Project #208: Diagnostics Demand Optimisation

Over the period 2017-2024, the percentage of people receiving their diagnostic test within the NHS target of six weeks has significantly fallen with only partial recovery and a direct link to waiting lists times.

At the same time, demand for diagnostic tests since the COVID-19 Pandemic has increased – particularly with regard to the 5 key diagnostic tests which make up 85% of diagnostic activity: CT, MRI, non-obstetric ultrasound, endoscopy and echocardiography.

Demand is being driven by population growth, ageing, and increases in diagnostic demand across elective, UEC, urgent suspected cancer, and screening.

If any potential underlying causes across the health spectrum are not identified and addressed, the increasing demand will continue to impact on post-COVID recovery, prevent achieving the 18-week Referral Time to Treatment (RTT) standard and recover the 6-week wait target.

The project aims to identify and quantify referral rates for specific tests and to identify any opportunities to address where the tests may have been unwarranted. A useful way to define this are tests requested outside of NICE guidelines, which are likely to be of limited benefit to patient outcomes.

Expert advice from clinical stakeholders has identified a list of 12 low value tests which fit this description:

1. Ultrasound for undescended testes
2. Chest X-ray in children/babies with mild/moderate bronchiolitis
3. Computerised Tomography (CT) for resolved transient ischaemic attack (TIA) unless clinical suspicion of alternative diagnosis that CT could detect
4. Computerised Tomography (CT) for suspected stroke (unless indicated by National Optimal Stroke Imaging Pathway (NOSIP))
5. Computerised Tomography (CT) for established epilepsy
6. Electroencephalogram (EEG) to exclude suspected epilepsy when the clinical presentation supports a diagnosis of a non-epileptic event
7. Magnetic Resonance Imaging (MRI) for headaches, to rule out brain tumours
8. Magnetic Resonance Imaging (MRI) for non-specific low back pain
9. Musculoskeletal (MSK) Ultrasound for osteoarthritis without atypical features
10. Routine vitamin D testing in asymptomatic patients
11. Echocardiogram without prior N-terminal pro b-type natriuretic peptide
12. Gastroscopy in people under 55 years old

For the project to be able to address the underlying causes – including the potential unwarranted demand – we first need to build an understanding all referral sources in both primary and secondary care settings.