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Over half of GPs manage bowel disease patients without specialist support



More than half of GPs are taking sole responsibility for managing patients with inflammatory bowel disease (IBD), despite lacking the training and resources to do so, a survey of Southampton doctors has revealed.

The study, presented at the recent British Society of Gastroenterology conference, found almost 60% of GPs reported they manage patients with established IBD independently, without any specialist involvement.

The authors, led by Dr Fraser Cummings, consultant gastroenterologist at Southampton University Hospital, said the lack of specialist support ‘raised clinical governance concerns’ and called for better shared-care approaches between primary and secondary care.

GP leaders said the findings reflected an ongoing problem and called for secondary care to take more responsibility for patients with chronic bowel and other conditions.

Dr Cummings’ team surveyed 164 GPs from a total of 37 surgeries in the city about their knowledge and management of IBD.

The results showed GPs dealt with an average of 2.8 consultations with adult patients with IBD each month, with 59% of GPs reporting they managed those patients with established IBD independently.

The survey also found the majority of GPs reported insufficient knowledge and confidence as well as inadequate resources for managing this patient group independently.

In line with this, 82% of GPs said they would prefer to have shared-care with hospital IBD services.

The authors concluded: ‘A high proportion of patients with inflammatory bowel disease are being solely managed by GPs. General practitioners’ lack of knowledge, confidence and resources in caring  for patients with IBD inevitably occurs when managing an infrequently seen chronic condition, raising clinical governance concerns.

‘Low exposure to this patient group questions cost-effectiveness of measures to improve GPs’ knowledge base. [The] findings support a shared-care approach between primary and secondary care.’

The British Society of Gastroenterology last year published a series of standards aimed at CCGs and NHS managers to improve access to consultants for patients with IBD, following an earlier audit of IBD that found the majority of IBD services did not have shared care protocols in place for outpatients.

Dr John O’Malley, a GPSI in gastroenterology who practices in Stockport, said the latest study underscored problems identified in a more recent audit of IBD in primary care and suggested these are still not being addressed.

Dr O’Malley said: ‘The paper sums up nicely what we found before – and shows it is still an issue. There are a lot of people with well controlled [ulcerative] colitis and Crohn’s [disease]who do need follow-up. Whether that has to be in the secondary care setting is debatable, there could be some sort of community care based on shared care principles, with fast-track back into the clinics and perhaps IBD nurses doing that role rather than GPs.’

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee agreed patients with IBD should be cared for by a specialist even when stable, and said the findings reflected the wider issue of GPs taking on management of patients with complex conditions without necessary resources or shared care agreements in place.

Dr Green said: ‘Patients with IBD should be under the care of a consultant, even if their disease appears to be stable, as few GPs will have the knowledge or resources to properly follow up these patients, and the consequences of inadequate follow-up can be severe.

‘Unfortunately we have seen too many patients with many types of complex chronic diseases discharged to primary care, often as a result of efforts to manipulate new-patient to follow-up ratios, and with little thought as to what is best for the individual patient. Sometimes this happens without individual reviews and inevitably it is the patient’s GP who has to try to pick up the pieces.’