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Hello Greg,
This is a valuable project because commissioning groups appear (anecdotally) to concentrate on interventions. We need to put diagnosis under the spotlight too. I am certain that you will not pursue this with only money in mind because some of the investigations you list have harm associated with them (particularly radiation).
Here is my suggestion (purely anecdotal):
Pelvic ultra-sound for young women with non-specific pain. Potential harm: anxiety on discovery of insignificant cysts.
CT scans for headache. GPs have been give direct access to reduce neurology referrals. Potential harm: radiation. Alternative less harmful procedure: a neurological examination, accompanied by commentary e.g. "Looking at the back of the eye tells us a lot about the brain", reassures 99% of patients. 

For those outside the UK, we should explain that over the next two years, general practitioners will be given the budgets to commission health care services with the hope that this will reduce spending. These new constraints were introduced in a government paper called "Equity and Excellence: Liberating the National Health Service".


Dr Kev (Kevork) Hopayian, MD FRCGP
General Practitioner, Leiston, Suffolk
Hon Sen Lecturer, School of Medicine, Health Policy and Practice, University of East Anglia
GP CPD Director, Suffolk

On 2 Dec 2010, at 08:14, Fell Greg wrote:

good point
and yes is the answer
but I, personally, am principally concerend with the primary care stuff. In the English health care system tests ordered within hospital are covered within tariffs - so therefore payers dont pay so directly as those in primary care
that said, needless tests to contribute to cost inflation more broadly.
I will circulate final list when trail goes cold.
g

________________________________

From: Evidence based health (EBH) on behalf of Anthony Cummins
Sent: Thu 02/12/2010 07:38
To: [log in to unmask]
Subject: Re: "needless" path or biochem or imaging tests ordered from primary care



In the interests of fairness I assume that you are applying this to hospital junior staff who would generally use much less discretion in ordering tests than GPs?

Dr. Anthony Cummins MRCGP
Lecturer/ Academic Researcher
Dept of General Practice & HRB Primary Care Research Centre
RCSI Medical School
Beaux Lane House
Lower Mercer Street
Dublin 2
T +35314028604
E [log in to unmask]
W www.hrbcentreprimarycare.ie
Mon, Tues & Thur only. At other times please phone departmental secretaries directly on 014022304 or 2306

On 1 Dec 2010, at 23:19, "Fell Greg" <[log in to unmask]> wrote:




in cash strapped times of austerity we are starting of a discussion with our GPs on path / biochem / imaging / other tests that are commonly ordered from General Practice that are poorly evidenced / rarely add to clinical picture or change a clinicial decision

Just a disucssion thus far, and obviously does need contextualising properly. And obviously this is part of a much broader debate about areas on which we can "spend less on health care whilst loosing little health outcomes"

Some of the obvious ones that we have started with

Vit d deficiency test
Spinal xr- low back pain
Knee mr - many
Spinal mr - low back pain
pregnancy tests (£8 from lab rather than the £1 for doing them in house).
only doing creatinine instead or U and Es and creatinine
Apparently nail scrappings for fungus cost nearly £100 so I was told

any Xray for soft tissue injury
FSH in perimenopause
asking for PV/CRP and ESR at same time
MSU MC+S in uncomplicated lower UTI (in women ) (except if 3+/year- then MC+S)


what would you add to the list


Greg Fell
07957 144899
.


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This e-mail is intended for the use of the addressee only and may contain confidential information, copyright material or views/opinions that do not necessarily reflect those of Bradford and Airedale teaching Primary Care Trust. If you receive this email by mistake please advise the sender immediately. All should be aware that this email may be subject to public disclosure under the Freedom of Information Act 2000 and that emails may be monitored.....