remain suppressed

for several months following treatment ofthyrotoxicosis, which those new to thesubject may not appreciate. Overall, topicsare covered in a logical manner, with goodexplanations of the basis of disease (afterthe description of normality!) and therationale for the testing of particularanalytes.I particularly liked the section on cardiac

muscle, which is within Chapter 13,Muscle. This pulls together the clinicalpresentation and electrocardiogramfindings, with the biochemical findings inmyocardial infarction. This includes a list ofhistorical markers of myocardial damagewhich have been superseded by troponins,again, a good learning section for thosenew to the profession who take troponinsfor granted! This includes reference toAcute Coronary Syndromes (ACS), togetherwith a clinical practice point.This book contains some very detailed

information and, I feel, would be ideal(together with other resources) for thosestudying for FRCPath, as well as thoselooking for a refresher/reminder ofparticular clinical situations. This book isideal for dipping into either at a basiclevel, or when studying for FRCPath.My only (personal) irritation is the

Americanised text, e.g. ‘tumor markers’and ‘heme’, as well as ‘z’ rather than ‘s’,but as I say, that is a personal preference! This is certainly a book that you will find

on my bookshelf. �

Book Review: Clinical ChemistryIan Hanning, Lead Editor, ACB News

The Health and Care Professions Council(HCPC) has launched its new tribunalservice, The Health and Care ProfessionsTribunal Service (HCPTS).The HCPTS is a new impartial hearings

service which will provide a distinctidentity to highlight that the adjudicationof fitness to practise allegations isundertaken at arm’s length by panelswhich are independent of the HCPC whoinvestigate the matter.It comprises the Tribunal Services Team,

which manages the operations of thehearings and the Tribunal, which are thePanels that make decisions on what actionis needed to protect the public. HCPTSPanels may caution or place restrictions ona registrant’s practise and in the mostserious of cases remove or suspendprofessionals from the HCPC Register.Based in a dedicated centre in

Kennington, London, the HCPTS is part ofthe HCPC but will be operationallyseparate from the regulator’s complainthandling, investigation and casepresentation.John Barwick, Acting Director of Fitness

to Practise, HCPC said: ‘It is important forus to deliver a service where there is adistinct separation. The HCPTS will providereassurance to registrants that the Panelmaking a decision on allegations aboutthem is at arm’s length from theorganisation that investigated the matter.It is important from a registrant and publicperspective that our hearings areobjective, impartial and transparent.’For more information on the HCPTS,

all current fitness to practise cases, andrecent decisions visit: www.hcpts-uk.orgFor further information please contact

the HCPTS Press Office on Tel: 020 78409137 or Email: [email protected]

Please note:

1. The Health and Care ProfessionsTribunal Service (HCPTS) is the fitness topractise adjudication service of theHealth and Care Professions Council(HCPC). For more information on thepurpose and structure of the HCPTS,visit: www.hcpts-uk.org/aboutus/roleofhcptribunalservice

2. The Health and Care ProfessionsCouncil is an independent regulator setup by the Health and Social WorkProfessions Order 2001. The HCPCkeeps a register for 16 different healthand care professions and only registerspeople who meet the standards it setsfor their training, professional skills,behaviour and health.

3. You can find out more about hearingsand allegations by visiting:www.hcpts-uk.org/hearings/calendar

4. Anyone can contact the HCPC and raisea concern about a professional on theHCPC Register. This includes membersof the public, employers, the police and other professionals. Visit:www.hcpc-uk.org/complaints/raiseaconcern/

5. The HCPC currently regulates thefollowing 16 professions. Each of theseprofessions has one or more ‘protectedtitles’. Anyone who uses one of thesetitles must register with the HCPC. To see the full list of protected titlesplease see www.hcpc-uk.org/aboutregistration/protectedtitles

� Arts Therapists� Biomedical Scientists� Chiropodists/Podiatrists� Clinical Scientists� Dietitians

10 | General News


Health and Care Professions CouncilLaunches Arm’s Length Tribunal Service

� Hearing-aid Dispensers� Occupational Therapists� Operating Department Practitioners� Orthoptists� Paramedics� Physiotherapists� Practitioner Psychologists� Prosthetists/Orthotists� Radiographers� Social Workers in England� Speech and Language Therapists

6. The HCPC regulates social workers inEngland. Social workers in NorthernIreland, Scotland and Wales areseparately regulated by the relevantCare Council in that country.

7. Registrants can appeal the panel’sdecision. Appeals are made directly tothe High Court in England or Wales,the Court of Session in Scotland or theHigh Court of Justice in NorthernIreland. Appeals must be made within28 days of when the Notice of Decisionand Order is served. The Panel’s orderdoes not take effect until the appealperiod has expired or the appeal hasconcluded.

The Health and Care Professions CouncilPark House184 Kennington Park RoadLondon SE11 4BU �

General News | 11


VoicepieceThe greatest challenge for the NHS overthe coming years is to find new and moreeffective ways of working to ensuresustainable, high quality care for all. One significant change is the growingcoupling of diagnostics to medicine asmore personalised drugs and approachesare developed.As Healthcare Scientists, we have to

constantly transform the way we work inresponse to advances in technology andchanges in the external environment, andconstantly strive to improve our servicesand the way we work within them so wecan do the best for our patients.Many healthcare science interventions

require administration of prescription-onlypharmaceuticals, from the use ofsalbutamol in the diagnosis of asthma byPhysiologists through to the use ofcontrast agents in MRI or the drugs used innuclear medicine. It doesn’t make sense topatients or service efficiency that differentprofessions have to be brought in to thedelivery of routine tests and procedureswhen it could be delivered in a one-stop,joined up way.Finding ways that Healthcare Scientists

could be permitted to administerprescription-only drugs could potentiallyprovide real benefits for patients byallowing the creation of more flexible,redesigned services which would bepatient-centred with new roles and newways of working within the profession. NHS England's Chief Professions Officers’

Project: Medicines Supply, Administrationand Prescribing Mechanisms, is a newprogramme which aims to make the casefor legislative change so that suitablyqualified and registered staff can get theright medicines to their patients when

they need them. Ultimately this willimprove services to patients, transformcare, and deliver value and sustainability.

Healthcare ScientistAssociates Announced Working in partnership with the NationalMeasurement System, NHS England’s ChiefScientific Officer’s Knowledge TransferPartnership programme presents a uniqueopportunity for clinical leaders tocollaborate with senior Scientists.Following a call for applications, NHS

England’s Chief Scientific Officer wouldlike to congratulate the first fourHealthcare Scientist Associates who havebeen appointed. They are:

� Dr Rachel Carling, Consultant ClinicalScientist, Director of Service and Clinical Lead, Viapath, Guys and St Thomas’ NHS Foundation Trust.

� Dr Colin Baker, Head of RadiotherapyPhysics, Royal Berkshire Hospital NHSFoundation Trust.

� Dr Bal Sanghera, Clinical Scientist, Paul Strickland Scanner Centre, Mount Vernon Hospital.

� Dr Jason Cashmore, ConsultantPhysicist, Deputy Head of Physics,University Hospital Birmingham.

OpportunitiesInnovative Healthcare Scientists are invitedto join the Clinical Entrepreneurialprogramme. Applications opened on 10thJuly 2017.The Clinical Entrepreneurial programme,

hosted by NHS England and HealthEducation England, is aimed at healthprofessionals who are developing clinicalinnovations or enterprises. Healthcarescientists who are passionate about

12 | General News


Snippets from the Chief ScientificOfficer’s Bulletin, June 2017

continuing in clinical practice whilstpursuing their entrepreneurial aspirationsare invited to apply for a place on theprogramme. Applications are open until9th August 2017. The NHS Innovation Accelerator (NIA)

2017 is now open for applications.Launched in January 2015, the NIA is an

NHS England initiative, delivered inpartnership with academic health sciencenetworks, and hosted by UCL Partners. TheNIA aims to create the conditions neededto make evidenced healthcare innovationsmore widely available to patients. The NIA2017 is looking for local, national andinternational innovations that address NHS priorities including mental health,urgent and emergency care and primarycare. The deadline for applications is 26thJuly 2017.

Updates from the CSO TeamConsultant Clinical Scientists make a veryimportant contribution to high quality,safe and effective patient care throughadvances in technology, innovation andimproved interaction and communicationwith clinical teams and patients. The NHSHigher Specialist Scientist Trainingprogramme aims to train and develop anincreased number of very seniorConsultant Clinical Scientists who can leadthe development of new research, technology and practice working withinmulti-professional clinical teams to deliverquality improvement, innovation andworld-class outcomes for patients. If youare an employer, you can access guidancefor employers planning for and recruitingConsultant Clinical Scientists.

