Primary and Community Care
Information Hub
Information Hub for Synnovis users
Welcome to the information hub for the pathology services provided to primary and community care in Southwark, Lambeth, Bromley, Bexley, Greenwich and Lewisham. These services are provided by Synnovis in south east London.
These pages have been designed to provide all colleagues working in primary and community care settings with the resources they may need.
Find out more about transformation here.
Non-urgent pathology activity restrictions eased
The new electronic health record (EHR) system, Epic, and the Beaker laboratory information management system (LIMS) are now live across Guy's and St Thomas' and King's College Hospital Trusts.
Synnovis would like to thank you, our primary care colleagues, for your ongoing support. We are cognisant of the additional time, planning and work undertaken by each practice to reduce non-urgent pathology activity.
Thanks to these collaborative efforts, the primary care pathology activity reduction period will end at 23:59 on Friday 13 October. This means you may begin to order non-urgent tests once more.
Please do bear in mind, however, that as activity volumes return to normal levels, we will be continuing to respond to and resolve ongoing issues. The likelihood remains that some test turnaround times may continue to be longer than normal.
If you require support or identify a new issue, please continue to communicate with us by reaching out to your local IT helpdesk.
Once again, thank you for your patience and understanding.
Critical results for phoning at KCH DH
Please see attached Chemistry critical results phoning limits
Clinical guidance for samples during activity reduction
Microbiology samples (urines and stool)
- Please avoid sending microbiology samples if a patient can be treated with first line antibiotics.
- Urgent microbiology samples should be collected in red and green top boric acid containers which improve the stability of samples.
- Urines and stool samples for biochemistry can be refrigerated if they have to be stored overnight.
Phlebotomy samples (blood)
- Only send urgent blood samples.
- Do not refrigerate blood samples as these can be affected by the cold, leading to spurious results for some analytes.
- Routine blood samples cannot be stored at GP practices or at laboratories due to the potential for them to degrade.
Urgent Pathology Test Guidance
This list is not exhaustive, and we encourage clinical professionals to order samples where you believe they are clinically justified for the safe clinical management of your patients. This is intended as a guide to assist clinical staff in making an appropriate risk assessment of the clinical scenario.
Download the urgent pathology test guidance document or view below.
| URGENT | ROUTINE | |
|---|---|---|
| Renal profile | • diuretic adjustment in heart failure • clinical concern re hyper or hypo kalaemia • possible hyponatraemia e.g. polydipsia, polyuria • Acute kidney injury |
• Post introduction of ACE or ARB – if clinically appropriate delay medication introduction, so renal profile at 2 weeks can also be delayed • Part of Long Term Condition (LTC) review – T2DM, CVD, CKD, etc |
| Liver profile | • Acute jaundice • Possible liver failure e.g. ascites • Cholestasis of pregnancy • Acute alcohol toxicity |
• Part of LTC review • Post introduction of statin – consider delaying start of medication so liver profile at 6 weeks can also be delayed • Monitoring of long term liver conditions |
| Full Blood Count | • High risk anaemia e.g. severe menorrhagia, severe haemorrhoids, melaena • Possible haematological malignancy • Acute sepsis • Possible Immune Thrombocytopenic Purpura (ITP) |
• To exclude anaemia in lower risk clinical scenarios • Monitoring/follow up of platelet count over 100 |
| Urate | • Make a clinical diagnosis of acute gout and treat accordingly | • Monitoring of effectiveness of allopurinol/td> |
| Ferritin, Iron studies | • If MCV reduced, treat as iron deficiency, consider FIT | • Diagnosis of iron deficiency |
| B12, Folate | • Symptomatic patient (neurological), with possible severe B12 deficiency | • Excluding deficiency in absence of severe symptoms |
| INR/ Coagulation screen | • For patients on warfarin with symptoms or recent dose change | • For patients with bruising, low risk bleeding |
| D-dimer | • D-dimer, for exclusion of VTE but consider whether better done in A&E if patient is symptomatic | |
| CRP and ESR | • ESR - If possible diagnosis of temporal arteritis | • For diagnosis of inflammatory conditions |
| Vitamin D | • Confirmation of rickets in child, where high clinical suspicion | • Routine monitoring of patients at risk of nutritional deficiency e.g. parenteral feeding, post bariatric surgery |
| Bone profile | • Acute hypercalcaemia or hypocalcaemia | • Routine monitoring of hyperparathyroidism, or CKD stage 4 or 5 |
| Thyroid profile | • Acute thyrotoxicosis/thyroid storm | • Routine monitoring of hyper or hypothyroidism |
| HbA1C | • N/A | • Routine monitoring of T2DM or NDH |
