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Can anyone detect our National Screening Committee?

Copperfield

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You know who’s in charge of Clinical Excellence, don’t you? Of course you do. It’s everywhere, isn’t it, NICE – like an omnipresent manic street preacher evangelically doling out guidance, press releases and bulletins to an increasingly bewildered and bored audience.

Who’s in charge of screening, though? Aha! Did you even know there’s a National Screening Committee? Well, there is. It comprises some Great and Good, as you expect, and they do stuff on screening, also as you’d expect.

But they fly very much under the radar, don’t they? Maybe that’s because they have fewer things to pontificate on than NICE, and work in less controversial territory. Or maybe they’re just shy.

Whatever. I find the low profile disappointing. I have a bit of a thing about screening, adhering very firmly to the wise and often quoted view that, ‘The only certainty about screening is its potential to cause harm’*. So my issue with the NSC is that it’s too quiet. I want its informed and evidence-based view on various ‘initiatives’ that sound to me like screening-through-the-back-door.

The only certainty about our National Screening Committee is that it remains hidden and undetected

It’s not for lack of opportunity. We’ve just had the story about a charity-based young persons’ cardiac risk screening programme, my local CCG is considering an atrial fibrillation screening initiative and the new NICE guidance recommending spirometry for incidental findings on X rays or scans sounds like reverse-engineered screening, too. 

Where is the voice of reason saying, ‘We do have a National Screening Committee, you know,’ or, better, ‘Hang on, let’s evaluate this?’ or, even better still, ‘No you fools, stop now!’

Do you hear me, NSC? Speak up, please. Because, currently, the only certainty about our National Screening Committee is that it remains hidden and undetected, as if in some sort of pre-clinical state. In which case maybe we need to screen for irony.

* I have tried to trace this comment to its source and have drawn a blank, which raises the possibility that I made it up. I do often quote it, though.

Dr Tony Copperfield is a GP in Essex

 

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Readers' comments (10)

  • Agree. Also needs greater voice on PSA and screening CT scans in private sector. Emotive stories from pressure groups/pop stars seem to carry more weight.

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  • It’s the festive season and yet nobody has thought of providing gift-tokens for scans. Consider how much your dearly beloved would appreciate one for a ‘fMRI brain’?

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  • Lets put the term "screening" to one side for a moment and consider AF; is it really asking too much to perhaps check a BP manually, with palpation of the ("Aha-its irregular") pulse to establish the zone where the systolic may be, leading to a sequence of thoughts in the clinicians mind along the lines of "Could this be AF? Maybe I should listen to the heart and feel the pulse at the same time?"

    Or is the clinical skill of BP checking/pulse analysis been consigned to a previous era because now we have digital BP machines (whose readings will be suspect in the presence of an irregular pulse volume/rate)?

    This is simple stuff and sadly not infrequently overlooked- not so long ago a patient had a raised BNP in the setting of mitral regurgitation and was sent for an ECHO. The appropriately tart reply of the report pointed out that the cardiac structure was unchanged from the previous ECHO but her known AF was batting along at 120-130. If the clinician who requested the damned ECHO and bothered to FEEL the pulse and engage the brain the need for this imaging would probably have been unnecessary.

    My last gripe on AF- for now- is the situation where the computer-generated ECG report shows AF and the clinician accepts this without critical appraisal which stems from an inability to independently analyse the ECG; the patient ends up anticoagulated for a wandering atrial pacemaker rhythm.

    Let us not conflate the term screening with basic bloody competence which we should be doing without it having to become a "program or initiative".

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  • I'd ban the electric ones apart from the patients using them at home. Agree with IDGAF

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  • Another vote up for IDGAF - we got rid of all our automatic BP machines several years ago for exactly that reason; the best screening for AF is during manual BP checking by docs & nurses and I would urge all practices (and hospitals) to do the same

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  • In all fairness to the National Committee their actual recommendations are pretty clear on most matters (a firm thumbs down to the majority of suggested national programs for adults)

    Their recent and historic recommendations are available at:
    https://legacyscreening.phe.org.uk/screening-recommendations.php

    I agree with Tony that we just don't hear enough about the Committee's opinions. Again as Tony implies this is probably because their views are "evidence based" rather than "read it in the Mail" based.

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  • The NSC is a rare bastion of good sense... and therefore is routinely disregarded.

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  • https://choosingwiselycanada.org/common-tests-treatments-procedures/ - has lots patient pamphlets on why tests or antibiotics etc aren't needed, there is a uk choosing wisely website. australian one quite correctly states if you don't know how to interpret the test then you should not order it!!!!

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  • Perhaps look at the New Years Honours lists Tony!

    But I believe that those purchasing, procuring, designing or delivering health checks (including screening) are all looking for some sensible advice in order to do things differently and better.

    Developing such recommendations would, undoubtedly, also be welcomed by those responsible for broader health care provision in appreciation of the potential impacts of ill-considered testing on hospitals.

    However, at present, such guidance is largely absent and, although I have lobbied for action in the UK with NHS Screening and others, there seems little appetite to become involved.

    I hope my recent book - recently reviewed in Pulse - might help to fill the gap.

    Although I would not claim to have provided all the answers I have set out a new approach to health checks and screening based on value.

    Nick

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  • *Not sure if he's the originator but I've heard Sir Muir Gray use your quotation. And he is a past leader of the NSC.

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