1. Introduction
2. Organisation of JPAC
3. JPAC Board
4. Executive Working Group
5. Standing Advisory Committees
6. Outputs from JPAC
Download the JPAC Terms of Reference in PDF format.
The structure and function of the Joint United Kingdom Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) and its Standing Advisory Committees (SACs) has been kept under review since its creation in 1987.
The most recent review into JPAC’s ways of working was carried out in 2023 and highlighted a number of opportunities for improvement to its structure and processes. The review’s recommendations aimed to equip JPAC to better address emerging challenges, increase its resilience in the context of external factors, and ensure it remains sustainable for the future.
JPAC has two distinct remits:
JPAC guidelines, which constitute JPAC’s professional advice to the Services, aim to be evidence based as far as possible and are reviewed regularly. The guidelines also take account of relevant Recommendations and Directives from European organisations such as the Council of Europe (CoE) and the European Union (EU). Services may choose to deviate from JPAC guidelines, but any such deviation should be substantiated and well documented.
JPAC ensures that no conflict arises, or could reasonably be perceived to arise, between the public duties and private interests, financial or otherwise, of its members. All members of JPAC, the EWG and the SACs are required to declare any interests upon appointment, and by annual declaration organised by the JPAC Office. Any new interests should also be declared at the next relevant meeting.
JPAC, the EWG and the SACs operate from a presumption of transparency and should be open as is compatible with the requirements of relevant legislation, such as the UK General Data Protection Regulation (UK GDPR) and the Freedom of Information Act (FOIA).
All proceedings should aim to maintain high levels of transparency, for example, by clear documentation of decision-making processes and by the timely publication of papers, minutes and other outputs from meetings where appropriate. The release of papers and proceedings of meetings are guided by the requirements of the FOIA and supported by NHS Blood and Transplant (NHSBT), the host organisation for JPAC.
Open discussion is encouraged, and meeting chairs should bear in mind the need to ensure that attendees are able to speak fully and frankly so as not to impede debate. Differences of interpretation and opinion should be impartially and unattributably recorded in meeting minutes. It is recognised that professional advice includes expert judgement in addition to objective or factual information, and wherever possible the degree of certainty and the rationale for judgements should also be recorded.
Further guidance on unanimity and dissenting views can be found in the JPAC Ways of Working.
Where possible, meetings should be held within an agreed regular schedule, but ‘extraordinary’ meetings may be held where there are unavoidable time constraints that may adversely impact donor or recipient care. Extraordinary meetings should be documented in the same detailed manner as routine meetings to ensure there is a clear audit trail showing how decisions were made.
Government devolution has empowered individual Health Departments to make their own policy decisions. Changes in the organisation and management of the Blood Transfusion and Tissue Transplantation Services throughout the UK, in 1997, resulted in the setting up of four National Services and the introduction of individual and statutory accountability vested in Chief Executives, for clinical governance and controls assurance.
The UK Forum was formed in 1999, consisting of the Chief Executives and Medical Directors of the four Services, and takes the lead in these discussions. Decisions on implementation and policy lie with the individual Chief Executives, their Service Boards and, where appropriate, their respective Health Departments. UK Forum agrees the Terms of Reference for JPAC.
The JPAC EWG, formed in 2005, coordinates the work of the individual SACs and reports to the overarching JPAC Board which itself reports directly to UK Forum through the Director.
SAC Chairs report on the progress of their previous year’s activities at an annual review meeting with the Professional Director of JPAC. Workplans are produced annually, agreed between the SAC Chair and the Professional Director, and indicate the topics planned to be covered during the year. The collated JPAC workplan is then submitted to UK Forum annually. New developments during the year may arise and take precedence on the agendas of any group.
The JPAC Office consists of the Professional Director of JPAC, the Deputy Professional Director of JPAC, the JPAC Scientific Publishing Manager, the Scientific Lead for Safety Policy (JPAC/SaBTO) and the JPAC Administrator.
Roles and responsibilities of the JPAC office are outlined in 3.2.
The JPAC Office reports to the EWG via the Professional Director.
Each SAC consists of subject matter experts led by a Chair.
Roles and responsibilities within SACs are outlined in 5.2.
The specific scope of each SAC is detailed in their own Terms of Reference, but a general remit applies to all (see 5.1). There are currently six SACs, but SACs may be established and disbanded according to the needs of the Services, following JPAC and UK Forum approval.
Further SAC sub-committees may be set up with the approval of the Professional Director. These may be long-standing sub-groups, such as the SACTTI Working Party on Parasitology and Blood Safety, or ‘ad hoc’ working groups convened to consider specific issues within a clearly defined timeframe. Short-life working groups report back to their parent SAC and are disbanded upon completion of the task.
All SACs report to the EWG via their Chair, who will submit their recommendations for changes to guidance to the JPAC Office in the first instance. Some recommendations can be approved by the Professional Director but, depending on the nature of the change involved, approval will be sought from the EWG and then, if further discussion is required beyond this level, be submitted for approval by the JPAC Board.
Details of the Delegated Approval system can be found in the JPAC Ways of Working.
