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Is NHS ready for bowel screening?

By Anna Hodgekiss

The future of the national bowel cancer screening programme was secured last week, with the Government finally agreeing to stump up the cash.

But while the logistics appear to be sorted and the funding in place, questions remain about how the programme will impact on GP workload and the overstretched NHS.

The programme is costing £10 million to set up and aims for national coverage by 2009, by which time two million people a year will be receiving faecal occult blood tests through the post.

But while the programme is designed to avoid a direct burden on GP workload, research in the pilot sites suggests it will have an impact all the same.

A study published in the British Journal of General Practice last year found screening increased the burden of paperwork and administration on GPs and created demand from patients for information.

The University of Edinburgh research reported that 40 per cent of GPs were braced for a substantial increase in workload with introduction of the programme.

Professor David Wells, one of the study researchers and professor of general practice at the university, says GPs will inevitably have to plug gaps in the procedures for screening. 'GPs will see an increase in patients asking about the tests and whether they recommend taking them, so their role in educating people is crucial,' he says.

An evaluation of a pilot in Warwickshire suggests the impact of screening on patient awareness will play an important role in its expected success.

The study ­ presented at this week's annual conference of the Association of Surgeons of Great Britain and Ireland ­ found the pilot had an immediate impact on patient attitudes and GP referral patterns.

But researchers warn GPs will have to remain aware of the possibilities of colorectal cancer, even when tests are negative.

Professor Wells says: 'GPs must remain aware as someone with rectal bleeding and abdominal pain may test negative, falsely reassuring the patient.'

Dr Jamie Dalrymple, secretary of the Primary Care Society for Gastroenterology and a GP in Norwich, admits the sensitivity of faecal occult blood testing is 'not brilliant' and GPs will have to remain aware of colorectal cancer symptoms.

But he says of greater concern is the fear that NHS endoscopy services might not be able to cope with screening.

'The issue of having people in place to perform these procedures is something that has been highlighted as a potential problem. This is why the independent sector may spot endoscopy as a service that needs supporting. This concerns me, but we must be realistic if there's no one else to do it.'

GP cancer leads warn colonoscopy waiting lists are already full to bursting in some areas, and that the national bowel cancer screening programme will put them under even greater pressure.

Dr Nick Brown, a GP in Chippenham and former cancer lead in Kennett and North Wiltshire PCT, says his local hospital already has a backlog of 1,000 colonoscopies, with this expected to double in the next year.

'Money has been agreed for the FOBs, but as the most overspent PCT in the country there's no money to reduce the waiting lists,' he says. 'I worry that the diagnostic care pathways have not been considered enough.'

Dr William Hamilton, a senior clinical research fellow at the University of Bristol who specialises in cancer diagnosis, also expresses doubts on whether services will be able to cope.

'This is the $64,000 question. It's certainly a concern. The risk from a positive FOB is a higher percentage than the standard pick-up rate in a two-week clinic, so you could argue they should get priority. Of course both groups merit rapid assessment, but I am unconvinced the resources are in place.'

But Professor Tony Morris, president of the British Society of Gastroenterology and director of the National Endoscopy Training Centre, insists symptomatic patients will not be adversely affected by the screening programme.

'I want to reassure GPs that this is a phased roll-out, and screening will not go ahead in areas with long waiting lists.'

The screening programme has had a stuttering start, but GPs will hope it soon hits its stride.

Screening in numbers

· 100 screening centres

· 300 colonoscopists to be employed

· 2 million people aged 60 to 69 to be tested each year

· 2 per cent of tests will be found to be abnormal

· 15 per cent of bowel cancer deaths to be prevented

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