Empowering primary care to improve cancer survival rates

As the biggest cause of premature and avoidable deaths in London, transforming services to deliver world class cancer outcomes remains a priority for healthcare professionals across the capital.

To do this, first and foremost our focus has to be on prevention so that we avoid people having to face an experience with cancer.

We also know we are diagnosing cancer too late and the impact on patient outcomes is a significant problem. Regardless of where people live or their background, they should be diagnosed early and given the opportunity to access the most effective treatments available and the highest possible chance of survival.

Encouraging patients to understand what symptoms to look out for and act early on them involves continuous effort.

Work being done through public health teams and national awareness raising campaigns is making a real difference in the number of people seeking advice and receiving successful treatment.

Just one example of this is the results from the 2013 Public Health England ‘Be Clear on Cancer’ campaign for bladder and kidney cancer. They show that around 18% more people visited their GP when they noticed the most common symptom of blood in their pee. As a result, diagnoses of bladder cancer increased by 8% and for kidney cancer by 22%. It is thought that this early detection may have saved as many as 90 lives. It is encouraging to see that, when armed with the right information, people are taking charge of their own health and getting symptoms investigated early.

The integral role primary care plays in early diagnosis also needs greater attention.

As a GP in Croydon since the early 1980s, I have seen cancer care shift from being predominantly hospital based and the role of primary care is receiving the kind of recognition and support it needs to be effective. We are a key point of contact for someone with cancer, involved in important milestones during their treatment.

With GPs now leading the planning and buying primary care services as co-commissioners, we also have a unique opportunity to improve our approach to many aspects of cancer care.

In July 2015 the Independent Cancer Taskforce published their 2015–2020 strategy for achieving world-class cancer outcomes. From a total of 96 recommendations, improvements that could be driven in primary care were identified as:

  • Early diagnosis — promoting earlier recognition of signs and symptoms and ensuring GPs have direct access to key investigative tests
  • Living with and beyond cancer — commissioning and promoting more holistic care and tailored support for each individual, as well as increasing self-management
  • End of life — supporting earlier conversations about end of life care
  • Patient experience and engagement — working with patients and the public to co-design services to meet people’s needs
  • Cancer education — promoting access to cancer education to raise awareness of the role primary care can play in supporting people with cancer
  • Carers support — working closely with local authorities to make sure carers are a priority and we give them what they need

Importantly, we are starting to see these recommendations turn into commitments and action. Updated NICE guidelines empower GPs to refer people with suspected cancer directly for testing, rather than referring within the previous two-week window.

Changing the way the system works to give primary care clinicians this kind of control is already having a positive impact in managing cases of colorectal cancer. GPs can now make direct referral for colonoscopy. They lead on following up results and managing any diagnosed non-cancer conditions. This effectively removes a very large number of two week referrals from hospitals — giving our secondary colleagues more capacity to focus on other patients, and importantly — giving patients a better experience and shorter waiting times.

Continuing to make change of this scale will not happen overnight. But there is real momentum and vision amongst primary care leaders to rise to the challenge ahead of us.

Empowering those working in primary care can contribute to earlier diagnosis, improve patient experience and help us see major improvements in cancer survival rates — helping us along our path of regaining ground from our international neighbours and achieving world class cancer outcomes.

Dr Anthony Brzezicki, Chair, Croydon CCG

Dr Brzezicki has been a GP at the Queenhill Medical Practice in Croydon since 1983. His special interests are in prescribing and cancer.

He was part of the first wave of the Prescribing Collaborative and chaired the third wave for England.

He worked in the Breast Unit at Croydon Health Services NHS Trust for 10 years, and has been a MacMillan GP, Primary Care lead for South West London and worked in the common cancer group developing the Case for Change for Cancer in London, the Model of Care and sat on the London Cancer Board.

He is now a GP member of the Transforming Cancer Team for London, chairing the Early Diagnosis work stream for London.

He has also been a GP member of the London Cancer Alliance Clinical Board and a Non-Executive Director of London Cancer Board. Tony is also Co-Chair of the London Cancer Commissioning Board, and clinical lead for the Healthy London Partnership Cancer programme.

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