The EWG consists of the members of the JPAC Office (see 2.1.1), the Chairs of the SACs and a Clinical Transfusion Medicine (CTM) Specialist who acts as a formal clinical representative to JPAC.
The EWG reports to the JPAC Board. The EWG is empowered to discuss and approve changes to guidance that do not require the attention of the full JPAC Board (see 4.1) but will report such approvals to the JPAC Board at the next relevant meeting.
The JPAC Board consists of the members of the EWG (see 2.1.3), the Medical Directors of the four Services, and representatives from the UK Quality Managers group (UKQM), the Irish Blood Transfusion Service (IBTS), the Medicines and Healthcare products Regulatory Agency (MHRA), MHRA South Mimms Laboratories (formerly the National Institute for Biological Standards and Control, NIBSC) and the Human Tissue Authority (HTA).
The JPAC Board reports to UK Forum via the Professional Director. The JPAC Board discusses and approves guidelines changes and informs UK Forum of progress against the JPAC workplan at the next relevant meeting.
Observers may attend EWG/JPAC or SAC meetings at the discretion of the Professional Director or SAC Chair, respectively. If requested, observers may act as meeting participants but decision-making and lines of accountability must be well documented.
Many organisations within the health system have increased their commitment to lay representation within their advisory and decision-making structures and processes. The skills and expertise of lay representatives with professional backgrounds, while not directly relating to its remit, can contribute considerably to JPAC’s work. Lay representation is defined as the inclusion of a representative who has personal experience of health or social care services relevant to the topics being discussed. Within the context of JPAC, this may include blood, tissue or stem cell donors and recipients, and advocates from relevant voluntary support organisations representing disease-specific patient groups or minority ethnic groups in the UK.
The JPAC Board includes permanent lay representation, appointed with the approval of the Professional Director of JPAC, according to the procedure described in the JPAC Ways of Working. Upon appointment of a lay representative, it is important that the purpose and reason for their inclusion is clear and that they understand the role that they are requested to fulfil within the remit of JPAC. Induction and ongoing support will be provided by JPAC Office.
While lay representatives provide valuable insight, the scientific and technical subject matter of SAC meetings means that permanent lay representation is not included on individual SACs. However, within their work programmes, SACs are expected to consult with lay representatives as part of stakeholder engagement where this is considered to be relevant and appropriate.
JPAC has a strong commitment to undertaking external stakeholder consultation when considered appropriate to a work programme. This may include relevant external organisations, lay representatives, or wider consultation with stakeholders that are permanently represented on the JPAC Board (e.g. MHRA, HTA, UKQM).
End-users are likely to include healthcare professionals that access the JPAC website, refer to the Red Book, Donor Selection Guidelines or Geographical Disease Risk Index, or those who read Position Statements and other documents issued by JPAC.
JPAC’s stakeholder and end-user engagement is informed by use of the Alliance of Blood Operators (ABO) Risk-Based Decision-Making Framework (RBDMF), itself designed to ensure appropriate end user representation in managing and communicating blood safety risk. The framework provides guidance to SACs on JPAC’s expectations relating to stakeholder consultation where it is appropriate to their work programmes. Explicit consideration of stakeholder consultation forms an integral part of the JPAC workplan, including timely identification of appropriate sources and justification, where needed, for not undertaking engagement at an early stage. More information on the ABO RBDMF can be found in the JPAC Ways of Working.
The JPAC Board is required to:
While JPAC is not responsible for implementation of guidelines within individual Services, it is important that JPAC is kept informed of implementation arrangements and dates across the UK Services. This is done through engagement with Quality Assurance Managers within each Service.
Any changes to the remit of JPAC must be approved by UK Forum.
The Professional Director of JPAC is required to:
The Deputy Professional Director of JPAC is required to:
The Scientific Lead for Safety Policy is required to:
The JPAC Scientific Publishing Manager is required to:
The JPAC Administrator is required to:
The EWG is required to:
Aside from the members of the JPAC Office (whose roles and responsibilities are outlined in 3.2) and the Chairs of the SACs (see 5.2.1), the EWG includes a CTM Specialist.
The CTM Specialist is required to:
All SACs and SAC sub-committees are required to:
The Standing Advisory Committee on Blood Components is required to:
The Standing Advisory Committee on Care and Selection of Donors is required to:
The Standing Advisory Committee on Immunohaematology is required to:
The Standing Advisory Committee on Information Technology is required to:
The Standing Advisory Committee on Cellular Therapy Products is required to:
The Standing Advisory Committee on Tissues is required to:
The Standing Advisory Committee on Transfusion Transmitted Infection is required to:
Individuals may contribute to a SAC in the following roles:
It is important to note that there is a degree of overlap within the roles given above, and some individuals may participate in multiple roles. When it is relevant to decision-making, the capacity in which an individual participates in proceedings should be clearly understood and documented.
For some SACs, lay representation (as outlined in the JPAC Ways of Working) is also encouraged.
SAC Chairs are required to:
Deputy SAC Chairs are required to:
Deputy Chairs will usually be existing SAC members. If there is no formal Deputy Chair, a SAC member may be nominated by the SAC Chair to temporarily deputise when required.
