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Direct GP access to imaging tests ‘not cost-effective’

By Lilian Anekwe

Allowing GPs direct access to cancer imaging tests only leads to ‘minor reductions’ in referrals, a study has shown.

The Government has promised GPs easier and faster access to diagnostic tests, including a £750m investment in a major expansion of GP access to cancer diagnostics.

NHS Nottingham City brought in a scheme in 2009 to allow GPs direct access to brain MRI in primary care, to diagnose more serious malignancies in patients with headache, ‘in an attempt to demand manage the inexorable annual increase in neurology referrals’.

It was predicted that this strategy would save £50,000 and substantially reduce new patient referrals.

A study presented at the Association of British Neurologists annual meeting found GP referrals to neurologists fell by 3%, from 5,723 to 5,554. But in spite of the direct MRI access, 20% of patients were still subsequently referred to the neurology clinic within six?months of their MRI appointment, at an estimated cost of £80,000.

The audit of referrals to the neurology department in Nottingham found that over a 12-month period 169 scans were performed as a result of GP referrals.

The study also reported found that despite the PCT introducing guidelines for GP referrals, ‘there were some bizarre clinical indications including psychosis, neck pain and total body pain’.

‘Our department also received some unusual requests for information including whether it was safe to scan patients with dental fillings’, the research found.

Dr Adrian Wills, a consultant neurologist at Nottingham University Hospitals NHS Trust, concluded: ‘A minor reduction in new neurology referrals was demonstrated but cause and effect could not be established. In summary it appears that allowing GP’s direct access to brain imaging is not cost effective.’

A spokesperson for NHS Nottingham City said: ‘This was a new service pilot and as such has been kept under review. The results of our review suggest that the majority of scan requests are appropriate and that the rate of positive and incidental scans ordered by GPs is the same as local consultant neurologists.

‘With onward referral rates of 17%, patient satisfaction very high and an estimated financial saving of more than £31,000 we do feel this service has delivered some of the benefits we were looking for.’

Improved GP access to cancer diagnostics ‘not cost-effective’