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Blood testing is the latest epidemic in primary care

By Dr Livingstone

09 Oct 2020

There needs to be a PCN-wide consensus on which patients, on which drugs, need which blood tests, writes The Pharmacist’s GP blogger Dr Livingstone.

Help! Bang in the middle of whatever coronaviral wave is swamping us by the time you read this, I’m noticing another pandemic. This time, it’s blood tests. Hundreds of them – and most shouldn’t have been taken in the first place.

What’s this got to do with pharmacists? Quite a lot, to be honest. Since many pharmacists started working for PCNs, they’ve been heavily involved in medication reviews – and this activity has escalated since ‘structured medication reviews’ kicked in as one of those PCN contract specifications we’re enjoying so much.

While it’s been gratifying to see the great ‘pharmacists in practice’ project progress from pupal to full-on-lepidopteral, we all know that a butterfly flapping its wings in one place can lead to a hurricane elsewhere.

And that’s what’s happening. Medication reviews seem to be inducing an irresistible urge to bleed the patient – you’re going about it like vampires in a garlic-free world. We GPs have always moaned about GP trainees having a tendency to reflexly tick all the boxes on the blood test form. But with clinical pharmacists, indiscriminate testing on the back of every medication review seems to be completely out of control.

As a result, I’m spending a large part of my day (and, increasingly, my evening) trying to interpret blood tests which I didn’t order and which should never have been done in the first place – such as the FBC, LFT, U&E, cholesterol, TFT, HbA1c and calcium I’ve just dealt with in a patient on thyroxine. TFT yes. All the rest, no. This amounts to population whole-blood-screening, which is unscientific, unnecessary, time consuming, costly to the NHS, not recommended in any guidance, and, from where I’m sitting, really annoying.

But – before you rise to the defence of the pharmacy profession – it’s not your fault. It’s ours. We’ve put the cart before the horse here. Everyone needs the tools to do the job. Which means, in this case, coming up with a PCN-wide consensus on which patients, on which drugs, need which blood tests. Sorry about that, and, believe me, we’re working on it. In the meantime, though, can I suggest that less is more? As in, less pharmacist blood testing means more GP sanity?

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