Intended for healthcare professionals


What general practitioners should do about breast screening

BMJ 1995; 310 doi: (Published 28 January 1995) Cite this as: BMJ 1995;310:204
  1. Paul A Creighton
  1. General practitioner Broomhill Health Centre, Morpeth NE65 0SR

    Employ more staff, set priorities, and delegate

    Despite evidence that the national breast screening programme is working well, primary health care teams could do still more to improve uptake.1 2 Why, for example, are rates of breast screening in Grampian lower than those of childhood immunisation and cervical screening (as reported in this week's journal, p 2293)?

    General practitioners are well placed to encourage women to attend for breast screening, and they have received guidelines on improving the quality and uptake of the screening programme and on ensuring that women receive information and counselling.4 Yet their wholehearted commitment seems doubtful,5 6 and Rudiman and colleagues have tried to find out why.3 The factors that they identify include scepticism about the value of breast screening, lack of involvement with the local breast screening centre, lack of financial incentives to reach targets for breast screening, and lack of time.

    One of the difficulties is that breast screening units provide a specialised service, often at some distance from the practice, whereas primary care teams do cervical screening and childhood immunisations themselves. General practitioners may also be sceptical about the value of breast screening in reducing the morbidity of and mortality from breast cancer.7 8 9

    Introducing payments for achieving targets in cervical screening and childhood immunisation has improved uptake10 but this may have adversely affected general practitioners' morale. Extending targets to breast screening might increase dissatisfaction and also, more importantly, lead some general practitioners not to comply solely for financial reasons.

    To create more time for screening, general practitioners should improve managerial support in their practices and delegate to other members of the primary health care team. Practice managers should have a relevant qualification in practice management to attract partial reimbursement of their salaries. Managed practices could then set priorities, identify the resources needed to achieve these priorities, and audit their performance. Practices would have to know the cost effectiveness of their screening and health promotional activities. This approach would enable general practice to undertake any new screening programmes, improve the functioning of the practice team, and give general practitioners more time to concentrate on clinical tasks.

    Vocational training for practice managers could improve practice management in the same way that vocational training improved the quality of general practice. This training could be based around the core skills that have recently been identified by the Association of Managers in General Practice.11

    Practice nurses do most of the health promotion and screening in general practice. The staff reimbursement scheme for general practice has become cash limited since 1990 and general practitioners wanting to employ extra nurses may be unable to do so unless they pay for any extra nurses themselves. If screening programmes in general practice are to achieve their full potential the salaries of practice nurses should be fully reimbursed, provided that practices can prove the cost effectiveness of extra nurses.

    General practice cannot keep absorbing more work without more resources. Recent reports suggest that the second round of breast screening may not have reached the same proportion of eligible women as the first.12 Only with the right allocation of resources can general practice in Britain deliver highly effective national screening programmes.


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