Accreditation MasterclassPresentation Slides nowavailableIn April 2017, NHS England, in partnershipwith the Royal College of PhysiciansImaging Services Accreditation Schemeand the United Kingdom AccreditationService, hosted an AccreditationMasterclass. The masterclass was aimed athealth professionals involved incommissioning or implementing anaccreditation or quality improvementprogramme or with an interest in thissubject. The presentation slides from themasterclass are now available on NHSNetworks’ website. Please [email protected] if you have anyqueries.

New Healthcare Sciencepages of the NHSEngland website nowavailableThe Office of the Chief Scientific Officerhas published new Healthcare Sciencepages on the NHS England website. Accessthe pages to learn about healthcarescience and how the CSO’s Office drivesthe contribution of science to healththrough its programmes, to ensure theNHS can deliver on its commitment towork at the limits of science. As well askeeping you up-to-date with the latesthealthcare science news, there are links topublications and events from the Office ofthe Chief Scientific Officer, and theopportunity to subscribe to the CSObulletin. These pages will also host theupcoming series of CSO blogs from acrosshealthcare science. Please share the pageswith your networks. �

General News | 13


14 | General News


Health Education England (HEE) is workingwith the College, the Institute ofBiomedical Science and the Association for Clinical Biochemistry and LaboratoryMedicine to address issues relating to thedevelopment of the pathology workforce.As part of this work, they are looking for

local examples of workforce innovationand best practice. The initial focus of thiswork is on the chemical pathology andhistopathology workforces, consideringthe role of the Healthcare Scientist as wellas the medical workforce.Please share examples of innovative

ways of working. Suggestions include, but are not restricted to, examples of:

� Skill mix and role expansion.� Innovative local solutions to address workforce gaps.

� How training capacity has beenincreased to deliver training within service.

� Workforce adaptation anddevelopment to address IT andtechnological changes.

In your response please provide a summaryof your local arrangements and outlinewhat you perceive to have worked welland what hasn’t worked well. To respond to this request please

print out and complete the form printed opposite and email it [email protected] by 31st August 2017 (extended from July). �

Request for Examplesof Innovation andBest Practice Acrossthe ChemicalPathology andHistopathologyWorkforce

We are asking all ACB Members toparticipate in the next workforce surveywhich will be sent out soon.Workforce information is essential for

workforce planning at local and nationallevel, and it is vital in the currentchanging climate within the NHS,Universities and industries. It will enablethe ACB, in collaboration with theRCPath, to effectively support itsmembers across a range of areas andultimately lead to improved patient care. The information gathered will be

anonymous and strictly confidential. It will be used for statistical purposes,workforce planning, education, trainingand ACB Office based projects.Your input will be appreciated very

much.

Charles van HeyningenACB Workforce LeadEmail: [email protected] �

Workforce Plans

General News | 15


Name of organisation/service

Example of workforce innovation/best practice

What worked well?

What didn’t work well? Please include a summary of any particular issues or challenges

16 | General News


The deed governing the Benevolent Fundwas revised in 2013 to cover persons who are or have been Members oremployees of the Association and thedependents of deceased or disabled pastor present Members or employees of the Association. The Fund has had a few applications for

support in the last 10 years. While this may be a reflection that hardship is,fortunately, uncommon, it is possible thatpeople who might be eligible for support,for example, the surviving partner of adeceased member or employee, individualsthat may be having problems withdisability, long-term illness, health or other circumstances making their lifeintolerable may not be aware of theFund’s existence. We would therefore askmembers to make potential beneficiariesaware of the Fund’s existence.

Applications for support should be sentto the ACB Office.You may also like to make a donation to

the Benevolent Fund, which again can besent to the ACB Office. If you would like to increase the value of your donation,for UK tax payers, at no extra cost toyourself you can do this through CAF(Charities Aid Foundation) athttps://www.cafonline.org/my-personal-giving/start-giving/find-a-charity You will then need to enter in the

Charity Number 254213 in Charity Name,tick the search charity number box andthen select search. You will then be able toselect donate, in this way the fund willreceive the tax you have already paid onyour donation from the Inland Revenue. We thank you for your kindness in

considering this request. �

The Association for Clinical Biochemistry& Laboratory Medicine Benevolent Fund

The CP Stewart Memorial Fund wasestablished specifically to providefinancial help to Members wishing totravel to other laboratories in order tolearn a new technique and introduce it intheir own departments. It cannot provide funds to support

research performed in a member’s homelaboratory, for which scientificscholarships are available. Again, applications for disbursements

from the Fund should be addressed to the ACB Office in the first instance. �

C P StewartMemorial Fund

CondolencesIt is with regret that we must inform youof the sad news of the passing of severalACB Members.Emeritus Member Peter Scott passed

away on 2nd June aged 90. During histime with the ACB Peter served asChairman (1985-1987), Chair of the FCS(1980-1982), National Member of Council(1983-1984), Council representative forMidlands (1971-1973) and Chair of theMidlands region (1966).Emeritus Member Professor Barbara

Billing died on 20th May 2017. ProfessorBilling joined the Association in 1957. Retired Member Raymond Smith, who

joined the ACB in 1960, has passed away. Retired (Overseas) Member, Dr David

Gordon Campbell, has also passed away.He joined the Association in 1964. �

Microbiology News | 17


The Diggle Microbiology ChallengeThese multiple-choice questions, set by Dr Mathew Diggle, are designed withTrainees in mind and will help with preparation for the Microbiology Part 1FRCPath exam.

Question 2 from JuneA 22-year old female medical student recently returned from Tanzania presents with ahistory of haematuria. On investigation schistosomal serology is shown to be positive.

Select the treatment of choice:

A) Albendazole B) Ivermectin C) Mebendazole D) Praziquantel E) Suramin

AnswerD) Praziquantel is an anti-trematode agent, causing severe paralysis of the fluke’smuscles

Albendazole is an anti-helminthic agent, effective against cestodes, and somenematodes (Ascaris, Enterobius). Ivermectin is effective against Strongyloides.Mebendazole is effective against nematodes (Enterobius, Trichuris and Trichinella).Suramin is prescribed in the treatment of sleeping sickness (Trypanosoma bruceirhodesiense, Trypanosoma brucei gambiense).

Question 3Many antiviral drugs act by inhibition of a viral DNA polymerase enzyme. Select thevirus for which this class of drugs would be effective:

A) Cytomegalovirus B) Influenza C) Measles D) Mumps E) Rabies

The answer to Question 3 will appear in the next issue of ACB News – enjoy! �

18 | Practice FRCPath Style Calculations


You need to make up a phosphate buffer with a pH of 7.4 and a total phosphateconcentration of 40 mmol/L. Calculate the amounts of sodium dihydrogen phosphate anddisodium monohydrogen phosphate that need to be weighed into 1 litre of water, giventhat the pKa is 6.82 (atomic weights: Na 23, P 31).

FRCPath, Autumn 2015

The Henderson-Hasselbalch equation relates the concentrations of acid and salt to pH:

pH = pKa + log10 [salt][acid]

The dihydrogen phosphate ion dissociates to give monohydrogen phosphate andhydrogen ions:

H2PO4– HPO42

– + H+

Therefore the relevant form of the Henderson-Hasselbalch equation is:

pH = pKa + log10 [HPO42–]

[H2PO4–]

Only the total phosphate concentration is given so express the concentration of one interms of the other:

Total phosphate = [HPO42–] + [H2PO4

–] = 40 mmol/L

Therefore [HPO42–] = 40 - [H2PO4

–]

Substitute this, pH = 7.4 and pKa = 6.82 into the Henderson-Hasselbalch equation andsolve for [H2PO4

–]:

7.4 = 6.82 + log10 (40 - [H2PO4–])

[H2PO4-]

log10 (40 - [H2PO4–]) = 7.4 - 6.82 = 0.58

[H2PO4–]

(40 - [H2PO4–]) = antilog10 0.58 = 3.80 (to 3 sig figs)

[H2PO4–]

40 - [H2PO4–] = 3.80 [H2PO4

–]

40 = 3.80[H2PO4–] + [H2PO4

–] = 4.80[H2PO4–]

[H2PO4–] = 40 = 8.33 mmol/L

4.80

Deacon’s Challenge No 191 - Answer

Practice FRCPath Style Calculations | 19


Question 192A metabolic disease is known to result in decreased plasma activity of enzyme X. X was measured in 100 normal subjects and 100 individuals with the disease. A reasonable Gaussian distribution was obtained for each population with thefollowing statistics:

Mean (m) Standard deviation (s)Normal subjects 1025 U/L 100 U/LDiseased group 530 U/L 200 U/L

Find the decision level at which sensitivity is equal to specificity. What is thesensitivity (and hence specificity) at this decision level?

