You need to close those baffles
Meh, the dispersion I get would make Le Cleacâh envious
Iâm posting on the off chance that some one knows whatâs 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 werenât. One of the ones which he thought was definitely worth having done was âflexible sigmoidoscopyâ 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 thatâs 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 âBowel scope screenings like this are soon to be available to everyone over 55 on the NHSâ. That was Aug 2015.
Shortly after the programme I had a routine GPâs appointment and I said I was 56 and Iâd like to book my bowel scope screening please. She said that the practice didnât routinely do sigmoidoscopy screening. Once patients were over 60 theyâd be enrolled in the Faecal Occult Blood programme (so-called âpoo sticksâ) which checks every couple of years to see if youâve already got cancer. I said that was all well and good, but Iâd sooner prevent the cancer rather than find Iâd got it and have to face unpleasant long-term life-changing treatment with no guarantee of success. She was lukewarm about it, said sheâd 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, yesterdayâs local paper has a piece from the nearest hospitalâs 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 wasnât available to me and I should talk to my GP about it. I went round to my GPâs surgery (itâs just a few minutes walk away), spoke to the practice manager who claimed ignorance of the scheme but said sheâd get a GP to call me to discuss it. Since itâs not urgent that wonât happen for a week.
Does anyone know whatâs 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. Itâs 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 itâs not aware that itâs being rolled out and, when I mentioned it in 2015, seemed unconvinced that it would be a good idea. When my GP calls Iâm planning to ask who makes the decision about access to this scheme. If itâs his practice and heâs decided not to offer it then Iâll let him know that Iâll be writing to the paper so they can make this clear in a correction to their original article.
VB
About as much fun as having something shoved up your, err, no, wait âŚ
Donât mince about. Go and scream at your GP. If, or when, that doesnât work, change your GP. Get the test done.
Having had 2 incidences of GIST (nasty enough) I wouldnât 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.
It is not that bad. For the full John Inman try walking about with a catheter in .
Iâve had an endoscopy down the throat and into the stomach. Having watched Mosley, the one the other way really doesnât look that bad (I guess because the rectum doesnât have a gag reflex).
VB
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 isnât.
Itâs 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 youâre on the phone to the helpline ask if you can be sent the clinical access policy to understand the basis on which theyâre making eligibility decisions.
If you want to discuss any of this further then please get in touch.
Iâve 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 donât seem to get this done. Either that, or he just enjoys looking up peoples arses.
Keep pestering them until they give in. Itâs worth it.
GPâs 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 didnât 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.
Iâd send them an email and letter by recorded delivery asking for the test and if not a written response as to why they wonât provide it.
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.
Thatâs useful to know. Thanks.
Thanks Wayne, I was hoping this was up your street. Iâll try the helpline again tomorrow.
My practice is within the Oxfordshire CCG which is split into six localities. In their words âEach localityâs 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 buyâ. 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 wouldnât 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 theyâve produced for the newspaper article is âa visiting professorâ with a Russian name. So perhaps he isnât NHS-funded at all, and in fact the major hospital in the county is offering a procedure which the entire countyâs CCG wonât 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 thereâs no mini CCG funding lottery.
It looks like either -
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The CCG is funding this but has a tight access policy to protect its financial risk.
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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 - theyâre restricting the access to get a small cohort to create the clinical case for proper funding.
Fundamentally itâs important to find out who has been promoting this - it will be somebodyâs 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 itâs the Endoscopy Deptâs fault. They are actively rolling out flex sig screening for everyone over 55 and neither the CCG nor the GPâs are resisting this. They need background checks on the patients though, so the referral process is via GPâs. The GPâs 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 theyâre up to 30% (not sure if thatâs 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 werenât 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 theyâve 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 isnât in a position (yet) to help them with it.
So, cock-up rather than conspiracy. Iâm 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 doesnât then I wonât be side-lined into the poo sticks programme when I pass 60 (Sept 2018).
VB
I donât know about bowel screening, but youâre soon going to need help for RSI with all that typing
I wonder if this is our should be, rolled out nationally. Sounds like it should be.
The weatherâs gone nuts. 26th of April and itâs 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 itâs 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 letâs say Iâm not exactly comfortable with that âŚ
VB