Requesting non-genomic tests in England

 

Genomic and non-genomic tests

For practical purposes, any test which is not included on the Test Directory is considered a non-genomic test. If ‘molecular’ tests are considered any ancillary tests performed on tumour tissue which have prognostic or predictive value, or which identify (or infer) the presence of underlying genomic alterations, the vast majority of molecular tests are genomic. Common exceptions include:

  • ALK immunohistochemistry;

  • HER2 immunohistochemistry;

  • HER2 in situ hybridisation (e.g. FISH, DDISH);

  • MMR (mismatch repair) immunohistochemistry;

  • PD-L1 immunohistochemistry;

  • ROS1 immunohistochemistry;

  • TRK immunohistochemistry.

 

Funding and provision of non-genomic tests

Genomic tests are centrally funded by NHS England, but non-genomic tests are not. Funding arrangements differ across England:

  • Some pathology departments pass the cost of each of these tests back to local Cancer Services. These departments do not have to bear the costs of this testing.

  • Some pathology departments absorb the cost of these tests in their own budgets. The trust will allocate a certain sum to the department each year to pay for all its activity, including non-genomic testing. If the requirement for testing increases, the pathology department will need to propose a business case for more funds from the trust to cover the additional cost.

Therefore, unlike genomic testing, trusts, Cancer Services and pathology departments have control over funding of non-genomic testing. They are therefore free to decide how and where non-genomic testing occurs. They may choose to undertake testing in-house or to outsource it to other NHS departments or to the private sector.

GLHs are generally not able to provide non-genomic testing (which is particularly the case for immunohistochemistry). Even if a GLH is able to provide a non-genomic test, the referring centre will be invoiced for it.

 

How do I request a non-genomic test?

Each pathology department will have its own arrangements for undertaking non-genomic tests. If a test is not performed in-house, it may be outsourced to an NHS department or to the private sector. The arrangements differ significantly from one centre to another.