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

2. Executive Summary

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.

There is considerable variation in the use of laboratory diagnostic tests across primary care. Some of this variation can be attributed to clinical and demographic differences. However, some variation can be attributable to differences in practice processes and pathways or individual requester preferences.

It should be noted that demand optimisation focuses not only on potential over-requesting, but also on under-requesting. Therefore, it is not necessarily about reducing request numbers, rather it is about reducing variation in requesting patterns.

Whilst wholescale implementation of demand optimisation will have an element of cost avoidance through avoiding unnecessary testing and repeat testing, there will also be cases where testing increases.

The Scottish Government has funded the National Demand Optimisation Group (NDOG) work since its establishment in 2016, originally under the auspices of the Healthcare Science National Delivery Plan (NDP). Since then, the NDOG has established itself as a national programme of work.

This report highlights the many achievements in Phase V of the programme, including:

• Publication of the primary care Atlas of Variation for diagnostic laboratory tests
• Development and publication of an education toolkit on the 'Right Decision' platform
• Development and implementation of a user guidance manual and videos
• Delivery of a number of presentations and Atlas of Variation demonstrations to a wide range of key stakeholders
• Development of a template for primary care flash reports
• 12 NHS Boards now contributing Atlas of Variation data, which allows for a more comprehensive comparison of data
• Examples of quality improvement work such as blood glucose testing in NHS Fife
• Poster presentation at the NES Annual Virtual Conference - "An Educational Toolkit for Demand Optimisation when using the Atlas of Variation in Laboratory Diagnostic Testing."