She said: "Irritable bowel syndrome is very common and can or those most severely affected it can be an incredibly debilitating condition. "This research is certainly interesting and will offer hope to many people who are living with what can be very distressing and embarrassing symptoms. "However, we also know that even when new innovations are accepted by the NHS, referral times for any form of cognitive behavioural therapy can be long, so we need to make sure that all new therapy services are properly funded and resourced to ensure our patients can access them as promptly, equitably and effectively as possible."

She said: "Deaths from malignant melanoma, the most serious form of skin cancer, are increasing more than any other cancer, so identifying skin cancer at the most timely stage possible leads to better health outcomes and, potentially, saves lives. "However, introducing this extra step to the process of urgent referrals implies doubt about GPs' clinical judgment and risks adding substantial delays to the process. "It is vital that all new initiatives are piloted carefully and appropriately funded before roll-out to ensure patient safety and prevent significant adverse impact on GP workload. "Unlike many other cancers, skin cancer is often visible, and  better access to diagnostic tools like dermatoscopes in our practices, along with the training to use them, is welcome. "GPs are already doing a good job of appropriately referring patients we suspect of having cancer, but we need proper resources if we are to continue to deliver the best possible care to all our patients, both now and in the future."

She said: "Deaths from malignant melanoma, the most serious form of skin cancer, are increasing more than any other cancer, so identifying skin cancer at the most timely stage possible leads to better health outcomes and, potentially, saves lives. "However, introducing this extra step to the process of urgent referrals implies doubt about GPs' clinical judgment and risks adding substantial delays to the process. "It is vital that all new initiatives are piloted carefully and appropriately funded before roll-out to ensure patient safety and prevent significant adverse impact on GP workload. "Unlike many other cancers, skin cancer is often visible, and  better access to diagnostic tools like dermatoscopes in our practices, along with the training to use them, is welcome. "GPs are already doing a good job of appropriately referring patients we suspect of having cancer, but we need proper resources if we are to continue to deliver the best possible care to all our patients, both now and in the future."

She said: "Asthma can be incredibly debilitating for some patients if not well-controlled, so anything that helps to improve the lives of our patients living with the condition is a good thing. "Giving patients more control over how they manage their condition can make a real difference to their quality of life, and high-quality patient decision aids are a really welcome additional tool for GPs and their clinical teams when helping patients select the best treatment. "Also, most people want to 'do their bit' to help the planet, so many patients will welcome this opportunity of actively selecting medication that is proven to have the least effect on the environment. "However, GPs will only recommend treatment based on the unique circumstances of the person sitting in front of them, and patients and clinicians should not feel pressured to choose a particular type of inhaler if it will not properly fulfil the patient's needs."

She said: "Asthma can be incredibly debilitating for some patients if not well-controlled, so anything that helps to improve the lives of our patients living with the condition is a good thing. "Giving patients more control over how they manage their condition can make a real difference to their quality of life, and high-quality patient decision aids are a really welcome additional tool for GPs and their clinical teams when helping patients select the best treatment. "Also, most people want to 'do their bit' to help the planet, so many patients will welcome this opportunity of actively selecting medication that is proven to have the least effect on the environment. "However, GPs will only recommend treatment based on the unique circumstances of the person sitting in front of them, and patients and clinicians should not feel pressured to choose a particular type of inhaler if it will not properly fulfil the patient's needs."

She said: "We would like to clarify the action that the College is taking in light of the latest developments in Brunei. "We are all shocked by the situation and have said publicly that we categorically condemn these actions. "We are urgently reviewing the situation at the highest levels. The challenge we have is that it takes time to get the necessary advice and to get the relevant people together to make decisions about all the options we have to consider. As the College is a registered charity, we also have to comply with charity law and governance. "I appreciate that this is frustrating, but I promise our members that I am doing all I can to hasten the process so that we reach firm conclusions as swiftly as is safe and responsible to do so. I will, of course, communicate the decisions to all our members as soon as we can. "We are a diverse and inclusive College and are very proud of our strong LGBT+ community of doctors and staff. We abhor any form of human rights abuse."

She said: "We would like to clarify the action that the College is taking in light of the latest developments in Brunei. "We are all shocked by the situation and have said publicly that we categorically condemn these actions. "We are urgently reviewing the situation at the highest levels. The challenge we have is that it takes time to get the necessary advice and to get the relevant people together to make decisions about all the options we have to consider. As the College is a registered charity, we also have to comply with charity law and governance. "I appreciate that this is frustrating, but I promise our members that I am doing all I can to hasten the process so that we reach firm conclusions as swiftly as is safe and responsible to do so. I will, of course, communicate the decisions to all our members as soon as we can. "We are a diverse and inclusive College and are very proud of our strong LGBT+ community of doctors and staff. We abhor any form of human rights abuse."

