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£400m cancer revamp calls for speedy GP referral

Six point plan to deliver ‘world class cancer service’ recommends faster referral and improved diagnostics

Mark Gould

Monday, 20 July 2015

NHS patients in England should get results for cancer tests within four weeks of being referred by a GP by 2020 according to the long awaited report by NHS England's Independent Cancer Taskforce (ICT).

The report sets out six strategic priorities which it says can help the NHS achieve "world-class cancer outcomes", adding at least ten years to the lives of 30,000 cancer patients every year by improved treatment, changing lifestyles and faster diagnosis.

It calls on the NHS to replace old radiotherapy machines and invest in specialist staff to ensure it delivers "world class" cancer care. The plan will cost some £400m to implement. Its authors say it will result in commensurate savings and improve the lives of many tens of thousands.

The six priorities are:

  • A radical upgrade in prevention and public health. The strategy outlines how the NHS should work with the Government to improve public health, including adopting a new tobacco control strategy within the next 12 months, and a national action plan on obesity. The Taskforce wants to see a reduction in smoking from 18.4 per cent now, to less than 13 per cent by 2020.
  • A national ambition to achieve earlier diagnosis. The ambition set out is that, by 2020, 95 per cent of patients referred for testing by a GP are definitively diagnosed with cancer, or cancer is ruled out, and that patients get this result within four weeks. This requires a significant increase in diagnostic capacity, giving GPs direct access to key investigative tests, and the testing of new models which could reduce the burden and reliance on GPs. Currently, patients urgently referred for suspected cancer by their GP need to be seen by a specialist within 14 days of referral, but no guidance exists for when patients can expect to get the results.
  • Patient experience on a par with clinical effectiveness and safety. The strategy recommends giving all consenting patients electronic access to all test results and other communications involving further care by 2020. Patients should also have access to a clinical nurse specialist or other key worker to help coordinate their care. The NHS must continue to develop and adopt meaningful ways to measure a patient’s experience, including the annual Cancer Patient Experience Survey.
  • Transformation in support for people living with and beyond cancer. By 2020 every person with cancer should have access to elements of a ‘Recovery Package’ – a comprehensive plan that outlines treatment as well as post-treatment support and care. A national quality of life metric should be developed by 2017 to ensure better support for people after treatment has ended. Clinical Commissioning Groups (CCGs) must ensure they commission appropriate End of Life care, in accordance with NICE guidelines and the Choice Review.
  • Investment to deliver a modern high-quality service, including:
    • A replacement plan for radiotherapy machines as they reach 10-years and upgrading of existing linacs by the time they have been operational for six years;
    • A permanent and sustainable model for the Cancer Drugs Fund to help patients get access to innovative cancer treatments;
    • A nationally-commissioned, regionally-delivered, molecular diagnostics service, to guide more personalised prevention, screening and treatment;
    • Plans to address critical deficits in the cancer workforce.
  • Overhauled processes for commissioning, accountability and provision. Clearer expectations need to be set by the end of 2015 for how cancer services should be commissioned, with most treatment then being commissioned at population sizes above CCG level. By 2016, a network of Cancer Alliances should be established across the country. These will bring together key partners at a local level, including patients. The Alliances would use a dashboard of key metrics to address variation and support service redesign.

ICT chair Harpal Kumar said: “We have an opportunity to save many thousands of lives from cancer every year. We’re better informed than ever about how best to prevent, diagnose and treat the disease, and how to deliver better patient experience and quality of life. What’s needed now is action."

Royal College of General Practitioners chair Dr Maureen Baker said the report's recommendations, if implemented and resourced properly, have the potential to save thousands of lives. “We have a severe shortage of family doctors and the access we currently have to diagnostic tools is completely inadequate, so we particularly welcome the drive to give GPs better access to relevant scanners – something that the College has long been calling for.

“Anything that can be done to lower patients’ anxiety and any undue distress when they have – or might have – cancer should be encouraged, so we also support the aspiration to provide patients with their test results within four weeks.

“However, we realise that the system is already overloaded and we must ensure that there is sufficient imaging and specialist capacity to cope with the increased number of referrals, before promises are made to patients that cannot be delivered.”

She also feels that the public health recommendations in the report are also important but would like them to go further. "We need significant, ongoing public awareness campaigns to educate the public about the causes of cancer – more than 40% of cancers are related to lifestyle choice – and to encourage people who have signs of cancer to approach their GP as early as possible."

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