More resources needed: doctor

More resources are needed for colonoscopy services throughout the country, the Royal New Zealand College of General Practitioners' outgoing medical director Richard Medlicott says.

Dr Medlicott, who left his medical director role at the end of August, said concerns about access to colonoscopy were not unique to Southern District Health Board.

"Our concern is that rigid adherence to guidelines for screening referrals may result in poor outcomes for patients who fall into a grey zone. Guidelines are not protocols.''

When family doctors felt reluctant to refer patients for colonoscopy there was a risk of delayed or missed bowel cancer diagnosis.

The college appreciated that resources were limited, but it would like to see more assigned to colonoscopy services.

It was a complex issue and the college would welcome suggestions for innovative ways of managing colonoscopy demand.

GPs would try to follow guidelines for direct access to publicly-funded colonoscopies, but would also continue to refer outside the guidelines if they had particular reasons for concern, he said.

Dr Medlicott was commenting on concerns raised by some GPS in the SDHB area about access to colonoscopy for their patients.

These concerns were raised in the wake of the recent damning report, by general surgeon Phil Bagshaw and gastroenterologist Dr Steven Ding, into colonoscopy access for Southland Hospital surgeons and wider issues involving colorectal cancer (CRC) management and the relationships with the SDHB gastroenterology department .

That report called for an urgent overhaul of CRC management.

GPs said they were reluctant to refer patients who did not meet the strictly-imposed direct access to colonoscopy guidelines but had concerning symptoms - termed being in the "grey area'', fearing such a request would be declined.

An informal survey by Wellsouth Primary Health Organisation of its 83 practices attracted 32 responses in five days, with nearly all respondents acknowledging having patients, or being aware of cases, where there were adverse outcomes due to denial or delays in referrals being accepted.

Concerns have also been raised about the tone of the communications with the gastroenterology department, some GPs describing them as "unusually and needlessly rude and unprofessional''.

As of last Friday, DHB chief executive Chris Fleming said he had not received any examples of the rude and offensive letters referred to by the GPs . (A week earlier he had invited GPs to share copies with him.)

Mr Fleming did not respond to an additional question asking whether he considered reviewing the department's correspondence himself rather than waiting for GP contact.

  • Yesterday Mr Bagshaw and Dr Ding discussed their report with Health Minister David Clark and director general of health Anthony Bloomfield.

Speaking after the meeting, Mr Bagshaw said they had listened to the report writers outline their concerns in detail and he and Dr Ding were told they would be "looking into them''.

He did not wish to comment further at this stage.

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