The current state of screening in general practice

The aim of this study was to describe the range of screening services offered by general practitioners (GPs).

A postal questionnaire survey was sent to a random sample of one in four GPs in general practices within the geographical boundaries of North (East) Thames Region. The questionnaire was divided into five sections, the first covering practice details and the other four covering screening directed at different groups of patients. Each GP in the sample was sent the general section and two other sections.

The overall response rate was 67.7 per cent. There was inter-practitioner variability in screening practice in all four patient groups. A number of GPs did not undertake all screening tests required by the national GP contract or recommended by national or local policy, and some had introduced screening programmes of uncertain benefit. There was little evidence of systematic audit of screening programmes. Differences in screening provision were observed between GPs in Greater London and nonmetropolitan areas, but there was little difference between single-handed and group practice, or between fundholding and non-fundholding GPs, except in the provision of child health surveillance.

Primary care teams carry out screening for a wide range of conditions but the lack of uniformity of practice and of evaluation makes it unclear to what extent the population benefits from these activities. The importance of national and international screening policies is obvious, but there is a need to go beyond publication and dissemination of guidelines to develop implementation strategies which take account of the variations in the way GPs actually address screening in their practices.