Columnist Dr Tony Copperfield on the new guidance that says GPs should manage suspected colorectal cancer patients below the new FIT threshold
Well, I do wish they’d make their minds up about whether GPs are not referring enough potential cancer patients (those ‘missing’ prostate cancers that have fallen down the back of a sofa), should be bypassed completely (those scan-while-u-wait lung cancer pilots) or should stop requesting so many 2ww appointments (those of us annoyingly constipating the urgent colonoscopy clinics with indiscriminate referrals).
Let’s just focus on that latter example, shall we, because it’s currently hotter than an endoscopic diathermy. Frankly, that recent diktat about FIT testing gave me a seizure. In case you missed it, the plan now is for us GPs to ‘manage’ lower GI cases ourselves if the patient has a negative FIT test, even if they tick the NICE criteria for bowel cancer two-week waits – to the extent that hospitals can bounce these referrals back.
This gives me a squeaky bottom feeling, which I grant you probably isn’t bowel cancer, but is the result of turning conventional teaching, a lifetime’s practice and current NICE guidance on their respective heads.
But seek the get-out clause and ye shall find. Two of them, in fact.
One is that we can, in fact, refer as per usual if there is ‘ongoing clinical concern’. Which, of course, there is, otherwise why would we have been doing the FIT test in the first place? This isn’t so much an escape hatch as a gaping hole of logic.
And the other is that, according to the new guidance, those patients with an abnormal full blood count get past the bowel bouncers. Fab, because there’s always something red-dotted in an FBC, isn’t there, even if it is a parameter no one looks at, or understands, or can remember what it stands for, like the RDW. And if there really isn’t any suitable abnormality, keep repeating the FBC until there is: remember, bleed a punter often enough and their ferritin will drop.
Besides, the 2ww is pretty much the only way I can actually get my patients seen these days. So even if someone could resolve the above reservations, and they can’t, it’s not going to work until ‘routines’ get a reasonable appointment rather than a vague promise and a phone call one year later timed for when they’re unavailable. Because, naturally, they’re on the bog.
Dr Copperfield is a GP in Essex. Read more of Copperfield’s blogs here
Brilliant !
The patient concern arguably will be greater than the clinicians but the fact remains that ( small) numbers of tumours will evade the FIT test not to mention the polyps that are large enough and presumably best removed.
Thanks Copperfield. It is hilarious. Unfortunately it is real-all signs of a 2ww NHS needs to rescue itself. The system has finally cracked even more.
NHS – GMC – CQC buddying rules:
Don’t give antibiotics. But be sepsis aware.
Don’t refer. But diagnose cancer early.
Be a whistleblower. But, don’t speak up or else.
Patient first. But, fob them off.
Be a gatekeeper. But shut the gate.
Don’t give OTCs. But see minor ailments.
Don’t act outside competency.
But be everything – and cover up for everyone.
Yes Copperfield. If they stopped scoping 24 year olds with IBS and bloating after 1g of cocaine and a donor kebab and countless doses of azithromycin et al. and their new vegan lactose semi-free neutral life, then people with a tumour might actually win. But, no; keep coding “sigmoidoscopy normal”. Until this country locks down on under 30 year olds, it will never, ever, ever win. Buscopan and nannying a diet of Red Bull and one smashed up bruised and empty avocado wins. Noisy wants, beat need. All inclusivity. Bravo.
Well said Patrufini, well said. Quote “don’t act outside competency”,–our health secretary gives her antibiotics to friends and family. The double standards, practicing medicine illegally.
Is this new guidance based on robust evidence? I don’t know but it is part of my PDP to find out. If it is, reducing the number of 2ww referrals will be a good thing.
Patrufini makes a very valid point about under 30s with IBS. We GPs need to be more assertive about making a positive diagnosis (of IBS) in this group and have guidelines that support us to do so because there will always be a minute number of exceptions. Maybe a -ve FIT test is the ammunition that we need to reassure them?