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woensdag 7 maart 2018

RCGP: PSA tests should not be offered routinely to men without symptoms of prostate cancer, says College

PSA tests should not be offered routinely to men without symptoms of prostate cancer, says College

She said: "Prostate cancer costs thousands of men their lives every year across the UK, and GPs are working hard to ensure that patients are able to recognise the symptoms of prostate cancer, which if caught and managed in a timely way, can greatly increase their chances of survival.

"GPs have long held reservations about the effectiveness of PSA testing based on previous research findings, in particular with regard to potential overdiagnosis and its associated risks - today's research supports these concerns.

"It shows that PSA testing is not sensitive enough to either detect the subtle variations between prostate cancers or exclude clinically insignificant cancers. The results being that in some cases the need for urgent treatment might be missed, while in others it causes unnecessary worry for patients, who might have to undergo a biopsy and deal with the associated risks of the procedure.

"This large, high-quality study is really useful in backing up our calls for GPs to have better access to a more specific and sensitive test than the PSA test. It is now important that this research is taken into account as new research is commissioned and new clinical guidelines are developed.

"The College does not recommend that the PSA test is offered routinely to men who do not present with prostate cancer symptoms. However, if a patient is concerned about developing the disease or about any worrying symptoms we would encourage them to speak to a healthcare professional."

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RCGP condemns NHS Digital decision to ignore recommendations to suspend MOU with Home Office

The Memorandum of Understanding between the three organisations permits the disclosure of NHS data to help the Home Office track those suspected of offences relating to immigration, including overstaying a visa.

Professor Helen Stokes-Lampard writes that the College is concerned about the "possible impact of this on patient confidentiality" and that it is the RCGP's view that has there is "no requirement to change the current system, which enables information and records to be obtained via court order."

She continues that since news of the MOU was announced, the College has consistently said that "GPs and other health professionals have a duty to deliver care to patients, regardless of their individual circumstances. This care is provided on the mutual understanding that the information our patients share with us remains confidential. This principle is fundamental to the trust which exists between doctors and patients.

"Any process that undermines this trust will both deteriorate the doctor-patient relationship, and deter vulnerable people from seeking medical assistance when they need it.

"We recognise that the information shared as a result of the MOU is considered to be non-clinical, but any information, even names and addresses, are given by patients in good faith and with the understanding that this remains confidential."

Her letter also cites concerns regarding public health, writing that "it is crucial that vulnerable patients do not stop presenting to their GP fearing the consequence of immigration enforcement."

The College's intervention comes in the wake of correspondence between Health Select Committee Chair Dr Sarah Wollaston, a former GP, and NHS Digital recommending that the MOU be suspended until there has been a thorough review of public interest in maintaining a confidential medical service.

NHS Digital refused on the grounds that it was justified given public concern regarding immigration.

The letter also notes "increasing levels of concern from… the National Data Guardian, British Medical Association, Public Health England, and General Medical Council, about the impact of the MOU on the doctor-patient relationship, patient confidentiality, and public health."

Professor Stokes-Lampard acknowledges that it is "encouraging that the government has commissioned Public Health England to look at the impact of the MOU on public health," but that the College is "concerned that this work will not report until January 2019."

Until the outstanding issues regarding patient confidentiality and public health, the impact of the MOU this on the doctor patient relationship, the potential for this to deter vulnerable people from seeking medical assistance, and the concerns about risk to public health are resolved, the College is urging NHS Digital to take heed of the Health Select Committee's recommendation to suspend the MOU.

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Alcohol and drug abuse not restricted to the young, says RCGP

"Substance misuse is a very concerning issue for the whole population – it is not the preserve of young people - and GPs understand that addiction to any substance can have serious, negative consequences on our patients' health and wellbeing.

"GPs will look at the physical, psychological and social factors potentially impacting on the health of the patient in front of us – and as part of this we will ask our patients questions about their alcohol intake, smoking and any drug use so that we can determine the most appropriate and effective treatment for them.

"It is alarming to see a doubling in deaths related to poisoning from substances in older people and highlights the very real dangers of alcohol and drug misuse.

"While alcohol is safe in moderation, it is also important to be aware of your alcohol habits at home, in private - as it can be more difficult to keep track of exactly how many units you're having when they are not being measured out in standard sizes - and if you notice it's becoming a problem, you should be honest with yourself and seek help to limit your alcohol intake."

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