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GP workload warning as primary care diagnostic testing increases threefold

GPs are ordering three times as many diagnostic tests as they did 15 years ago, a study has found.

Researchers estimate GPs are now spending up to two hours a day reviewing test results, pushing GP workload to 'saturation point'.

The researchers suggest reasons for the hike in diagnostic tests are related to GPs providing more services than they did 15 years ago, including more long-term conditions monitoring.

The study, led by researchers from the University of Oxford, looked at data for around 250m tests that were ordered by GPs between 2000/01 and 2015/16. 

It concluded that:

  • The age and sex-adjusted rate of total test use increased from 14,869 tests per 10,000 person years in 2000/01 to 49,267 in 2015/16.
  • In 2015/16, patients had on average five tests per year compared to 1.5 per year in 2000/01.
  • The annual rate of test use increased significantly after the introduction of QOF in 2004 and this rate was highest in over-85s, increasing by nearly 6% between the introduction of QOF and 2015/16.
  • Renal function, full blood count and liver function tests were the most ordered tests throughout the study, with vitamin D tests, knee MRI and pelvic CT showing the greatest increases after the introduction of QOF.
  • Overall, around 90% of the specific tests looked at in the study saw increases in use during the study period. 

As a result, researchers estimate that the average GP 'spent 1.5 to two hours reviewing test results each workday in 2015/16', which they said was 'more than threefold increase from the estimated 2000/01 figure of 25 to 35 minutes daily'.

The paper said: 'Our results support other evidence that suggests general practice workload in the UK is reaching saturation point.'

The researchers suggested policymakers use the study results to 'assess trends in the use of tests' and as 'guidance for future healthcare resource planning'.

RCGP chair Professor Helen Stokes-Lampard said: '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. Ultimately, our priority is to our patients and we will work in their best interests.

'This research looks at the increase of number of requests for tests GPs make, 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.'

BMA GP Committee chair Dr Richard Vautrey said: 'This rapid change, with practices now doing a lot of clinical activity that was traditionally done in hospitals, has had a major impact on workload as it has not been matched by the necessary increase in resources, and therefore the Government should recognise this by addressing this in their forthcoming long-term plan for the NHS.'

BMJ 2018; available online 28th November

Readers' comments (8)

  • Dear All,
    ....and every single on of those Vit D tests was a complete waste of time. Daily Mail medicine persists.
    regards
    Paul C



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  • THE REASON IS BECAUSE WE ARE ALL "LIVING IN FEAR" OF PATIENTS ON A DAILY BASIS... THANKS TO THE "DAILY NUTTER" AND THE GOVERNMENT.

    I HAVE NOTICED THAT CONSULTANTS THESE DAYS SEEM "IMMUNE" TO ANY COMPLAINTS WHILE THERE HAS SEEMINLGY BEEN AN ESCALATION IN "VEXATIOUS" COMPLAINTS AGAINST GPS WHO ARE SEEN AS EVIL, LAZY AND STOPPING PEOPLE GETTING WHAT THEY WANT.

    I CAN HONESTLY SAY THAT I CAN'T THINK OF A WORSE CHOICE THAN GENERAL PRACTICE

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  • Vinci Ho

    (1) No doubt , whether we like it or not , the reality is the boundary between generalist and specialist is more blurry these days at the level of diagnostician (not therapist yet) , as far as NHS GPs are concerned.
    (2) The pendulum clearly has swung to one extreme because of shifting workload (as well as liability) to GPs driven by austerity in last 10 years.And there is no braking system or in fact , technocrats did not care to have a braking system . Kill the chickens to get the eggs and now there are not that many left .
    (3) The amount of knowledge and skills needed to be an ‘average’ GP is certainly different as well . But fundamentally , time for upskilling while coping with daily workload is one essential resource. Ironically, this requirement to be more ‘knowledgeable’ could be an reason to attract more of our youngsters to join this career but stakeholders must look at this issue seriously and this can only happen if the resources are laid down precisely.

    Once again , my slogan still rings , ‘ the government needs us more than we need it.’
    😑😶

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  • Vit D waste of time mainly as done in wrong patiernts...knee mri isnt a GP test on the whole...argueably CT pelvis sint either - referral to specialist 1st

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  • Vincent, you are right, of course...
    The government do need us more than we need them BUT they are either thick or in denial because only a criminally insane moron would continue "terrorising GPs" with such a huge GP shortage...draw your own conclusions.

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  • Consultations are up 3X as well. Profit has fallen in NI from 80 to 60 pounds average while workloads have trebled. And we persist with the Contract that pays per patient. Of course, the DOH loves it. I think we are mugs for doing it. But the GP trainee numbers have increased, so why would the DOH pay per appointment, when it can get everything extra not only free but for less money?

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  • David Banner

    Re Paul Cundy ,
    Bang on. The runaway train of utterly useless Vit D testing has been a total farce and a scandalous squandering of scarce resources. This pointless test should be banned in Primary Care, vit D should be blacklisted from prescription except in specific patient groups , and Secondary Care need to stop randomly testing then dumping responsibility back on GPs.

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  • As long as we accept these conditions and do little else apart from moan about them, this insane hamster wheel of working in General Practice will continue. As comments above note, why would the powers that be change a system that gets more than its pound of flesh and more from us. WE need to speedily continue to vote with our feet by RLE as the cavalry isn’t coming. It’s just such a slow and painful death for us.

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