Two-tailed values of the normal deviate (z-score) and probability (P) are:

P(%) 10 5 2 1 0.2 0.1z 1.65 1.96 2.33 2.58 3.09 3.29

The concentration of the other species [HPO42–] is calculated by difference:

[HPO42–] = 40 - 8.33 = 31.67 mmol/L

For each salt:

Concn (g/L) = Concn (mol/L) x MW = Concn (mmol/L) x MW1,000

MW NaH2PO4 = 23 + (2 x 1) + 31 + (4 x 16) = 120

MW Na2HPO4 = (2 x 23) + 1 + 31 + (4 x 16) = 142

Wt NaH2PO4 to make 1L = 8.33 x 120 = 1.00 g (to 3 sig figs)1,000

Wt Na2HPO4 to make 1L = 31.67 x 142 = 4.50 g (to 3 sig figs)1,000

20 | Current Topics


Colorectal cancer (CRC) is the third mostcommon cancer in the UK, and when theNational Institute for Health and CareExcellence (NICE) published their guidanceon Suspected Cancer: Recognition andReferral (NG12) in June 2015, oneparticular aspect of it came as a surprise tothe laboratory community. Faecal OccultBlood Testing (FOBT) was being advocatedonce again for patients over 50 withoutrectal bleeding who had weight loss orabdominal pain or those under 60 withchange in bowel habit or iron deficiencyanaemia or over 60 with anaemia. This wasto become an issue for many Biochemistrylaboratories, as despite its successful use inbowel cancer screening programmes, mostlabs had discontinued FOBT due to poorsensitivity and specificity in thesymptomatic population. These patientswere now being referred directly for acolonoscopy, putting pressures on thisservice and possibly subjecting many morepeople to a potentially risky invasiveprocedure. This led us as a profession toquestion whether we should bereintroducing a test with proven fallibilities,or should we be looking for an alternative?Like FOBT, Faecal Immunochemical Tests

(FIT) can detect blood in stools that is notvisible to the naked eye, but quantitativelyrather than qualitatively and withincreased sensitivity and specificity. FIT hasbeen approved for the Scottish BowelScreening Programme and has beenrecommended for adoption in the NHSBowel Cancer Screening Programme in

England. It uses a dedicated faecalsampling device which the patient uses tocollect a minute amount of sample whichis stored in a stabilising buffer. Thesesampling devices have been approved fortransport by UK postal services and theycan be analysed directly in the laboratoryusing either a dedicated analyser or onsome mainline chemistry analysersdepending on the method chosen.Could FIT therefore be used to

determine which patients are most likelyto benefit from further investigation?With this in mind the DiagnosticsAssessment Programme of NICE isdeveloping guidance on the use ofquantitative faecal immunochemical testsin the NHS. The independent NICEDiagnostics Advisory Committeeconsidered the evidence from publishedstudies (n=10) on the subject andeconomic modelling, and took intoconsideration the views of clinical andpatient experts. The final guidance waspublished on Wednesday 26th July 2017and recommends that FIT is used to triagereferrals for people reporting bowelsymptoms to their GP, who are consideredunlikely to have bowel cancer. It is thought that the use of the tests can aid adecision to refer on a suspected cancerpathway. Now we are left with the question of

how we go about introducing a new testas part of the diagnostic patient pathway.Successful trials using quantitative FIT havetaken place in Scotland within the NHS

FIT for the Future: Using Faecal Testing to TriageSymptomatic Patients at Risk ofColorectal CancerDr Ian Godber, NHS Lanarkshire

Current Topics | 21


Lanarkshire and NHS Tayside HealthBoards and both are now offering FIT aspart of the referral pathway from Primaryto Secondary Care. Practice does varythough with results either going back tothe General Practitioner or to thesecondary care gastroenterology or gastricsurgeons depending on the referralpathway being used. Successfulimplementation does however requirecollaboration between all groups of healthprofessionals involved in this diagnosticpathway with adequate educationalresources being provided. In NHSLanarkshire for example the laboratoriesworked with representatives from PrimaryCare, General Surgery, Public HealthMedicine and the Endoscopy service inorder to agree the pathway and thetesting protocol. Dedicated samplingdevices are required, hence logistics mustalso be considered. How do you supplythese devices along with patientinstructions to your GP surgeries? How doyou get the samples back from thepatients? These will all be important

questions which need to be consideredwhen a service is set up. Funding will alsobe an issue. However, should the test resultin a reduction in colonoscopies then thismay be easier to justify with a potentialtransfer of funding from endoscopyservices. Getting the evidence to supportthis may prove to be more problematicthough as patients are often still seen insecondary care but in an outpatient clinicwhere their symptoms can be assessed,rather than in the endoscopy unit.The introduction of FIT testing is one

example of how we, as laboratoryprofessionals can be leading on, andworking with clinical specialties toincorporate biochemistry testsappropriately and effectively intodiagnostic pathways. We need to ensurethat diagnostic tests of this nature areintroduced and used in an appropriatemanner with agreed outcomes based onthe results, and that there is an effectivemechanism in place to further investigateand treat patients highlighted byabnormal results. �

22 | Current Topics


On 8th March 2017, thisWorkshop was hosted by NHS England in partnershipwith the British Society for Gastroenterology and the Association of Coloproctology of GreatBritain and Northern Ireland

In England, endoscopy services arestruggling to cope with increasing demandand there is currently a low conversionrate to cancer in all symptomatic pathwaysi.e. we are conducting endoscopies on alarge numbers of patients who don’t havecancer. FIT may have a wider role as anobjective triage tool in all symptomaticpatients referred from primary care. The updated NICE guidance will be helpful to support clinicians to think aboutmaking FIT testing available and how bestto use it in the colorectal diagnosticpathway. On the 8th March NHS England

conducted a workshop with 50 cliniciansfrom 10 different geographical areas inEngland and representatives from acrossthe colorectal cancer pathways includingthose from: General practice,gastroenterology, colorectal surgery,clinical chemistry, the bowel cancerscreening programme, screening hubmanagers, NICE, NIHR, the companies whosupply the 4 analyser platforms. Thepurpose of the workshop was to hear from

those who had already collected dataabout FIT for symptomatic patients, discussthe gaps in our knowledge and how wecould fill them, and to find out what thevarious groups thought they could do tomove forwards with FIT.

� A summary was given of pre-analyticaland analytical variability of FIT testing.There is currently no standardisation orharmonisation across the differentanalytical platforms, there are potentialinherent problems with samplingtechnique (stool samples aren’thomogeneous) and there are noestablished EQA schemes or 3rd partyIQC materials available.

� Research underway in 4 units inEngland was presented. All studies haddifferent approaches and all diddemonstrate that FIT has potential as arule out test for colorectal cancer:

� Aintree (Paul Scaife, ColorectalSurgeon) talked about a prospectiveresearch study they conducted onFIT samples acquired via per rectum(PR) examination, and processed onan OC Sensor.

� Nottingham (Ayan Banerjea,Colorectal Surgeon) talked about aservice evaluation that they hadconducted in partnership with theirCCG. They have been measuringquantitative FIT testing on twodifferent analyser platforms.

� Coventry (Monika Widlak,Gastroenterology Registrar)reported on a study comparing

NHSE Scoping Workshop: FIT for Symptomatic Patients,the way forwardSophie Lumley, GP Trainee, Clinical Fellow, NHS England and Sally Benton, Guildford Screening Hub Director

Current Topics | 23


faecal calprotectin and FIT testresults on 2ww patients. Tests wereprocessed on an HMJack at Rugbyscreening hub.

� York (James Turvill,Gastroenterologist and DanielTurnock, Clinical Biochemist)reported on a prospective researchstudy that they are in the secondphase of. They have been doing 2FIT tests and a faecal calprotectin onall patients.

It is hoped that once complete allpieces of work will be published.

The main gaps in our knowledge,identified from talks and discussionsduring the workshop were:

1. The pre-analytical and analyticalvariability of FIT testing, the lack ofEQA scheme.

2. What the threshold for ‘FIT negative’patients should be in the symptomaticpopulation.

3. How we can manage the potential for confusion between FIT forsymptomatic patients and for thecolorectal cancer screening programme(non-symptomatic patients).

4. The role of FIT in symptomatic patients– what the impact on services would beif it was used a triage tool.

5. Whether FIT testing and decisionsaround the results should be made inprimary or secondary care.

6. The practicalities of operationalising FITin the colorectal diagnostic pathway.

Moving forward, a 3 phase approach wasproposed for collecting sufficient dataaround the robustness of FIT testing andthen how best to use it in the colorectaldiagnostic pathway.

� Phase 1 – Robust data collection on5000 patients – to confirm the ability ofFIT to safely exclude cancer, andhighlight which patients and cancersare at risk of false negative FIT results.Data of this nature are already beingcollected in various locations, but it will be important to link up thefindings to look at large numbers ofpatients and cancers.

� Phases 2 and 3 – Using FIT as a triagetool first in Secondary Care andeventually in Primary Care. Initiallypatients may be triaged to a specialistclinic to review their symptoms butultimately FIT testing could be used as atool by GPs to rule out cancer anddecide how best to manage a patient’ssymptoms.

