For the right reasons and in the right settings, point-of-care testing (POCT) is a great use of technology and could really improve efficiency for the NHS and convenience for the population. The big caveat is that it needs to be done when it is clinically appropriate and not just because technology makes it possible.
Obviously all the issues of management, training, ensuring quality of results, connectivity with the patient record etc, with which we are all familiar, are also critical factors. So, with the recent changes in England to establish networks and the ever-increasing workload of tests, I believe POCT has a valid role to play in helping to deliver healthcare and ease the burden on laboratories.
The new IVD Regulation, which will not be fully in force until 2022, has added additional requirements for POCT which strengthens the safety of the tests and any associated kit, including a requirement for performance studies to be performed in locations where they will be used (eg in an ambulance). The Regulation also uses the term ‘Near Patient Testing’ rather than POCT, so I am trying to use the ‘new’ terminology, but it will take it a while for this to run off my tongue!
Dan Lasserson, now Professor of Ambulatory Care in Birmingham, set up an exemplary Emergency Multidisciplinary Unit in Oxfordshire some seven years ago. This is run with the support of the pathology team at the John Radcliffe Hospital and uses POCT to minimise secondary care admittance for the frail elderly. This has led to a big reduction in admittance and reduces bed stay by people who have become too weak and unwell to live independently at home. This will also ease the need for social care. There are other great initiatives around the UK using POCT in innovative ways, and it would be great to compile these so they could be applied in other regions as appropriate.
For some time, pharmacies have wanted to provide POCT services as part of their NHS offering but, along with additional testing being done at a GP practice, the biggest hurdle is financial. There is no obvious mechanism for getting the tests funded and neither GPs nor pharmacists will do this if they have to bear the cost. Most other barriers seem to disappear or can be bypassed if the money becomes available. This is particularly frustrating when supporting a reduction in antibiotic prescribing, where a number of simple tests could help clinical decision-making on infections.
My wish list for the future may be rather controversial and represents my own views and not necessarily those of BIVDA or the IVD industry, but it definitely includes GPs becoming salaried NHS employees rather than contractors to the NHS, and for biomedical scientists to have a career option working in the community to support near patient testing.
Doris-Ann Williams MBE
British In Vitro Diagnostics Association