Cancer in Primary Care
The earlier a cancer can be diagnosed the greater
the prospect of a cure. The later a cancer is diagnosed the
harder it is to treat and the poorer the patient’s chances of
survival. Evidence suggests that later diagnosis of cancer
has been a major factor in the poorer survival rates in the UK
compared with some other countries in Europe. One of the
priorities of the
Cancer Reform Strategy is to diagnose cancers at an earlier
stage.
The National
Awareness and Early Diagnosis Initiative aims to ensure
that this work is taken forward. There are seven workstreams,
one of which focuses on interventions in primary care and is led by
Professor Greg Rubin on behalf of the Royal College of General
Practitioners. There are four parts to the programme of work.
1. A baseline
assessment of interval from first presentation to
diagnosis
There is limited available data on the interval from symptom
onset to diagnosis for most cancers. The time covered by this
period can be attributed to patient, doctor or system factors. The
national audit will examine factors affecting the patient journey
from the time of first presentation to the point that the diagnosis
is made, i.e. it will focus on doctor and system delay.
2. An analysis of Significant Event Audits for
cancer diagnoses
Significant Event Audit is a quality
improvement tool that is in routine use in general practice. SEA
provides a structured narrative analysis of the circumstances
surrounding the event of interest. Qualitative analysis of the
content of a large number of SEAs for the same event allows
recurring themes to be identified. These can then form the focus
for service improvement.
View more on Significant Event
Audits
3. Development of an audit
template
Audits of cancer diagnosis have already been
undertaken in some parts of the UK, notably in Scotland. Their
focus has been largely on the use of the rapid referral process.
National audits are in place for some cancer sites (bowel, head and
neck, upper GI) but these largely concentrate on the post-diagnosis
experience.
4. Programme
development
This programme has an oversight group drawn from academic and
service general practice, the DH NAEDI team and the cancer
charities. This group will take an overview of the development of
the National Audit, ensuring that it integrates with service
delivery in general practice, the objectives of the Cancer Reform
Strategy, and the shared research agenda of NAEDI, CR-UK and the
NCRI. It will meet 2-3 times a year, and also communicate by email
and teleconference as necessary.
Author biography
Professor Greg Rubin leads the work on the
interventions in primary care on behalf of the RCGP.
Greg Rubin is a GP and Professor of General
Practice and Primary Care at Durham University His principal
research interest is the management of gastrointestinal problems in
primary care and at the interface with secondary care, particularly
for cancer and inflammatory bowel disease, and he has published
extensively on this subject. He leads the ‘early diagnosis’ theme
within the NCRI Primary Care Clinical Studies Development Group and
heads the National Audit of Cancer Diagnosis in Primary Care on
behalf of the Royal College of General Practitioners. He chairs the
Royal College of General Practitioners’ Scientific Foundation
Board.
He has extensive experience of working with
Primary Care Trusts on the organisation of health care services and
in his present role heads a team of researchers that supports the
evaluation, research and development agenda associated with
commissioning of health care.
circ@rcgp.org.uk
0203 170 8231