NHS England is keen to encouragecollaboration between different localitiesto collect data as part of these phases.Coordination of activity in different areasis key to facilitate moving forwardpragmatically with FIT and the 16 Cancer Alliances across England are ideally positioned to support work locallyand help with this coordination of activity. �

24 | Current Topics


The flexible working survey showed thatover a third of the 191 respondents hadflexible working arrangements, either part-time or full-time equivalent(see the Documents section in theMember’ area of the ACB website).Individual responses suggested that

opinion is split between those who viewpart-time/flexible working as a burden onthe department versus those who saw it asan opportunity to bring more people tothe team, retain skills and knowledge, and employ more productive, motivatedstaff (Table 1).

Who Would Want to WorkPart-Time? Moving onfrom 9-5Dr Rachel Wheeler, St George’s University Hospitals NHS Trust

Table 1: Opinions from the flexible working survey on flexible working

Current Topics | 25


Generally people reported choosing towork part-time to achieve a better work-life balance, though it was widelybelieved that the only really acceptedreason for this involved children.Impending retirement may be anotherincreasingly common reason, or the‘retirement’ that leads to part-time work(so-called 'retire and return'). This articlelooks at working flexibly. There is notmuch advice around about working non-standard hours, but drawing onfeedback from the survey and members’personal opinions, this article attempts togive some pointers.

1. Be Aware

Prejudice exists and like it or not, if youare working flexibly you may face this. It helps if you are supported by strongleadership and an open, fair system. All ofus should try to support colleagues andgently challenge prejudice. Many of ushave already benefited from flexiblearrangements, and owe it to others tocreate the same opportunities despitecurrent pressures. Colleagues may make assumptions about

you because you work flexibly (especially if

you are returning to work after anabsence), about your abilities or what youmight want/be interested in. This is morelikely to be due to unconscious bias ratherthan malice. Work hard to commandrespect and be patient. It takes time to winpeople over.

2. Be Brave

If you want to change your working hours,let your manager know – they cannotbegin to consider your request until theyknow what you would ideally like. If youare worried, ask around, pay attention tothe diversity of working arrangementsalready in place in your department, andraise the subject informally to gauge initialreaction.Apply for full time posts! Most posts will

consider applications from people whowant to work part-time or flexibly. If thatends up being the only reason why you arerejected, you will still have gained valuableinterview experience.

3. Be Reasonable

Ultimately, your department has a serviceto deliver. Yes, everyone has the right torequest a change to working hours,

Some Guiding Principles – Geoff Lester1. Managers have to manage the service delivery to the necessary standards.

Remember they are spending public money.2. Employment law includes the right to request a change to working patterns and the

right to an explanation for refusal; the principle of equal pay for equal work;freedom from discrimination (at least on the protected characteristics); equitabletreatment of part-time workers.

3. The Agenda for Change national terms and conditions of an average 37.5 hourweek. AfC also defines what bands have access to enhanced pay for unsocial hoursand/or overtime (hours more than 37.5). These are contractual entitlements.

4. Remember, when managers consider a request they will have to look at the impacton the full relevant workforce. E.g. Does it mean that someone else ends up alwaysworking into the evening to complete work not done because you finish at 15:30?Does it mean that some do not get opportunity for enhanced pay because someoneelse always works Sunday?

5. There are some fixed commitments e.g. Same amount of mandatory training orCPD, regardless of hours worked.

26 | Current Topics


but that does not mean it will be granted. The more senior your post, the moreresponsibility you will have in servicedelivery so try to come up with a plausibleway in which the department might copewith you reducing your hours. Take full responsibility for your work –

don't assume colleagues will finish yourwork. Make it the exception rather thanthe norm, or make sure there is someplanned handover process. It can bedifficult if you have to leave at a certaintime and cannot work late, and this can

lead to resentment from staff if they oftenend up staying late to finish work. Be aware of others’ hours and be asflexible and constructive as you can.Flexible working often requires flexibility

on both sides. There may be particularhours or meetings that you must be therefor. Consider working different daysoccasionally (with appropriate notice) togain training opportunities, or even toprovide extra cover to the department forexceptional staff absences.

Flexible Working – Jessica SchroederI started to work part time (22.5 h then 30 h) in my 8B post following maternity leave.This has improved my work and family life balance, especially while my son is young,and also allowed the band 7 taken on for my maternity cover to extend her contract. I have relocated since then and when I applied for another Band 8b post, I was able

to negotiate part time hours (30 h per week). I have managed this by working flexibledays or shorter days, but I find it is easier for me and the department to have one fullday off rather than working shorter days. The funds for the hours I did not work werekept within the department and used for other positions. I did not feel that my rolewas undermined by working part-time, although sometimes it does feel like working afull-time job within less hours.It was interesting to note that in the recent survey over a quarter of respondents

work part-time, and most were arrangements made in post. I would hope this wouldhighlight that in our profession there is very much a need for part time roles, and itwould be good to see more posts advertised as part-time or job share.

How to Work Flexibly – Consultant Clinical ScientistAs we all strive to establish a true work-life balance, more and more staff aresubmitting flexible working requests, whether because of childcare or carerresponsibilities, or just a hatred of shift-working. The key to a requests’ success andmaintaining positive working relationships is to be empathetic with your department,and don’t be selfish. This will endear yourself to colleagues who will have to pick upthe slack that your absence creates. Consider your department’s pressures andprocesses, recognise when labs are at their busiest e.g. due to the GP work coming in.Don’t hold your lab to ransom; in every lab where I’ve worked, there has beensomeone on a 7.5 hr/week contract. Why? “Because they’d have left if I didn’t agree toit”. This type of arrangement is not helpful and I’m yet to find one where both sidesare happy with it.Most trusts will have a lengthy “Flexible Working Policy” but the reality is, if your

request is reasonable and is perceived to be based on necessity and not just a knee-jerkresponse to a negative experience, it is likely to be looked on favourably by mostreasonable managers.

Current Topics | 27


4. Think Ahead

If you reduce your hours, your departmentmay see this as an inconvenience, or as auseful cost-saving. Either way, there is noguarantee that you can then increase yourhours whenever you might want to in thefuture. Consider this when planning yourfinances. Consider also the impact on yourpension e.g. the 2015 NHS Pension Schemeis calculated from Career Average Re-valued earnings (based on a proportionof pensionable earning in each year ofmembership).

5. Be Patient

If you choose to reduce your hours, yourcareer may slow down. It can be hard towatch full time colleagues apparentlyprogress faster, but be patient. Make arealistic plan for your career. Keep tryingto fit in things that will advance yourcareer or improve your CV. Don't letyourself be side-lined because you arepart-time; find constructive, realistic waysto stay involved and if necessary, bide yourtime. Reducing your hours should not ruleout career progression in the longer term.

Flexible Working and Retirement – Charles van HeyningenIn the later stages of my career I developed a serious illness and had to take six monthsoff on sick leave. On returning to work my colleagues encouraged me to work flexiblyand part-time before resuming full-time work. Soon after this it became apparent that I could retire from the NHS and resume on a

fixed-term part-time basis. This was financially attractive and ensured an optimumlong-term pension. This was in keeping with my wish to step down towards retirementrather than opt for a sudden cessation from full-time working. The Hospital Medical Director was very supportive and made arrangements with the

medical staffing team for the change of contract required. At the end of the two-yearpart-time contract I chose to fully retire. A Consultant Clinical Scientist colleague had made a similar part-time working

arrangement and in practice the outcome was equivalent to having a job sharecontract.

Making it Work – Sarah BeckMy experience of flexible working at two Trusts has been a positive one. When I firstreduced my hours to 0.8 WTE (from full-time) this was met with no issue frommanagers or colleagues. More recently I moved to a different Trust taking up aConsultant Scientist position. I continue to work 0.8 WTE despite the fact that the jobwas advertised as a full-time post. Due to my inability to relocate, my hours have beenadjusted (late start, late finish) to cope with the long commute, and I have the abilityto work from home.I am lucky to work in a department whose leadership and management is inclusive

and forward-thinking in the interest of retaining high quality HCS staff. Fifty percentof the band 7 and above HCS staff within our team have some form of flexible workingarrangement. Whilst this can be challenging, it needn’t be detrimental to the servicewith good communication, a team ethos and a reasonable degree of flexibility on allsides. On the contrary, I think staff that have a work-life balance that suits them, willperform better in work with increased efficiency and enthusiasm.

28 | Current Topics


Anyone in their 40s or younger will nownot be eligible for state pension until 68,so that’s an extra year in which to achieveyour goals!

