Optimal testing in GP practices

Laboratory tests are on the rise in UK healthcare. Half of the tests ordered by GP practices are to monitor long-term conditions such as high blood pressure, diabetes and chronic kidney disease. There is some evidence and guidance on which tests people with chronic diseases should receive and how often they should be tested, but there’s a lot of variation in which laboratory tests GP practices order. When researchers asked 20 GP practices in North Devon what tests they ordered for these patients, no two practices were the same.

Testing is generally considered a good thing, but unnecessary tests can cause problems, such as false alarms. If test results are abnormal, further tests or referrals might be needed to find out what’s wrong. This can be worrying for patients. Sometimes doctors may never find a cause for an abnormal blood test.

Unnecessary testing can also lead to over-diagnosis: diagnosis of a condition which would never have caused problems during a patient’s lifetime. Unnecessary testing also impacts GP workload, as the results need to be reviewed and abnormal results must be investigated. On the other hand, failure to test may lead to missed diagnoses, complications, patient harm and legal action.

Project aims

This project aims to develop recommendations on which tests people with high blood pressure, diabetes and chronic kidney disease should have to monitor their condition.

As a first step we will use routine data collected from GP practices on which tests are being ordered for these patients, to see how much variation there is. We will then review national guidelines and the recommendations they make. We will also review studies that have already been done on this topic. An expert group will discuss the results and plan a grant application for a larger study.

Anticipated impacts

The learning from this project could reduce unnecessary variation in routine monitoring of chronic conditions in primary care. This is likely to mean fewer tests are performed. We will also create methods for other researchers to use to develop testing recommendations for other long-term conditions being treated in GP surgeries.

Lead collaborators

  • Ed Mann, Tyntesfield Medical Group
  • Katharine Alsop, Nightingale Valley Practice