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Very wide variations in use of diagnostics across England

Patients in certain areas of country hundreds of times less likely to be offered some tests, new atlas shows

Caroline White

Friday, 29 November 2013

There are significant differences in how health conditions are tested for and monitored across England, shows the first NHS atlas, illustrating wide variations in the use of diagnostic services across the country.

Some of these differences may be explained by true clinical variation, but access to equipment and trained staff, and lack of knowledge may all have a part to play, suggests the atlas, published by Public Health England (PHE).

The 69 different maps of England in the atlas provide a graphic illustration of the local variations for a wide range of diagnostic services covering imaging, endoscopy, physiological diagnostics, pathology, and genetics.

The maps provide information down to the level of the former local primary care trusts. And some of the maps now show CCG activity. They show that patients in certain areas are hundreds of times less likely to be offered some tests than in other parts of the country.

The aim is to prompt questions about the reasons behind the variation. “Why do commissioners in one locality commission over four times the number of audiology assessments per head of population than commissioners in another (see Map 23, pages 102–103), and why is there 170-fold variation in the usage of rheumatoid factor?”, asks the foreword.

The maps highlight variations in the speed of response to stroke, with significant numbers of patients waiting 24 hours for a brain scan and delays in CT scans for some trauma patients.

And there are very large local variations in the use of many specialised tests, including those for sleep disorders, thyroid, rheumatoid arthritis, allergies, and vitamin D.

There’s a 392-fold difference in vitamin D tests, a 184-fold difference in blood glucose tests, and a 117-fold difference in serum folate tests, requested by GPs. And patients in some parts of the country are 59 times more likely to get a DEXA bone scan or 56 times less likely to get a glomerular filtration rate test.

Feedback loops in the commissioning system, the adoption of new technologies,  service and pathway redesign, and quality assurance and peer review systems may all help to iron out some of the variation, suggests Professor Sue Hill,  Chief Scientific Officer for England, in an accompanying presentation for the launch of the atlas.

Professor John Newton, Chief Knowledge Officer at PHE, said: “These data have been available for some time, but the levels of variation revealed may still come as a surprise to many people working in the NHS. It is essential that this variation is understood and addressed if patients are to get the maximum benefit from these hugely valuable technologies.”

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