6. Be Realistic

Even in the most supportive department,the reality is that there will be regulartimes when you are not present in thedepartment. This means that tasks that arecontinuously required will have to beshared with someone else, or may not begiven to part-time staff. Also,communication will be more of achallenge. We pick up a surprising amountjust from daily chatter. Be pro-active instaying up to date with information, andin constructively suggesting helpfulcommunication channels. Every department is different and you

bring a unique set of skills to yourdepartment. Managers must abide byemployment laws, but ultimately eachsituation will be resolved locally. Someuseful and interesting resources are givenbelow. It may be that there is something

you think the ACB could provide orfacilitate e.g. Carer travel grants (see thisexample www.smbe.org/smbe/AWARDS/ChildCareTravelAward.aspx), a mechanismto search for potential job share partnersor potential part-time candidates tocomplement a flexible working proposal. If you have ideas of initiatives or resourcesyou would like to see from the ACB tosupport flexible working, please contactthe ACB Workforce Lead, Charles vanHeyningen, or the Equality, Diversity andInclusion Champion, Rachel Wilmot. In the next two ACB News, we will look atflexible working from the manager’sperspective, and the impact of part-timework around retirement. �

References� Iwasaki, A. Balancing family life with ascience career. Nature Immunology,2015; 16 (8): 787-790

� Pensions website:https://www.nhsbsa.nhs.uk/nhs-pensions

After attending the STP electivepresentation day in my first year, shortlyafter starting the programme, I wasinspired by the amazing opportunity andendless possibilities the elective presented.Before leaving the event, I had made thedecision that I wanted to use my electiveto experience healthcare in a completelynew social-economic setting, and pushmyself out of my comfort zone. I thereforedecided to spend 4 weeks at the ChemicalPathology Department of TygerbergHospital, Cape Town, South Africa (SA). In January of my second year I contactedthe Head of Department (HOD), and byApril my placement was arranged and

booked for the following September.Tygerberg Hospital is the largest publictertiary hospital in Western Cape Townthat works as a teaching hospital inconjunction with the StellenboschUniversity Faculty of Medicine. The publichospital laboratories in SA are run by theNational Health Laboratory Service (NHLS),with over 6,700 employees, all of whomare joint service and academic employeesat one of 9 university partners.Throughout my elective I was therefore anaffiliated student at the StellenboschUniversity Faculty of Medicine andhonorary employee at Tygerberg Hospital.Throughout the 4 weeks I shadowed

Trainee Elective in South Africa: Sunsets,Safaris and ScienceKate Fenna, Royal Surrey County Hospital, Guildford

30 | Trainee News


Meet the team: from left to right: Prof A Zemlin (Deputy HOD), Dr R Kariem, Dr J Thumeka, Kate Fenna,Prof RT Erasmus (HOD), Dr M Rensburg, Dr E Kruger, Dr N Nadoo, M Hoffmann

registrars, consultants and laboratory staff.The team were so welcoming and kindlyarranged a full time table for my timethere. I attended daily ward rounds andclinics in different disciplines, spent time atthe home of the first ever heart transplant,Groote Schuur Hospital, and visited theRed Cross Children’s Hospital. As a way ofgiving back to the department I presentedat two journal clubs, and completed aproject on AKI prevalence rates which iscurrently under review for publication. As a result of my project the HOD hasoffered to sponsor me to attend andpresent my project at a conference in SAlater this year. I had the most incredibly

eye-opening experience, saw sights I willnever forget and made friends for life. The elective is an amazing opportunity foryou to grow professionally and personally,to experience once in a life timechallenges, and make professional andpersonal connections. As a result of myelective I have a network of internationalcolleagues, have become an affiliatedmember of the South African ChemicalPathology Society and will be sponsored toreturn to SA. All because I made thedecision to go for it! I even managed totick off a few bucket list items whilst I wasthere; like a real African Safari andclimbing Table Mountain. �

Trainee News | 31


32 | Trainee News


What would you do with six weeks inwhich you could decide the location andcontent of your training? This is thequestion faced by Scientific TrainingProgramme (STP) trainees as they headinto their second year of training. Theelective experience is a mandatory part ofthe STP which is aimed at facilitating awider experience of healthcare in a settingthat is different from the trainee’s usualenvironment. Many choose to headabroad to experience healthcare in adifferent culture, but there are a hugerange of opportunities available to theresourceful and imaginative trainee athome in the United Kingdom (UK).

I decided to use my elective to broadenmy experience and understanding of massspectrometry. Fortunately, the Sheffield-based laboratory where I wastraining had close links with theDepartment of Toxicology at King’sCollege Hospital in London, with bothdepartments being headed by ProfessorRobert Flanagan. Professor Flanagan putme in contact with his senior methoddevelopment scientist, Lewis Couchman,who arranged a six-week programme inwhich I worked alongside some of thescientists responsible for developing andrunning the mass spectrometry assays atKing’s. Lewis allowed me to gain hands-on

Trainee Elective in London: King’s CollegeHospital ToxicologyEdmund Rab, Northern General Hospital, Sheffield

Tecan freedom evo robotic sample handling platform used for the pre-analytical preparation of samplesfor clozapine and norclozapine analysis

Trainee News | 33


experience in some of the assays that hewas developing. This included a flowinjection tandem mass spectrometrymethod for the analysis of clozapine andnorclozapine which utilised a roboticplatform for pre-analytical samplepreparation, and the analysis ofhaemoglobin variants using highresolution mass spectrometry. I was alsoable to gain insight into the use of Q-Exactive™ accurate mass technology forthe screening and confirmation of drugs ofabuse in urine. Away from the toxicologylaboratory, I spent a week workingalongside David Taylor and Norman Taylorin the steroids laboratory and even hadtime to attend a porphyria clinic,something which I would not have had theopportunity to do in Sheffield. When I wasnot working, accommodation andnutrition was kindly provided by myparents in law and I was able to use thetime in London to catch up with friendsand family.

My elective experience was thoroughlyenjoyable and allowed me to expand myknowledge in a way that I would not havebeen able to achieve at my home hospital.Prior to arranging my visit to King’s, I didthink about going abroad for my electivebut it is my opinion that I gained morebeneficial experience and contacts bystaying in the UK. The experience gainedat King’s was a major contributing factorto my suitability for the job that I acquiredfollowing my STP training and I now workat Sheffield Teaching Hospitals developingmass spectrometry assays on our owninstruments. My words of advice for anytrainee thinking about what to do for anelective would be to think about the skillsthat you could gain which you could bringback to your home hospital. You may findthat the skills and experience acquiredbecome instrumental in attaining your first post as a Clinical Scientist and theymay be something that you draw uponthroughout your career. �

Q-Exactive™ high-resolution mass spectrometer used to screen for and to confirm the presence of drugsof abuse in urine

ACB Scotland gathered fortheir ‘Spring’ meeting atWishaw General Hospital, NHS Lanarkshire.The theme of the meetingwas ‘The Liver’ and somehot topics were eagerly anticipated

Liver Fibrosis Biomarkers

The first speaker, Professor Peter Hayes,showed that a meeting in Scotland is theapt place to discuss liver disease as hehighlighted that Scottish mortality ratesare still on the rise despite a decrease inour UK and European neighbours. He gave a detailed description of theadvantages and disadvantages of currentliver fibrosis markers such as hyaluronicacid which his clinic has access to inEdinburgh. He then explained that liverbiopsy is not the gold standard anymoreand that non-invasive elastography using a Fibroscan, which is a measurementof liver stiffness, is the preferred option. In addition, the Fibrotest and EnhancedLiver Fibrosis (ELF) scores were alsodiscussed as tools of fibrosis assessment.His memorable comment that 5 cups ofcoffee a day gives an 80% reduction in riskof liver cirrhosis certainly made an impacton the audience.

Non-alcoholic Fatty Liver Disease

Next to present was Dr Jennifer Logue,who gave us a clinician’s perspective ofassessing patients with non-alcoholic fatty

liver disease (NAFLD). She talked usthrough her approach at the lipid clinicand how she uses the AST:ALT ratio (with aratio >0.8) to decide which patients needreferral to gastroenterology. She justifiedthe use of statins on her patients by citingthe GREACE trial published in The Lancet,2010 which demonstrated that statinswere associated with an improvement inLFTs. Lastly, she gave an interestingaccount of how they refer patients toWeight Watchers in a bid to reduce theirNAS score. Just a 7% body weightreduction is required to improve your NASscore by 3 points bearing in mind that ascore of >5 is consistent with NASH. A study by Sattar et al, BMJ (2014) whichused Weight Watchers on their patientsled to a reduction in ALT and improvedtriglycerides were noted too.

Alcoholic LIver Disease

Dr Alistair Gilchrist opened his talk onalcoholic liver disease (ALD) with some thought-provoking statistics on deathrates due to alcohol. He reported that 1 in20 of all deaths in Scotland is due toalcohol and this is twice the level seen inEngland. In fact, a female in Scotland willdie from liver disease more than a male ofthe same age in England because ofalcohol. He showed that alcohol is now70% more affordable than compared withprices back in 1980. Medically speaking, he explained the use of the GlasgowAlchoholic Hepatitis Score (GAHS) whichuses age, wcc, urea, platelet ratio andbilirubin to assess prognosis with a score of >9 being poor. Plus the use ofdecompensated cirrhosis care bundles inthe first 24 h of admission are saving lives.

