North London Partners in health and care

'Right Test Right Time' GP pathology guidance launched

During February, Phase One ‘Right Test Right Time’ Pathology Guidance for GPs was launched across all north central London (NCL) CCGs.  

The project provides guidance and defined pathology ‘order sets’ to help answer common GP diagnostic and monitoring questions for conditions such as diabetes, cardiovascular disease and chronic kidney conditions. 

This guidance was developed by a strategic transformation programme (STP) clinical reference group of local lead clinical pathologists (from all four NCL acute trusts), hospital specialists and GPs. 

There is a great deal of unwarranted variation in the use of pathology based on the blood sciences (biochemistry, haematology, etc). The 2008 Carter review of NHS Pathology Services in England estimated that perhaps a quarter of pathology requests are unnecessary. The impact on patients of this variation is often over-investigation, duplicate testing, unnecessary appointments and increased anxiety. 

The STP project draws on work that has been done for the Choosing Wisely campaign, and is inspired by the significant efficiencies found by colleagues in other parts of London, and North Devon. 

In addition to helping answer common GP diagnostic and monitoring questions the phase one guidance will also:

  • ensure the universal introduction of online ordering systems, via T-Quest or SunQuest, to improve ease of ordering and the efficiency and accuracy of communication with the labs
  • enable GPs to view hospital test results for their patients, where these have been processed in the same laboratory 

NCL CCGs and local acute trusts are implementing plans to roll out the new guidance to all GPs, as well as ensuring all GPs have access to T-Quest or SunQuest electronic ordering systems, which will include prompts linked to the guidance.  

In addition to the guidance roll out, GP practices will be provided with new reports to highlight how their testing behaviours adapt in line with phase one advice during 2019/20.  Phase two guidance for further test areas will be launched in early 2019/20. 

There is no plan to reduce the availability of the current range of pathology tests that can be ordered in primary care.  Where GPs wish to order additional tests or reduce test requests based on individual patient needs they may do so. 

For a more detailed explanation of the plans for the group and guidance please contact your local GP diagnostic lead: 

 You can find the Phase One guidance on all CCG GP specific websites in NCL.