Low-value care is one of the quiet drains on primary care: it can expose patients to unnecessary treatment, add avoidable workload, and consume resources that could be used for higher-value clinical work. A BMJ Medicine systematic review and meta-analysis brings useful evidence to a practical question for general practice: what actually helps reduce low-value tests and treatments?
The review, titled Effectiveness of different de-implementation strategies in primary care, analysed 140 randomised trials of interventions designed to reduce care that offers little or no benefit to patients. The trials covered common primary care targets including antibiotic prescribing, other drug treatments, imaging, and laboratory testing.
Key takeaway
The clearest signal was not that one simple educational message solves the problem. The review found moderate-certainty evidence that provider education combined with audit and feedback reduced targeted low-value care. Other strategies, including provider education alone, audit and feedback alone, patient education, decision support, and combinations of these approaches, may also reduce low-value care, but the certainty of evidence was generally lower.
In practical terms, this points towards a familiar lesson in quality improvement: changing clinical behaviour usually needs more than information. Clinicians need clear standards, usable data, feedback loops, and support for conversations with patients.
Why low-value care matters in general practice
Low-value care is not just a policy phrase. In day-to-day primary care, it can mean antibiotics for likely viral infections, repeat investigations that do not change management, imaging where harms outweigh benefits, or prescribing patterns that continue because stopping is harder than starting.
For patients, low-value care can create false reassurance, incidental findings, adverse effects, and anxiety. For practices, it can mean extra appointments, follow-up results, prescribing reviews, and administrative work. For the wider NHS, it diverts capacity from care that is more likely to improve outcomes.
What the BMJ Medicine review found
The authors screened more than 13,000 abstracts and included 140 randomised trials. Median follow-up was 287 days. More than half of the trials aimed to reduce antibiotic use, while others focused on drug treatments, imaging, and laboratory testing.
Across the evidence base, de-implementation strategies reduced targeted low-value care by roughly 10-35% in relative terms. Multi-strategy approaches appeared more promising, particularly where patient education was combined with clinician-focused education and feedback. The review also noted that provider education plus audit and feedback had moderate-certainty evidence, making it one of the more defensible choices for service improvement.
What this means for clinicians
For GPs, appraisers, and practice leaders, the review supports a pragmatic approach: choose a specific low-value activity, measure it, give clinicians feedback, and pair that with concise education that explains both the evidence and the intended alternative.
The patient side matters too. Many low-value interventions persist because they are easier to offer than to explain. Patient-facing information, shared decision making, and consistent practice messaging can help reduce the pressure to prescribe, refer, scan, or test when the likely benefit is small.
Questions for appraisal and revalidation
This paper also offers useful material for reflective practice. Clinicians could use it to consider:
- Which low-value interventions are most common in my clinical setting?
- Do I have feedback data that shows my own prescribing, testing, or referral patterns?
- Where could patient information make it easier to avoid unnecessary care?
- What would be a realistic quality improvement project for my practice or PCN?
Bottom line
The BMJ Medicine review suggests that reducing low-value care in primary care is possible, but it needs structured de-implementation rather than vague encouragement. The strongest practical message is to combine clinician education with audit and feedback, then support patients with clear explanations about why more care is not always better care.
Source: BMJ Medicine: Effectiveness of different de-implementation strategies in primary care. DOI: 10.1136/bmjmed-2025-001343