Developing evidence based optimal testing strategies to monitor long term conditions in primary care


National Institute for Health (NIHR) Programme Grants for Applied Research (PGfAR) Ref. NIHR201616

What is the research question?

How do we optimise tests for monitoring long-term conditions (LTC; hypertension, type 2 diabetes and chronic kidney disease) in primary care?

What is the problem?

The number of blood tests performed in the NHS is increasing. Over half of these blood tests take place in general practice to monitor long-term conditions (LTC). Testing blood can be unnecessary, may cause distress and lead to further tests and treatments that may not be needed. However, not testing may miss things that might be wrong. Current guidelines on what tests people with LTC should have to monitor their condition are based on expert opinion rather than research evidence.

What is the aim of the research?

We want to develop evidence-based testing strategies to monitor people with high blood pressure, diabetes and chronic kidney disease in general practice. This will let patients, doctors and nurses know which are the best tests for these conditions, how often to test patients, and how to use the results. It has the potential to free up resources from general practice, reduce unnecessary testing for patients and improve overall management of LTC.

How will this be achieved?

We are proposing a 5-year programme. First, we will review existing research evidence and analysis of data from GP practices. We will build mathematical models to look at whether tests improve patient outcomes and how often they should be used. Then, we will interview patients, GPs and nurses about their views on testing and how they would feel about changing testing practice. Next, we will work with patients, doctors and nurses to produce information in the form of leaflets or online guides to support those using the new testing strategy. Finally, we will evaluate our new testing strategy by implementing it in a range of GP practices and comparing them with those following their usual testing practice. We will compare the testing rates between the GP practices to see how the new policy has been adopted. We will also look at patient outcomes such as hospital visits and GP consultations to check that patients are not experiencing a deterioration in their condition due to changes in the testing system.

Who is leading the research?

Dr Penny Whiting, Associate Professor, Population Health Sciences, University of Bristol.

Further information:

Dr Penny Whiting

For more information or to get involved in this project, please contact

The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.