Have a Cup of Coffee With Your 5-a-DayJennifer Lochrie, Hairmyres Hospital

34 | Meeting Reports


He concluded by saying that public healthmeasures are cheap and the most effectiveat tackling ALD in Scotland.

Intelligent Liver Function Testing Project

Dr Michael Miller of Ninewells Hospital,Dundee presented preliminary data fromhis pilot evaluation of a synergistic liverdiagnostic pathway. The key reasons fordoing this are that liver disease continuesto rise as a cause of death rates in the UKand that studies have shown that LFTs arenot always reliable predictors of liverdisease. The aim of the study was tocompare current pathways for LFTrequesting with the new semi-automatedsystem. The iLFT pathway was used in 6 GPpractices in Tayside during a 6 monthperiod and they were asked if they wantedto screen for liver disease if the resultswere abnormal. The GPs first had to enterin patients alcohol consumption, their BMIand if metabolic syndrome was present ornot. Also in Dundee hospital laboratories,they use a real-time track system whichcan change where the sample goes fortesting depending on the patient’s resultsand so further testing can be done on thesample and it will give a preliminarydiagnosis and suggest referral tosecondary care. The preliminary outcomesfrom a data-set of 229 subjects showedthat 65 patients were diagnosed with liverdisease. The early data has shown that iLFTcan improve the interpretation of primarycare LFTs.

Viral Hepatitis

Dr John Logan, Consultant of Public HealthMedicine in NHS Lanarkshire, talked usthrough a public health exercise thatresulted when a health professional was

diagnosed with hepatitis C. He highlightedthe extensive contact tracing required,organisation of laboratory services to testcontacts and he discussed some of theissues surrounding routine testing ofmedical professionals for blood borneviruses. He gave an interesting insight intohow to deal with the media when suchnews is released to the general public.

Retiring Consultants

At the end of the meeting, the ACBScotland Chair honoured the careers ofthree newly retired Consultants: Dr IanGunn, Dr Philip Wenham, and Dr SimonWalker. It was an amazing fact to knowthat they had clocked-up more than 100years of clinical biochemistry betweenthem. They were wished all the best fortheir plans for retirement.Thanks to ACB Scotland for organising

this informative meeting. �

Meeting Reports | 35


Recently retired Consultants: Dr Simon Walker, Dr Philip Wenham and Dr Ian Gunn werepresented with a retirement gift from Dr Michael Murphy, ACB Scotland Chair (secondfrom right)

With the stratified/personalised medicineagenda, the 100,000 genome project,diagnostics in the battle with AMR and thenew IVD regulations, the evidence-baseduse of In Vitro Diagnostic (IVD) medicaltests is increasingly being recognised as avitally important way the NHS can improvethe healthcare it provides.In recognition of the importance of IVDs

to healthcare, the National Institute forHealth Research Clinical Research Network(NIHR CRN) West Midlands sponsored aScientific Meeting on 19th June atBirmingham Research Park, Edgbastonwhere over 70 delegates representingindustry, laboratories and academiagathered on a very warm Mondaymorning. The meeting was to explore theneeds of the NHS, industry and academiaworking together in the development,validation and evaluation of tests and newways of working. Organised by the WestMidlands Laboratory Medicine ResearchGroup in conjunction with the WestMidlands ACB, it featured short talks froma range of stakeholders and organisationsinvolved in the IVD development pathway,showcasing the potential of laboratorycontributions to raise the profile of theresearch, clinical and diagnostic expertiseof laboratory professionals.The speakers reinforced the central role

IVDs play in clinical pathways and the needfor a common understanding andlanguage to describe the pathways for

their development. There werepresentations from academic, industry andclinical perspectives with speakers fromthe University of Birmingham, theEuropean Federation of Clinical Chemistryand Laboratory Medicine (EFLM), BIVDA,the NIHR Diagnostic Evidence Cooperatives(DECs), the Academic Health ScienceNetwork (AHSN), the CRN, the MHRADevices Division, NICE and the 100,000Genome Project. They outlined, usingexamples, the roles their organisationsplay along the pathway and the servicesand expert advice they provide to supportresearchers (including laboratoryprofessionals), academics and industry inensuring the work is relevant to and canbenefit the NHS and to improve the rateof successful study delivery in the NHS.Themes that ran through the talks

included an emphasis on placing clinicalneed at the centre of development work,the need to evaluate tests in appropriatepatient groups, the importance of accuratedata collection for test performanceinforming the design of appropriateclinical evaluation studies, and the needfor research comparing tests and practicesin current use with access to real life data.The new IVD regulations were spokenabout in depth with the potential formore test evaluation studies. The ‘valueproposition’ was introduced as paramountin demonstrating what an IVD test coulddo and where the greatest benefit may be,

The Role of the LaboratoryProfessional in theDevelopment, Validationand Evaluation of New TestsDr Owen Driskell, National Institute for Health Research (NIHR), and Dr Phillip Monaghan, The Christie NHS Foundation Trust, Manchester



including the role and purpose of any newtest in the clinical pathway. Does it fit withthe health system priorities? Is the costjustifiable (in terms of its impact on healthresources)? What are the patient outcomes(are there incremental patient benefits)?Working towards a well constructed andreliable evidence base, with the publishingof protocols and full results, in order tofacilitate implementation.All of the speakers stressed the need to

think of the whole IVD developmentpathway early, and not just the differentstages, as evaluating the clinical need orthe type of evidence required early,dictates how you progress along anypathway and what support you mightneed. There is a lot of help out there.In terms of the roles for NHS laboratories

there are multiple opportunities at everystage along the pathway. Specificexamples mentioned include the use of‘real’ patient samples, followingappropriate guidelines for R&D activities,and the need for beta testing sites (whereproducts in the final stages ofdevelopment are trialled by partiesunconnected with the developmentprocess) in real life situations.Furthermore, the laboratory professional’sknowledge of current diagnostic practicewithin the NHS informs the valuepropositions and the design and delivery

of clinical trials and service evaluations.Our laboratories serve the patientpopulations that would benefit from theresearch and this is where the researchneeds to be done according to Prof ChrisWhitty, Chief Scientific Advisor to theDepartment of Health.Discussion at the end centred around

where the different organisations fittedalong the IVD development pathway(included in Figure 1 below) with theAccelerated Access Review cited as a good place to start understanding theoverview. The different organisationsoverlapped in areas along the pathwaybut had different perspectives andfunctions with some being laboratoryscientist led (the EFLM), others being NHS(eg. the DECs, CRN and AHSN) and industryled (BIVDA), and others being non-governmental bodies or regulators(MHRA). It was agreed that there are manyneeds and opportunities for NHSlaboratory professionals to contributetheir skills and expertise at multiple stagesalong this development pathway withpossibilities to collaborate and lead onfuture developments. Overall, the day provided a thoroughly

enjoyable and productive meetingprompting requests for it to be repeated. For further information please contact

Owen on [email protected] �



Figure 1: The Invention,Evaluation,Adoption and DiffusionPathway



It was on a sunny Friday 30th June 2017when ACB delegates from across the UKarrived at the august surroundings of theGovernor’s Hall at St Thomas’ Hospital inCentral London. After a cordialintroduction from Dr Chris Chaloner weheard from Dr Nick Furnham (LondonSchool of Hygiene and Tropical Medicine)with a wide-ranging talk about therelationship between single nucleotidepolymorphisms and drug resistance; hedemonstrated how phylogenetic variationin bacterial DNA can inform us aboutcurrent and impending drug resistance,and how this may aid future drug design. The next talk by Dr Juan Antonio

Vizcaino (European BioinformaticsInstitute) was an informative and future-scoping presentation on the links betweengenomics, transcriptomics, proteomics andmetabolomics, and how mechanisticunderstanding of these links may uncovernovel biomarkers in the future. The next presentation was by Dr Spiros

Denaxas (The Farr Institute) who gave us areal sense of the complex algorithms,including machine learning, used in theanalysis of big data. Examples included theuse of the UK CPRD to generate riskprediction tools in disorders such as type 2diabetes and COPD.After lunch, Professor Dimitris

Grammatopoulos (Chair, TranslationalMedicine, Warwick) took us on a journeythrough the labyrinth of bioinformatics.We were struck by the amount of datawhich is available for analysis from thegenome to biomarkers to socioeconomicand educational data.

