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GPs should be incentivised to identify continence needs, says NHS England



GPs should be incentivised to better identify and manage bladder and bowel incontinence in at-risk patients, new guidance issued by NHS England says.

The guidance, Excellence in continence care, sets out a range of ways to improve services for patients living with bladder and bowel problems.

It suggests that as GPs were relieved of QOF duties they would be well placed to take on case-finding and offering support for continence problems through the enhanced service on case management of elderly and vulnerable groups.

However, the GPC said the suggestion showed NHS England was ‘out of touch’ with overburdened GPs and that the main barrier to good care was the long waiting times when referring patients to continence services.

The recommendations come out of the Francis Report into failings at the Mid-Staffordshire NHS Foundation Trust, which highlighted concerns about ‘this most basic of needs’.

NHS England said people with continence needs often believe there is no help available, while continence problems are frequently overlooked ‘by providers in all settings’.

It said it wants to improve services to give patients a better quality of life and more independence, with less reliance on pads and products by using alternative treatments – as well as cutting admissions to hospitals and care homes and reducing complications, such as urinary tract infections, faecal impaction and skin breakdown.

The guidance says that GPs could be encouraged to case-find and support more patients with continence through their case management of elderly and vulnerable patients.

It states: ‘Changes to the GP contract require case management of patients, personalised care planning and care coordination and these will support greater awareness of needs.

‘Movement away from the QOF will give GPs opportunities to focus on real quality improvements including: case finding of patients with bladder and bowel problems; self-support; the identification of the requirement for domiciliary care and nursing home support.’

Dr Richard Vautrey, deputy chair of the GPC said many practices were already ‘developing closer links with community teams as part of their focus on the 2% most vulnerable patients’ but that ‘the reality in many areas is that the continence services can’t cope with the number of referrals they receive and waiting times can often be unacceptably long’.

Dr Vautrey added: ‘The suggestion that the modest QOF reductions so far implemented have given GPs any more time to do this shows how out of touch NHS England seem to be about the level of workload pressures GPs and their practice teams are under.’