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GPs need better test access to improve cancer diagnosis

Thousands dying unnecessarily from cancer each year in England because of late diagnosis

Louise Prime

Tuesday, 27 November 2018

Thousands of cancer patients are dying unnecessarily each year because the NHS in England has failed to improve quickly enough, the Health Foundation warned this morning. It called for radical improvements to close the gap on cancer survival between England and comparable countries, and greater support for GPs in referring patients for investigation if they suspect cancer. GP leaders responded that if they are to further improve timely cancer diagnosis they need better access to tests and more time with patients.

In the independent health and care charity’s latest report Unfinished Business, in collaboration with former national cancer director Professor Sir Mike Richards, it said early diagnosis and investment in diagnostics must be a priority. It found that significant improvements have been made on mortality, survival rates and patient experience of cancer care over the past 20 years in England; more care is delivered by multidisciplinary teams; and both technology for cancer care and data/intelligence on cancer have improved markedly. But despite successive cancer strategies’ stated ambitions to be the best in Europe and the world, the report found that the gap in survival rates has not been closed.

The report’s authors pointed out that although early diagnosis and treatment are critical to improving cancer survival – for example, five-year survival for bowel cancer is more than 90% if caught early but less than 10% if diagnosed late – the proportion of people being diagnosed with cancer at an early stage remained almost static between 2015 and 2017.

They noted: “To close the gap, there will have to be radical improvements in the early diagnosis and detection of cancer. The NHS will need to invest significantly in boosting diagnostic equipment and workforce. … It is also vital that primary care is resourced to meet demand for appointments.

“Research has found that patients in England are more reluctant to bother their GP than people living in other countries. In 2017, Cancer Research UK found that 22% of respondents were worried about wasting the doctor’s time and 45% said they found it difficult to make an appointment.”

The Health Foundation called for greater funding and support for GPs, to enable the investigation of patients who have symptoms that indicate a 3% or higher risk of cancer, as recommended by NICE guidelines; along with additional staff and equipment in hospitals to meet demand for referrals. It said: “In the past, efforts to encourage GPs to refer early for suspected cancer have been met with resistance from commissioners under pressure to limit referrals, and by limited hospital capacity to meet demand for diagnostic tests such as endoscopy.”

The Royal College of GPs pointed out that GPs are in a difficult position when it comes to referral, facing face harsh criticism whether they refer too many patients to specialist care, or too few. Yet, it pointed out, 75% of patients found to have cancer are referred after only one or two consultations, and in the past five years the proportion of cancers diagnosed as an emergency has dropped from 25% to 20%; and a higher proportion of patients are also being diagnosed at an earlier stage.

College chair Professor Helen Stokes-Lampard said this morning: “A key factor in being able to diagnose patients in a timely way comes down to having access to the right diagnostic tests – and GP access to appropriate diagnostic tests is among the lowest in Europe.

She added: “We desperately need for GPs and our teams to have better access to high quality diagnostic tools in the community and the appropriate training to use them.”

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