Slaughterhouse

You need to close those baffles :smile:

Meh, the dispersion I get would make Le Cleac’h envious

I’m posting on the off chance that some one knows what’s going on with this -

A couple of years ago TV doc Michael Mosley looked at a few health screening tests with a view to working out which were worthwhile and which weren’t. One of the ones which he thought was definitely worth having done was ‘flexible sigmoidoscopy’ http://www.bbc.co.uk/programmes/p02z88f7. This puts a camera up your bum and looks at the lower bowel. It can spot cancer, if you have it, and it can also spot polyps. The NHS says that most doctors believe that all bowel cancer starts as polyps. So if they find them during sigmoidoscopy they remove them. This reduces your risk of bowel cancer almost by half (bowel cancer is not uncommon, so that’s a BIG reduction). The latest results from a huge ongoing study show that a single sigmoidoscopy procedure is effective for a very long time (at least 17 years) http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30396-3/abstract. The caption at the start of the Mosley clip says “Bowel scope screenings like this are soon to be available to everyone over 55 on the NHS”. That was Aug 2015.

Shortly after the programme I had a routine GP’s appointment and I said I was 56 and I’d like to book my bowel scope screening please. She said that the practice didn’t routinely do sigmoidoscopy screening. Once patients were over 60 they’d be enrolled in the Faecal Occult Blood programme (so-called ‘poo sticks’) which checks every couple of years to see if you’ve already got cancer. I said that was all well and good, but I’d sooner prevent the cancer rather than find I’d got it and have to face unpleasant long-term life-changing treatment with no guarantee of success. She was lukewarm about it, said she’d had a patient die after a sigmoidoscopy that went wrong and eventually agreed to discuss it with her colleagues and get back to me. Of course she never did.

A year and a half on, yesterday’s local paper has a piece from the nearest hospital’s cancer screening folks imploring people to get a sigmoidoscopy done, pointing out the very serious risks of the disease and bigging up the benefits of the procedure. There was a case of a local guy who had had a malignant abnormailty detected and dealt with. There was a phone number for you to call if you wanted the test done. http://www.oxfordmail.co.uk/news/15226979.Over_55s_called_on_to_take_up___39_life_saving__39__cancer_screening_offer/ I called. Long story short, they said the procedure wasn’t available to me and I should talk to my GP about it. I went round to my GP’s surgery (it’s just a few minutes walk away), spoke to the practice manager who claimed ignorance of the scheme but said she’d get a GP to call me to discuss it. Since it’s not urgent that won’t happen for a week.

Does anyone know what’s going on here ? There clearly is a scheme which one bit of the NHS has been rolling out for the best part of two years. It’s reached Oxfordshire and people in Oxford are publicising it and being treated under it. Another bit of the NHS (the bit that seems to control my access) says it’s not aware that it’s being rolled out and, when I mentioned it in 2015, seemed unconvinced that it would be a good idea. When my GP calls I’m planning to ask who makes the decision about access to this scheme. If it’s his practice and he’s decided not to offer it then I’ll let him know that I’ll be writing to the paper so they can make this clear in a correction to their original article.

VB

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About as much fun as having something shoved up your, err, no, wait …

Don’t mince about. Go and scream at your GP. If, or when, that doesn’t work, change your GP. Get the test done.

Having had 2 incidences of GIST (nasty enough) I wouldn’t want to risk one of the really nasty bowel cancers. Early detection is key to positive outcomes.

Except for straight afterwards, when you might not have any choice.

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It is not that bad. For the full John Inman try walking about with a catheter in :scream:.

I’ve had an endoscopy down the throat and into the stomach. Having watched Mosley, the one the other way really doesn’t look that bad (I guess because the rectum doesn’t have a gag reflex).

VB

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So this sounds like the potential that one CCG is funding and promoting the treatment, hopefully on the logic that investing in prevention is better than paying for and subjecting patients to the cure, whereas another isn’t.

It’s worth working out which CCG your practice is being funded by and belongs to, and where the boundaries of the others are.

I would ring the helpline back and ask them which CCGs are funding the treatment and whether this is the basis of eligibility (which I suspect it is).

You can always ask to be registered at another practice and therefore switch CCGs to one that is currently funding (the scheme might be non recurrent and withdrawn at the next financial year).

While you’re on the phone to the helpline ask if you can be sent the clinical access policy to understand the basis on which they’re making eligibility decisions.

If you want to discuss any of this further then please get in touch.

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I’ve had this done. And the full one all the way up to the other bowel. I was getting blood in my stools. They found three polyps and dealt with them there and then. One large polyp was also sent off for testing - thankfully it was benign. The surgeon who did the procedure said he would make it compulsory for all men over the age of 45 if he had his way, but finances and woolly thinking by different health areas don’t seem to get this done. Either that, or he just enjoys looking up peoples arses.

