Variations in Access, Uptake and Equity: Radiology Services

D Worthington, M Daziel and P Robinson - £38,000

There are many examples of substantial variations in access to health services. Numerous studies have consistently demonstrated three or fourfold variations in GP referral rates to hospitals after allowance has been made for the obvious factors such as population needs, GPs’ knowledge etc.

The NHS recognises that it “must accept that there are limits to the acceptable range of variation. It is one thing to justify variations on the grounds that local practitioners have developed a new approach... or that the needs and wishes of local people require a different pattern of provision. It is something quite different to tolerate differences in the quality of health care which arise simply out of historical accident or professional conservatism.”

The objectives of the research at the outset were to:

  • Improve understanding of the reasons for variations in the uptake of a specific service, namely a radiology service.
  • Investigate and evaluate possible ways in which managers and health care professionals could beneficially influence the uptake of services.
  • Recommend ways in which managers and health care professionals could beneficially influence the uptake of services.
  • Contribute to a general methodology for undertaking this process elsewhere and for other services.

The research had two main foci:

  1. To improve understanding of variations in radiology referral rates. Referral rates from GPs, outpatient clinics, inpatient care and A&E were considered separately and together. Factors investigated included population size and age structure, distance, deprivation, hospital, GP practice, individual GP, specialty and hospital consultant.
  2. To identify routes to beneficial change. When apparently influencial factors were potentially controllable by the NHS, routes to beneficial change were investigated with the local health professionals and managers. These included tailored reports, presentations and questionnaires for GP practices and for hospital consultants; guidelines and protocols; and service developments supported by patient flow modelling.