As part of Pulse’s latest series, Emma Wilkinson explores how unofficial screening tests and health checks are putting even more pressure on GPs
Whether it is a result of campaigns to push unofficial screening, private health checks or at-home testing kits, general practice and the wider NHS is frequently left to pick up the pieces of ‘abnormal’ results.
It is a growing issue yet there seems to be little appetite for the Government, NHS or regulators to push back.
Vice-chair of the Association of Directors of Public Health Greg Fell says one of the reasons the National Screening Committee (NSC) was set up in the first place was to bring some oversight to NHS screening programmes – ensuring not just what was offered but also how and to what population groups.
‘Capacity in services is part of that and there are knock on consequences. What gets deprioritised because of screening? There is also the issue that if you’re going to screen for something, you really should be responsible for the whole pathway of care,’ he says.
But in the case of unofficial screening, many people are being actively encouraged to seek further advice from their GP. Glasgow GP and original founder of the RCGP overdiagnosis group says patients ‘often come back to the NHS to get their test results, or queries about them sorted out, or abnormal ones repeated in an NHS lab’.
‘Every minute the NHS spends dealing with the results of tests we didn’t order and wouldn’t recommend is a minute we can’t spend on someone else. These companies effectively steal NHS resources,’ she adds.
Surrey GP Dr Lis Galloway says she her practice is seeing this scenario play out roughly three to four times per week: ‘That’s over 30 hours a year of work that we didn’t create and that private companies profited from.’
She adds: ‘Our duty of care is such that once we’ve seen a result, we have to take action and of course worried patients are caught in the middle…Screening companies seem to be well aware, and it could be argued are taking advantage of this.’
The pressure this is placing on GPs has not gone unnoticed by the profession’s leaders. In 2019, the RCGP issued a statement citing ‘serious concerns’ about screening that is being done not under the recommendation of the NSC or NICE.
The statement followed a survey in 2018 which found 91% of doctors had seen patients in the NHS to discuss the results of private screening and three-quarters of the time further resources in testing or appointment were done.
RCGP chair Professor Kamila Hawthorne says GPs are worried about the quality of non-evidenced screening that businesses are offering patients, and the wider impact this may have on limited NHS resources.
‘In many cases, the results have little or no value to the patient’s health, so this takes up valuable GP time when we and our teams are working under considerable pressure, and patients who really need our care and services are struggling to access them,’ Professor Hawthorne said.
‘Businesses that sell non-evidenced or unapproved screening services should not assume that GPs in the NHS will deal with the results.’
The College and the BMA have also produced a template letter that GPs can use to push back when private providers expect them to follow up. This asks providers to make patients aware of what is and is not approved by the UK NSC or equivalent at point of sale and to offer follow up of results that ‘does not put pressure on NHS general practice workload’.
But without Government action, GPs may struggle to effect change on their own – especially with the pressures on NHS waiting lists meaning more people are turning elsewhere for advice. There are also wider issues at play, around overmedicalisation and health anxiety, as GP and professor of primary care research at Hull York Medical School Joanne Reeve points out:
‘I have never experienced in 25 years of practice, the levels of health anxiety around at the moment, for all sorts of reasons. I spend every consultation in some way helping someone make sense of their health issues and it is not about giving them a test or a diagnosis or a tablet.’
She adds: ‘We have screening programmes being pushed by charities and we now have supermarkets and whoever else making money out of it as well. But the NHS does it too, health checks being a case in point.
‘We have completely lost the plot on what the goals of health or healthcare should be.’