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NHS review calls for GP practice financial incentives to boost screening uptake


By Emma Wilkinson
16 October 2019

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Financial incentives should be considered for GP practices and primary care networks to boost the uptake of screening programmes, an independent review of adult cancer screening programmes has found.

This could be particularly relevant in bowel screening, where GPs currently have less involvement than with other programmes, the report by former CQC chief inspector Professor Sir Mike Richards said.

But GP leaders have stressed the pressures medics face and said any extra work practices may have to carry out to boost uptake ‘should be funded appropriately’.

The review was commissioned by NHS England in response to national scandals over the failure of Capita to pass on screening letters to 48,000 women and an IT error that had led to 450,000 women missing cancer screenings.

In addition, it was asked to address concerns about falling rates of attendance in NHS breast and cervical screening programmes.

‘Payment by activity’

Among a wide range of recommendations, the review concluded that screening incentives for providers could include ‘payment by activity, targeted payments for enhanced services or enhancements to GP payment systems at either practice or primary care network level’.

Practices already receive some additional funding for carrying out cervical screening tests, through QOF payments.

The report highlighted seasonal increases in cervical screening activity – linked to QOF targets – as evidence for the effectiveness of financial incentives.

It said GPs do not feel as involved with bowel cancer screening – a programme the Government has already pledged to extend to more people by lowering the starting age from 60 to 50, as set out in the NHS long-term plan.

The screening report said: ‘Financial incentives to encourage GPs to promote uptake in people who have not participated within a set time of being sent a kit should be considered, taking into account of course, the need to minimise the administrative burden on general practice.’

For cervical screening, it said the introduction of primary care networks ‘provides a new opportunity to provide more convenient services within a reasonable distance of people’s homes’.

Under the new GP contract, practices are paid to join networks, which will become responsible for delivering seven ‘service specifications’ in the coming years, including those focussed on increased screening and earlier detection of cancer.

Incentivised to provide convenient appointments

The report added: ‘Primary care should be incentivised to provide screening services at times which are convenient for people who are eligible for screening.’

The review is also heavily critical of delays to the introduction of faecal immunochemical testing (FIT) for bowel cancer, which only began in England in June after an initial pilot in 2003 and an eventual green light from the National Screening Committee in 2015.

It is hoped that the roll-out of FIT kits could boost uptake by at least 7%, with figures showing a boost of 8.5% in Scotland since 2017 when the test was introduced there.

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