This week’s blog comes from Kirklees GP Dr Matt Kaye

For many people, their personal experience of cancer begins with visiting their GP with symptoms of concern. As patients continue along the stages of diagnosis and treatment, contact with their GP may be less, but that does not diminish the role of primary care in the ongoing health and wellbeing support that patients may need to access during this period.

Grant funding from Cancer Research UK enables me to concentrate on the charity’s priorities, particularly around improving early diagnosis and making more cancers curable. However, while not the focus of my role, I am also involved in helping people – patients and professionals - to understand the vital importance of the primary care team in supporting patients not only at diagnosis, but right the way along their journey to living with and beyond cancer. 

We know that the average GP practice of around 8,000 patients has approximately 280 patients living with and beyond cancer at any one time, and that number is set to double by 2040. We know that over half of those patients will have been diagnosed more than five years ago, that they attend their GP practice more frequently than other patients of the same age, often presenting with a range of needs that are both clinical and holistic in nature.

At the same time, the numbers of people surviving cancer treatment is increasing. More people are going on to live with the disease for many years, just like other long-term conditions such as diabetes, COPD and arthritis, and so their ongoing management through regular reviews is a way of monitoring and addressing any changes in health, while at the same time fostering a relationship where more advice and support can be accessed quickly when needed.

Patients can present with a range of emotional, social and financial needs, as well as physical effects, and taking forward the personalised care agenda with patients who are considered suitable for a supported self-management approach will form a key part of my work in 2019/2020.

An important element of this will involve working with primary care colleagues across West Yorkshire and Harrogate to ensure the delivery of high quality cancer care reviews – part of the Recovery Package suite of interventions (read more here) and a tool which supports the development of personalised care for patients living with cancer. This will build on the work undertaken by the Alliance in listening to patients and professionals about what makes a good cancer care review, and identifying some key principles for making them happen (read more here).

The NHS Long Term Plan sets a new ambition that, by 2028, the proportion of cancers diagnosed at stages 1 and 2 will rise from around half to three-quarters of patients. It pledges to ‘raise greater awareness of symptoms of cancer, lower the threshold for referral by GPs, accelerate access to diagnosis and treatment and maximise the number of cancers that we identify through screening’.

In West Yorkshire and Harrogate we still have areas where our uptake of cancer screening falls significantly short of the required levels, and I will be working with colleagues across primary care to help identify and address those issues in our priority populations and localities.

The roll-out of Rapid Diagnostic Centres across the country will build on the ten models already piloted through CRUK for patients with vague but concerning symptoms (the so-called ACE pilots) and who may previously have required a number of GP referrals before a firm cancer diagnosis was confirmed – so often called the ‘cancer ping pong’ effect.

The new RDCs will play a role in the diagnosis of ALL patients with suspected cancer, bringing together the latest diagnostic equipment and expertise, meaning quicker access to an accurate diagnosis and start of treatment. The majority of patients will not have cancer, but may have other conditions, and will also be referred on quickly to receive the right support.

All of these developments require the involvement and commitment of primary care teams and the Alliance has established a Community of Practice to facilitate discussions and enable a shared understanding and approach to these and other important areas of work across West Yorkshire and Harrogate.

At the last Community of Practice meeting, among the challenges we set ourselves was to raise the profile of the National Cancer Diagnosis Audit (NCDA) in recognition of the value practices have reported from previous audits.

The (NCDA) looks at primary and secondary care data relating to patients diagnosed with cancer. It helps us to understand pathways to cancer diagnosis, what works well and where improvements could be made. The audit looks specifically at clinical practice in order to understand interval length from patient presentation to diagnosis; the use of investigations prior to referral, and the referral pathways for patients with cancer and how they compare with those recorded by the cancer registry. More information on the NCDA is available on the Cancer Research UK website.

This year, our practice has decided to take part in the NCDA to review what is happening at local level with regards to referral patterns and diagnosis. This is to help us reflect on the care we offer to our patients around new cancer diagnosis and to improve the care we provide.  It is also a great audit to do for GP appraisal and earns us marks for good practice from the CQC!

It will provide an invaluable insight into our patients’ journey in primary care prior to being diagnosed with cancer. Previous audits have shown that more than 60 percent of patients diagnosed with cancer visit their GP less than three times before a referral is made. It’s clear from previous data, however, that some patients eg those with colorectal or lung cancer tend to attend for multiple visits or are referred at a much later stage in their disease.

If you want to learn more about the detail of the NCDA and the practice sign-up position across WYH, you can read the first of my primary care Community of Practice blogs, which will be published several times a year, through the Cancer Alliance programme office. Contact Janette.earnshaw2@wakefieldccg.nhs.uk for more information.

Have a good weekend,
Matt