Pulse February 2019 issue - Page 10

10 Analysis How the NHS long-term plan will aff ect your clinical practice NHS England has set out a number of clinical aspirations that will change GPs’ care of patients, including earlier detection and treatment of illness, and patient self-referral. Nicola Merrifi eld and Emma Wilkinson provide an at-a-glance guide ONLINE For full coverage of what the long-term plan means for practices, visit pulsetoday.co.uk/ news Pulse February 2019 Screening What the plan says The bowel cancer screening age will be lowered from 60 to 50, with use of the easier faecal immunochemical test for haemoglobin to boost uptake. Lung health checks, currently being trialled in Manchester and Liverpool, will be extended. Mobile lung CT scanners will be deployed to pick up more cancers at an earlier stage. NHS Health Checks will be reviewed to make them more eff ective and boost uptake, and working with the voluntary sector, community pharmacists and GP practices will off er opportunities to test patients for hypertension and other high-risk conditions. Testing for familial Self-referral What the plan says The number of physiotherapists working in primary care networks will be increased so patients can be seen without needing a GP referral. But self-referral goals do not stop at musculoskeletal (MSK) services, with the plan proposing to off er direct access to cancer diagnostics for people with red-fl ag symptoms. It also points to new technologies to allow easy access to decision trees and referral forms, meaning some patients can avoid GP referral for an appointment. What it means Most regions have confi rmed pilot sites for hypercholesterolaemia will be extended to identify at least a quarter of patients with the condition over the next fi ve years. What it means The changes to bowel cancer screening will be detailed in NHS England’s report this summer on a proposed overhaul of cancer screening in general, following high-profi le errors. New technologies and screening criteria are among the factors under consideration, and GPs have called for the review to look at balancing benefi ts and potential harms to patients. What GPs say GP and University of Birmingham clinical research fellow Dr Samuel Finnikin said: ‘There seems to be no regard for potential harms and opportunity costs of screening programmes. ‘Lung cancer screening is not approved by the National Screening Committee (NSC) and NHS Health Checks are widely criticised. Programmes should all be NSC-approved – it’s an irresponsible use of scarce NHS funds to implement them simply because they’re popular with the public.’ self-referral to MSK services and such schemes are generally popular with GPs. But plans, fi rst reported by Pulse in 2015, to allow patients to bypass GPs for diagnostic cancer tests have been less well received. While in theory self-referral may lead to patients being diagnosed more quickly, there are concerns about the impact on secondary care resources and overall patient care, and the eff ect on GPs’ gatekeeper role. What GPs say Birmingham LMC executive secretary Dr Robert Morley said: ‘This represents a huge change to the tried and trusted way in which GPs act as the gatekeeper for patients with worrying symptoms. ‘The risks are not just that secondary care services are overwhelmed with inappropriate self-referrals, potentially to the detriment of those who really do need to be seen, but also that patients will not receive the holistic care they need from their GP.’