Cancer as a clinical priority for general practice

Sir Harpal S. Kumar, Chief Executive Officer, Cancer Research UK

Two years ago, I was putting the finishing touches to a new NHS Cancer Strategy for England. It was developed with input from hundreds of written submissions, nearly 100 workshops and meetings, the proactive involvement of patients, and consultation with around 30 cancer charities and almost all relevant professional groups – including the RCGP. It is now the blueprint for transforming NHS cancer services in England, although a similar plan has been subsequently developed for Scotland, with many of the same themes.

The Strategy was written against a backdrop of success, with cancer survival rates doubling in the UK over the last 40 years1. But there is much more to be done. At Cancer Research UK our ambition is to accelerate progress so that three in four patients survive cancer by 2034. We believe that primary care has a pivotal role to play and have been working increasingly closely with the profession, especially focusing on improving diagnosis and prevention.

If we are to have a chance of managing the burden, we must reduce the unnecessarily large numbers of patients diagnosed too late for optimal treatment. Treating earlier stage cancer costs approximately one third that of later stage treatment2. UK cancer survival still compares unfavourably on the international stage, with particularly poor stage distribution at diagnosis for lung and bowel cancers compared to the best performing countries with similar health expenditure and systems.3,4 

Cancer Research UK has invested in an extensive team of facilitators covering England, and the urban areas of Scotland, and now expanding into Wales and Northern Ireland. The team currently delivers 1650 interactions every month, offering primary care practices early diagnosis tools, providing training, supporting local action planning, and facilitating better communication between primary and secondary care. More information on our Facilitator Programme can be found on our website.

Cancer Research UK’s strategic partnership with the RCGP: ‘Cancer as a Clinical Priority’ has been in place for the past five years, and has recently been extended for a further five. In partnership we will raise awareness of the critical role general practice plays in cancer control, and improve the capacity and capability of general practice to ensure appropriate recognition, management and referral of patients in primary care using evidence of best practice.

Highlights from 2016-17 include our ‘Cascade’ thought leadership seminars, Faculty educational workshops, the development of an e-cigarettes position statement, a review of the RCGP curriculum, and the creation of a web-based cancer toolkit. More information on our collaboration can be found on our website.

Our Cancer Research UK Strategic GP Leads offer clinical leadership and educational capacity to Strategic Clinical Networks to improve cancer pathways and reduce variation. An independent evaluation on the programme is now helping us evolve and improve our support to Cancer Alliances as they are established across the country.

Significantly, primary care cancer research is also going from strength to strength - Cancer Research UK has awarded its first £5m Catalyst award to the ‘CanTest’ research project led by primary care academics Prof Willie Hamilton and Dr Fiona Walter.  This new international collaboration aims to improve and develop new ways of diagnosing cancer in GP surgeries, assessing the accuracy, cost effectiveness and suitability of a range of diagnostic methods and tools for both patients and GPs, to reduce waiting times and lower the burden of referrals. This collaboration will help us discover new and more effective ways to diagnose cancer and realise the potential for improving outcomes for patients.

General practice faces increasing pressures. Recently when Prof Helen Stokes-Lampard and I met, we discussed the workforce challenge, as well as the opportunities in cancer services. We agree on the vital role that GPs play, and renewed the commitment of the College and Cancer Research UK to our collaboration.

What does the future hold at a time of political change and severe financial pressure on the NHS? There are acute workforce shortages and continually missed cancer waiting times, and we know that these things do not have a quick fix. There will be changes still to come – whether through federations of practices or the ending of the commissioner/provider divide. The constant is that primary care will be crucial to improve cancer outcomes. Primary care will be a vanguard for person-centred, integrated services.

Together, we have an opportunity to save many thousands of lives from cancer each year, and at the same time, significantly improve patients’ experience and care. We are better informed than ever about how best to prevent, diagnose and treat different types of cancer, and how to deliver better patient experience and quality of life.  Working together, I am optimistic that the RCGP and Cancer Research UK can continue to push for this to be taken forward at pace, so that patients benefit as soon as possible.

References:

1. Cancer Research UK http://www.cancerresearchuk.org/content/cancer-survival-statistics Accessed January 2016
2. https://www.incisivehealth.com/uploads/Saving%20lives%20averting%20costs.pdf
3. Walters. S., et al., Lung cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK: a population-based study, 2004-2007. Thorax, 2013. 132(3): p551-564
4. Maringe, C., et al., Stage at diagnosis and colorectal cancer survival in six high-income countries: A population-based study of patients diagnoses during 2000-2007. Acta Oncologica, 2013. 52(5): p919-932

 

 

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