I realise the new contract is a bit of an, er, imposition. And that there are bigger fish to fry than the teensy minnow swimming around the contractual backwater that is Annex C, section 4. But that’s precisely where I’m going to direct you.
Because that’s where you’ll find, under ‘Updated Early Cancer Diagnosis service requirements 2022/23’, the directive to focus on prostate cancer, on the basis that referral rates are currently lower than expected. So we have to, ‘…develop and implement a plan to increase the proactive and opportunistic assessment of patients for a potential cancer diagnosis’.
Hmmm, OK, so for prostate cancer, I guess that must be…what, exactly? Surreptitiously ticking the PSA box with every cholesterol check? Casually offering a DRE when men attend with a sore throat? Opportunistic prostate MRIs at supermarket checkout-scanners?
Jeez. Just in case you have ‘urology’ on your PDP, here’s a quick factual refresher. Prostate cancer generally produces zero symptoms. It’s typically discovered coincidentally when investigating unrelated LUTs. The PSA is a very dodgy biomarker and requires full pre-test discussion. The older a man gets, the nearer a state of normality having prostate cancer is. Many men die with prostate cancer rather than of it, and would have been better off not knowing.
Given that context, the revised service requirement seems about as sensible and evidence-based as the last clinical bright-idea Trojan-Horsed through a PCN service spec: AF screening.
Neither AF nor prostate screening is supported by evidence or the National Screening Committee, but what does that matter when you’ve got a PCN document to draft, only a vague idea of what you’re doing, and the back of an envelope to do it on?
So, fellow GPs, off with the cloak of science and on with the rubber gloves! I mean, I know we’re supposed to be going digital, but this is ridiculous.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield