Primary and Community Care

Question

11:28:00

Asked by

To ask His Majesty’s Government what steps they are taking to support primary and community care settings to integrate in vitro point of care diagnostics.

My Lords, we recognise the value of point-of-care diagnostics in enabling earlier detection, reducing avoidable hospital admissions and supporting more personalised care. As part of our 10-year plan, we will ensure that more tests, including in vitro point-of-care diagnostics, take place in the community, which will be closer to people’s homes. Use of in vitro point-of-care testing is encouraged where clinically appropriate, including in community diagnostic centres, and is supported by the development of 27 pathology networks.

I thank my noble friend the Minister for her very positive reply, but I will take it a little further. Do the Government appreciate the enormous potential benefit of in vitro diagnosis for the National Health Service and patients? On the latter, patients would be able to go to their local pharmacy, away from the queues in their GP surgery or local A&E department, and be diagnosed and treated in a matter of minutes. My second question is: what government funding support will be given to pharmacies having to buy the diagnostic machines or boxes, which cost about £2,000 each, and to support the necessary training for pharmacy staff?

This is a good news story, and I certainly share my noble friend’s view of the benefits that he outlined. Community diagnostic centres are now delivering additional tests and checks in 169 sites across the country. They have delivered almost 4.5 million tests, checks and scans since last July, and we have committed to expanding the number of existing CDCs and their opening times. In England, Pharmacy First clinical pathways have been developed closely with various experts, including pharmacists. The funding for the core community pharmacy contractual framework has been increased to over £3 billion, representing the largest uplift in funding of any part of the NHS. We are grateful for the role that pharmacies play.

My Lords, does the Minister agree that, when we discuss in vitro testing, we should also talk about in vivo testing? That involves taking a history and doing a thorough physical examination of the patient on the spot, but it seems to be going out of fashion. I will illustrate that with the story of a member of staff who had consulted me. He had been investigated at the “St. Elsewhere” hospital for six months, but they had missed the fact that he had ruptured his Achilles tendon. I did an in vivo spot diagnosis. I put my index finger down his Achilles tendon—with his permission, of course—and I could feel the gap in his Achilles tendon where it had ruptured. They had not examined him. Is it not time that we did this inexpensive business of taking a history and doing a thorough physical examination?

I am very glad that the noble Lord asked for permission. I take his point. I know that he understands the value of in vitro point-of-care testing, but he makes the good point that what matters is what is clinically appropriate in the circumstance. We would all expect that to happen for the benefit of the patient.

My Lords, I will follow on from the Minister’s Answer. While being supportive of the general trend, what metrics and measures have the Government put in place to ensure that those tests indeed create positive patient outcomes and healthcare efficiency to help future induction of the tests in the NHS?

We will ensure, through our 10-year health plan, that the additional tests, including in vitro point-of-care diagnostics, are taking place in the community. I look forward to being able to provide more information to the noble Lord.

My Lords, we on these Benches welcome the Government’s stated commitment to innovation in primary care and the commitment to continue the rollout of community diagnostic centres, which were started by the previous Government. However, unfortunately, last year the Patients Association highlighted barriers to the rollout of point-of-care diagnostics, particularly in rural areas. Is the Minister aware of those concerns, and what plans does the department have to tackle those barriers?

Our commitment to moving towards a neighbourhood health service obviously allows for attention to be given to different circumstances, including in rural areas. It will mean that more care can be delivered locally and that problems can be spotted earlier, including any problems with rollout. We will shortly provide details of a national neighbourhood health implementation programme. We liaise with various groups, including the Patients Association, and I am grateful for their input and for flagging up any difficulties, which we absolutely seek to resolve.

My Lords, while I accept that in vitro diagnosis at the point of care has great benefits, it is important to address the challenges that we will need to face. They include quality control and the standardisation of equipment used, as well as making sure that the appropriate people are trained, that assessments are made of the results obtained and that proper, good outcomes are delivered. Who will be in charge of delivering this, at the integrated care board level and the national level, to make sure that it is effective?

The noble Lord is right that it is one thing to provide a service; it is another—and so important—to make sure that it is provided appropriately and accurately. ICBs will have their own arrangements. Within that, NHS England is currently responsible for ensuring that this takes place. We will ensure that there are regular updates. If any noble Lord is aware of particular difficulties, I would be very pleased to hear about them; for example, if there is a problem with quality control.

My Lords, does the Minister agree that even deeper and wider embedding of diagnostics across the NHS, including more in community pharmacists and GP surgeries, would help in the fight against not only antimicrobial resistance but other infectious diseases? In addition, it would stimulate the venture capital business in diagnostics. All these factors together have the potential to boost NHS productivity dramatically, and would therefore help to boost the country’s growth trend.

I certainly agree with the very strong points that the noble Lord has made. This is obviously a health improvement policy for patients and to support the NHS, but it is also about developing growth and the opportunity for new ways of doing things. We welcome and support innovation.

Building on a point made by the noble Lord, Lord Hacking, and others, there are many examples where the ideal place to do a diagnostic test is in a primary care setting. Urinary tract infections are a typical example of that, because you can solve it quickly in that setting, avoiding future hospital visits and much pain and suffering. However, that means taking budgets away from secondary care settings and giving them to primary care GPs, pharmacists, et cetera. Are the Government prepared to do that to see these benefits arise?

We are constantly reviewing how best to support where we need to go. In this case, it is about getting tests done closer to home. The noble Lord is right that, for a number of people, the GP practice is a good place to do that, but not in all cases. What matters is doing what is appropriate. We announced an £889 million uplift for general practice in 2025-26, which is the largest uplift to GP funding since the beginning of the five-year framework in 2019, and we have also agreed a new GP contract. The noble Lord will be aware that we recently announced over £1 million to help the quality of the primary care estate, to ensure that we can provide some 11 million further appointments this year. While I accept that this issue is about configuration, I assure the noble Lord of our support for GPs.