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Put cap on requests for tests

From Dr David Church, Machynlleth

The doctors here have been trying for some time to get patients to turn up spontaneously for blood tests when they are due (eg for UE checks for hypertensive patients on diuretics).

We already run systems where patients are encouraged to make their own appointments with the phlebotomist or practice nurse for blood tests for HbA1c, INRs, lithium, thyroid replacement monitoring, and many others.

They do not need to see the GP first for 'permission', although an annoyingly high number still do!

On the other hand, our staff are aware of the maximum frequency tests should be allowed and would advise patients when they do not need repeat testing (eg lipids more than twice in a month to see if their margarine is expensive enough, PSAs when they have no indication for it, etc).

If unnecessary tests are allowed from other outlets without some limit, they should definitely not be charged to the NHS, but paid for privately.

Only tests essential to the care of the patient should be paid for by the NHS. Whole-body CT scans, for example, which are never of clinical use but carry a high radiation exposure and risk of false-positive abnormal results, should not be available without prior NHS recommendation (ie never).

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