Continued from the e-newsletter
Dr Barrett: ‘With IBD, as with so many other specialities of medicine, hospital specialists are now tending to deal with the more complex and difficult cases, with the day-to-day IBD management moving into primary care,’ explains Dr Barrett. ‘In addition, GPs are also now carrying out many more diagnostic tests for IBD, including faecal calprotectin. As a result, IBD is becoming an increasing part of the GP workload which is why it is important for GPs to be properly supported with clear, easy to access information on the speciality.
‘Unfortunately, we do know that gastroenterology is an area that is often overlooked in primary care, with no special funding available in the GP contract. This inevitably has had an effect on the teaching of gastroenterology at a primary care level.
‘Added to which, IBD can be difficult to diagnose, particularly in the early stages when the symptoms can be vague and nonspecific. The patient can sometimes be misdiagnosed with Irritable Bowel Syndrome, which may lead to a delay in the correct treatment. In the worst-case scenario, a patient with IBD can eventually develop colorectal cancer, so it is vitally important that the condition is diagnosed correctly and as soon as possible.
‘I know from personal experience how easily misinterpretation of symptoms can occur. I was a GP and I had worked in gastroenterology during my training, yet it took me over a year before I accepted that my symptoms were something more than IBS and sought help from my GP.
‘We hope that the Toolkit will support GPs to improve their ability to diagnose IBD and we are delighted that the RCGP has provided public access to the Toolkit.’
Dr Barrett aims to leverage his term as Clinical Champion for the Spotlight Project and also as Chair of the Primary Care Society for Gastroenterology to ensure that IBD and gastroenterology in general gets a better deal at primary care level, and he and his committee have pinpointed key areas for positive change.
‘We hear from our members that they often struggle with a lack of communication, with vital information still being passed back to them from the hospital via letter. Inevitably some hospital teams are better at communication than others,’ he explains.
‘We would urge that all patients are discharged from hospital with a clear care plan, including a clear diagnosis, investigation results, flare-management plan, and dates of next tests and appointments, together with contact details for the local IBD team.
‘This would have the added benefit to the hospital teams of being able to discharge the patient back into the community, confident that their patient’s care plan will be continued without any confusion.
‘Secondly, we would argue that, as IBD patients continue to be transferred from secondary to primary care, the appropriate resources go with this transfer.
‘Overall, it is an exciting time for gastroenterology and IBD; the role of the faecal microbiome in underpinning a wide range of conditions, and the impact that stress, nutrition, antibiotics and exercise can have is becoming an important area of research. We should recognise this and support everyone who is working in this field.’