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Activity Benchmarking History

In view of large perceived inequalities in pathology test use amongst general practices in South Durham, Dr Stuart Smellie documented and investigated these. He found the differences to be far greater than expected and also to be similar both within and between different NHS hospital catchments. They were not explained by any factors such as practice type or patient age/sex and were concluded to reflect differences in clinical behaviour 7,8.

For both clinical and financial reasons local Primary Care Trusts wished to rectify inappropriate over (and under) testing. They were, however, unaware of how their general practices compared with others. South Durham produced graphical quarterly activity benchmarking reports including guidance on best practice. Initially the reports were anonymous in order to reveal only the identity of individual practices in their own personalised reports. These reports have been enthusiastically received by GPs who are actively requesting information and support regarding pathology testing and PCTs asked for the identities of all practices to be shown.

South Durham is currently trying to help two local trusts develop the scheme and a number of other laboratories are attempting to follow. The methodology used however is manual, labour intensive and limited to producing activity reports.

The benchmarking approach was used to successfully implement and monitor an intervention to improve use of cholesterol testing published in the British Medical Journal as a quality improvement report, and subsequently was applied to use of outpatient services to abolish a 36 week waiting list and avoid the need for a second coronary prevention clinic (Figure 3a-c).

Extrapolation of uses.

Referrals to a cholesterol/heart prevention clinic by 22 general practices in South Durham before (Figure 3a) and after (Figure 3b) introduction of an intervention to improve appropriate use of resources, and the subsequent effect on waiting list for the clinic (Figure 3c).

Figure 3a

Figure 3b

Figure 3c

In order to involve more users and broaden the service provision it is essential to take the collection of data and dissemination of information onto a more automated format and develop a model useable by all those who would wish to and to combine this with means of disseminating guidance and educational material.