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GPs to be ranked on lab test use

Exclusive: GPs will be benchmarked on the laboratory tests they order under Government plans to cut the cost of pathology services by 20% over three years, Pulse can reveal.

Ministers aim to arm CCGs with information on variation in requests from GPs and their adherence to NICE guidelines, after audits showed request rates differed by up to 100-fold between practices. But GP leaders warned the move could add to the ‘big black cloud' of performance management from CCGs, as they scrabble to find savings under QIPP.

Dr Ian Barnes, national clinical director of pathology, told a meeting of pathologists earlier this year a ‘major culture shift' was required in use of lab services, and that the Department of Health was determined to implement cost-cutting recommendations from the 2006 Carter review.

He highlighted data from Connecting for Health pilots showing request rates from GP practices varied by over 100-fold for rheumatoid factor, and nearly 30-fold for parathyroid hormone: ‘A minimum of 20% efficiency savings are required. We need to change working practices.'

The DH said it had asked the NHS Information Centre to collate data on GP requests extracted from the pathology messaging system: ‘Such an approach, if supported by commissioning groups, will enable analysis of variance linked to population and disease prevalence. It will also allow the NHS to monitor adoption of standards suggested by NICE.'

The DH said it was looking at whether there was any correlation with testing rates and further diagnostic steps, potentially showing whether the testing thresholds of GPs were too high.

A review of pathology services by Lord Carter in 2006 found they should be ‘streamlined' and set up as independent networks from hospitals.

Pulse has learned NHS managers across the country are beginning to reconfigure pathology services. Trusts are developing ‘demand management' strategies and electronic systems to reduce duplication of tests by GPs.

NHS Midlands and East launched a consultation last month on a scheme to save £30m, and plans to reduce ‘duplicate testing' by developing ‘better communication and IT solutions'.

NHS London is to reconfigure pathology services, including plans for GPs to send all results with their referral to prevent duplication.

Dr Robert Morley, executive secretary of Birmingham LMC, said there were ‘enormous' differences in testing rates, but variation should not be used to performance manage GPs.

‘I fear this exercise will be done neither properly nor for the right reasons,' he said.

‘We all know the big black cloud of performance management is looming large over us with the advent of the NHS Commissioning Board, who will use CCGs to do their dirty work.'

Dr Richard Dales, secretary of Herefordshire LMC, said: ‘I suspect a rigid approach via NICE guidelines may increase testing rather than decrease it.'