"We are delighted to see the HPV vaccine extended to young boys in Northern Ireland. This brings us in line with other areas in the UK. "The vaccine helps to protect young boys and girls from a virus that can trigger a range of cancers and is proven to be very effective in protecting women against cervical cancer. "We hope that parents will take the opportunity to have their children vaccinated as soon as the vaccination programme is offered come September." Welcoming access to the Faecal Immunochemical Test (FIT) for screening bowel cancer, Dr Doran said: "It is great to see two very positive announcements coming from the Department of Health today. "Anything that helps improve the rate of identifying bowel cancer is welcome. Patients will be contacted directly if they fall within the age category for the screening programme once available and we encourage people to respond if they are contacted."

"We are delighted to see the HPV vaccine extended to young boys in Northern Ireland. This brings us in line with other areas in the UK. "The vaccine helps to protect young boys and girls from a virus that can trigger a range of cancers and is proven to be very effective in protecting women against cervical cancer. "We hope that parents will take the opportunity to have their children vaccinated as soon as the vaccination programme is offered come September." Welcoming access to the Faecal Immunochemical Test (FIT) for screening bowel cancer, Dr Doran said: "It is great to see two very positive announcements coming from the Department of Health today. "Anything that helps improve the rate of identifying bowel cancer is welcome. Patients will be contacted directly if they fall within the age category for the screening programme once available and we encourage people to respond if they are contacted."

"Disease mongering is scaremongering and it has the potential to cause huge strain for the NHS and  other healthcare systems around the world. "Giving people unnecessary medical labels causes anxiety and distress and, in the worst cases, causes harm that can ruin lives. It also leads to unnecessary workload burdens in general practice and secondary care, and consumes funding that could be much better spent elsewhere on the care of patients who really need it. "This is a controversial but ground-breaking paper that should spark a widespread debate on the entire industry that has grown up around disease mongering and overdiagnosis. "GPs and our teams see over 1m patients a day in England alone. We understand how overdiagnosis adversely affects people - and the associated workload and costs - and we would welcome the opportunity to lead neutral and unbiased discussions with our specialist colleagues and members of the public about how we tackle the issue. "We also welcome the idea of 'diagnosis reviews' similar to the medication reviews that GP teams already have in place. "It is ironic that at a time when the health service is buckling under the strain of unprecedented demands, we live in a society where 'want' is increasingly prioritised over genuine 'need'. "This paper could be just the impetus we need to re-evaluate our priorities for some aspects of patient care." Read the RCGP response to BMJ Evidence-Based Medicine

"We fully understand and appreciate the concerns of our members and the strength of feeling on this issue. "The College is an inclusive organisation that thrives on its diversity and and believes in equality for all. "We abhor any abuse of human rights and categorically condemn the recent developments in Brunei. We wish to reassure our GP members, our staff, and all other organisations who work with us, that this is being discussed with urgency at the highest levels of the College. "It is in all our interests that we reach a speedy resolution, but it is imperative that we work with other organisations, not least the Foreign and Commonwealth Office, to ensure that any decision does not compromise our colleagues working in Brunei or the work that the College is doing there to improve the care of patients."

"The College will be reviewing the situation in light of emerging developments and in no way condones any abuses of human rights in the UK or abroad. We are an organisation committed to raising standards of healthcare for patients all over the world, and to this end have had a formal collaboration with Brunei for more than ten years supporting the development of primary care and the training of GPs in the country."

