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At the heart of general practice since 1960

Only GPs can rescue chlamydia screening, NHS report warns

By Lilian Anekwe

The Government's flagship

£80m national chlamydia screening programme is failing and only general practice can save it, warns an official NHS evaluation.

The major new report, seen exclusively by Pulse, recommends paying GPs for screening and using practice nurses for partner notification.

Screening in general practice is currently opportunistic, but the report, which is with the

Department of Health, recommends a proactive approach.

Practice registers could be used to invite patients for regular screening as they are already for cervical cancer, the report concludes.

An assessment of screening pilots found uptake was currently only 30 per cent – a figure that 'would not have an appreciable impact on either prevalence or complication rates'.

The report warns: 'The results challenge some assumptions about chlamydia epi-demiology, screening and management of infection.'

It says screening is currently failing to target men in particular, and that general practice is the best place to do this.

Dr John Macleod, a GP in Birmingham and member of the evaluation team, told Pulse: 'If screening uptake is low, it won't have any impact on the burden of disease.'

Dr Macleod, who is also senior lecturer in the department of primary care and general practice at the University of Birmingham, added: 'Currently GPs are compensated, but not enough to prioritise screening.'

The evaluation – the Chlamydia Screening Studies Project – examined data on more than 19,000 patients aged 16 to 39 in two pilots in Birmingham and Bristol. It also reviewed previous NHS-commissioned pilots and other evidence on screening.

The only trial to achieve the clinically important benchmark of 50 per cent coverage of sexually active women aged 16 to 24 was in Portsmouth, where GPs 'received generous financial incentives' of £25 per test for the first 6,000 tests and £10 per test thereafter.

Dr Richard Ma, a member of the RCGP's sex, drugs and HIV task group and a GP in

Islington, north London, said paying GPs would be crucial in delivering an effective screening programme. 'Opportunistic testing is not going to offer the coverage needed. The only way is by using GP registers, and so GPs have to be involved.'

Dr Stephen McKinney, a GP in Portsmouth who participated in two screening trials, said screening was more successful when it was 'clear participation would be worth our time'.

The DoH said it was 'looking at the findings of the research to examine the implications for the programme' – which is to be rolled out nationally by 2007.

lanekwe@cmpmedica.com

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