Tom MacDonald, Professor of ClinicalPharmacology and Pharmaco-epidemiology in the Medicines MonitoringUnit, Medical School at Dundee gave avery entertaining and relevant narrative ofhis group’s work over recent years inrelation to drug prescribing patterns andhow these relate to critical outcomes forpatients. For example, he described howexposure to sodium-containingformulations of medicines was associatedwith significantly increased odds ofadverse cardiovascular events comparedwith standard formulations of those samedrugs. He also highlighted the incalculablevalue and under-utilised potential of NHSrecords in understanding the antecedentsand course of disorders from the rarest tothe most common across all of the UK. Next, Craig Webster (Birmingham) gave

us a very helpful update on the interfacebetween the laboratory and GP practicesin relation to how clinical diagnosis anddecision-making can be aided by thelaboratory at many levels.Finally, Professor Jonathan Kay (Oxford)

gave a seminal review of how the highlevel design of laboratory systems, in termsof data management and analysis, canenhance the value of results by givingthem greater context and interpretation,citing renal function as one example.All the speakers gave time for questions

both at the end of their presentations andat the breaks. At the end of the day, we alltook away our own learning points whichwill aid us in the coming weeks andmonths in our work and in our aspirationsever to do better for our patients. �

Bioinformatics inLaboratory MedicineDr Adrian Heald, Salford Royal Hospital, Salford and Dr Chris Duff, Royal Stoke University Hospital, Stoke

Our fourth meeting was held in the ACB Conference Suite on 24th April 2017.After networking over a sandwich lunch,retired members were treated topresentations by Dr Sandra Rainbow on“Vitamin D; new wonder hormone?” and“Biological variation in kidney disease“ by Dr Ed Lamb.Dr Rainbow began her talk with a

description of a primitive plankton thathas existed for over 500 million years andwhich makes what is probably the originalsunscreen!

She then described the advances leadingto the discovery and role of Vitamin D incalcium homeostasis. She highlighted thefact that foodstuffs in the US have beenfortified with Vitamin D since the 1930s;this does not occur in UK with theexception of hard margarine.Sandra reported that there has been a

dramatic increase in the number ofpublications on Vitamin D over the last 10years. There has also been substantialmedia interest in the benefits of Vitamin Dwith articles on its role in boosting

ACB Retired Members’GroupRuth Lapworth

Dr Sandra Rainbow and Dr Ed Lamb





immunity, disease prevention and theneed for supplementation. Vitamin D deficiency is widespread in the

UK population, especially in winter. Sandraexplained this is probably due to publicawareness of preventative measuresagainst skin cancer, lifestyle changes dueto a reduction in outdoor activities as wellas changes in the population mix. Therehas also been a resurgence in the numberof cases of rickets. Despite this, the UKgovernment has not taken steps to fortifyfood and there is no national guidance onsupplementation for the general (well)population. However, most of the retired members in

the audience admitted taking supplements(up to10,000 IU once a week) during thewinter months. Ed introduced the subject of biological

variation by stating that kidney disease isasymptomatic until the late stages and istherefore heavily reliant on biochemicaldata. Knowledge of biological variationallows an objective assessment of thevalue of various kidney function tests inthe diagnosis, monitoring andmanagement of patients with kidneydisease. He described the sources of variation

including pre analytical, analytical, withinand between subject variation and howthese could be combined to derive theoverall biological variation and the criticaldifference for an analyte.Creatinine is widely used as a test of

kidney function but is poor at detectingkidney disease in the population. Ed statedthat two sequential creatinine results needto differ by more than 12% to besignificant. In contrast, cystatin C is goodfor the detection of kidney disease in thepopulation but it has been reported thatthe within-subject variability is too large tomake it useful for monitoring anindividual’s disease progression. The clinical utility of creatinine has been

improved by stratifying results withrespect to age, gender and muscle mass:essentially the eGFR. Comparison of thevariability of the eGFR compared to thereference GFR and its use in outcomestudies resulted in defined changes ineGFR being used in NICE Guidelines.Ed then showed data to support the use

of ACR to detect albuminuria: it has lowervariability than alternative indices. He thencast doubt on the use of PTH to monitorCKD patients for metabolic bone diseasedue to its large biological variation. Hisview is that bone alkaline phosphatase is abetter index of bone disease.Finally, he provided 2 examples where

knowledge of the biological variation of atest limits its usefulness. These were TSAT(transferrin saturation index) in renalanaemia and troponin as a marker of ACS(acute coronary syndrome) in dialysispatients. �

� The next meeting will be held onMonday 6th November 2017.

ACB South-West and Wessex RegionalScientific Meeting

Trace Elements Jointly organised with the Supra-Regional AssayService for Trace Elements

6th October, 2017The Oake Manor Golf Club, Oake, Taunton, Somerset, TA4 1BA

09:45-10:30 Registration & Tea/Coffee10:30-11:00 Principles of Trace Element Analysis using ICP-MS

Chris Harrington, Guildford11:00-11:30 The Acute Phase Response and Its Effect on Trace Element Status

Nicholas Martin, Imperial11:30-12:00 The Assessment of Iodine Status

Patrick Wainwright, Southampton12:00-13:00 Lunch, networking & meeting our Sponsors 13:00-13:30 Dangers of Ayurvedic Medicine

Kishor Raja, King’s13:30-14:00 Trace Element Supplementation and Toxicity – Separating Sound Advice

from Bad Science Elizabeth Fox, Leeds

14:00-14:30 Parenteral Nutrition Associated Hypermanganesaemia Maeve Tierney, Southampton

14:30-15:00 Tea/Coffee break and networking 15:00-15:30 Management of Parenteral Nutrition Associated Hypermanganesaemia

Peter Austin, Southampton and Oxford15:30-16:00 Low serum Copper: A Diagnostic Approach

Paul Cook, Southampton 16:00 Close

Information on this meeting and registrationis accessible via the ACB Regional Meetings website:

www.acb.org.uk


Future Meetings | 41

42 | Future Meetings


ACB ScotlandNational Autumn Meeting 9th-10th November 2017Norton House Hotel, Ingliston, Edinburgh

Thursday 9th November09.00-09.30 Registration and Welcome 09.30-10.45 Junior Members’ Papers Speakers TBC10.45-11.00 Tea and Trade Stands11.00-12.30 Reproductive Endocrinology:

Update on the Uses of AMHProf Richard Anderson (Queen’s Medical Research Institute, Edinburgh)Diagnosis and Management of the Menopause: Highlights from Recent Guidelines Dr Heather Currie (Dumfries & Galloway Royal Infirmary)Testosterone Measurement and Reference Intervals in the MaleDr Julian Barth (Leeds General Infirmary)

12.30-13.30 Lunch13.30-15.30 Renal Biochemistry and Fluid Balance:

Update on Investigation and Management of HyponatraemiaProf Stephen Ball (Manchester Royal Infirmary)Clinical Biochemistry and Kidney Disease: Current Laboratory IssuesDr Edmund Lamb (East Kent Hospitals)Measurement of Creatinine in Paediatrics: A Clinician’s PerspectiveDr Heather Maxwell (Royal Hospital for Children, Glasgow)

15.30-16.00 Tea and trade stands16.00-17.00 Inter-region Biochemistry Pub Quiz

Quizmaster – Dr Kevin Deans (NHS Grampian)17.15-19.30 Leisure activities19.30 til late Dinner

Friday 10th November09.00-09.30 Registration09.30-10.00 Updates in Cardiology

Prof Nick Mills (Queen’s Medical Research Institute, Edinburgh)10.00-12.00 Introducing a New Test to Your Laboratory: An Interactive Workshop

Dr Bernie Croal (NHS Grampian) (Break for tea & trade stands at 10.30)12.00-12.15 ACB Scotland Business Meeting12.15-13.15 Lunch13.15-14.00 Audit Session:

Pancreatic Enzymes Audit Dr James Logie (Edinburgh Royal Infirmary)Critical Results Communication Audit Dr Neil Greig (Victoria Hospital, Fife)

14.00-15.30 Hot Topics:FIT Testing Dr Ian Godber (NHS Lanarkshire)Use of Biologic Therapies Dr Jonathan MacDonald (QEUH, Glasgow)Copeptin (CT-ProAVP) in the Investigation of Polyuria/PolydipsiaDr Christopher Boot (Royal Victoria Infirmary, Newcastle)

15.30-16.00 Tea and trade stands16.00-16.45 Plenary Lecture: Communication of Laboratory Results

Dr Craig Webster (Birmingham Heartlands Hospital)16.45-17.00 Presentation of John King Award and Close of Meeting

