Helping GPs to hone their skill at identifying cancer early will go a long way to improving survival rates
Andrew Lansley has two big ideas about how to reform the NHS. First, a new focus on improving patient outcomes and, second, getting GPs to commission services. But how do these ideas fit with the government’s priority of tackling cancer?
‘GPs simply do not have the patient numbers to commission effectively’
Ministers announced a “refresh” of the cancer reform strategy within two months of coming into office and a week before they had even published the health white paper. The new £200m a year cancer drug fund was also one of the few policies to survive the Treasury’s red pen intact after the comprehensive spending review.
This is a clear statement, not only about the importance the government places on cancer reform itself, but also about the importance it places on getting cancer reform right for the broader NHS transformation to be a success.
Although cancer survival rates have improved over the last three decades, it is scandalous that, particularly after a step change in investment in recent years, we are still floundering in the lower divisions of the international cancer league.
Evidence shows that those patients who survive one year stand as much chance as our European neighbours of surviving for five years. However, our one year survival figures are relatively poor. This suggests the NHS does comparatively well in treating cancer once it is detected, but falls down when it comes to diagnosis - late diagnosis makes for poor one year survival figures.
That is why we must get the NHS to focus on one-year survival rates as a means of encouraging earlier diagnosis. The all-party parliamentary group on cancer recommended a new one year survival rate measure in our report into tackling cancer inequalities last year, and the government has adopted our recommendation in the health white paper.
Exactly how these one year figures will be presented is still in the melting pot. The National Cancer Intelligence Network and Office for National Statistics have done some excellent work on this. Whatever the result, it must not be seen as a league table but rather a performance table in order to ensure all PCTs and GP consortia are tasked with improving their performance, irrespective of how they compare with others.
The focus on patient outcomes should not just be about the one and five year survival rates, but also include patient experience measures and longer-term quality of life measures.
This focus on outcomes may suggest there is a question mark over whether process-based targets, such as waiting times, are needed. The real problem in late diagnosis is not whether it takes one or two weeks to see a specialist. The real problem is how long it takes for someone to be suspected of having cancer in the first place. This is first and foremost about awareness. Perhaps there is a need to find a way to incentivise GPs to improve early detection and referral via mechanisms such as the quality and outcomes framework.
As for Andrew Lansley’s second big idea - GP commissioning - questions remain as to how specialist cancer services are going to be commissioned by GP consortia.
There is undoubtedly room for improvement when it comes to PCT commissioning for cancer services at the moment. There is often confusion between the roles of strategic health authorities, primary care trusts, cancer networks and individual hospital trusts.
However, the issue is whether GP commissioning will make things better. To play devil’s advocate, cancer is still a relatively rare disease dealt with principally by clinicians and nurses in hospitals. GPs tend to play a role in the early and late stages of the care pathway but are far less involved during the ever growing bit inbetween. Indeed, the primary care structure isn’t currently set up to manage cancer as a long term condition anyway - few QOF points mean low prioritisation.
So the relationship between the national commissioning board and PCTs and GPs needs to be understood by all. In particular, the role of cancer networks in supporting GP consortia needs to be clarified quickly before they are broken up and perhaps the expertise lost.
Another concern relates to the disparity of access when it comes to the cancer drugs fund. Early evidence suggests that in some regions individual applications to the PCTs continue, whilst in others, the cancer network appears to have direct access to the fund. One hopes best practices from the interim drugs fund will be applied uniformly.
I’m sure these are issues which the cancer community will want to raise with Andrew Lansley at the all-party parliamentary group on cancer’s Britain Against Cancer conference on 14 December. Mr Lansley has very kindly agreed to be our keynote speaker.
There is no doubt in my mind that a refocusing of the NHS to improving outcomes will come to be seen as the greatest innovation for patients - provided it is allowed to succeed. It must not be undermined by problems over GP commissioning. Patients have already waited too long to be in the European cancer premier league.
John Baron is chair of the all-party parliamentary group on cancer and Conservative MP for Billericay and District.
- Acute care
- Andrew Lansley
- Clinical Leaders
- Clinical news (NICE, NSFs)
- Comprehensive spending review 2010
- Conservative policy
- Department of Health and Social Care (DHSC)
- Government/DH policy
- GP commissioning/practice based commissioning (PBC)
- Health white paper
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- Lib Dem-Tory coalition
- NHS England (Commissioning Board)
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- Quality and outcomes framework (QOF)