1. Clinical pathway
Identify a clinical pathway where genomic medicine is, or will be, required for delivery (either for testing or management).
The Clinical Pathway Initiative (CPI) aims to support the integration of genomic competences into the education and training of the NHS workforce with a nationally co-ordinated and consistent approach.
The initiative is led by the Genomics Education Programme, in collaboration with NHS England’s Genomics Unit and the Academy of Medical Royal Colleges. It works by mapping clinical pathways to the required competencies – and associated education and training – needed to deliver each step on the pathway.
The aims of the CPI are to:
- introduce a unified approach to the integration of genomic medicine across the different specialties;
- harness and share expertise from around the country;
- identify the workforce development and education needs;
- highlight gaps in resource provision to support education and training needs; and
- avoid duplication of effort around resource development.
Each completed pathway allows service leaders, educators and individuals to identify the workforce development aspects along a patient’s genomic testing journey, to access available education and training resources, and to ensure consistency in delivery of patient care.
Downloads
To support you in developing your own clinical pathway project, we have developed some handy resources:
How to develop a clinical pathway project
Each CPI project is built around a clinical pathway where genomics is, or will be, embedded into routine care. This approach is being used across the NHS Genomic Medicine Service to recognise the competencies required of the workforce involved in each step of the pathway, and the educational resources that can be used to achieve these competencies.
The pathway should be high-level and linear, and should primarily aim to identify the genomic competencies for healthcare professionals in each step of the patient journey. Many pathways are likely to be smaller sections of larger pathways or networks. There will also be examples of pathways that branch, depending on results or referral criteria.
Click through the steps below to see how a pathway project can be developed.
2. Component pathways
Reduce a larger pathway into its shorter component pathways.*
3. Component steps
Break down each pathway into its component steps. The number of steps will depend on the CPI project being developed.
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4. Competency alignment
Identify the competencies (knowledge, skill or attitude) required by professionals to deliver each of these steps.
5. Education and training
Identify education that can be used to support the competency and numerically label each one; for example, learning resource 1 will support competency 1.
6. Workforce groups
Align the pathway to the workforce group who will be delivering each step of the pathway.
* For instance, a larger pathway to investigate an intellectual disability might be divided into two smaller pathways: a) requesting genomic testing; and b) interpreting and feeding back results.
We have produced a range of resources about how to write a CPI, including a spreadsheet template and author role description, which may be of help when developing your own. To help with authoring the CPI, the provided template contains a number of competencies that the CPI team believe are common to many clinical pathways.
If you have a CPI that you would like to develop, please read the CPI author role description and complete the submission form. If you have any questions, you can get in touch with the CPI project co-ordinator.
View the guidance
You can view an exemplar of a clinical pathway project as part of our information pack, which includes further details, handy flow charts, templates and guidance.
Established CPI projects
Below you will see a table of established CPI projects so that, if you are inspired to initiate a pathway project, you can see which ones are already under way. If you have any questions about a particular CPI project, you can contact the lead author via the links below.
| Clinical Pathway Initiative project | Author (click to contact via email) |
| Aminoglycoside toxicity in neonates (point-of-care testing) | Lianne Gompertz |
| Cystic fibrosis carrier testing | Joanne Hargrave |
| Cystic renal | Vicky Carr |
| DPYD | Emma Groves |
| Familial hypercholesterolaemia | Jude Hayward |
| Glioma | Daniella Lynch |
| Hirschsprung disease | Jo Kennedy / Sarah Smithson / Sam Boland |
| Hypotonic infant | Melody Redman |
| Inherited retinal dystrophy | Sian Sperring |
| Lynch syndrome | Nicola Husain |
| Neurology (adult with a neurological condition) | Heidy Brandon |
| R14 Acutely unwell children with a likely monogenic disorder in the NICU setting | Danni Bogue |
| R142 Glucokinase-related fasting hyperglycaemia | Joanne Hargrave |
| Sickle cell carrier status | Rossby Awadzi |
FAQs
What if a CPI has already been developed for my chosen pathway?
In some instances, there can be a benefit of having two similar pathways reflecting different deliveries, depending on regional services. If this occurs, please contact the CPI project co-ordinator to discuss further. Equally, if your CPI pathway of interest is in development and you would like to contribute, please liaise with the CPI project co-ordinator, or contact the author directly.
Who should I involve when developing my CPI?
We would recommend that key stakeholders help to write, and/or provide feedback, on your CPI. These stakeholders could be from various working groups who will be delivering care in your chosen pathway, national groups, charities and patient groups. You can also get in touch with the Genomics Education Programme team to provide guidance to the structure of your CPI or if you are having difficulties in identifying a working group.
How should I work with my CPI stakeholders?
There are a variety of ways that you can work with your stakeholders. Some working groups have organised workshops with all their stakeholders, while others have had individual meetings and requested feedback via email, and some a combination of both. A member of the Genomics Education Programme team can be present and provide guidance at meetings, at your request.
Do I have to keep all elements in the CPI template?
No. We would recommend that you use the general structure of the template, but pathway steps can be added, deleted or separated to suit your CPI project. The key competencies that we would anticipate to be in most, if not all, pathways are provided in our template, but please feel free to use your judgement as to whether these need to be adjusted for your pathway.
How do I assign educational resources to each pathway step?
Education and training packages will be required to support each of the pathway structures that are developed. Resources may already exist, and these should be signposted from the CPI. Or they may need to developed. In the latter scenario, the Genomics Education Programme team can help to facilitate the design of new resources to meet your need.
What will happen when I submit a CPI pathway?
Once submitted, the Genomics Education Programme team will work with the author to refine and review the CPI before presenting it to the HEE/NHSE joint Workforce Steering Group (WSG) for sign-off ahead of publication.
Once finalised, the CPI can be submitted for final review via email with an opportunity to present at the WSG. When the CPI has been signed off at this final review stage, it will be uploaded to the Genomics Education Programme website, to be freely available for you and others to access and use.
How will the CPIs be used?
The CPIs will be used however they best fit into clinical practice. This might be by service leads wanting to identify and arrange training and education packages for their workforce, or by individuals seeking to identify and advance their own competencies.
We are currently gathering more information about how CPI pathways are being used in practice through our submission and feedback forms.
How will the success of the CPIs be measured?
CPI authors will be asked to provide the Genomics Education Programme with baseline data about their chosen pathway, such as the current education and training provided to their workforce and measurables around patient care.
The GEP team would also like to encourage all end users of a CPI pathway to let us know it is being used, to allow our evaluation team to conduct a comparison of any outcomes that occur. If you wish to know whether we have any information about how your CPI is being used by others, please contact the CPI project co-ordinator.
What baseline data should I collect with my stakeholders?
The Genomics Education Programme is asking all authors to provide baseline data regarding current education and training for genomic competencies and measurables around patient care associated with their chosen pathway, if available. The types of data required, or indicators of good practice, should be discussed with the GEP team to be individualised to your chosen pathway.
Contact us
If you are interested in developing a CPI project, you can submit an expression of interest.
If you have a question about the Clinical Pathway Initiative, please contact the project co-ordinator Claire Healy or project lead Ed Miller.
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