Phlebotomy (Blood Tests) services / Secondary Care Policy
As a GP practice, we are currently trying to manage a huge and unprecedented rise in workload, in part fuelled by a rise in requests from hospitals and other clinics for us to do blood tests / ECGs on their behalf.
We have aduty of care to our patients to provide a core GP service, which means that we need to be able to offer appointments to our patients for tests that the Practice GPs or nurses have requested.
In the past we have been happy to support secondary care by doing blood tests and other investigations. However, this un-resourced demand is reducing availability of appointments for our own blood tests, ECGs etc. There are often unrealistic expectations of when these tests must be done, and often they can’t be done in the expected timeframe.
Patients often present to us asking for tests without the appropriate paperwork and forms, creating delays in clinics while our nursing team / phlebotomists have to interrupt other clinicians in order to find out what is needed and to generate the forms.
Results are returned to us rather than the requesting Clinician in secondary care. This causes problems when dealing with abnormal results, particularly as it is so difficult to contact the appropriate secondary care Clinician and ensure that they are taking responsibility for the tests that they have requested. This creates additional work, often for the duty doctor who doesn’t necessarily know the patient or the context of the tests requested in the first place, and this is potentially unsafe.
Most challenging is the expectation for us to take on monitoring of patients due to lack of capacity or lack of appropriate resources in other systems that should be providing such care. This is happening when patients are waiting to be seen, or even instead of accepting a referral at all. We do not accept this responsibility should fall on general practice by default, this is unsafe for patients.
General Practice is also experiencing exceptional demand and is not resourced or specialised enough to safely do what should be done by secondary care.
These new guidelines are provided with the intention of facilitating the safe and effective care of our patients with the resources that we have.
Blood test requests that we will arrange for patients
· Post hospital discharge bloods – no more frequent than one week.
· High riskdrug monitoring when we have signed an agreements with a specialist to do this.
· Heart failure nurse requests.
· Diabetic specialist nurse requests.
· Dementia support worker requests.
· Drug and alcohol team requests.
· Practice based specialist Clinician requests.
Blood tests that we will no longer carry out
· Any requests which ask us to forward the results to the hospital / specialist.
· Fertility clinic requests.
· Requests from outpatient NHS clinics.
· Requests from private clinics.
· Psychiatry requests.
· High risk drug monitoring during initiation, before a shared care is in place.
· Pre-op checks.