Cancer care in general practice

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Dr Anthony Cunliffe, a cancer specialist GP in South London, looks at GPs' challenges and successes coming out of the peak of Covid.

As part of the long term plan the NHS has the ambition to diagnose 75% of cancers at stage 1 or 2 by 2028. This was always going to be a challenge and now the Covid pandemic has a significant impact on the progress that has been made. However, the ambition remains, and general practice has a vital role to play if it is to be achieved. 

For most people, the journey to a diagnosis of cancer starts in general practice and most GPs will see many patients each week whose symptoms could represent an underlying cancer but at the same time, the average full-time-equivalent GP will only see around eight or nine new diagnoses each year. What this means is that the job of triaging the right people to the right tests at the right time is a difficult one.  

Covid backlog 

The Covid pandemic had a significant negative impact on the numbers of people being referred for suspected cancer for a myriad of reasons. However, despite general practice being under more pressure and delivering more appointments than ever before, GPs are pulling their weight in trying to address the cancer backlog brought about by the pandemic and are referring record numbers of people into the suspected cancer referral pathways. 

This is what is needed, and we know that most of these referrals are appropriate but, at the same time, this obviously puts a significant pressure on the health system and can leave our secondary care colleagues challenged to meet the waiting time standards. The urgent suspected cancer pathways alone will not drive us to achieve the ambitions in the long-term plan but we are seeing new developments that may help. 

New tools and services 

A plan to increase the amount of direct access imaging available to general practice will create new pathways for us to investigate those patients for whom we may have concern but who might not meet the NICE guidelines. Likewise, the roll out of the Rapid Diagnostic Centres who can review and investigate rapidly those patients who have more vague symptoms but nevertheless trigger that GP hunch that something serious may be wrong, can help us when we aren’t quite sure of the right pathway to use to get someone diagnosed or reassured efficiently. 

Further advances in testing such as the NHS Galleri trial that is piloting a new test which detects circulating DNA may also, depending on the results, bring about another tool for our diagnostic armory to empower GPs to diagnose patients at the earliest stage possible. There are other pathways to diagnosis being trialed currently such as direct referrals for patients or Pharmacy referrals onto suspected cancer pathways, the results of which will be interesting. 

The importance of general practice 

However, although as general practice teams, we welcome new ways to get people into the system to get investigated appropriately, in my opinion GPs and our general practice colleagues remain the most important group of professionals to drive the early diagnosis agenda forward right from increasing our patients awareness of the signs and symptoms of cancer, supporting uptake to the cancer screening programmes and ensuring that those patients that we see with potential signs and symptoms of cancer are seen and investigated as rapidly as possible.