Blood Tube Shortage: Testing Times

Late last week NHS England wrote to all GPs to warn of a shortage of test tubes. It advised that a product shortage was "impacting most main blood tube supplies" and that the current "constrained" situation is likely to worsen in the coming weeks. This development has understandably led to concerns being voiced by various entities and has triggered alarmist news reporting. The shortage is likely to be felt across the medical profession but is particularly worrisome for GPs for who are responsible for around 50 million blood tests per year. GPs (and their insurers) should carefully consider the potential impact of this development and what steps can be taken to guard against future liability.

NHS England's letter encloses urgent guidance on recommended actions which are intended to "safely manage demand". All primary care and community testing must be halted until 17 September 2021, except for those that are "clinically urgent". The letter goes on to detail four examples of testing that will be considered clinically urgent:

1. Bloods that are required to facilitate a 'two week wait' referral (potential cancer cases);
2. Bloods that are extremely overdue and/or essential for safe prescribing of medication or monitoring of conditions;
3. Bloods that could avoid a hospital admission or prevent an onward referral; and
4. Those with suspected sepsis or conditions with a risk of death or disability.

Allegations of a delay in diagnosis of a serious condition are among the most common negligence claims faced by GPs. As a patient's primary care provider, a GP is the first medical practitioner to review a patient who has concerns. There may be occasions when a serious condition is not immediately recognised, perhaps due to the presenting symptoms being consistent with a different, less concerning, medical issue, or the symptoms requiring monitoring for potential improvement before further investigations take place. This can result in delays in the patient receiving treatment, and the GP's (alleged) failure can become the subject of litigation.

Such a claim will be founded on the basis that earlier diagnosis would have avoided a period of pain and suffering and/or that the patient's outcome may have been better, or (in very serious cases) that the delay led to death. GPs prudently seeking to avoid such claims might well institute precautionary investigations, including blood tests.

The current shortage of test tubes means that GPs will have to decide (with relatively little guidance) which blood tests are urgent and which can wait. It is certainly foreseeable that a GP could be criticised for deciding a blood test was not "clinically urgent" if later investigations reveal a sinister diagnosis for which prompt treatment was key.

In order to protect themselves, GPs should ensure they keep comprehensive notes setting out why they have concluded a blood test is "clinically urgent" or not. Where they conclude the latter, a detailed summary including references to the patient's symptoms, possible causes of the symptoms and the reason why a blood test can be delayed should be included, in order to assist with explaining the decision in the event it later becomes the subject of an allegation of avoidable delay.

GPs should also ensure that they have robust follow up procedures in place. If a decision is made to delay a blood test, the patient needs to be explicitly told that a blood test would usually be desirable but that it is being delayed due to NHS England guidance;  the GP should explain why it is considered that the delay is unlikely to have adverse consequences. The GP should record this conversation in the patient's notes. A plan should be agreed with the patient as to when the blood test will take place and how this will be arranged, and the patient's contact details should be confirmed to avoid any additional delay in arranging a necessary blood test.