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Better care continuity ‘would boost early cancer diagnosis’

Researchers have called for a return to ‘smaller GP teams’ and longer consultation times to enable GPs to pick up cancer earlier.

The team of primary care academics from London argues that having smaller teams would improve the continuity of care needed to allow GPs to use their ‘gut feeling’, based on their knowledge of individual patients, to pick up on serious disease, while longer consultations are needed to give them time to explore symptoms properly and consider patients’ wider care concerns.

Writing in the Journal of the Royal Society of Medicine, the researchers say the recent trend towards bigger practices with large patient lists being shared among several GPs, particularly in inner-city, deprived areas such as Tower Hamlets that have poor cancer survival rates, is contributing to a lack of continuity of care.

And they point out that GPs are under especially tight time pressure, with the shortest consultation times in Western Europe, which increases the risk for errors and thresholds for intervention.

Amongst other recommendations, the authors also call for better dissemination of information and control over GPs’ caseloads, and encourage the introduction of patient-held records, which they say will help to improve continuity of care.

They write: ‘If patients can access all the information about themselves, make appointments, order repeat prescriptions and access information and decision making tools, this could increase health literacy, improve concordance and accuracy in the records as well as a trusting adult-to-adult relationship that itself improves health and outcomes.’

But they say the recent NHS reforms and continuing pressure on resources mean their recommendations ‘will be difficult to implement’.

Lead author Dr Thomas Round, clinical research fellow at King’s College London, said: ‘Early diagnosis is the result of the best interaction between patients and their GPs. Some of the interventions we are suggesting, such as longer GP consultation times, have been advocated by the RCGP, and could be implemented at an individual GP and practice level.

‘However, they would be difficult to implement given recent NHS reorganisation and constrained budgets, with primary care dealing with 90% of NHS patient encounters with less than 9% of the NHS budget.’