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What does the future hold for lab services?

To mark our new clinical series on interpreting lab test results, Dr Ceridwen Coulson discusses the future of lab services

To mark our new clinical series on interpreting lab test results, Dr Ceridwen Coulson discusses the future of lab services

Because much of the work is conducted away from the patient, there is a risk of viewing laboratory medicine as a non-clinical service. But some 80% of diagnoses and many decisions in chronic disease management involve lab tests.

Many GPs use a fairly limited repertoire of lab tests in everyday practice: 25 routine tests account for more than 90% of GP activity in our labs. ‘Barn door' results can be straightforward to interpret, although there are pitfalls.

And increasing numbers of doctors leave medical school with limited formal training in the use and interpretation of routine lab tests.

As new tests become available it is important that GPs expand their repertoire.

Developments

Other areas for development include rapid access to diagnostics in convenient locations. More blood tests may be carried out in primary care or in patients' homes and we are also likely to see phlebotomy and sample drop-off services made more accessible.

The second independent review of pathology services is expected in the autumn when an emphasis on quality is expected. The Darzi report stressed it should be easier for patients to access information about their care.

Clinicians will need to have rapid access to reliable information to choose the right test at the right time. They will have to know how to interpret and explain the result, especially as web-literate patients may come armed with probing questions.

Electronic test requesting systems are also being introduced and will gradually become more interactive.

A world of tariffs and Payment by Results can produce perverse incentives to overuse some tests or underuse others. Nevertheless, as technology improves, the possibilities for laboratory medicine to make an even greater contribution to patient management also increase.

Regardless of how the NHS operates, this progress can only lead to better patient care.

Dr Ceridwen Coulson is consultant chemical pathologist at the North Bristol Trust and director of clinical practice for the Association for Clinical Biochemistry

Further reading

labtestsonline.org.uk is a general resource for patients to explain how tests are used in different situations.

bettertesting.org.uk is a website for professionals, containing frequently asked questions, but may also be useful for patients seeking answers in specific situations

www.cks.library.nhs.uk is a primary care guidance resource on the whole patient management process including diagnosis, referral, treatment and follow-up

Lab testing

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