Demand optimisation in laboratory medicine: phase two report

Phase two activity report produced by the Scottish National Demand Optimisation Group (NDOG).

1 Foreword

The aim of Realistic Medicine is to strengthen the relationships between those who provide and receive care, ensuring that people receive appropriate and beneficial care that is evidence-based and in line with their preferences. Variation in healthcare exists for all sorts of legitimate reasons, but identifying and tackling unwarranted variation is essential to improving outcomes derived from healthcare across Scotland. 

This report looks to tackle unwarranted variation across laboratory diagnostic testing. While some of this variation can be explained by clinical circumstances and demographic differences, some of the variation is suggestive of considerable levels of inappropriate demand as a result of over-requesting, under-requesting and unnecessary repeat testing. 

Laboratory testing plays a very important role in healthcare from before birth to after death – this includes screening, diagnosis, treatment decisions and monitoring. Considerable unwarranted variation exists across Scotland with regards to laboratory test provision and use. This potentially impacts both laboratory and the general NHS provision of service.

NHS Scotland is unique within the UK, having developed since 2015 a national approach to promote more appropriate laboratory testing by forming a National Demand Optimisation Group. The Scottish National Demand Optimisation Group (NDOG) had its inception from the Healthcare Science National Delivery Plan (2015) and in 2017 released its first phase of work that focused around defining recommendations for future demand optimisation structures and implementation strategies.

The work of phase II has developed a Diagnostic Atlas of Variation (AoV). The identification of good practice for potential roll out along with the inception of a National Atlas of Variation for laboratory testing will allow the development of future approaches that inform more rational testing while ensuring equal access to new and novel testing.

I fully endorse closer collaborative working with the wider healthcare family across patient pathways as being the key for the success of interventions aimed at driving more appropriate testing and look forward to the outcomes that phase III of the programme aims to deliver.

Dr Gregor Smith
Deputy Chief Medical Officer for Scotland
Scottish Government

Karen Stewart
Healthcare Science Officer
Scottish Government

Demand Optimisation in Laboratory Medicine Phase II Report - the full development of an Atlas of Variation (AoV) for laboratory test requesting covering multiple disciplines from the whole of Scotland. this report is the second phase of a previously issued report, which can be found at and is an associated document to the Healthcare Science National Delivery Plan which can be found at

Genetics/Molecular Pathology consortia



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