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December 2018

Number of diagnostic tests rises threefold in 15 years

More than three times as many diagnostic tests are being ordered in general practice than 15 years ago, shows a study published in the BMJ.

The increase is attributed to the increase in services previously provided in hospitals that are now provided in primary care, and to more monitoring of patients with long term conditions.

The tests are costing the NHS in excess of £2.8bn a year and ordering them and reviewing their results has increased workload pressure in general practice, the authors say.

Using a database of patients registered with general practices, the study found that between 2000-01 and 2015-16 the number of tests ordered per 10,000 person years increased 3.3 fold from 14,869 to 49,267, an increase of 8.5% a year.

On average, patients now have five tests per year, compared with 1.5 in 2000-01.

A total of 44 specific tests were looked at, including laboratory tests, imaging, spirometry, cervical smears, and electrocardiography.

RCGP chair Professor Helen Stokes-Lampard said: ‘GPs are in an incredibly difficult position when it comes to making referrals or ordering investigations, in that we get criticised when we do, and criticised when we don’t.

‘This research looks at the increase of number of requests for tests, but not the reasons why and whether they were appropriate – and both of those must be key when making a judgement about whether an increase is positive, or not.

‘The fact that the last 15 years have seen more varied and more accurate diagnostic tests become available in the NHS is a good thing – but these do come at a cost. It’s obviously important to consider NHS resources when deciding to make a request for a test, but GPs and their teams don’t take the decision lightly, or if they don’t think they will genuinely help in narrowing down what might be wrong with a patient.

‘We’re now serving a growing and ageing population, and where many patients are living with multi-morbidities, so, as this report shows, there will be a completely appropriate increase in the number of tests being carried out in the community as these conditions and the medications used to treat them are monitored. We would argue that GPs and our teams need far better access to diagnostic tests in the community, so that we can make a more informed decision about requesting more specialised tests or making a referral to a hospital colleague.’