Temporal growth and geographic variation in the use of laboratory tests by NHS general practices: using routine data to identify research priorities

Busby, John; Schroeder, Knut; Woltersdorf, Wolfram; Sterne, Jonathan AC; Ben-Shlomo, Yoav; Hay, Alastair; Hollingworth, William
April 2013
British Journal of General Practice;Apr2013, Vol. 63 Issue 609, pe256
Academic Journal
Background: Laboratory tests are extensively used for diagnosis and monitoring in UK primary care. Test usage by GPs, and associated costs, have grown substantially in recent years. Aim: This study aimed to quantify temporal growth and geographic variation in utilisation of laboratory tests. Design and setting: Retrospective cohort study using data from general practices in the UK. Method: Data from the General Practice Research Database, including patient demographics, clinical details, and laboratory test results, were used to estimate rates of change in utilisation between 2005 and 2009, and identify tests with greatest inter-regional variation, by fitting random-effects Poisson regression models. The study also investigated indications for test requests, using diagnoses and symptoms recorded in the 2 weeks before each test. Results: Around 660 000 tests were recorded in 230 000 person-years of follow-up. Test use increased by 24.2%, from 23 872 to 29 644 tests per 10 000 person-years, between 2005 and 2009. Tests with the largest increases were faecal occult blood (121%) and C-reactive protein (86%). There was substantial geographic variation in test utilisation; GPs in some regions requested tests such as plasma viscosity and cardiac enzymes at a rate more than three times the national average. Conclusion: Increases in the use of laboratory tests have substantial resource implications. Rapid increases in particular tests may be supported by evidence-based guidelines, but these are often vague about who should be tested, how often, and for how long. Substantial regional variation in test use may reflect uncertainty about diagnostic accuracy and appropriate indications for the laboratory test. There is a need for further research on the diagnostic accuracy, therapeutic impact, and effect on patient health outcomes of the most rapidly increasing and geographically variable tests.


Related Articles

  • GPs are baffled over pay.  // Pulse;2/23/2004, Vol. 64 Issue 8, p1 

    Reports that general practitioners in Great Britain are struggling to work out their practice income and potential pay rise for the year 2004. Possible percentage of basic income that comes from the British government's minimum practice income guarantee (MPIG) correction factor; Remarks by...

  • Compromise on enhanced services pay. Lepper, Joe // Pulse;2/23/2004, Vol. 64 Issue 8, p4 

    Reports that general practitioners (GP) in Great Britain are making compromise deals with primary care organizations (PCO) to set up lower-paid versions of national enhanced services. Proposal to set up local enhanced services that involve less work for GP; Compromise plans by PCO in Surrey and...

  • Make use of GPs' business acumen.  // Pulse;2/23/2004, Vol. 64 Issue 8, p4 

    Reports on the statement by British National Health Services Confederation lead negotiator Mike Farrar that primary care organizations need to use general practitioners' entrepreneurship abilities when implementing the general medical service contract. Involvement of GP in management.

  • NHS leadership council 'sidelines' primary care.  // GP: General Practitioner;5/1/2009, p16 

    The article reports on the development of the Great Britain's National Health Service (NHS) Leadrship Council in Great Britain. It reveals that the council will be responsible in enhancing the primary care services provided by NHS across the country. However, David Jenner of NHS Alliance raises...

  • Exclusive - PCTs admit to freezing PMS pay. Ireland, Tom // GP: General Practitioner;9/25/2009, p1 

    The article reports that the Primary Care Trusts (PCTs) have declined to award uplifts to Personal Medical Services (PMS) despite the advice from the Department of Health (DoH) in Great Britain. It mentions that 42 percent of general practitioners (GP) partners work under the contract of PMS. It...

  • Did the NHS Plan actually deliver? Ireland, Tom // GP: General Practitioner;5/1/2009, p18 

    The article reports on the review conducted by the All Party Parliamentary Group for Primary Care and Public Health on the performance of the National Health Service (NHS) Plan in Great Britain. The group stresses that NHS has failed to meet its goal of providing efficient primary care and was...

  • NHS statistics show a drop in GP complaints. Lepper, Joe // GP: General Practitioner;11/23/2007, p14 

    The article reports on the statistics from the Information Centre for Health and Social Care of the National Health Service of Great Britain. The figures show a 2 percent decrease in written complaints across family health services, from 43,349 in 2005/6 to 42,592 in 2006/7. There was a marked...

  • GPs who sell substandard surgeries set for windfall. Cameron, Ian // Pulse;1/13/2003, Vol. 63 Issue 2, p12 

    Focuses on the scheme developed by the government to compensate the negative equity of general practitioners (GP) in Great Britain. Factors influencing GP to sell substandard surgeries through the National Health Service (NHS) Local Improvement Finance Trust; Accounts on the apprehensions felt...

  • Cleared GP still cannot practise.  // Pulse;2/3/2003, Vol. 63 Issue 5, p20 

    Focuses on the refusal of the National Health Service to grant a general practitioner permission to return to practice in Manningtree, Essex, England.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics