Chemical pathology and the new contract for GPs

The new GMS contract agreed in 2003 is arguably the biggest change in terms of service since the formation of the National Health Service. Work practices, and hence surgery income, will be determined by several income streams, one of which is a quality payment for achieving defined clinical goals.¹ Several of those goals directly or indirectly involve the results of analyses carried out in pathology laboratories,¹ and accordingly the new contract will potentially have a major impact on the workload within pathology and to varying degrees within subspecialties.

Quality indicator points

Clinical quality indicators comprise 550 of the 1050 points and 91 directly involve results of tests carried out in chemical pathology (table 1).¹ Requesting patterns vary from one practice to another² and region to region, and similarly, the availability of tests varies from one laboratory to another. Accordingly, the effect will vary for each laboratory depending on the relative workload from general practice and the current background rate of requesting. Microalbuminuria is one test mentioned in the new GMS contract that fits into this category, with some district hospital laboratories not currently providing this assay on a routine basis.

“The new GMS contract will probably increase the number of disease registers for many general practices”

In addition to the specific analytes mentioned in table 1, at least 33 points indirectly involve chemical pathology laboratories (table 2).¹ The use of angiotensin converting enzyme (ACE) inhibitors and A2 antagonists should result in repeat renal profile requesting in accordance with the British National Formulary advice³ for repeat testing after each titration step. Patients with hypertension are often on ACE inhibitors or A2 antagonists, …