Chris Lancelot - Focusing on simple tests can save lots of money

Despite reminders about reducing NHS expenditure, few realise what huge savings could be made through more focused use of imaging and lab tests. Some PCTs have cottoned on - but in typical PCT fashion, by imposing a blanket ban on the more expensive investigations, such as MRI scans.

The GP Record, by Fran Orford www.francartoons.com
The GP Record, by Fran Orford www.francartoons.com

But there are better ways to save money. Although individual MRIs are costly at around £365 each, their judicious use - especially in back pain - may avert an expensive and otherwise unnecessary referral. By contrast, 'ordinary' blood tests can be vastly more wasteful of resources. How many of us arrange lab tests almost without thinking, and without realising just how expensive they are? Exact charges vary, but an FBC costs around £10; U&Es £7; LFTs £10 and TFTs £20. So a basic screen of FBC, ESR, U&E, LFTs, CRP, TFTs and glucose will cost the NHS £60.

As a one-off this isn't too bad - except that this scenario is being repeated, nationwide, tens of thousands of times each day. To us it's routine - like taking a BP, only more costly.

Indeed, individual prices mean little. It is cost multiplied by volume which causes the true expense. It's so easy to spend money on a whim: 'We need another creatinine - and while we're at it, do another FBC ...'

Doctors must waste millions each year like this. It isn't efficient. Yes - an MRI scan is expensive, and we think carefully before ordering one: but performing just FBC, U&E and LFTs on 13 occasions (easy in a single day) will cost roughly the same, with much less chance of finding any important abnormalities.

And I'm as guilty as anyone. Until recently, I hadn't realised just how expensive basic lab tests were. With no financial imperative, I also hadn't developed a clear concept of the frequency (or rather, infrequency) with which certain investigations need be carried out - for example, LFTs after full stabilisation on statins.

With the impending shift of work from secondary to primary care, and with referrals under constant scrutiny, GPs must have all necessary investigations available to them. Rather than limiting us by type of investigation, PCTs need to support us over targeting investigations efficiently, while recognising the importance of the more expensive tests in avoiding unnecessary referrals.


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