At the time of publication of the MOD response to the report by the King's Fund Health Quality Service, following the audit of the GVMAP carried out on 18 December 1998, implementation of appropriate action to fulfil a few of the audit recommendations was not complete. In response to the report's recommendation for a clinical audit of GVMAP, in sections 6.7 to 6.11, and for all assessments to have a clear purpose, in section 11.3.1, MOD said that a review of the appropriateness of clinical investigations offered as part of the programme was underway. It was explained that advice had been taken from the Royal College of Pathologists (RCPath) on the blood tests undertaken and that, in parallel, a random sample of patient notes had been reviewed to assess the utility of the tests. It was expected that this would lead to a critical review of, and possible amendment to, the range of clinical tests undertaken at GVMAP.

The review has now been completed. This has involved reviewing a random sample of 300 medical records of veterans who have attended the GVMAP – approximately 10% of the total - and discussions of the findings with the RCPath.

The advice from the RCPath, on the basis of the evidence reviewed, is that a number of the tests currently undertaken should no longer form part of the routine package of investigations on those attending the GVMAP. This is because the results have been effectively normal or because the very small number of abnormal results resulted from clear cut medical conditions diagnosed by other more specific means.

It is generally accepted that it is clinically inappropriate, and at times harmful to a patient, to conduct unnecessary tests. Nevertheless, it is the policy of the GVMAP physicians to arrange any tests that are clinically indicated and these tests will still be available if there is a clinical indication that they would be helpful. This review will be conducted annually as part of the GVMAP Management Plan and the range of investigations amended as appropriate in the light of scientific and medical evidence. Further investigations can be added to the list of those undertaken routinely if there is a need so to do.

This change is based on the best clinical advice and is in line with good clinical practice.