GP participation in increasing uptake in a national bowel cancer screening programme: the PEARL project.

BACKGROUND: The NHS Bowel Cancer Screening Programme (BCSP) in England does not involve general practitioners (GPs). Uptake is ∼58%. The Practice Endorsed Additional Reminder Letter (PEARL) study piloted a GP-endorsed reminder letter. METHODS: General practices in Wessex with uptake <55% (prevalent invitations) were invited to participate. Subjects who had been invited for screening, sent a standard 28-day BCSP reminder letter but had not returned a test kit within 30 days of the standard reminder were sent a second reminder letter bearing the GP's letterhead and signature. Uptake was compared between PEARL and non-PEARL practices by standardised uptake ratio (standardised for prior prevalent uptake and other confounders). In addition, 25 non-PEARL practices were matched with PEARL practices for prior prevalent uptake and number of invitees. RESULTS: Twenty-five practices agreed to participate. A total of 3149 GP-endorsed reminders were sent. Uptake in the PEARL practices was 54% compared with 51% in the matched-control practices. The adjusted RR for uptake was 1.08 (95% CI: 1.05, 1.11, P<0.001) for all invitees and 2.18 (1.79, 2.66, P<0.001) for invitees who had not returned a kit following the standard reminder. CONCLUSIONS: The GP-endorsed reminder was associated with significantly increased uptake among subjects not responding to the standard reminder letter.

General practitioners' use of sickness certificates.

BACKGROUND: At present, sickness certification is largely undertaken by general practitioners (GPs). Guidance from the Department of Work and Pensions (DWP) is available to help with this task; however, there has been little formal evaluation of the DWP's guidance in relation to day-to-day general practice. AIMS: To assess GPs' training, knowledge and application of the DWP's sickness certification guidelines. METHODS: A structured questionnaire was sent to GPs within a (former) primary care trust (PCT). It probed demographics, training and knowledge of sickness certification guidelines. Case histories and structured questions were used to assess current practice. RESULTS: In this group of 113 GPs, there was a low awareness and use of the DWP's guidelines and Website relating to sickness certification. The majority of the GPs (63%) had received no training in sickness certification, and the mean length of time for those who had received training was 4.1 h. Most GPs also felt that patients and GPs have equal influence on the duration of sickness certification. CONCLUSIONS: This evidence of variable practice indicates that GPs should have more guidance and education in sickness certification. Closer sickness certification monitoring through existing GP computer systems may facilitate an improvement in practice that benefits patients and employers. The DWP, medical educators and PCTs may all have an additional role in further improving sickness certification practice.