| Allergy testing | • N/A | • Diagnosis of possible Ige mediated allergies |
| Infertility testing | • N/A | • Diagnosis of primary/secondary infertility issues • Baseline tests prior to referral |
| DMARDS monitoring | • N/A | • Consider delaying tests if patient stable and has been stable for some time |
| FIT | • If patient may need to be referred onto 2ww pathway | • Follow up FIT to previously borderline sample |
| CA-125 | • If clinically indicated and this may help to decide if 2ww referral is indicated | |
| PSA | • For suspected cancer – for 2ww diagnosis | • Consider delaying routine PSA testing for monitoring post cancer treatment or previous borderline result |
| MSU | • Where sensitivities are clinically important e.g. treatment failure, children and male adults, high risk systemic infection/sepsis | • Treat according to symptoms if positive dipstix (cloudy urine, leucocytes, nitrites) • Consider delaying MSU for investigation of lower urinary tract symptoms (LUTS) i.e. where using MSU to exclude infection |
| Mycology | These samples can be delayed |
Activity Reduction Q&A
Pathology activity will be restricted to urgent testing only until Friday 13 October. This means that no routine tests can be processed. It is important not to take routine blood or urine samples from patients during this time, as they may not be able to be stored or processed and may need to be retaken. If you do order tests before and during the activity reduction window, please ensure the patient knows not to book an appointment to have their blood taken between until after 13 October. We are working with phlebotomy providers to find additional ways to share this message with patients.
Yes. As always, it is critical to the efficient operation of laboratories – and the expedient turnaround of test results - that all tests are ordered electronically. This is because using paper request forms requires samples to be booked in manually, which is time consuming, especially if the handwritten form does not match the sample label exactly. We will continue to accept samples accompanied by paper booking forms, but would note that turnaround times will be notably slower for these samples owing to the additional admin required.
No routine tests will be processed between October 5 and 13 October. There will likely be some disruption to the service while the new processes are fully embedded. We will continue to communicate with primary care colleagues throughout the transition.
We recognise that in some circumstances, you may need to order urgent or critical tests, so please continue to request these where you believe they are clinically justified for the safe clinical management of your patients. All urgent samples must be marked as ‘urgent’. Please note that turnaround times may be slightly longer than normal during the activity reduction window.
Please endeavour to bring forward all routine tests for example, any monitoring bloods scheduled for 5 to 13 October so they are taken and carried out in September wherever you can. This will help to reduce turnaround times after implementation of Epic as demand will temporarily be notably higher when testing comes back online. If this is not possible, please schedule routine tests after 13 October. Please note that routine tests received cannot be processed during the activity reduction window.
Please avoid planning LTC clinics that will need pre-assessment tests to be taken during the activity reduction window. Where long term condition clinics are planned, please endeavour to order routine tests before the activity reduction window allowing enough time for patients to have these taken before the activity reduction periodd, noting that there is generally a week's delay in getting a blood test appointment at many of the main Phlebotomy clinics.
We will continue to phone through any abnormal or critical test results directly to the practice as per standard operating procedure.
Yes, but you will need to ask patients not to book blood test appointments before October 13 as they cannot be processed by the laboratory. Please note that samples cannot be stored, either at the practice or the laboratory, because of the potential for them to degrade before they can be analysed.
Our courier routes and collection times will remain unchanged throughout the activity reduction window to ensure the timely collection of urgent samples.
No. These are two entirely separate projects, although both form part of the overarching plan to transform pathology services across south east London by 2025.
For issues and queries relating to tQuest, please contact tquest@synnovis.co.uk
For issues and queries relating to EMIS, please contact the EMIS helpdesk or ICB help desk.
For all clinically related queries about samples or test results, please contact customerservices@synnovis.co.uk as normal.
For all non-clinical queries, please contact letstalk@synnovis.co.uk
Synnovis pathology services support
Email us at customerservices@synnovis.co.uk or telepone 020 4513 7300
Visit our dedicated Customer Services page to find our opening hours.
Last updated: 12/10/2023
