Dr Abhijit Gill runs the Acute Diagnostic Oncology Clinic (ADOC), based at Chelsea and Westminster Hospital NHS Foundation Trust, which aims to improve both the patient and GP experience of accessing cancer diagnosis services.
‘It’s a service specifically for GPs to use in cases where cancer is suspected but the patient is suffering vague, non-specific symptoms and so there is no obvious pathway to refer to,’ Dr Gill explains.
‘Instead of the GP having to send the patient down different pathways to eliminate cancer, which takes time and delays treatment, they can be referred to us. Previously, there was a real gap in where these patients could go.’
How the clinic works
All patients accepted to ADOC are triaged by an experienced clinical nurse specialist who provides support and advice if there are more appropriate pathways.
‘We see patients within five days, or sooner if needed,’ Dr Gill explains. ‘The clinic can offer same day investigations, a rapid turnaround of results, input from oncologists, access to multi-disciplinary teams and a much shorter time to treatment.
‘Before ADOC these patients were often referred by their GP to A&E - which we know is not an ideal place for patients to receive a cancer diagnosis,’ he adds. ‘Or GPs referred patients to different two-week wait clinics, where the patient might "bounce" between primary and secondary care teams, while efforts to eliminate a diagnosis of cancer are made.’
ADOC was set up four years ago and was initially run by the hospital’s acute oncology consultant and a nurse specialist, without a GP. At that time it accepted referrals where the GP suspected cancer but the patient was too unwell to wait for the two-week wait referral pathway.
Dr Gill joined the clinic in March 2018. Now, with a GP on the team and funding from the official charity of Chelsea and Westminster Hospital, CW+, the clinic accepts a wider range of referrals and patients with vague symptoms.
Bringing in the skillset of a GP has made a valuable difference, Dr Gill says, not only because it means more patients can be seen but he can also deal with any general medical issues that arise.
What does the GP role involve?
‘In a significant proportion of patients we find cancer and in those cases we refer to the appropriate oncologist and get them seen quickly,’ says Dr Gill.
‘For those already undergoing treatment under the oncology team at Chelsea and Westminster I can offer general medical input. That might be managing the side effects of treatment or medically optimising other chronic conditions so the patient can get on with treatment.’
Dr Gill’s expertise is also put to use when it comes to patients for whom cancer isn’t in the end diagnosed.
‘Many patients who we find don’t have cancer may nevertheless still suffer serious medical conditions. There will be something going on that hasn’t been diagnosed,’ he explains. ‘If cancer has been excluded we don’t simply send the patient back to their GP so that they have to be investigated all over again. We will try and find out what is going on. We have diagnosed problems such as colitis, vasculitis, renal failure and more.
‘Once a diagnosis has been made this is communicated back to the patient’s GP so they can make a referral in to their local services. We work with the patient's GP to find the right care for their patient.’
Rachel Sharkey, clinical nurse specialist who helped to launch ADOC agrees that having the input from a GP has been a huge benefit, particularly for those patients who don’t get a diagnosis of cancer but are struggling to find out what is wrong with them. ‘Feedback from patients and GPs has been really positive about what we do,’ she says.
The data shows that while the national average cancer conversion in two-week wait clinics is 5%, some 20-25% of those who attend ADOC are diagnosed with cancer.
‘We think that the high conversion rate indicates that our referral process is ensuring we see patients that are appropriate for this pathway. It shows we are catching cancer earlier for patients, which might not have been picked up elsewhere,’ Dr Gill says.
Data also shows that ADOC patients start treatment by day eleven, on average, compared with the 62-day target set under the national guidelines.
‘We are trying to operate in a more streamlined fashion,’ says Dr Gill. ‘The intention is not to compete with existing pathways that work well. We are simply trying to provide rapid diagnosis for the patients that don't fit or fall between those pathways.’
Year on year the number of referrals to the clinic has increased. ADOC now sees patients from all surrounding CCGs and has good working relationships with many practices.
Developing a special interest in cancer
Dr Gill now spends two days a week at ADOC and for the rest of the time is a salaried GP and oncology lead at Park Medical Centre in west London. So how did he develop this fairly unique career?
As a junior doctor at Chelsea and Westminster Dr Gill says he found himself torn between specialising in general practice or oncology. He believed that GP skills could benefit acute oncology and started thinking about how he could combine the two roles.
‘There was no established role to do both, even though I could see there was a need for it,’ he says. ‘As a GP registrar I spent my study sessions sitting in clinics at the hospital to learn more and think of ways of how I could be involved long term and how to benefit patients. It took a long time but eventually it all came together.’
Dr Gill attended lectures and seminars and undertook clinical work during study sessions to improve his knowledge and expertise. He is currently studying for a diploma in oncology.
‘Obviously I’m not a oncologist but I’m trying to show how GPs can work more closely with secondary care and bring extra benefit to patient care,’ he says. ‘Oncology can appear a daunting subject but there is scope for GPs to make a difference in this field. We have a lot of skills to bring to the table so we shouldn’t shy away from getting involved.’
How to develop a special interest in oncology:
- Attend local study days run Macmillan (www.macmillan.org.uk) or other providers to get a flavour of what’s involved.
- Use any study release days to get first-hand experience of your local oncology department.
- Sign up for formal training and a qualification, such as a diploma.
- Speak to your CCG cancer lead or Macmillan GP to get advice and information about services in your area and how you might be able to help.