Structures for Community Laboartory Services

Current Structure

Currently a number of providers deliver community laboratory services. However, the majority is delivered by DML. A small percentage of tests known as ‘sendaways’ are forwarded to LabPlus for testing. In principle ‘sendaways’ are less routine test that are not on the current schedule and are of low volume and outside the capability of community laboratory providers. However, changing technology within laboratories and changes in medical practice some of these tests now have higher volumes and could be undertaken by the community laboratory provider.

All three DHB laboratories undertake a small level of community laboratory tests. These referrals are frequently DHB staff that through convenience uses the DHB laboratory service rather than the community provider service. Some tests come from non-DHB staff who for whatever reason find it more convenient to get their samples taken at a DHB hospital.

The community laboratory provider has a collection facilities spread throughout metropolitan Auckland and a transport system to get samples from the place of collection to the laboratory. Some general practices also collect samples, particularly in the more rural areas where DML do not have a collection facility.

Consultant doctors (pathologists) are employed by all the laboratories to provide expert advice on the interpretation of test results.

Some Options for the Future

Future structural options for community laboratory services are many. The following table looks at some of the options and considers some of the strengths and weakness of each.

Option	Strengths	Weaknesses
Single provider of total service.	§ Potential for maximisation of efficiency of service. § Maximum service accountability § Potential for improved relationships with doctors requesting tests. § Potential to maximise effectiveness of referral quality programmes. § Single focus on quality	§ No competition. § No incentive to implement referral quality management programmes. § Potential for increase costs for funder.
Multiple providers of service.	§ Competition. § Cost containment. § Promotes innovation and service improvement.	§ Less service efficiency. § Less effective referral quality programmes. § Multiple approaches to quality.
Service split in to component elements under separate contracts (i.e. separate contracts for collection, testing and consultant advice).	§ Not reliant on same provider(s) for total service. § Potential to seek best value for money in each service element. § Able to review separate elements independently for quality, efficiency and cost. § Competition both within and across the service elements. § Allows new providers to enter part of the service mix.	§ Requires multiple providers to work together. § Potentially most costly. § Requires increase coordination efforts.
Each DHB has service provision tailored to local population needs (i.e. non regional service and each DHB choosing independently appropriate service model and providers for its population need).	§ Maximised health outcome.	§ Reduced ability to maximise value for money. § Reduction in efficiency.