Business Case for a new Consultant Chemical

Pathologist for the South Essex Hospitals group

Dr. Anil Simhadri

MA(Cantab) MB BChir (Cantab) MRCP MSc FRCPath (Part 1)
ST7 In Metabolic Medicine/Chemical Pathology
London Deanery

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Chemical Pathologist
• Chemical Pathologists are medically qualified and combine laboratory
medicine with clinical skills.
• They are uniquely placed to ensure lab results are clinically relevant.
• They also can lead clinical services where clinical biochemistry
expertise adds value.

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Services potentially offered by Chemical Pathologist

1) Cardiovascular risk/Lipid clinics

2) Metabolic Bone/Osteoporosis clinics
3) Endocrine/Renal stone clinics
4) Duty signing/Clinical validation
5) Running dynamic function unit
6) Supporting the lab / MDM / GP liaison
7) Participate in clinical trials
8) Publications
9) Teaching and training (UG & PG)
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Currently many such services are referred to
King’s or St Thomas Hospital from South Essex

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Income Generation:
1) Lipid clinics
2) Bone/Osteoporosis clinics
3) Endocrine clinics

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NHS England 5 year plan
• Prevention is better than cure

Public Health England 2017

“We can prevent more than 9,000 heart attacks and at least
14,000 strokes over the next 3 years with better detection and
management of:
• high blood pressure
• high cholesterol

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 Lipid clinics
NICE Guidance CG181 2014
• Cardiovascular disease (CVD) accounting for almost a third of all
deaths in the UK.

• Following require referral to specialist clinics

• Total cholesterol >9.0mmol/litre

• Triglycerides > 20mmol/litre that is not a result of excess alcohol or

poor glycaemic control

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 Osteoporosis Clinics
NICE Guidance CG146 2012

• Patients referred from fracture liaison nurse specialist

• Referrals from Primary Care
• Referrals from Secondary Care

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Income Generation*:
• Approximate £200-£250 per new patient
• Approximate £150 for a follow up
• 4 new patients and 6-8 follow ups ~ £2200/week
• Annual income £2200 x 40 = £88,000

* Per weekly lipid/osteoporosis clinic

• The frequency of clinics will be based on the demand for the services
within the region

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Expenses/Resources available:
• Consultant Chemical Pathologist £85,000
• Medical secretary £15,000
• Laboratory investigations (in-house/send away/RCPath MRI)
• Current Formulary (discuss with lead pharmacist)
• Nurse time
• Dietetic support
• Clinic space
• Radiological Investigations

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Conclusion:
• Clinics will generate profit when run efficiently (approx. £176,000 -
£85,000 - £15,000 = £76,000)*
• Some activities may not bring immediate financial gain but have the
potential in the future
• Research/publications
• Teaching

*Assuming 2 clinic sessions per week

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