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NHS review calls for GP financial incentives to boost screening uptake



Financial incentives should be considered for GPs and primary care networks to boost uptake of screening programmes, an independent review of adult cancer screening programmes has found.

This could be particularly relevant in bowel screening where GPs currently have less involvement than with other programmes, the report by former CQC chief inspector Professor Sir Mike Richards said.

But GP leaders have stressed the pressures GPs face and said any extra work practices may have to carry out to boost uptake ‘should be funded appropriately’.

The review was commissioned by NHS England in response to national scandals over the failure of Capita to pass on screening letters to 48,000 women and an IT error which had led to 450,000 women missing cancer screenings.

In addition, it was asked to address concerns about falling rates of attendance in NHS breast and cervical screening programmes.

Among a wide range of recommendations, the review concluded that screening incentives for providers could include ‘payment by activity, targeted payments for enhanced services or enhancements to GP payment systems at either practice or primary care network level’.

GP practices already receive some additional funding for carrying out cervical screening tests, through QOF payments.

The report highlighted seasonal increases in cervical screening activity – linked to QOF targets – as evidence for the effectiveness of financial incentives.

It said GPs do not feel as involved with bowel cancer screening – a programme the Government has already pledged to extend to more people by lowering the starting age from 60 to 50, as set out in the NHS long-term plan.

The screening report said: ‘Financial incentives to encourage GPs to promote uptake in people who have not participated within a set time of being sent a kit should be considered, taking into account of course, the need to minimise the administrative burden on general practice.’

For cervical screening, it said the introduction of primary care networks ‘provides a new opportunity to provide more convenient services within a reasonable distance of people’s homes’.

Under the new GP contract, practices are paid to join networks, which will become responsible for delivering seven ‘service specifications’ in the coming years, including those focussed on increased screening and earlier detection of cancer.

The report added: ‘Primary care should be incentivised to provide screening services at times which are convenient for people who are eligible for screening.’

The review is also heavily critical of delays to the introduction of faecal immunochemical testing (FIT) for bowel cancer, which only began in England in June after an initial pilot in 2003 and an eventual green light from the National Screening Committee in 2015.

It is hoped that the roll-out of FIT kits could boost uptake by at least 7% with figures showing a boost of 8.5% in Scotland since 2017 when the test was introduced there.

GP leaders said they would welcome the roll-out of evidence-based screening schemes, but warned GPs would require more resources so as not to impact on their other areas of work.

BMA GP Committee chair Dr Richard Vautrey said: ‘Practices are not commissioned to deliver this particular screening service [for bowel cancer] and so, given the workload pressures facing GPs and their teams, the cost of any additional work required to improve uptake should be funded appropriately.’

RCGP chair Professor Helen Stokes-Lampard said: ‘Evidence-based screening can be a vital tool in spotting early signs of certain cancers and in some cases, can have a very positive impact on survival rates.

‘Offering women more flexibility over access to cervical screening could potentially break down barriers for some people.’

She added: ‘General practice is already stretched to its limits so we would need additional resources before we could create more flexibility.’