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At the heart of general practice since 1960

Farewell to a tried and trusted friend

While finding it cheaper to use the Central Sterilising Services Department, Dr John Couch retains a soft spot for the trusted practice steriliser which new regulations have consigned to the skip

An internal email appeared on my screen recently from our practice nurses. It read: 'Steriliser put in skip last week. RIP.'

This event was, of course, precipitated by the national rule changes designed to ensure higher standards of sterile instruments in primary care. The email barely disguised the nurse's joy at being rid of the daily chore of sterilising equipment.I could understand her attitude. On the other hand the steriliser has been an essential piece of GP kit over many decades. Its ability to produce aseptic equipment at fairly short notice has made many of the practical aspects of primary care considerably more flexible. For more than 40 years before nGMS in 1990 GPs were taking cervical smears and performing minor surgery. Later on they were fitting IUCDs. In fact it was not unusual for our pre- and post-war colleagues to be rather heroic in their use of patients' kitchen tables. The Central Sterilising Services Department (CSSD) could be very slow, especially in rural areas, so a practice steriliser was essential.Under the terms of the 1990 contract defined payments were made for smear, minor surgery and IUCD fitting. Then the recent GP contract added payment for extended minor surgery via enhanced services. None of this would have been possible without our stainless steel friend, and each practice was able to earn a considerable amount of money as a result.

Breaking down the cost

There were, however. costs. These included having to buy a new steriliser every eight to 10 years, nurse time in processing equipment, and the increasing costs of steriliser maintenance and servicing as regulation increased.

It would have been easy to make a complete switch to CSSD, but we researched the costs of disposable instruments and found that in some cases they were cheaper.The actual breakdown was interesting. Switching to disposable vaginal specula was cost neutral and we felt more user acceptable. Disposable forceps were cheaper. Disposable proctoscopes were paradoxically more expensive with the result that we are using CSSD for these. Minor surgery packs and IUCD packs are also cheaper via CSSD. It is certainly worth costing individual items in the same way if you have not already done so. We compared the old costs (using a steriliser) which included capital purchase, maintenance and servicing with our projected new costs and found they were broadly neutral. However, we then added the time that our healthcare assistants and nurses were spending on daily sterilising, including prior rinsing and soaking in some cases. We discovered that we would actually make a saving with the new system. This is the first time I can remember a new regulation resulting in a saving to practices, albeit unintentionally. I now share at least some of the nurses' joy. But I must admit to experiencing a nostalgic sense of loss as our tried and trusted steriliser heads for the nearest metal reclamation yard.

Dr John Couch is a GP in Ashford, Middlesex

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