Demand optimisation in laboratory medicine phase V: final report June 2022

Demand optimisation is defined as the process by which diagnostic test use is optimised to maximise clinical utility, which in turn optimises clinical care and drives more efficient use of associated scarce NHS resources. Report from the National Demand Optimisation Group (NDOG).

1. Foreword

The work of the National Demand Optimisation Group (NDOG) aligns with the ethos of the Realistic Medicine approach[1]; strengthening the relationships between those who provide and receive care and ensuring that people receive appropriate and beneficial care that is evidence-based and in line with their preferences. Using evidence intelligently to continuously improve and challenge existing healthcare models, the approach taken by the NDOG is aligned with the principles of the National Performance Framework[2], in particular contributing to the associated health outcomes as it aims to ensure appropriate diagnostic testing for the Scottish population.

Throughout Phase V, the NDOG has continued to work collaboratively with a range of stakeholders to deliver key outcomes and outputs that will result in a reduction in unwarranted variation in diagnostic laboratory tests in primary care, throughout Scotland.

This report details the main outputs of the Phase V programme of work, including national rollout of the primary care Atlas of Variation (AofV) for diagnostic laboratory tests and associated education toolkit on 1 April 2022.

The Atlas of Variation contains monthly data on primary care requesting for a suite of diagnostic laboratory tests from cancer, cardiac, diabetes and other general pathways. The Atlas of Variation consists of three separate dashboards that allow GP practices to compare request rates with their cluster, health board, peer group and Scotland overall.

The education toolkit will contribute towards the delivery of standardised diagnostic testing practices across all boards in Scotland, with the aim to reduce harm, waste and unwarranted variation to improve health outcomes by providing advice for selected tests on; background; when to test; when not to test and when to repeat a test. The work of the NDOG strongly aligns with the Realistic Medicine policy.

Laboratory testing continues to play a vital role in healthcare delivery and improved outcomes in patient care. With the Atlas of Variation and associated education toolkit now live across Scotland, the focus will now shift towards quality improvement initiatives.

We fully support the continued work of the NDOG and look forward to the anticipated outputs of Phase VI over 2022-2023.

Catherine Ross
Chief Healthcare Science Officer
Scottish Government



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