Keep pestering them until they give in. It’s worth it.

GP’s now have to pay for this sort of test/procedure out of their own budget and have become very reluctant to spend it.

I had a knackered shoulder and my GP didn’t want to do anything until I mentioned I had medical cover and then he was all over printing referrals and recommending hospitals/consultants to me.

I’d send them an email and letter by recorded delivery asking for the test and if not a written response as to why they won’t provide it.

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Referral behaviour varies greatly between GPs even in the same CCG funding environment. But just to be clear, referrals for diagnostics and treatment do not come out of GP practice budgets.

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That’s useful to know. Thanks.

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Thanks Wayne, I was hoping this was up your street. I’ll try the helpline again tomorrow.

My practice is within the Oxfordshire CCG which is split into six localities. In their words “Each locality’s population has different needs and working this way allows the individual GP practices in each locality to reflect your health needs in the services that we buy”. As far as I can tell the localities are strictly geographical. So all of my local GPs are in the same locality. The nearest one who is in a different locality is in a different town quite a few miles away. It would be non-trivial to try to re-register there and even then I wouldn’t have shifted CCG, just locality.

Again as far as I can tell, the treatment is being promoted by a department within the major hospital in the region, not explicitly by the CCG. At least some patients resident in Oxfordshire are being treated. But I note that the patient they’ve produced for the newspaper article is “a visiting professor” with a Russian name. So perhaps he isn’t NHS-funded at all, and in fact the major hospital in the county is offering a procedure which the entire county’s CCG won’t fund. That would be precisely the sort of Kafkaesque situation which only NHS fucking disintegration could deliver.

VB

Okay so this is an interesting one. Oxford CCG covers a wide geography and so there’s no mini CCG funding lottery.

It looks like either -

  1. The CCG is funding this but has a tight access policy to protect its financial risk.

  2. The hospital has decided to provide this but without specific funding from the CCG and will try to code it in a way that they will get paid - they’re restricting the access to get a small cohort to create the clinical case for proper funding.

Fundamentally it’s important to find out who has been promoting this - it will be somebody’s pet project

Thanks for this advice. It worked. I called the Endoscopy Dept at the hospital directly and was put through to the bowel screening office. In two 5-10 minute phone conversations I got the whole sorry story (or, perhaps, a very elaborate cover story).

Anyway, it turns out it’s the Endoscopy Dept’s fault. They are actively rolling out flex sig screening for everyone over 55 and neither the CCG nor the GP’s are resisting this. They need background checks on the patients though, so the referral process is via GP’s. The GP’s have to be connected to the departmental admin system practice by practice. To avoid being overwhelmed Endoscopy have taken a cautious approach to the speed at which the programme is rolled out. So far they’re up to 30% (not sure if that’s 30% of patients or 30% of GP practices) with all the practices in central Oxford done, a handful just north of the city and, on its own it seems, Chalgrove. My area is scheduled to go live early next year. The rollout is scheduled to complete over the whole county in August 2018.

I said that all sounded plausible but what was the point then of the press articles ? They are entirely about encouraging more take-up which would make no sense at all if there was currently no spare capacity. The guy on the phone simply apologised that they had stirred the press up too soon. He said they really should have waited until the end of this year or early next. There had been quite a few phone calls like mine and he was just very sorry that they weren’t ready for me yet. Reading the article again it seems that the take-up among the 30% who are already live has been disappointing (only about 50%). I guess the department wanted to try to fix this low take-up with a public frightener and appeal. But instead they’ve frightened everyone, 70% of whom then discover that not only is there a problem they should be really scared about but, worse still, the NHS isn’t in a position (yet) to help them with it.

So, cock-up rather than conspiracy. I’m still having the conversation with my GP though and when I do I want to get him to promise me a referral for next spring. If the rollout goes as planned then that will be automatic. If it doesn’t then I won’t be side-lined into the poo sticks programme when I pass 60 (Sept 2018).

VB

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I don’t know about bowel screening, but you’re soon going to need help for RSI with all that typing :smile:

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I wonder if this is our should be, rolled out nationally. Sounds like it should be.

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The weather’s gone nuts. 26th of April and it’s snowing here in France (350m a.s.l.). 3 or 4" on the ground.

It is being Bob.

The problem for me is the timescale. From the link above As of March 2015 about two thirds of screening centres were beginning to offer this test to 55 year olds. More than two years later my local screening centre (the Endoscopy Dept at the John Radcliffe hospital) has got as far as rolling this out to 30% of its GP practices. They tell me that it’s planned to be rolled out to my practice early next year, which would be just in time for me. But only just. Given NHS planning let’s say I’m not exactly comfortable with that …

VB