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Independents' Day

GP leaders warn cancer awareness campaigns could cause treatment delays

Exclusive Major cancer awareness campaigns due to begin over the next few weeks will put additional pressure on GPs, with the extra workload potentially leading to treatment delays for other serious conditions, claim some LMC leaders.

Public Health England says that two national awareness campaigns - for breast and lung cancer - and other regional campaigns will be run in February and March after pilots showed they led to increased public awareness of cancer symptoms and diagnosis rates.

But GP leaders say they are concerned that the overlapping publicity campaigns do not take account the increased pressure they will put on already hard-pressed practices and how they will affect access to appointments for other conditions.

Pulse revealed last year that while the previous ‘three-week cough’ lung cancer awareness campaign - run in nationwide in 2012 - resulted in an additional 700 cancers being diagnosed, with a shift towards earlier stage diagnoses, the campaign also led to an additional 200,000 GP consultations.

A new national breast cancer awareness campaign runs from 3 February to 16 March and will encourage women aged 70 years and older to not assume they are ‘past it’ and ask about breast cancer symptoms. It will use TV and other media as well as direct mail.

According to a letter from the Department of Health, Public Health England and NHS England, results from a regional pilot suggested GPs may see more patients coming to their practices with breast cancer symptoms or mentioning them during home visits, but ‘this is not likely to represent a major additional pressure’.

A pilot of the breast cancer campaign carried out in January to March in 2013, saw a 13% increase in referrals for suspected breast cancer symptoms among women aged 70–79 years. PHE said it was ‘still awaiting data’ on the impact on breast screening services.

The lung cancer reminder campaign will overlap the breast cancer campaign, beginning from 10 March to the 31 March ‘with the possibility of being extended into April’.

Other regional awareness campaigns for ovarian and oesophageal cancer will also run from the 10 February in the north-east, Lancashire and Merseyside.

GP leaders said the overlapping campaigns would put practices under yet more pressure and warned patients could experience unnecessary delays securing appointments as a result.

Dr Robert Morley, secretary of Birmingham LMC, told Pulse although messaging of the breast cancer campaign seemed reasonable, he was concerned at the timing.

He said: ‘I don’t think any practice is going to complain about the fact a patients of any age are going to be encouraged to go and see them straight away if they’re worried about breast symptoms. [But] there is more concern about the lung cancer campaign – most GPs feel it is not clinically appropriate and increases both workload and unnecessary chest X-rays.’

He added: ‘Clearly seeing more patients and getting more diagnoses is all well and good but it’s got to be balanced against the capacity of general practice, with its current workload and funding issues, as well as potential unintended consequences, including delays in investigating patients with other serious symptoms.’

Dr Brian Balmer, Essex LMC medical secretary, also welcomed the breast cancer campaign, but warned there was a risk of being ‘over-cautious’ through the three-week cough campaign.

Dr Balmer said: ‘It is a bit like the two-week wait approach – if you are too cautious you flood the system, and people who really do need help are delayed. On the other hand if you don’t inform people properly those who are genuinely sick also do not get treated – there’s no magic wand. Getting the balance right is immensely difficult.’

But Dr Paul Roblin, medical secretary of Berks, Bucks and Oxon LMC, said the previous lung cancer campaign had not led to any complaints from practices in his area.

Dr Roblin said: ‘It’s not unreasonable to say, if you’ve had a cough for three weeks, have a consultation with your GP.

‘The major unintended consequence would be having a lot of “trivia” blocking consultation slots that could be used by other people – and I just didn’t see it.’

Readers' comments (7)

  • I am very happy for raising awareness and earlier diagnosis of cancers. Its just that when we start increasing the number of chest Xray requests the reporting time locally went from less than 1 week to > 3 weeks. Unfortunately the 2ww for lung cancer has abnormal CXR as a most important criteria which means there is a delay of approx 5 weeks (3w for CXR report+2WW) after seening a GP. So this campaign would be useful if there is a preplanned increase in radiology services and reporting anticipating the demand.

    Also GPC should be negotiating for HRG4 tarrif for GP consultantions rather than present scenario as we will be happy to see more patients if we can have more staff and colleagues to help.

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  • As mentioned above, not only is the capacity in general practice a concern but also capacity in secondary care. I know from my colleagues endoscopy lists are at full stretch, consultants are being paid extra (very well, if I may add) to come in to do operations/clinics, and more specialist nurses are employed and jobs delegated to cope with the demand.

    All of this costs money but NHSE expects this to be delivered without extra funding. Jeremy Hunt himself admitted NHS activity has been going up by 4%/year whilst the funding has flatlined in real terms for several years now. So, in reality we had funding cuts!

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  • What impeccable timing. Three major campaigns launched during GPs' busiest quarter.

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  • Russell Thorpe

    6 extra consultations per GP to just fill in an X ray form hardly onerous. The only hope for improved outcomes is ealier diagnosis so gripes about increased work load doesnt wash with me. If you cant cope with this campaign your practice is the issue not the campaign.

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  • 6 extra consultations per GP to just fill in an X ray form hardly onerous. The only hope for improved outcomes is ealier diagnosis so gripes about increased work load doesnt wash with me. If you cant cope with this campaign your practice is the issue not the campaign

    are you really a GP? do you literally just fill in the XR form no questions asked when someone presents with a 3 week cough? - so many differentials!

    Why not just leave the forms in the waiting room with a label - "refer yourself if you've been coughing more than three weeks"?

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  • Regarding the 6 extra consultations comment: You're correct, possibly an extra hours work, but this is on one issue. Look at the rest of the additional work that is provoked/promoted/demanded by each different gov dept/CCG/Patient group/ charity/academic body that 'only' the GP can do and has to because they're in the right place. Most of it is well meaning and even may result in better, more timely care but we do not have the resources to take on everyones 'extra' wishes, let alone the CCGG/NHSEng demand. This is without the public demand that often is ramped up by the press and other sources ot well meaning medical information.

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  • There is another problem concerning the commissioning of specialised services. Where does the money come from for increased demand for PETCT and radiotherapy? It takes at least six weeks for NHS England to catch up with trend data; just long enough for every patient to breach on their cancer pathway!

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