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Paperwork fiasco: the crazy things we waste our time on

I am a GP in a three-partner practice of 5,700 patients. Every three years we are sent a list of patients age 50 to 65 who are shortly due to be recalled for breast screening.

The list comes from the local health authority and we are asked to verify all the demographic details – name, address, date of birth and NHS number – and mark which patients should be excluded from the recall as they are terminal or have had a bilateral mastectomy. In a few seconds we can produce from our computer a list of patients who are terminal or have had a bilateral mastectomy.

As to checking all of the names and addresses, well that is absolutely laughable. There is a daily electronic communication between the surgery computer and the health authority computer to update the databases as patients come and go from the practice. To actually check this information would be about as useful as comparing the new telephone directory to the old one to see who had changed their number or gone ex-directory.

The list of patients I mention above is not sent electronically or even on A4 paper but on those old-fashioned, massive A3 tractor-fed sheets in a pile 55mm high. It is a complete waste of my staff time to even attempt to check the demographic details.

We will just return the pile to the health authority, for them to destroy, together with our short list of excluded patients. The same fiasco is going on all over the country which equates to a pile of paper 550 metres high.

I have spoken to my local health authority and they agree it is a crazy system but they are told by the National Breast Screening Service that they must do it.

I have spoken to Dr Julietta Pattnick, who runs the National Breast Cancer Screening Service, and she agrees there is considerable duplication of effort.

She has suggested the lists be scrapped but the NHS Information Authority has decided this cannot happen without first running a trial. They are worried they may possibly provide a useful service that is not immediately apparent. A trial is being conducted in Edinburgh which should report in early 2005.

The same thing is also going on with cervical screening but that is a bit more subtle as they are smaller lists. Although the population is larger, aged 25-65, and screening interval is longer – five years as opposed to three – the lists come every quarter or even monthly so they are not so noticeable.

Whatever happened to common-sense and Patients not Paper.

Dr John Rochford



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