Dr Richard Roope interview: GPs could widen role in cancer care

RCGP cancer lead Dr Richard Roope tells Stephen Robinson why GPs could soon be playing a much greater part in prevention.

Dr Roope: 'Primary care is already required to be engaged with screening, because we're meant to be doing what we can to improve the health of our patients'

Despite mounting pressure on general practice, RCGP cancer lead Dr Richard Roope remains an unwavering optimist.

Meeting in the vast atrium of the London offices of Cancer Research UK - the college's partner in cancer work - Dr Roope is quick to champion positives for the profession amid the gloom.

He highlights recent figures showing the UK has seen dramatic improvements in one-year survival rates. 'That is a fantastic testament to the systems we have in place, the endeavour of general practice, the Be Clear on Cancer campaigns, and primary care engagement,' he says.

Enduring priority

Dr Roope was appointed in April as the RCGP and Cancer Research UK clinical lead for cancer, to lead a programme of work designed to promote cancer as an 'enduring priority' for the college. His aim is to promote the importance of cancer prevention, diagnosis and care - and the key role of primary care - to everyone, from politicians to GPs.

Despite the positive survival trends, there is no room for complacency, he says. Dr Roope fears reduced access caused by the shortage of GPs and inadequate funding means some patients with symptoms suggestive of cancer may wait too long to see a GP.

Although most practices still offer same-day appointments, they can often offer routine appointments only two or three weeks in advance. 'If the patient doesn't identify their symptom as serious, they will think they are OK to wait three weeks.

'So you'll get someone with a sore throat who is insistent they want to be seen, but someone who has painless blood in their wee who thinks they can wait three weeks, and actually they've got bladder cancer.'

Asked whether pressure from funding cuts is blocking the improvement of early diagnosis rates, he adopts an optimistic stance.

'We could do more if we had more funding,' he smiles. 'The danger is that as funding is bled dry, and if the recruitment and retention problems we have experienced over the past two years continue, primary care is in trouble.'

Nevertheless, the RCGP cancer programme goes on and prevention will be at its heart. 'The prevention story is one that needs to be told,' says Dr Roope. 'In the UK, the latest data suggest 42% of cancers are lifestyle-related and preventable.'

Dr Roope believes practices should have more involvement. 'If you look at the small print of the GP contract, you could say primary care is already required to be engaged with screening, because we're meant to be doing what we can to improve the health of our patients.

'But there has been no administrative involvement, nor historically, has there been any financial support.'

He wants that to change, starting by shifting oversight of the national bowel cancer screening programme to general practice.

He believes this is a good place to start because bowel cancer survival is highly dependent on the disease's stage at presentation. 'If you look at the range of screening uptake, it varies from low 20% up to mid-70%.'

He says the UK should be aiming to raise bowel cancer screening to the level of breast cancer checks, which stood at 76.4% in 2012/13.

Right now, pilot programmes are under way to improve uptake in areas with some of the lowest bowel cancer screening rates in the country.

The Wessex Area Team, alongside local GPs, recently launched a pilot scheme to give 25 practices a more significant role in inviting patients for screening.

In the scheme, practices add their surgery logo and a GP's signature to letters from local cancer screening hubs that remind patients to return their completed faecal occult blood test kits. It aims to use patients' trust in their GP to improve screening rates. In return, practices receive a small fee to cover admin costs.

Pilot schemes suggest that of every six patients who previously failed to carry out the test, one will return the completed kit after receiving this letter.

'You could be going from 40% to 50% uptake by a simple letter going out. If it proves successful, there may be moves to look at that becoming a national roll-out,' says Dr Roope.

Any wider GP involvement in cancer prevention work would need substantial funding, he admits.

A system of performance-related payments could see practices encourage patients to take part in screening, he suggests. This would reward improvement against local baseline screening uptake, rather than a fixed national target, which would discriminate against practices in low-uptake areas.

He describes these incentives as a 'general aspiration', but believes they could be funded through the QOF or an enhanced service.

Campaign success

Dr Roope also backs the Be Clear on Cancer programme, for which evidence of benefit is growing: a study found bowel cancer diagnoses rose 12% as a result of increased GP referrals during the campaign in England in 2012.

The programme's campaign on three-week cough for lung cancer caused 'ripples' in primary care, he admits.

'But it's probably had the most impact in terms of results. There's been a very statistically significant increase in lung cancer resections, which is perhaps the best parameter for early entry into a pathway.'

The RCGP cancer programme will run until at least 2017, during which time GPs will hear much more about greater practice engagement in cancer prevention.

Dr Roope says: 'Ultimately I'd like to see that, in terms of outcomes, we've got up to the average for Europe, which I think is achievable.'

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