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At the heart of general practice since 1960

Hewitt says GPs will still have a voice

Emma Wilkinson reports on a potential workload explosion as researchers claim GPs should expand services

GPs may feel they are busy enough already, but screening experts have been queuing up in recent weeks to suggest more could be done.

Studies have highlighted the benefits of screening for everything from diabetes to osteoporosis (see box, below).

These are no pipe dreams either – the National Screening Committee is examining the potential of screening programmes for diabetes, atrial fibrillation, osteoporosis and aortic aneurism.

But every one of these would have significant implications for practice workload and resources – something many GPs feel is not properly appreciated by those responsible for policy.

Dr Mark Browne, a Derby GP and diabetes lead for Greater and Central Derbyshire PCTs, said: ‘It's all right saying let's screen, but without extra resources it's not possible. The problem is they assume we have the resources when we haven't.'

Dr Laurence Buckman, GPC deputy chair, warned: ‘Nothing will happen in general practice unless it is financially supported. Case-finding takes time and resources and you also need more resources when you have found patients with the illness.'

Sir Muir Gray, programme director of the national screening committee, insisted he was well aware of the problem.

‘We certainly wouldn't expect people to do things without resources,' he said, adding the impact on GP workload was considered ‘very carefully'.

Among the committee's rules on the viability of new screening programmes is a requirement that adequate staff and facilities are available.

Dr Surendra Kumar, a member of the committee and a GP in Widnes, Cheshire, was similarly sympathetic, but said a lot depended on how screening is implemented.

He told Pulse: ‘Opportunistic screening would be easier to implement but we need to make sure people who are most likely to suffer from particular diseases don't miss out. These are issues we are grappling with.'

Dr Browne suggested PCTs could ease the burden on GPs by running some screening programmes centrally.

‘One of the things that might negate the workload issue is they are bringing in centrally based servers so they'll be able to call people in without bothering us, for example, with mammography,' he said.

Dr Simon de Lusignan, who has researched case-finding in his role as senior lecturer in primary care informatics at

St George's Hospital Medical School, said it was important the ‘right choices are made' in selecting and implementing screening programmes.

Dr de Lusignan, a GP in Guildford, said: ‘There may be efficiency gains possible, for example tasks currently carried out by professional staff that can be done more cost effectively by healthcare assistants.'

But he added: ‘There is no getting away from the need for more resources – whether these are staff, IT, investigation, medication or referral.'

While the need for new funding is undeniable, potential methods of payment are more controversial.

Dr Buckman said the QOF would not be an appropriate place to incentivise case-finding, and that funding should go to national enhanced services instead.

But Dr Sally Hope, a GP in Oxford, said her experience of osteoporosis screening led her to believe it needed to be added to the QOF.

Dr Hope said: ‘Until this happens, GPs won't do it because it's a lot of work and it has to be made a GP target.'

Screening in the pipeline

Diabetes

•Researchers have just completed a pilot study in nine PCTs, screening all over-40s for diabetes.

•A nurse or healthcare assistant measured height and weight and those with a BMI over 25 were given a non-fasting blood glucose test.

•The National Screening Committee is to make recommendations at the end of November based on the results.

•Dr Azhar Farooqi, a GP in Birmingham who took part in the trial, said it worked well but there were ‘considerable workload implications'.

Pulse workload rating: 4/5

Osteoporosis

•The National Screening Committee does not currently recommend osteoporosis screening, but plans to re-evaluate its position next year following NICE guidance on fracture prevention.

•Dr Sally Hope, a GP in Oxford and member of the NICE guideline committee on osteoporosis, said the institute would be recommending a strategy for identifying high-risk individuals.

•‘We screened everyone over 75. The ones who were high-risk went for a DEXA scan. The workload was enormous.'

Pulse workload rating 4/5

Abdominal aortic aneurysm

•Trials of screening using ultrasound examination of the abdomen have found it reduces mortality.

The National Screening Committee plans to make a policy decision on a national rollout by 2006.

•Screening would be likely to include men aged 65-75. In trials, a vascular specialist nurse using a portable scanner screened patients at practices.

Pulse workload rating 2/5

Chronic kidney disease

•Automated searching of records can identify patients with CKD – with over 90 per cent undiagnosed.

•The National Screening Committee currently does not recommend screening but will revisit the issue within three years. The new NSF on renal disease recommends screening all patients with hypertension.

Pulse workload rating 3/5

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