Pathology Update for Dec 2025

Overall

• A set of minor but important system updates across pathology workflows.
• An updated pathology planning spreadsheet and list of new/changed reports is available to download at the bottom of this page.
• New reports are clearly marked "***New***” to help identify changes.

Blood Pressure (Home BP)

• The system now assumes patients may have (or can buy) their own BP machine, rather than needing to borrow one.
• Patients who d oneed a loan machine are still identified, but:
  • More patients will now fall into a generic “send message” pathway rather than machine-loan lists.
• Expected outcome:
  • Fewer patients in machine-loan reports.
  • More streamlined messaging around home BP readings.

Haematinics – Vitamin B12 - New pathway created but NOT enabled by default

• New preset message: “B12 – low end of normal” for when B12 is 180–350
• Message advises review if symptoms are present (with symptom list link).
• Not auto-enabled due to:
  • High patient volume (~20 patients/week).
  • Risk of unnecessary appointments.
• Practices can opt into:
  • Auto-file B12s above lower limit of normal.
  • Send patient messages if desired.

HbA1c / Diabetes

New report

• “Consider diabetic medication”
  • Flags patients with HbA1c >48 mmol/mol
  • Not on medication (diet-controlled)
  • Rising HbA1c but not yet “poorly controlled”
• Small numbers, intended as an early prompt.

More holistic review prompts

• HbA1c templates now flag related considerations, e.g.:
  • Statin optimisation
  • BP review
  • SGLT2 initiation
• Aim: support joined-up, holistic diabetes reviews without cluttering templates.

Lipids & Statins

LDL targets

• Custom LDL targets can now be coded (e.g. 1.8 or 1.6 post-MI/TIA).
• These override any other target
• System automatically compares results against the coded target.
• Currently available in the lipids template (may be expanded later).

Statin dose increase questionnaire

• If patient selects “I want to speak to someone”:
  • They are now instructed to contact the practice themselves for an appointment.
  • Patients will not be included in invite reports or reports to proactively contact, unless practices want to opt in.
• Rationale:
  • Reduce non-attendance.
  • Encourage patients to make a decision
• Data still coded so practices can:
  • Identify these patients.
  • Revert to active invitations if they choose.
• If not taking statin regularly:
  • Option to retry adherence → cholesterol recheck in 3 months (auto-triggered).
• New option for:
  • Statin declined / lipid-lowering therapy declined
  • New “stop statin” report added.

Referral & Risk

• Expanded “consider referral” category for severe hyperlipidaemia.
• Focus on:
  • Possible familial hypercholesterolaemia.
  • Simon Broome / Dutch Lipid Clinic Network assessment.
• QRISK no longer used in this cohort (can be falsely reassuring).
• Small increase in patient numbers, but clinically important.

Thyroid Function Tests (TFTs)

New reports and patient letters

• For patients with:
  • Existing subclinical hyper/hypothyroidism
  • No treatment
  • Expected, stable abnormalities
• New message explains:
  • Results are expected.
  • No treatment needed unless symptoms develop.
• Very small patient numbers.
• Automation applies if subclinical TFT automation is already enabled.

Albumin-Creatinine Ratio (ACR) / SGLT2

• Reports reorganised into clearer categories reflecting updated guidance.
• Makes it more explicit why SGLT2 inhibitors should be considered.
• Aims to improve awareness of newer guidance.