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GPs to refer ‘straight to test’ at ‘one-stop-shop’ diagnostic centres

lab samples

GPs will be able to refer patients directly for diagnostic tests at new community diagnostic hubs, NHS England has revealed.

Access to phlebotomy services should be standardised across the country so that testing is available six days a week in the community, potentially in GP practices, it said.

It comes three years after a GP trial launched in South Wales for a ‘one-stop-shop cancer diagnostics service – an idea first proposed in Wales’ 2016 cancer plan.

A major report accepted by NHS England today set out how the NHS will overhaul the ‘wasteful’ delivery of diagnostic services such as MRI, CT scans and phlebotomy.

‘One-stop-shop’ community diagnostic hubs should be set up across England away from hospitals, perhaps in free high street spaces or retail parks, it said.

The report, commissioned by NHS England under the long-term plan, said new ‘safe pathways’ for diagnostics should build on transformation such as telephone and virtual GP consultations, risk stratification tools and ‘patients being directed straight to test’.

It added that a ‘large proportion’ of elective diagnostic tests could also be delivered within the community.

GP practices could also have a greater role in phlebotomy services, taking referrals for blood tests from both primary and secondary care, the report recommended.

It said: ‘It is essential that these services are provided in the community and outside hospital settings. These could also be provided in a range of locations, including GP practices, high street pharmacies and CDHs.

‘At present,the provision of community phlebotomy services is highly variable. In some CCGs, GP surgeries are able to provide this five or six days a week. This level of provision should be the norm for all patients, with services being provided within primary care or other locations if more appropriate.’

Primary care networks  (PCNs) could designate one practice to deliver blood tests for patients who have not been tested for Covid-19 , the report added.

PCNs could also provide some of the ‘simpler’ cardiorespiratory tests, although this will be for ‘local decision making’, it said.

Meanwhile, the report said that GPs must have access to ‘expert advice and guidance’ as well as ‘clinical decision aids’ so that the ‘most appropriate investigations are requested’.

Point of care testing (POCT) for local monitoring of chronic diseases, health checks and ‘assessing patients who are deteriorating or acutely unwell’ is also being ‘introduced and evaluated’ in GP practices, it added.

Report author Professor Sir Mike Richards – who was the first NHS national cancer director and the CQC’s chief inspector of hospitals – said: ‘The pandemic has brought into sharper focus the need to overhaul the way our diagnostic services are delivered. 

‘While these changes will take time and investment in facilities and more staff, it is the right moment to seize the opportunities to assist recovery and renewal of the NHS.’

Other recommendations in the report include:

  • Separate testing for emergency and elective diagnostics to reduce delays
  • The doubling of CT scanning capacity over the next five years to meet increasing demand
  • Enhanced tests for heart and lung diseases due to coronavirus link
  • Urgent expansion of the imaging workforce with 2,000 additional radiologists, 4,000 radiographers and other support staff
  • More staff trained to undertake screening colonoscopies

NHS England said it would begin to introduce the measures ‘with immediate effect’ via a national Diagnostics Programme Board co-chaired by national medical director for England Professor Stephen Powis and national director of improvement Hugh McCaughey.

NHS England board papers published today said: ‘Some changes can be introduced with immediate effect and are already being incorporated into regional and system recovery plans, including the planning of hub-based diagnostics models in several locations.’

Detailed plans will be finalised once the budget is confirmed, but a ‘rolling programme’ of investment is ‘envisaged’ for 2021-25, the papers added.

It comes as researchers found that the number of new diagnoses of common conditions in primary care has halved during the height of the pandemic – leading to a potential ‘rebound’ in workload as patients come forward.

And NHS England said last month that GPs should use advice and guidance services to keep patients away from hospital.



Please note, only GPs are permitted to add comments to articles

Vinci Ho 1 October, 2020 10:56 pm

Oh dear
The maverick to ‘transform’ primary care but not actually work in general practice…..

Roger Neal 2 October, 2020 9:01 am

Why cant this happen in normal general practice? Block contracts are part of the problem. Our practice phlebotomy service is overwhelmed now because we cant appoint another phlebotomist because there is no more money.

Iain Chalmers 2 October, 2020 12:21 pm

Oh yeah. Lack of diagnostics has been highlighted before and even had buckets of transformation money thrown at it locally.

I would rank this with the 5000 magic GP’s that are coming.

Basically writing a report is ok but rolling sleeves up and helping actual delivery would impress me more.

With this twaddle wonder how long I can even stick 1/2 time

David Mummery 2 October, 2020 4:51 pm

The is basically the logical extension of the hot hubs : telephone consult 80%, those that need F2F go to these ‘diagnostic hubs ‘ for ‘escalated care’. Lots of GP building space now not needed = cost savings.

Michael Caley 2 October, 2020 5:59 pm

Heads up guys. Straight to test really means – GP assesses patient, GP orders test, GP receives test result, GP has appt with patient to explain results, GP has to do advice and guidance to get more advice on results, GP asked to do more tests, GP gets more results, GP had to refer to clinic.

You know – I prefer just – refer to clinic and let them do the secondary care stuff

Patrufini Duffy 2 October, 2020 8:37 pm

Now you want to build a 5* hotel with convenient procurement processes and middle men. World class. You realise your hypochondriac public will overhaul this in a second once they know they exist. Look what happened with free covid tests, they wasted them after trips to Ibiza like they waste and laugh at GP appointments. Symmetrically assymetrical.

John Puntis 6 October, 2020 6:46 pm

Totally unrealistic unless massive investment in kit (e.g. we are virtually worst in OECD for MRI ad CT scanners) and staff – 11,000 needed. Where will they come from? No money and no plan for staffing to provide basis for implementing the proposals in this report. Like much of Long Term Plan (from where it originates) aspirational – but now over to government to change its policies and invest to get NHS back on its feet including transformational deal for staff, and without throwing contracts at the perenially inefficient private sector. Dont hold your breath.