ABSTRACT
The commissioning of diagnostic services directly accessible from primary care has always been somewhat haphazard, often driven more by local specialist clinical interests or technological innovations than the needs of patients. Diagnosis is not only about detecting disease, but also about considering the potential impact of a particular pathway on patient outcomes. Possible outputs from a primary care-oriented testing needs assessment might include a proposed menu of tests directly accessible by primary care clinicians, pre-testing requirements for primary care clinicians linked to the menu of tests, testing intelligence to support clinical practice and suggested service specifications. The UK general practitioners are acquiring increased direct access to B-type Natriuretic Peptide (BNP) and echocardiography testing with the aim of improving the accuracy of the diagnosis of heart failure. As one of the symptoms of heart failure is 'fatigue' it is also quite possible to imagine that current battery of tests might be extended to include such items as C-reactive protein and BNP.
