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MRI study boosts drive for direct GP access to diagnostic tests

Moves to provide GPs with direct access to diagnostic testing have been boosted by research finding benefits for streamlining access to MRI in patients with knee problems.

A trial in 550 patients, from more than a 100 GP practices across the country, found a small but significant improvement in knee-related quality of life with the direct access scheme.

There was also a non-significant improvement in physical functioning.

The study comes with SHAs planning to give GPs increasing access to diagnostic tests under Lord Darzi's plan for the NHS, in a bid to reduce waiting times for patients.

A second study by health economists at the University of Birmingham found although the health gains under the MRI trial were small, the extra costs were minimal and the scheme was cost-effective.

Early MRI cost the NHS an additional £294 per patient at an incremental cost per QALY gained of £5,840.

Dr Stephen Brearley a researcher at the York Trials Unit, which carried out the effectiveness study, said on face value the two studies may seem conflicting.

‘It didn't produce that much benefit to patients. But the NHS is investing billions of pounds on diagnostic tests and this shows if you invest extra resources it is an efficient use of money. Just don't expect much gain in quality of life for patients.'

But he did point out that patients in the study were given a specialist orthopaedic appointment at the same time as offered early MRI so waiting times were not affected.

In the real world, the system would be used as a triage, so would potentially free up appointments for those who really needed them.

Dr Louise Warburton, a musculoskeletal GPSI who works in Shropshire, said she was in favour of GPs having direct access to MRI.

‘There's a lot of people who you wouldn't refer to orthopaedics but who you could refer to physiotherapy, so I'm sure it would reduce the number of referrals.'

She cautioned that a similar scheme in her area for MRI of the back and shoulder had not worked as GPs had not been comfortable in interpreting the results.

‘But an MRI of the knee is fairly straightforward as the reason is to make sure you don't have cartiliage damage or a ligament tear and if it doesn't show that it can be easily managed in primary care.'

Both studies are published in the British Journal of General Practice.

Dr Louise Warburton: in favour of GPs have direct access to MRI Dr Louise Warburton: in favour of GPs have direct access to MRI The move towards direct diagnostic access

Sept 07 - A trial of more than 4,000 patients in 16 countries suggests giving GPs access to natriuretic peptide blood tests could improve the diagnosis of heart failure in over 60s

March 08 - Research shows allowing GPs direct access to diagnostic testing for gastro-intestinal cancer dramatically cuts need for hospital appointments and is highly cost-effective

May 08 - Four SHAs – NHS Yorkshire and the Humber, NHS East of England, NHS South West and NHS South Central – have revealed 10-year plans to hand GPs greater access to diagnostic tests and other hospital services, acting on Lord Darzi's plans

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