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BMA Guidelines updated

Clinical and Prescribing – Andrew Green 

I have met with Prostate Cancer UK to discuss the role of primary care in diagnosis and management of patients with prostate cancer. I stressed that testing an asymptomatic person for latent disease is screening and should not be dressed up as case-finding. Screening should be approved by the UK National Screening Committee and, if worthwhile, set up properly and funded. The transfer of patients from secondary care to primary care for follow up, either because they are part of active surveillance, or because of a single unconfirmed raised PSA, or because they have cancer but have completed active treatment, is reasonable but only in the context of a local enhanced service and computer-aided recall systems and decision aids.

Richard Vautrey and I met with the National Cancer Czar Professor Sir Michael Richards to provide an input into his forthcoming review of cancer screening. He seemed well versed in the barriers patients find in accessing screening services, and in particular we raised the problems trans patients have in accessing screening services.

NICE have completed their consultation exercise on new quality metrics for primary care, and of particular interest are those that will impact QOF through the Heart failure, Asthma, and COPD domains. I attended the annual meeting to review the responses, though only as a ‘GP with expertise’ rather than representing the GPC, which would be against their terms of reference. There are some technical problems with the proposed indicators but I am quietly confident a set will emerge which will be helpful.

The BMA’s PCN Clinical Directors Conferenceincluded a module on the QOF changes.

The last meeting of PHE’s Expert Reference Group - prescribed medicines that may cause dependence or withdrawal has taken place, and the report is awaiting publication. This is a subject where the default option will be to blame GPs for over-prescribing, but I was heartened by the support given to us by the addiction and pain specialists on the group, who were clear that without extra resources no amount of ‘better training’ would reduce prescribing. 

We were concerned about the advice from the General Pharmaceutical Council suggesting GPs should authorise prescriptions from on-line companies for high-risk medications. I met with them, and they do appreciate our concerns, and with encouragement may tighten their guidance to do more to dissuade these prescriptions from being issued in the first place.

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