GPs at the heart of cancer reforms

GPs will be given direct access to diagnostic tests under DoH plans to improve cancer outcomes.

Under the DoH cancer strategy, GPs could send patients unsuitable for the two-week referral pathway directly for tests including MRI scans (Photograph: SPL)
Under the DoH cancer strategy, GPs could send patients unsuitable for the two-week referral pathway directly for tests including MRI scans (Photograph: SPL)

The cancer strategy outlined this month by health secretary Andrew Lansley aims to save an extra 5,000 lives by 2014/15. It is backed by £750 million - a big commitment in austere times - with good reason: cancer survival rates in the UK trail the rest of Europe despite years of investment.

The strategy will promote screening and awareness of the signs and symptoms of cancer through the new government body Public Health England.

GPs will be able to send patients unsuitable for the two-week referral pathway directly for tests including chest X-ray, non-obstetric ultrasound, flexible sigmoidoscopy and MRI brain scans.

The strategy also aims to supply better information for patients and commissioners in a bid to boost outcomes, promote uptake of the latest cancer procedures, and cut regional variation in treatment access.

It also aims to overcome problems identified in a National Audit Office report which found that cancer services in England do not provide value for money.


Dr Nick Simmerton: 'We need careful guidance to make sure use is appropriate.

The worry is inappropriate access' (Photograph: UNP)

Better value for money
The NHS currently spends about £6.3 billion a year on cancer care. The DoH believes its new strategy can provide much better value for money. But it admits the plans will not cut the cost of cancer to the NHS in the short term.

In fact, it predicts the NHS would have to spend an additional £917 million each year to have any chance of reaching its goals. Survival rates for all stages - not just early diagnosis - must improve to do so.

Clearly, the task is more complex than merely detecting cancers earlier.

Nevertheless, many are upbeat about the strategy. RCGP imaging lead and Yorkshire GP Dr Nick Summerton, who has a special interest in cancer, welcomes the strategy and believes it will improve early diagnosis and survival rates.

But he warns referral advice for GPs is lacking: 'We need careful guidance to make sure use is appropriate. The worry is inappropriate access: this is very much the view of the DoH as well,' he says.

Dr Summerton urges national clinical director for cancer in England, Professor Mike Richards, to form a GP-led group to create the guidance, based on primary care evidence, as soon as possible.

Similarly, although Cancer Research UK policy manager Emily Arkell praises the plans, she also warns of a clash with the ongoing NHS reforms.

'With responsibility for promoting awareness and early diagnosis being passed to Public Health England, it will be important that the reforms set out in Liberating the NHS do not impede the commitments in the strategy,' she says.

Deeply concerned
Cancer charity Macmillan is deeply concerned about the future of Cancer Networks, the raft of 28 expert bodies that support GP commissioning of cancer services.

Its chief executive, Ciaran Devane, says: 'Without the expert support that Cancer Networks provides, GPs will find it impossible to fulfil their new role.'

Mr Lansley defends the decision not to guarantee funding for the network past 2011/12, saying he will not 'pre-empt'

decisions by the NHS Commissioning Board. But he maintains that the board and GP consortia 'will seek to design future commissioning arrangements that build on the strengths that exist'.

In other words, GPs in their consortia alone can ensure Cancer Networks survive.

Consortia will need this support if they are to hit this strategy's lofty targets.

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