GP mythbuster 46: Managing test results and clinical correspondence

When we inspect, we ask whether practices are providing safe and effective care.

This includes asking:

• Does your practice have a safe and effective system to manage test results and clinical correspondence?
• When you request tests, how do you ensure that the practice receives and follows up on the results and correspondence?

Managing test results

Managing test results in general practice can be complex. The process:

• involves nearly every member of the practice team
• relies on practice systems and outside providers
• must communicate the results to the patient in a timely and clinically appropriate way depending on the level of risk.

Failure to follow up test results can be identified as a major problem in primary care settings. This can seriously affect patient care, including delays in diagnosis and effective treatment.

Having effective practice protocols and standardised processes can protect patients.

Patients are now able to choose to access their results using an ‘app’ on a mobile phone or computer. Systems must be in place to ensure effective communication of test results and correspondence.

Systems and protocols

We do not tell you what specific policies and processes to use when managing test results.

Each practice can develop its own systems and protocols to safely manage these. But you must be able to show their effectiveness.

You need to make sure the systems are safe and cover all aspects of the pathway, including:

• ordering tests and investigations
• ensuring patients attend and following them up if they do not, including appropriate recall systems
• checking and identifying when results come back – and taking action when they do not
• processing results in timely way. This includes when:
  • clinicians are absent
  • you receive results following requests made by short-term locums
• informing patients of the results
• recording and filing results appropriately and accurately
• ensuring appropriate follow-up of results and action-taking when results are abnormal.

Clinicians are individuals registered with a professional body. These include GPs, nurses, physiotherapists, paramedics and pharmacists. Non-clinicians are staff who are not on a professional register. For example, health care assistants and reception staff.

Where appropriate, any staff who review results should have:

• access to the medical record
• training to understand the significance of the results
• supervision and support on the day-to-day management of the test results.

Clinicians are responsible for making sure they act on results that alter patient management.

When a patient has multiple tests, it is important for your practice to have systems in place. These systems ensure that you see and act on all test results, even if they come in at different times. In these cases, there is a greater risk that some of the results are not actioned quickly – or at all.

All staff should be aware of their responsibilities for managing test results. They should have access to day-to-day support and appropriate guidance and training.

Communicating effectively

A critical part of the system is how well you communicate test results. For example, by telephone, letter, text, and use of an app. You must keep records of communication with patients.

Some things to consider in your system include:

• Clear timescales and lines of accountability when results are communicated.
• Clear, documented, next steps to follow when results arrive. If administrative staff need to take action, they need to have explicit instructions.
• A standardised set of words, terms and phrases used by administrative staff. They should use these to tell patients about common test results. Clinicians and administrators should agree on these. Patients need explanations in clear, unambiguous language.
• A clear approach and a protocol for informing patients (or their families, carers and key workers) of test results. Make patients aware of this policy. This includes how to verify the identity of a patient before giving them the results.
• Not just relying on the patient contacting the practice. If the results need action, contact the patient, even if you told them to contact the surgery. This will help prevent missing vital follow-up action.
• A clear policy on leaving voicemail and text messages if you are unable to contact the patient. There should be a way of making sure the patient is aware of the result and their expected actions.
• How to maintain confidentiality when talking by telephone or face-to-face at the practice. For example, a busy reception area can make it difficult.

Assessing your system

Audit the system regularly to make sure it is functioning effectively. This will help identify any changes or improvements needed.

Consider whether non-clinicians can safely perform certain tasks. This way, clinicians can focus on other work. For example, with appropriate safeguards, non-clinicians can review normal test results.

Managing clinical correspondence

The same safeguards apply to clinical correspondence. This includes, but not limited to:

• discharge letters
• referral letters
• Safeguarding correspondence
• Outpatient letters
• Investigation reports
• correspondence from other healthcare professionals.

This also includes any changes required to:

• a patient’s medicine
• clinical codes
• test results
• investigations. 

This process refers to effective workflow.

Some practices use a system where non-clinical trained staff change clinical codes on the patient record. Non-clinicians are sometimes able to identify where a change of medicine is required. They can then send this to the prescriber to get approval and a prescription.

Where this occurs, there should be clear training and protocols in place so that each member of staff is aware of their responsibilities. For example:

• The clinician ensures that they take action when appropriate.
• Non-clinicians can do some tasks if there are appropriate safeguards in place. This can include appropriate systems, processes, supervision and training.
• Usually, the GP or other appropriate prescriber should make changes to medicines. Where non-clinicians carry out administration tasks, the prescriber (who signs the prescription) remains accountable for the prescription and actions leading to its production.

To ensure the safe and effective handling of changes to clinical coding or medicines, you need to assess and audit the workflow process or protocol.

What we look for

We use these regulations when we review whether the practice is safe, effective, caring, responsive and well-led. When we assess the safe, effective and well-led key questions, we use:

• Regulation 12 (Safe care and treatment)
• Regulation 17 (Good Governance)

We look at how you:

• work with staff, people and partners to establish and maintain safe systems of care
• ensure your staff:
  • have qualifications, skills and experience
  • receive effective support, supervision and development
  • work together effectively to provide safe care that meets people’s individual needs
• communicate responsibilities, roles, systems of accountability and good governance to manage and deliver good quality, sustainable care, treatment and support.