A Testing Time Ahead: Pathology Services in the NHS Hospital and Primary Care Sectors

Abstract

The future of pathology services in the NHS is currently under consideration. Recent developments in diagnostic technologies and their possible impact on pathology testing in the future are discussed. Trends and patterns of demand for all three main pathology specialties are analysed over the 12‐year period, 1974‐86. The inflation‐adjusted, revenue cost of pathology testing per hospital admission (excluding capital costs) is shown to have fallen in real terms over this period, although it is uncertain whether this would still be the case were capital costs to be included. In the hospital sector, reported increases in demand can be quite simply related to increasing hospital activity by using a linear regression model. However, the very large increases in demand observed in the primary care sector cannot be related reasonably to any routinely reported practice activity indicators. The implications of this highly volatile pattern of demand in general practice are discussed, especially in relation to recent technological advances designed to produce rapid, near‐patient, surgery‐based tests. Although analysis indicates no evidence for historical technology‐induced increases in demand for laboratory services following the introduction of laboratory automation in the 1970s, the possibility of technology‐induced demand in the primary health care sector following the widespread introduction of surgery‐based tests is discussed.