Our role in advocating for cancer patients cannot be underestimated

7 August 2020

During the pandemic I found my brain too tired at night to focus on new reading material, so I started re-reading old novels. It was interesting to revisit old books which I had venerated in the past and found some less engaging when read from a different personal perspective.

A Year in Provence by Peter Mayle seems even more appealing, while other thrillers seem to have lost their ability to whet my appetite.

I have started to review old notebooks and emails and remember a world before COVID-19.

Cancer - the importance of early diagnosis

When I took up this post in November 2019, one of my personal priorities was to see how our College could support members in identifying cancer earlier and providing high quality palliative care - not only for patients suffering from cancer, but all life limiting conditions.

At the end of 2019, we highlighted the potential benefits of engaging with the Cancer Research UK (CRUK) National Cancer Diagnosis Audit (NCDA).

I have now received my own list of patients to review (17 for my practice of approximately 4200 patients) and I am looking forward to establishing how they were diagnosed and trying to establish what I can learn to ensure future patients are diagnosed earlier, if possible.

The benefits of engaging in this nationally recognised work is that it will not only analyse the primary care aspect of the patient’s care, but also the secondary care issues, and whether there are lessons to learn there.

It is completely non-judgemental and you can read more about this work online.

I’m looking forward to digging into my patients' charts and learning more to see if there are any systems which we could improve to ensure the earliest possible diagnosis of cancer.

This is so important as it will improve survival and could ultimately save lives. I will feedback more on this work as it progresses. If you would like to be involved, please get in touch and I will put you in contact with Lisa Cohen from CRUK.

At the height of the pandemic, Northern Ireland’s red flag referrals dropped from a usual figure of approximately 2,500 per week to 800 per week. That figure has only risen to 2,000 per week, so it is imperative we do not miss any diagnosis.

Last week, it was good to talk to our colleague Dr Yvonne McGivern who is the Macmillan Primary Care Director of the Northern Ireland Cancer Network.

Our advice is clear - if you have a concern about a patient who might have cancer, do not hesitate to refer through the appropriate route.

A recent modelling study in Lancet Oncology reveals a chilling picture, so please continue to refer patients with red flag symptoms to ensure we do not suffer from a dip in cancer diagnosis.

Delivering excellent care

Our role as expert specialist generalists when we diagnose, support and advocate for our patients with cancer cannot be underestimated.

I was in our office last week for the first time since lockdown. It was a surreal experience, but I was humbled and heartened by a hand-written letter from one of our patients to me personally.

The lady’s GP had retired during the pandemic and she felt he had been allowed to "quietly slip away into retirement almost unnoticed".

In her letter she told me about her diagnosis of breast cancer. Shortly after diagnosis, she attended her surgery for a routine blood test. She was surprised to see that an appointment had been made with her GP.

When she went into his surgery he greeted her warmly and said: "Mrs X – this is just a social call as I have not seen you since your problem began and I have been wondering how you were coping with it all."

She was very moved and supported by his proactive kindness, so I thought it was important we celebrate this exemplar of good care.

I know from my work with RCGP and by speaking to many of you, how far GPs go to support our patients - frequently giving up their own valuable time.

If you have a good idea or example on how we should provide best care for patients through either the early diagnosis of cancer or supporting patients with life limiting disease, please get in touch

Palliative Care Week

You may be aware that 13-19 September is Palliative Care Week and we have been approached by the All Ireland Institute of Hospice and Palliative Care to work together to highlight the important role GPs play in providing palliative care.

We hope to be involved in this year’s programme and I will update you when I have more details to share, but in the meantime, please note Palliative Care Week in your diary and keep an eye on other events.

Our COVID-19 End of Life Care resources are applicable to 'normal times' as well as a pandemic and have been expanded significantly, so check them out if you haven’t seen them. You can access them via our COVID-19 hub.

The importance of coding and data

Our vision document for general practice in Northern Ireland, Support, Sustain, Renew (1.67 MB PDF), is still as relevant today as it was when we launched it in November 2019.

It called on the Department of Health to "work with general practice to look at meaningful ways of measuring GP workload to inform and support improvement in the delivery of GP services and adjust workload burden."

It is difficult obtaining meaningful workload data. Being able to show the numbers of patients attending our surgeries or having telephone consultations is helpful, but it is not enough to show all that we do, so it is vital we all enter as much codable clinical data as possible into our clinical systems.

I have redoubled my own efforts since the pandemic started and am much more careful about entering codable problems and ensuring that even insignificant looking things, like whether it is a telephone consult or an attendance in the practice, are coded accurately.

We will work with the Health & Social Care Board to see how we can all improve this.

The old saying used to be "garbage in equals garbage out" but data literally has the power to save lives, as we can see with the NCDA work, so we aim to do more to help you with this when things settle a little.

Physical activity in older people

Generating Active Lives in Older People is a research project co-ordinated by the Institute of Public Health in Ireland which seeks to develop our understanding of the role of health professionals in promoting physical activity to older adults.

The project has been running for two years, during which time they have established a research project and advisory group with representation from many professional bodies across Ireland.

They intend to send out a survey at the end of August and we would be grateful if you can spare a few minutes to take part.

I will highlight how to engage in a later blog, but in the meantime, below are links to a number of research outputs from the project to date:

 Physical activity has massive implications for health and many patients forget its links to cancer.

Macmillan continues to provide a massive amount of free CPD so it is well worth visiting the section on their website dedicated to healthcare professionals.

Termination of pregnancy

Our position on abortion has not changed and we continue to encourage all members to practice within current legislation.

There is now an Early Medical Abortion (EMA) service in each of the five Health & Social Care Trusts and it can be contacted using the Informing Choices NI central access point.

There is still no service in NI for patients over 10 weeks, so these patients can access services through British Pregnancy Advisory Service central booking services.

Safeguarding

It has been difficult for all families living together during lockdown. I am stuck in the repetitive dad rant about the excesses of PlayStation and Fortnite with my own children.

The Safeguarding Board for Northern Ireland has a helpful guidance document (2.21 MB PDF) which can be shared with stressed parents like me.

The College has lots of our own resources on safeguarding and the RCGP safeguarding webinar is worth checking out.

I hope you are all getting some well-earned time off to recharge your batteries. If you are, please rest and accept my thanks for all you are doing for your patients.


Post written by

Dr Laurence Dorman, Chair of RCGP Northern Ireland

Dr Laurence Dorman took office in November 2019 after three years as Deputy Chair of Policy for RCGPNI. A GP principal in Mourne Family Surgery, Kilkeel, Co Down, since 2007, he is the fourth generation of GPs in his family. He was also, until recently, the Chair of Newry and District GP Federation. 

Laurence has particular interests in new ways of working in primary care, cancer care, and inspiring the next generation of GPs. He set up the successful Dear Colleague initiative to improve the interface between primary and secondary care and has been a strategic advocate for interface and communication since September 2017.

During his time as Chair, he wants to support College members to ensure that the future of GP services is protected, supported and sustainable.

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