Managing patient demand for blood tests during shortages

The importance of documenting decisions to defer non-urgent tests.

In response to global shortages of blood tube products, NHS England issued guidance on 10 August on prioritising blood investigations. Further advice was issued in a letter to GPs, pathology services and others affected on 26 August.

The 10 August guidance provided recommendations for measures aimed at optimising the use and management of blood tubes and preventing disruption to urgent care. It was published following consultation from professional bodies covering a wide range of clinical specialities.

The 26 August NHSE letter builds on the guidance from 10 August, aiming to provide further clarity on how to safely reduce demand for blood tubes. The current acute shortage impacts Becton Dickinson 5ml yellow top and purple top tubes, but there is significant pressure on similar products too.

NHS England says it expects supplies to be affected until mid-September. As a result, it has asked all providers of NHS services in England to follow a set of measures where safe and in line with senior clinical decision making.

For primary care, the measures are as follows:

  • All primary care and community testing must be halted until 17 September 2021, except for clinically urgent testing. Examples of clinically urgent testing include:
    • bloods that are required to facilitate a two week wait referral
    • bloods that are extremely overdue and/or essential for safe prescribing of medication or monitoring of condition
    • bloods that, if taken, could avoid a hospital admission or prevent an onward referral
    • those with suspected sepsis or conditions with a risk of death or disability.
  • Unless clinically urgent, practices should move blood test activity scheduled before 17 September to later in the year when supply improves.

If your practice has taken these steps but is still likely to run out of products within 48 hours, you are asked to notify your pathology incident director and your NHS England and NHS Improvement regional team.

Informing patients

The 10 August guidance clarifies that changes to blood tests should be explained to patients. If you need to defer a blood test, discuss your rationale with the patient and explain it is deemed clinically safe to do so.

If possible, provide a timescale for when a blood test will be undertaken once the shortage has resolved.

We would recommend communicating to patients in any of the following ways:

  • notice on website, waiting room and surgery entrance
  • adding a comment to your phone message
  • sending a text message or email to your patient list, ensuring patient's emails are not visible to others by using bcc box or similar
  • explaining shortage to patients whose pre-booked blood test is cancelled or rearranged.

Record discussions

Ensure that any decision to defer testing and discussions with the patient are thoroughly documented in case you are later called upon to justify the delay. The documentation might cover:

  • the rationale behind why the test has been deferred, including any input from a relevant specialist
  • explanation provided to the patient
  • any comments or questions from the patient
  • any safety netting advice provided and follow up plans in place, such as calling the practice/clinic within a certain timeframe if they don't hear from you.

Liability for delays

Members can look to us for support and advice with any patient complaints arising from delays in testing.

NHS England and NHS Improvement also state that they have made system regulators, including the CQC, aware of this guidance, and have confirmed with NHS Resolution that any clinical negligence claims that may arise from the blood tube shortage "will be captured in the usual way by the respective state indemnity schemes, the Clinical Negligence Scheme for General Practice (CNSGP) and for members of the Clinical Negligence Scheme for Trusts (CNST)." The guidance advises that "any incidents should be reported in line with usual guidelines."

You can contact us for further advice if you face this difficult situation.

This page was correct at publication on 06/09/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Ellie Mein MDU medico-legal adviser

by Dr Ellie Mein Medico-legal adviser

MB ChB MRCOphth GDL LLM

Ellie joined the MDU as a medico-legal adviser in 2013. Prior to this she worked as an ophthalmologist before completing her Graduate Diploma in Law in Birmingham.