The 'pan-College' advice is based on 2018 regulations issued by the Medicines and Healthcare Products Regulatory Authority (MHRA) around the prescribing and dispensing of valproate - but looks at the more challenging issues that clinicians across primary and specialist care might encounter in daily practice. These include transition from paediatric to adulthood services, competence to consent to treatment, and confidentiality. Valproate is licensed for use only in the treatment of epilepsy and bipolar disorder as it carries significant risk of birth defects and developmental disorders in children born to women who take the drug in pregnancy. The MHRA regulations state that valproate should not be prescribed to women in their reproductive years without a pregnancy prevention plan (PPP), unless a girl or woman suffers from a type of epilepsy that is not responding to other treatments. The authors of the new guidance take a pragmatic approach, considering issues through life stages. It does not profess to answer every complex ethical issue but brings together data and best practice from the collaborating bodies across the UK, as well as signposting to a wide range of helpful resources. Prof Helen Stokes-Lampard, Chair of the Royal College of General Practitioners, said: "Valproate use is now under strict regulation and we have clear guidance that it should not be prescribed to women in their reproductive years unless there are exceptional circumstances – but complex situations can occasionally arise. "The care of women with epilepsy can span GP and specialist care and I do hope this guidance will provide much-needed support to doctors across all medical specialties, helping them to act in the best interests of the individual girl or woman, and ultimately improve the care we provide to our patients. "Producing this report has taken a huge amount of work and I thank everyone who has been involved and contributed to it." Professor Sanjay Sisodiya representing the Royal College of Physicians and the Association of British Neurologists said: "The regulations around valproate have been well publicised. Their implementation in practice can throw up difficult situations. We hope that this document will provide both practical guidance and an illustration of the general approach which will be of value to clinicians. "We hope also that the joint provenance of the guidance will ensure consistent messages for clinicians and patients. We realise that additional changes may occur and intend to update the document over time." Dr Angelika Wieck from the Royal College of Psychiatrists, said: "Managing mental health is particularly important for childbearing girls and women. Although valproate is an effective drug for the treatment of bipolar disorder, when taken during pregnancy it often causes serious problems in the physical and mental development of the baby.  "The new MHRA regulations are designed to minimise exposure in pregnancy and the Royal College of Psychiatrists welcomed the opportunity to contribute to this important guidance to support clinicians in implementing the new regulations and providing the most effective and safe care possible." Royal College of Paediatrics and Child Health Clinical Lead, Dr Daniel Hawcutt said: "The dangers of valproate to the unborn child are now well recognised, so prescribing in women is now limited. However, it can be an effective medicine to treat seizures, especially in children. "This pan-College advice is designed to help paediatric neurologists, as well as other groups, implement the MHRA toolkit and pregnancy prevention programme appropriately across all age groups, and in those with particularly complex circumstances including pre- and peri-pubertal girls, or those with complex neurodisability." Mr Edward Morris, Vice President of Clinical Quality at the Royal College of Obstetricians and Gynaecologists, said: "Most women with epilepsy have straightforward pregnancies. But careful management of the condition is needed before conception and during pregnancy, because there are risks which need to be minimised and are associated with maternal use of valproate and birth defects and developmental disorders in children. "We welcome the publication of this guidance that provides further clarification for healthcare professionals on the use of valproate." Birte Harlev-Lam, Executive Director for Professional Leadership at the Royal College of Midwives, said: "This is clear and helpful guidance that supports the recent MHRA publication regarding Sodium Valproate in pregnancy. "It adds to and harmonises the information health professionals provide when discussing pregnancy with young adults and women who may be taking or could be prescribed Sodium Valproate. It is a great example of the multidisciplinary team working in collaboration for the benefit of the people we care for." Carmel Bagness, Professional Lead Midwifery and Women's Health at the Royal College of Nursing, said: "The RCN is pleased to have played a part in producing this new guidance, which will be welcomed by midwives and nurses, setting out the evidence and pathways of care recommended for girls and women who may be at risk from valproate use pre- conception and during pregnancy. "The guidance recognises the extra support needed by women with epilepsy when they become pregnant, and the difficult decisions that sometimes need to be taken. Having clinically-backed information on best practice will be a great help to nursing and midwifery staff." Read the guidance on valproate use in women and girls of childbearing years (PDF)

"Prescribing is a core skill for GPs, and we will only prescribe medication to a patient after a full and frank discussion with them, considering their unique circumstances, and if we genuinely believe they will be of benefit to their patient. "Antidepressants are no different, and it's really important that increasing numbers of antidepressant prescriptions are not automatically seen as a bad thing, as research has shown they can be very effective drugs when used appropriately. "It can be difficult to determine why prescribing rates fluctuate, these figures could indicate rising awareness of mental health conditions in society, and that more patients are feeling able to seek medical care for them – as well as demonstrating an improvement in the identification and diagnosis of mental health conditions. "Regardless of the reasons why someone might seek treatment for mental health conditions, GPs will take into account the physical, psychological and social factors potentially impacting on their health, as well as clinical guidelines, when formulating a diagnosis and treatment plan. "No doctor wants their patients to be reliant on medication – and most patients don't want this, either – so where possible we will consider alternative treatments, such as CBT and talking therapies, but unfortunately access to these important services in the community is patchy across the country. "NHS England's GP Forward View, which fed into the NHS long-term plan, pledged for every GP practice to have access to one of 3,000 new mental health therapists. We need this, as well as other promises made in the NHS Long-Term Plan, to be delivered as a matter of urgency, so that we can continue to provide the best possible mental health care to our patients."

She said: "Gatekeeping schemes play a significant role in the triaging of patients in the NHS and beyond, and as this study shows, GPs worldwide are doing an excellent job of caring for patients in their communities, close to home, and keeping people out of hospital wherever possible. "Unlike most other healthcare systems around the world, the NHS is free at the point of need and so financial implications do not play any role in the gatekeeping function of UK GPs – most of the studies included in this systematic review were based in the US. "While it's clear to see why UK GPs are often called the 'gatekeepers of the NHS', we will always put the needs of the individual patient first and refer anyone who we think might need secondary care intervention. However, this research also highlights a chronic lack of access to diagnostic tests in primary care, which can have a huge bearing on referral rates for conditions such as cancer. "GPs take cancer diagnosis extremely seriously, and it's credit to our colleagues' hard work that 75% of patients found to have cancer in the UK are referred after only one or two consultations, and that in the last five years the proportion of cancers diagnosed as an emergency dropped from 25% to 20%. "Without access to the right diagnostic tests, however, this simply isn't sustainable and threatens the success of GP gatekeeping schemes across the country. That's why we desperately need GPs and our teams to have better access to high-quality diagnostic tools in the community, and the appropriate training to use them."