Impact of the new General Medical Services contract on the clinical laboratory.

The new General Medical Services contract that has been adopted in England and Wales, with similar contracts in Scotland and Northern Ireland, proposes far-reaching changes to the way in which general practitioners practise and are remunerated. This includes a range of quality indicators, which pay particular attention to chronic disease management. Among other things, the quality indicators require certain laboratory tests to be performed or result targets to be met in defined proportions of patients in particular disease categories in order to qualify for quality payments. This is a novel experiment, which may focus general practitioner activity on specific areas of patient management. It has significant potential impact on laboratories: testing activity in some areas may be boosted considerably; assay performance, notably bias, will have direct potential impact on practice earnings and any shift in clinical priorities may have future effects on assay development and repertoires as these become partly financially driven by practice income. The evidence base and research of the available guidance behind the indicators is sketchy in places and although there are 76 indicators several areas of practice are not addressed. The probable further increase in laboratory activity it may generate highlights the need for laboratories to continue to assist in promoting best practice in test requesting.