GPs 'must always consider cancer', says RCGP expert

Detecting cancers earlier rem­ains one of the toughest goals for general practice.

Professor Greg Rubin: start from point of suspecting cancer (Photograph: RCGP)
Professor Greg Rubin: start from point of suspecting cancer (Photograph: RCGP)

So when the RCGP asked Durham University’s Professor Greg Rubin, a former GP, to help tackle the issue he decided fresh tactics were needed.

‘It’s that perennial challenge,’ he says. ‘It’s rare to see a patient with cancer, but common to see patients with symptoms that might be cancer.’

Professor Rubin will lead a drive to bring cancer to the forefront of primary care work. This aligns with the DH’s aim to save 5,000 lives a year by improving early diagnosis.

The vital signs are healthy: an RCGP audit last year found 75% of all cancers in 2009/10 were referred for investigation within two GP consultations.

But rising survival rates mask a growing incidence of preventable cancers caused by poor lifestyle, which now exceed 100,000 cases a year.

Improving early diagnosis
So how can early diagnosis improve further when a GP may see some types of cancer only once in their career?

Professor Rubin says GPs must learn to think about cancer every time they consider symptoms. ‘GPs must start from the point of suspecting cancer,’ he says.

‘Our job is to have the suspicion of cancer and ground that suspicion on efficient assessment of patients and symptoms and risks.’

The RCGP will build a package of GP education around this approach, updating GP training, appraisal and revalidation. Computer-based algorithms will be key, too.

But Professor Rubin says an uneasy clash remains between the use of costly diagnostic scans and the need to tighten NHS purse strings.

‘There rem­ains a tension between referring people at lower thresholds of suspicion and the pressures of the Quality, Innov­ation, Productivity and Prevention (QIPP) agenda.

'But you have to balance that against wanting to reduce the number of cancers as emerg­ency presentations, which leads to more expensive and worse outcomes.’

In February, res­earchers said GPs must have greater access to tests and screening tools to cut large reg­ional differences in speed of dia­gnosis.

Professor Rubin says DH guidance last week on when GPs should inv­estigate vague cancer symptoms will reassure them that use of scans is offically ‘validated’. But improving access is ‘essential’ he says.

Commissioners and politicians will continue to spar. But Professor Rubin says: ‘GPs do a really good job on diagnosing cancer, but we’d all like to do a perfect job. We’re striving to do the best we can.’

Stephen Robinson

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