National Association of Primary Care (NAPC)
Rapid Response Survey
Doctors Split On Extending Screening Services
On the evening of 2 April 2008, NAPC conducted a rapid response survey of practices, which sought to establish the reaction Alan Johnson’s announcement that every UK citizen between the ages of 40 and 74 would be offered a free screening service to assess his/her risk of disease.
Doctors were split in their views on proposals for extended screening services, with some concerned that the changes would generate for an average practice around 80 additional appointments per week; laboratories would be challenged to turn round the results and prescribing budgets would rise exponentially.
A summary of responses is set out below:
Practices were divided in their comments, with 50% largely supporting the proposal, in part, subject to an extensive range of reservations and 50% indicating their objections to the initiative. There was a considerable degree in overlap in the comments of those who supported the proposal and in those who objected.
Of those who supported the proposal, the following comments were made:
* Over 35s are offered health checks on request, although cholesterol screening is only carried out where clinically indicated. All new patients have the opportunity of a health check. However, if everyone over 40 decided to take up the offer, which would include a blood test and possibly an ECG, practices and laboratories would be inundated with demand. . Giving patients’ responsibility for their own health with the necessary interventions when needed is a sensible means of people management. Private providers might only cherry pick patients and leave the ones with chronic diseases who are not profitable.
* If it is rolled out nationally, it should be evidenced based. The scheme should be run as a pilot in one to three locations to determine it feasibility. What will be the benefits of the initiative and at what cost to our society?
* Most good practices are already doing this opportunistically.
* Once people get to about 40 they generally start taking an interest in their risk factors. The initiative reflects a public desire and should be commissioned from existing general practice.
* Our patient population would like risk assessments. However, the practice’s reservations are about the time they would take and it is not known whether they would make good use of limited time. Working men might appreciate the facility as they rarely visit their doctors.
Of those who were more critical of the proposal, the comments below were made:
* Any patient who wants a check-up can already have on free of charge whenever they want. The majority of patients do not bother. There is unlikely to be an increase in those who ask for on if this so-called ‘New Service’ is introduced.
* The public are definitely not interested in this.
* All screening causes harm; some may do some good as well. Where is the evidence for this spin. Screening sounds good, but the harm is rarely published.
* The only section of the public that will be interested are the people who already regularly turn up in surgeries. It will not reach men, particularly.
* This is part of a wider agenda – polyclinics would be able to undertake this work, so it gives a further incentive to build them. If patients decide to ask for risk assessments there will be a flood of worried well at existing surgeries. The whole emphasis is to drive privatisation.
Overall, there is a recognition that an extension of screening services is part of a continuum in policy development. However, this is mixed with some cynicism about the proposal. There was throughout the responses a genuine concern about whether mass screening was evidenced based and would represent value for money to the tax payer.
NAPC has a mixed membership of practices, PCTs and others from which volunteers provide a rapid response to topical issues by joining a syndicated email system designed to produce comments/data and opinion on subjects of the day affecting health care and health care related matters.
Respondents are based throughout the NHS for a rounded, well balanced view of events and include GPs, other clinicians, PCT and practice managers, as well as others working in and with primary care.
The process is to pose questions and invite responses within a very short timeframe. The answers to the questions are collated, graduated and evaluated into a unique snapshot of opinion, events, developments and trends in primary care.
This snapshot of responses to NAPC’s rapid response survey identifies both support for the trend in developments, as well as genuine concern about the effectiveness of blanket screening. Interestingly, its application to working men was raised on account of the lack of their engagement with health services.