SAC Secretaries are required to:
SAC Secretaries will usually be existing SAC members. Appointing a Secretary is optional within each SAC, left to the discretion of the Chair, though it is encouraged if no formal Deputy Chair has been appointed.
SAC members will be appointed by the SAC Chair, in consultation with the Professional Director of JPAC. The number of members will be left to the discretion of the Chair, but generally no more than 10 would be expected on each SAC. There is no maximum period for membership although each SAC’s membership should be regularly reviewed by its Chair. SAC Chairs are expected to consider succession planning for outgoing members, and should aim to stagger the appointment of new and replacement members to avoid turnover of the whole committee at the same time.
Unless specifically stated otherwise, SAC members are appointed foremost as subject matter experts to fulfil the role of the SAC, rather than as representatives of their particular profession, employer or interest group. However, whilst appointments should be made primarily on the basis of individual expertise, achieving representative membership from across the four Services is encouraged, as it brings wider experience to the SAC and contributes to UK-wide consideration of the impact of decision-making.
It is also advisable that there are members from outside the UK Services to provide SACs with alternative perspectives from relevant stakeholders.
In view of the complexity of the guidelines, flexibility is required and all SAC members are expected to work responsively, efficiently and effectively.
The Guidelines for the Blood Transfusion and Tissue Transplantation Services in the United Kingdom (known as the Red Book) contain guidelines and standards to be met in the care and selection of donors and by the resulting components and products. The Red Book describes technical details of the processes involved but does not cover the clinical use of the components and products.
The contents of the Red Book are reviewed regularly. A Change Notification system is in place to ensure that new guidelines are communicated to the Services.
The Donor Selection Guidelines (DSGs) are supplements to the Red Book, divided into the following:
The entries within each DSG are reviewed regularly. A Change Notification system is in place to ensure that new guidelines are communicated to the Services.
The JPAC website is available at www.transfusionguidelines.org and is publicly accessible. The website hosts the Red Book and the DSGs, as well as the JPAC Document Library.
The website is maintained by the JPAC Scientific Publishing Manager and the JPAC Administrator, in conjunction with the third-party service provider.
The current version of the Red Book and each DSG is available on the website and is maintained as a digital (online) resource only. Previously published hardcopies of the Red Book are now considered obsolete.
Changes to the guidelines indicated by issued Change Notifications are reflected on the website on the date of publication. Each DSG entry indicates the version of the guidelines at which an update last occurred and describes the reasons for change from the previous entry.
Static versions of the live JPAC Donor Selection Guidelines are available to be downloaded for offline (i.e. non-networked) use, known as source files. These include:
The currently available Source Files represent the current live version of each DSG and a new source file is generated by the JPAC Office whenever a change is made to a particular DSG. During the Change Notification pre publication stage (i.e. Quality Assurance departments of the four Services have been informed of an upcoming change), both the current and new versions of the source files are made available on the website. When a Change Notification is published, the new version of the source file becomes the current version, and the previous version is removed from the website.
Guideline users can issue printed controlled copies of the Source Files but control of such copies is the responsibility of each Service. JPAC ensures that any changes to the live guidelines are equally applied to the Source Files (and informs Quality Assurance departments of the four Services through the Change Notification process) but is not responsible for informing individual users of changes to the files or a failure to update locally stored versions accordingly.
The Document Library is a repository for documents relevant to the Services. Some of the documents are issued by, or on behalf of JPAC, whilst others are directives, guidelines or advice originating from other sources.
Change Notifications are the formal notification path used by JPAC to notify users of its guidelines of upcoming approved changes to the Red Book and the DSGs. They describe the relevant changes (e.g. current, new and removed text), the chapter or DSG entry to which they will apply and the publication date.
Change Notifications are prepared by the JPAC Office and co-signed by the Professional Director of JPAC and the Chair of the relevant SAC responsible for the change.
The issuing of Change Notifications occurs in two stages:
The pre-publication period for Change Notifications is agreed between the relevant SAC Chair and the JPAC Scientific Publishing Manager, and will vary according to its scope and urgency:
Once published, Change Notifications are available on the website.
Risk Assessments of transfusion transmissible infectious agents are carried out by SACTTI on a rolling basis. Most Risk Assessments have a 2-3 year review period but are also updated whenever a significant change is identified.
A list of current Risk Assessments is available on the website. Full Risk Assessments are not routinely published for public access, although they may be requested from the JPAC Office.
Position Statements are reviewed regularly and revised as required. Updated Position Statements may also facilitate necessary revisions to the Red Book or the DSGs.
Current Position Statements are available on the website. Previous versions of Position Statements are available from the JPAC Office on request.
The website currently hosts two types of General Document:
Documents issued by JPAC are reviewed regularly and updated versions published as required. While the JPAC Office makes every effort to ensure the latest version of documents not issued by JPAC are available, it cannot guarantee those documents are reviewed regularly or that updated versions have been forwarded to JPAC Office for publication on the website.
Documents which have supported a change to the guidelines, usually submitted to a JPAC, EWG or SAC meeting as an accompanying paper, are made available on the website where applicable. Supporting papers which are not available in the Documents Library are available from the JPAC Office on request.