Pathology is being re-drawn as a network. The diagnostics decisions still have to be right.
Consulting for pathology laboratories and networks on the work that decides whether a service runs well — lab workflow, assay selection, supplier evaluation, and accreditation readiness against ISO 15189:2022 and UKAS. Method-fair and led by the evidence: we advise on what the laboratory needs, with any commercial interest of ours stated up front. Elixir is also the UK partner for Technoclone GmbH, so where our advice touches a Technoclone line we represent, we say so on the page, not just in the footer.
Consolidation changes who decides, and what a wrong call now costs.
NHS pathology in England is being reorganised around a hub-and-spoke model — a structure NHS Improvement proposed in 2017, grouping trusts into roughly 29 pathology networks, each with a consolidated hub running the bulk of the workload and spoke sites handling urgent and point-of-care testing. As of 2026 that is the planned shape of the service rather than a finished one, and networks sit at different stages of it.
The figure of ~29 networks describes the original planned structure, not a guaranteed end state: after subsequent mergers, 27 are now in place, and the boundaries and pace vary by region. What is consistent is the effect on diagnostics decisions: a method, an instrument or a supplier is no longer chosen for one laboratory but for a network of sites that have to give the same result, on the same reference ranges, and hold up under UKAS assessment across the network.
~29 networks: NHS Improvement, Pathology networking in England — the state of the nation (PDF) (2018), on the 2017 hub-and-spoke proposal.
Consolidation and savings: Satta G, Edmonstone J. Consolidation of pathology services in England: have savings been achieved? BMC Health Serv Res 2018;18:862 (PMC6238267).
One choice, many sites
An assay or platform selected at the hub now propagates across spokes. A reasonable choice for a single lab can be the wrong one for a network that needs harmonised results and one set of reference ranges.
Consolidation exposes the seams
Sample logistics, turnaround for urgent work, and the split between hub and spoke testing all have to be designed, not inherited. The bottlenecks that a single site absorbed become a network-wide problem.
Accreditation across the network
Aligning methods, reference ranges and quality systems so accreditation holds across the network — under one multi-site schedule within a single legal entity, or separate, linked schedules across trusts, per the UKAS network model (LAB 61). More involved than accrediting one laboratory, and it has to hold up under assessment.
These are decisions where the science, the operations and the accreditation have to agree. Getting one right while the other two drift is how networks end up with a method that scores well on paper and fails at the bench.
Four areas where an outside read earns its keep.
Take the whole picture or the one area under pressure. Each is grounded in the laboratory's own data and the published evidence, not in vendor collateral.
Lab workflow
Mapping the path a sample takes across hub and spokes, finding the bottlenecks, and advising on the testing split and logistics so turnaround holds for routine and urgent work alike.
- End-to-end process mapping, hub to spoke
- Turnaround analysis for routine vs urgent
- Hub / spoke / point-of-care testing split
- Capacity and demand review
Assay selection
Choosing methods on what the evidence and your verification data say, with the network in mind — so results harmonise across sites and reference ranges hold up rather than diverging by instrument.
- Method comparison and verification design
- Harmonisation across networked sites
- Reference-range and traceability review
- Fit to clinical need, read from the evidence
Procurement & supplier evaluation
A structured, evidence-led read of competing systems and reagents — on performance, whole-life cost and service — with any commercial interest of ours declared in writing, so the network's choice rests on evidence it can defend, not on a vendor's claims.
- Like-for-like technical comparison of options
- Whole-life cost, not headline price
- Service, support and continuity review
- Evidence the decision can stand behind
ISO 15189:2022 & UKAS readiness
Preparing a laboratory or network for assessment against the current standard — gap analysis, documentation and verification evidence, and quality systems aligned so accreditation holds across the network's sites.
- Gap analysis against ISO 15189:2022
- Verification and method-comparison evidence
- Aligned methods and quality systems across networked sites
- Mock assessment and corrective-action planning
UK medical laboratories accredit to ISO 15189:2022. The deadline for transitioning from the previous edition was 6 December 2025, which has now passed — so readiness work today is against the current standard and centres on holding accreditation through assessment, not on planning the move. We work to the published UKAS requirements and the laboratory's own evidence, and say plainly where a gap needs closing before an assessor sees it.
Method-fair, evidence-led, and tied to your data.
No recommendation arrives written to suit a supplier. We scope against your service and your real constraints first, weigh the options on the published evidence and your own verification data, and will point you to the better option even when it isn't ours.
1 · Scope
A short, focused read of the service, the network's stage of consolidation, and where the pressure actually sits — workflow, methods, suppliers or accreditation. We agree what "good" looks like before any work is booked.
2 · Evidence
We weigh the options on the published literature and the laboratory's own verification and performance data — like-for-like, on the same terms — rather than on supplier collateral or a single site's habit.
3 · Recommend
A clear, written recommendation that names the trade-offs and the next-best option fairly. Where the better answer is a method or supplier we have no stake in, we say so — that is what method-fair means here.
4 · Embed
The documentation, comparison and readiness evidence the team keeps and can take into an assessment or a procurement — so the work survives the next reorganisation and the next new starter.
A considered, senior reply you can hold to account.
elixir draws on years of hands-on experience across NHS pathology — the laboratory and clinical-scientific side both — brought to every brief. Where another method, supplier or approach is the better answer for your network, we will point you to it.
Tell us what your network needs to get right.
Send a short note about the laboratory or network, the decision in front of you, and where it is under pressure — workflow, an assay choice, a supplier evaluation or accreditation. We will reply with how we would approach it, what it would involve, and an honest quote — usually within two working days.