Threefold rise in GP diagnostic tests prompts workload warning

The number of diagnostic tests and scans ordered by GPs has more than tripled in the past 15 years, with significant implications for GP workload, a new study has found.

(Photo: iStock.com/JazzIRT)
(Photo: iStock.com/JazzIRT)

The researchers estimated that the average GP now spends 1.5 to 2 hours reviewing test results each workday and highlighted that greater test use could lead to more consultations. ‘Our results support other evidence that suggests general practice workload in the UK is reaching saturation point,’ the study said.

The study authors suggested that NHS service changes, such as expanded access to diagnostics, the shift in services from secondary to primary care and the increased focus on managing long-term conditions could be some of the reasons behind the increase.

Researchers at Oxford, Bristol and Southampton universities looked at the change in the number of tests ordered by UK GPs between 1 April 2000 and 31 March 2016 using the Clinical Practice Research Datalink (CPRD).

The study - published today in the BMJ - found that the number of GP-ordered tests rose from 14,869 tests per 10,000 person years in 2000/01 to 49,267 tests per 10,000 person years in 2015/16 - a 3.3-fold increase.

Diagnostic tests

The study looked at all tests recorded, which were grouped into three categories: laboratory, imaging, or miscellaneous. The miscellaneous group included tests such as spirometry, upper endoscopy, colonoscopy, cervical smears and electrocardiography. The researchers also looked at 44 specific tests (28 laboratory, 11 imaging and five miscellaneous).

The use of all types of test increased ‘statistically significantly’ over the study period, as did 40 of the 44 specific tests.

Along with service changes being behind the rise, researchers also said the increase could reflect a greater expectation from 'increasingly-informed' patients that they should be tested. They added that testing may also be used by GPs for '"strategic, non-medical reasons" such as reassuring patients and ending consultations'.

However, the researchers said that because this was an observational study, 'no firm conclusions can be drawn about cause and effect'.

'Completely appropriate'

Overall, the researchers estimated that the total number of tests ordered by general practice in 2015/16 cost the NHS £2.4bn – £1.8bn for lab tests, £400,000 for imaging, and £600,000 for miscellaneous tests.

RCGP chair Professor Helen Stokes-Lampard said that, given the growing and ageing population, the increase in multimorbidity and improvements in diagnostic tests, the rise in the number of GP-ordered tests was 'completely appropriate'.

'GPs are in an incredibly difficult position when it comes to making referrals or ordering blood tests and other investigations, in that we get criticised when we do, and criticised when we don’t,' she said. 'Ultimately, our priority is to our patients and we will work in their best interest.

'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 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.’

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