Tests ordered by GPs cost NHS around £ 2.8bn per year
Thursday, 29 November 2018
GPs are now ordering more than three times as many diagnostic tests for their patients as they were 15 years ago, shows a study * published today in The BMJ.
Researchers found that the NHS costs more than £ 2.8bn a year, but the development is due to the fact that GPs now provide more services previously provided by hospitals and they monitor more patients with chronic illnesses.
A team of researchers from the universities of Oxford, Bristol and Southampton used the Clinical Practice Research Datalink (CPRD) to look at the change in the number of tests ordered by general practice between 1 April 2000 to 31 March 2016.
They 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 – representing an 8.5% increase per year.
On average, patients in 2015-16 had five tests per year, compared with 1.5 tests in 2000-01, the results showed, and the increase in the number of tests ordered was slightly higher in men (3.4 fold increase) than in women (3.3-fold increase), but greatest in older patients (4.6-fold increase for patients aged over 85 years).
The researchers looked at 44 specific tests including 28 laboratory tests, 11 imaging tests, and five miscellaneous tests, such as spirometry, cervical smears, and electrocardiography.
Significant rises in the number of tests ordered were seen for 40 of the 44 individual tests and across all three different test groups (laboratory, imaging and miscellaneous).
Increased testing may be partly due to changes in NHS service provision, they argued, citing examples that over the study period:
- GPs' ability to order diagnostic tests (particularly imaging) expanded
- many services were diverted from secondary to primary care requiring tests to be ordered by GPs rather than hospitals
- the QOF, which incentives GPs to monitor chronic disease using laboratory tests, was introduced.
Increased testing could also reflect the increasing number and duration of consultations in general practice with tests being used for "strategic, non-medical reasons", such as reassuring patients and end consultations, they added.
It could also reflect higher expectations from patients for tests.
The authors admit this was an observational study, so no firm conclusions could be drawn about cause and effect.
Nevertheless, they said: "Whatever factors contribute to increased test use, our results are likely to have major implications for general practitioners' workload. Greater test use is likely to lead to more consultations and an increase in non-consultation workload. "
Assuming it took up to three minutes to review a test, the authors estimated that the average GP spent 1.5 to two hours reviewing test results each workday in 2015-16.
Estimates from NICE put the average cost of a laboratory test at £ 6, an imaging test at £ 29 and a mixed test at £ 53, so the authors estimated that tests ordered by general practice cost £ 2.8bn in 2015-16 – £ 1.8 bn for laboratory tests, £ 400,000 for imaging, and £ 600,000 for miscellaneous tests.
Professor Helen Stokes-Lampard of Royal College of General Practitioner, Professor Helen Stokes-Lampard, said: "This research looks at the increase in the number of requests for GPs tests, but not the reasons why and whether they were appropriate. judgment on whether an increase is positive or not.
"It's obviously important to consider NHS resources when deciding to make a request for a test, but GPs and their teams do not take the decision lightly, or if they do not think they will genuinely help in narrowing what might be wrong with and patient. "
* O'Sullivan JW, et al. Temporal trends in the use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests. BMJ 2018; 363: k4666. DOI: 10.1136 / bmj.k4666