Register at www.acb.org.uk by 13th October

BIVDA News | 43


As we head into summer, a lot of time isbeing taken up with getting back in touchwith politicians before they head off afterrecess on 20th July. BIVDA first started itsParliamentary work stream in 1998supported by the then labour backbencherand scientist Dr Ian Gibson MP (NorwichNorth). Government affairs was notsomething I had really been involved inother than attending a couple ofParliamentary receptions as a member ofBIVDA, so it seemed quite daunting backthen. It’s become the side of my role Ipossibly enjoy the most! I’ve been anactive member of the Parliamentary &Scientific Committee and I am now proudto have been re-elected as a Vice-Presidentof this All Party Parliamentary Groupwhich does tremendous work to raiseawareness of scientific issues amongParliamentarians and holds monthlymeetings on topical issues presented bysome of the country’s experts in that field.The last meeting was on Fungal Diseaseand there was a big emphasis on the roleof diagnostics as well as some frighteningstatistics about the increase of prevalenceand the number of global deaths fromfungal infection (see graph) – as many asfrom TB and more than from malaria! If anyone is interested in reading morethen have a look at www.gaffi.orgThe biggest challenge working in

government affairs is keepingrelationships going as we don’t just haveto contend with general election and re-shuffles but also with changes topoliticians’ staff and within the civil serviceso re-establishing these post election andmaking new contacts has been high on our

agenda. Over the past 16 years I have onlyhad a handful of difficult or disappointingmeetings, MPs get a bad press but they arevery committed to what they do, workingvery hard and when people complain thedebating chamber looks empty ontelevision then they should be aware thereare a huge number of committees andactivities going on which are doingvaluable work on specific issues for thecountry. I think health issues in particularget a good deal of supportive cross partyco-operation which is not visible throughthe media.Laboratory Medicine is getting a very

good profile steadily and I always try toleave a mental image of somethingpositive for an MP or Peer to rememberabout how testing can improve outcomes– probably my favourite in recent years has

Industry Insights: August 2017Doris-Ann Williams, Chief Executive, BIVDA

44 | BIVDA News


been Calprotectin as they all get themessage that this can help prevent anunnecessary colonoscopy, a procedurenobody would have on the top of their listof life experiences to have!Last week we had our first formal

meeting with Health Minister LordO’Shaughnessy who has a very wideportfolio of responsibilities to coverincluding both pathology and the lifesciences industry. His background is ineducation but he is really getting to gripswith his brief and extended our allottedtime in order to really engage in the issuesBIVDA wanted to raise. And two days laterthe Minister made a very welcomeannouncement about £86 million offunding to support the practical uptake ofmedical technology (including IVDs). Thisincludes a £6 million PathwayTransformation Fund, which will help NHSorganisations integrate new technologiesinto everyday practices - this will helpovercome more practical obstacles such astraining staff on how to use newequipment.Two days before recess started I had a

really helpful meeting with KevinHollinrake MP (Thirsk and Malton), who ispassionate about raising the profile ofantimicrobial resistance and is looking forroutes to support this agenda and inparticular the better use of diagnostics. It’s a privilege to be able to engage withpeople like this who are prepared to make

a difference practically.Laboratory medicine is also being seen

positively by organisations like theWellcome Trust, Cancer Research UK andthe Medical Research Council, all of whomhave approached BIVDA to learn moreabout issues to support aspects affectingthe use of diagnostics in healthcare. Of course there have also been meetings

to go to with a more practical sideincluding an introduction to Einav BenYehuda who has just started at the end ofJune on a secondment from the CabinetOffice to head procurement within NHSImprovement. Hopefully her fresh pair ofeyes from a different background will spotthe opportunities being lost to benefitfrom pathology by all the perversefinancial flows of which we are all toofamiliar. We are also really starting to look at the

implications of the new IVD Regulationwith a UK stakeholder group meeting atMHRA on 18th July, the first since theRegulation was published. The shadow ofBrexit inevitably lies over this and thefrustration of not yet knowing if we willbe able to use this or will need a separateUK regulation for IVDs. So plenty to keep the BIVDA team busy

and for the October issue I will be able toshare some news about the work we aredoing on transparency of industry to theNHS – stay tuned and enjoy the rest of thesummer! �

“It is a constant source of frustration that implementation of new tests takes years toachieve. It means that not only are people not benefiting from improved diagnosisand disease management but also that the NHS is losing the chance to gain cost

efficiencies along clinical pathways.” Part of BIVDA’s response to Lord O’Shaughnessy’s funding announcement on 14th July

Crossword | 45


Solution for June’s Crossword

Across 7 The process of reduction division:

is some information incorrect? (7)8 Following regular practice, predecessor of

Army Reserve return home (7)10 Lawrence begins current high school (5)11 Conductor led coterie carelessly;

one missing (9)12 Reactive chemical toxin promotion is out of

order (7)14 New space probe leaves base for this 21 (6)16 Reformulated reagents help one make a

diagnosis of infection (7,6)20 Under the weather? Pointless sailing (6)21 See 3 Down24 Microwave oven component (not German

made) (9)25 Group settlement contains disquiet (5)27 Send short MS for higher degree research

worker (7)28 Phone registered nurse about renal unit (7)

Down1 Component of biochemical insulator (4)2 Model pharmacists reject scrip for a chest

problem (6)3/23/21 Licensee’s ale treatment destroyed critical

nutrient (9,5,7)4 Change course without qualification (5)5 Rota a bit disorganised? Shambles! (8)6 Pressure aunt to leave rough apartment

house (10)7 Practice orderliness (6)9 They admit gold speculation (6)13 Visionary speculator got so idle one

worried (10)15 Phosphorus-free hen protein could

provide this 3 nutrient (9)17 Cast aside distressing unsanctioned

imputation (8)18 Centre-forward member out of bed for

preparatory exercise (4-2)19 Drug for immediate use at home (6)21 Supplies eye-opening gags (6)23 See 326 Materials for analysis will be Spanish (4)

ACB News CrosswordSet by Rugosa

46 | Situations Vacant


To advertise your vacancy contact:ACB Administrative Office130-132 Tooley Street

London SE1 2TU

Tel: 0207 403 8001 Fax: 0207 403 8006

Email: [email protected]: 26th of the month prior

to the month of publicationTraining Posts: When applying for such posts you should ensure that appropriate supervision

and training support will be available to enable you to proceed towards HCPC registration

and the FRCPath examinations.

For advice, contact your Regional Tutor.

The Editor reserves the right to amend or reject advertisements deemed unacceptable

to the Association.

Advertising rates are available on request.

PLYMOUTH HOSPITALS NHS TRUSTCLINICAL SUPPORT SERVICES DIRECTORATE

CONSULTANT CLINICAL BIOCHEMIST Derriford Hospital, Plymouth

37.5 hours per week, (AfC Band 8c/d) £56,665-£69,168 and 8D - £67,247-£83,258

We are looking for an experienced and motivated Consultant Clinical Scientist to join our team. The successful candidate will have broad general experience, be HCPC Registeredas a Clinical Scientist, and hold the FRCPath, or equivalent. Postgraduate experience in aspecialist area would be an advantage. Candidates should have extensive experience at asenior professional level, but those with lesser experience are encouraged to apply and willbe considered.You will work with colleagues in Clinical Biochemistry providing authorisation, clinical

liaison, departmental management, audit, research and development, teaching andtraining. The post includes participation in a formal out-of-hours rota for the provision ofclinical advice, with colleagues from other sites across Devon and Cornwall.A visit, either prior to shortlisting or interview, can be facilitated. Interested candidates

should contact either Dr Tim Nokes - Clinical Head of Department for Derriford CombinedLaboratory on 792404/ 01752 431001 or Dr Tony Avades, Consultant Chemical Pathologist on01752 430037 / email [email protected] For further information and to apply, please see NHS Jobs. Job reference: 216-LS-C1547

PRINCIPAL CLINICAL SCIENTISTApplications are invited for the post of Principal ClinicalScientist (8a) in the Biochemistry Department of BlackpoolTeaching Hospitals NHS Foundation Trust, based atBlackpool Victoria Hospital. Blackpool Teaching HospitalsNHS Foundation Trust is situated on the west coast ofLancashire and offers a full range of district hospital andcommunity health services to a population of 1.6 million inLancashire and South Cumbria. The Trust provides servicesto the 440,000 residents of Blackpool, Fylde & Wyre andNorth Lancashire, as well as specialist tertiary care forCardiac and Haematology services across the wider region. The appointee will assist the Head of Department in

providing a comprehensive, cost-effective and high qualityClinical Biochemistry service in this UKAS accreditedlaboratory. They will be involved in the analytical,interpretative, audit, teaching and research activities ofthe department. The appointee will represent theBiochemistry Department on the Trust POCT Group andwill contribute to service improvement as well asfacilitating delivery of current service provision across thedepartment. The successful candidate will be expected to be an

experienced HCPC Registered Clinical Scientist in ClinicalBiochemistry and have successfully completed Part 1FRCPath. An MSc in Clinical Biochemistry or a relevant PhDwould be an advantage.For further details / informal visits contact: Dr Philip

Bladon, Consultant Clinical Scientist, BiochemistryDepartment on Tel: 01253 956627.