• general practice

It was very pleasing to see a paper reporting a pilot study of primary care endometrial sampling1as this was something I have been involved with over the last 25 years. However, I was a little disappointed that there was no reference to some of the previous work on this subject in primary care.2

I published two papers on this subject in 1998. The first considered the end of the operation of dilatation and curettage (D&C) which, until the 1990s, had been the investigation of choice for abnormal uterine bleeding and the emergence of new techniques such as Pipelle endometrial aspiration.3 The second paper I published was entitled ‘Endometrial sampling in general practice’ and was a case series of 38 women investigated for unexpected vaginal bleeding.4 I had introduced the procedure to the Honiton Practice in 1993, having held the appropriate qualification for intrauterine techniques for many years and having acquired further training from the local gynaecology department and taken advice from the relevant defence unions. It was not part of general medical services then, and under new general practice arrangements, it was recognised as ‘provision of secondary care within primary care’ and remunerated. It is also important to realise that the current National Health Service 2-week wait referral procedure did not exist then, and sometimes women with abnormal bleeding could wait quite a while for further investigation. One woman in this study was actually diagnosed with endometrial cancer from the primary care sample. The published study was awarded a local audit prize, and I also received a research award from the British Medical Association (BMA) for it.

I tried to help other practices introduce the procedure but with limited success. As further reorganisations of the NHS and primary care happened, this important service was rarely recognised and eventually funding ceased, although within my own practice, we continued to provide it. I hope that the recent paper in this journal1 will encourage a renewed interest in undertaking this procedure in primary care.