Over the last decade, the NHS has experienced an unprecedented rise in spending; total expenses for the NHS have increased by over £50bn, an 80% rise. Given large numbers of patients are seen in primary care (the majority of NHS consultations take place in primary care), rising expenses threaten the ability of the NHS to provide effective healthcare. A recent study suggests there is an urgent need to better understand GP workload, particularly changes in the number of tests ordered from primary care over time. To address this, we will determine if the total number of tests ordered from primary care has changed over time (2000 - 2015), the change in use of 25 specific tests over the same time period and differences in test use across different parts of the UK. This research will determine if test ordering from general practice has increased over time, identify specific tests that have increased most rapidly over time and as well as specific tests that are used more frequently in some regions in the UK. These results will inform policy makers of changes in test use, which can help contribute to policy changes required to help NHS sustainability.
Over the last decade, the NHS has experienced an unprecedented spending rise, net expenditure has increased by over £50bn, an ~80% rise. Increasing expenditure threatens NHS sustainability. Primary care accounts for 90% of NHS contact, but is on the brink of 'saturation point'. A recent Lancet study recommends quantifying primary care test use workload (ISAC Protocol Number: 15_120R). We aim to determine temporal change in total test use (2000- 2015), temporal change in 25 specific tests and geographical differences in total and specific test use. Tests ordered for patients from UK general practices registered in the CPRD from April 1st 2000 to March 31st 2015 will be analysed. We will use joinpoint regression to quantify temporal changes in test use. Trends will be examined nationally and also compared across different geographical regions. Using the same methodology we will examine the temporal and geographical variation for 25 specific tests. This research will facilitate a greater understanding of primary care activity and help shape policy, resource allocation and budgeting. Our results will also lead to further research, particularly investigating explanations for temporal and/or geographical variation. The ultimate aim of this research is to contribute to the changes required to ensure the sustainability of the NHS.
To determine the temporal change in test use in UK primary care from 2000 -2015; To examine changes in total test ordering in UK primary care from 2000-2015; To examine changes in use of 25 specific tests in UK primary care from 2000 -2015; To determine geographical differences in test use in UK primary care; To determine if geographical variation in total test use exists across the UK; To determine if geographical variation in use of 25 specific tests exists across the UK.
Rafael Perera - Chief Investigator - University of Oxford
Jack O'Sullivan - Corresponding Applicant - University of Oxford
Carl Heneghan - Collaborator - University of Oxford
Chris Salisbury - Collaborator - University of Bristol
Clare Bankhead - Collaborator - University of Oxford
Paul Little - Collaborator - University of Southampton
Richard Hobbs - Collaborator - University of Oxford
Sarah Lay-Flurrie - Collaborator - University of Oxford
Toqir Mukhtar - Collaborator - Imperial College London
Practice Level Index of Multiple Deprivation