‘We don’t need to check it, but we do check it’: a qualitative study of the views of primary care healthcare professionals on blood test monitoring in three long-term conditions

Background In the UK there is variation in which tests are used for monitoring Long Term Conditions (LTCs). Guidance that underpins testing practices for LTCs is often based on expert opinion rather than evidence. There is little insight into the views of primary care staff as to why such variation exists or on whether current LTC blood test monitoring is optimal. Aims To understand the views of Healthcare Professionals on blood test monitoring for three LTCs (type 2 diabetes, hypertension and chronic kidney disease), identify factors that shape monitoring practices for LTCs and inform the development and implementation of an optimised testing intervention for primary care. Design & setting Qualitative, in depth, semi-structured interviews with HCPs engaged in monitoring blood tests for LTCs in primary care in the West of England. Method Twenty-one HCPs were recruited from four GP practices. Practices represented a range of social deprivation scores, patient list size and demographics. Qualitative interviews were recorded, transcribed verbatim and analysed using a reflexive thematic approach. Results We identified variation in views and testing behaviours in blood test monitoring across HCPs and practices. HCPs reported that many of the drivers of testing variation in their experience were systemic, including barriers from IT systems, funding structures and inconsistent testing guidelines. Other drivers included socio-behavioural factors such as patient behaviours and HCP experience. Conclusion There is a recognition in primary care that testing for LTCs could be optimised but a lack of consensus on how to approach this. Practices employ different and various approaches to testing. This has important implications for effective implementation of interventions to optimise testing practices.