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Closing local practices may impact cancer diagnosis rates, researchers warn

Patients who have to travel over 30 minutes to see their GP have signficiantly worse cancer outcomes, a new study has found.

Researchers from the University of East Anglia and Public Health England assessed the extent to which access to GPs determines the route patients take to obtain a cancer diagnosis, and found that the farther patients need to travel, the more likely they are to present as an emergency cancer diagnosis and the less likely they are to undertake cancer screening.

The study saw that the ‘risk of diagnosis at death is particularly alarming’ for patients forced to travel farther, with a 10-fold increase for stomach cancer, 7-fold for colorectal cancer, 6-fold for breast cancer and almost 5-fold for prostate cancer.

The researchers told Pulse that there was a ‘possibility’ that centralisation of GP services may lead to later diagnosis.

GPs warned that with the rise in small practice closures, patients will be forced to travel longer distances to see a GP and this could have a negative impact on clinical outcomes.

The researchers assessed 737,495 patient records with a primary diagnosis of specified cancers in England diagnosed between 2006 and 2010.

They saw that around 88% of the population had access to their GPs within an estimated 10-minute drive. Those with the poorest access (more than 30 minutes) comprised just 0.7% of the population.

The paper, published in Oxford Family Practice, said: ‘Longer travel was associated with increased risk of diagnosis via emergency and death certificate only, but decreased risk of diagnosis via screening and two week wait.

‘Patients travelling over 30 minutes had the highest risk of a death certificate only diagnosis, which was statistically significant for breast, colorectal, lung, prostate, stomach and ovarian cancers.’

It said that while only 0.7% of the sample travelled longer than 30 minutes to see their GP, the outcomes amongst these patients were ‘concerning’.

‘The magnitude of apparent effect for risk of diagnosis at death is particularly alarming: 10-fold in stomach cancer, 7-fold in colorectal cancer, 6-fold in breast cancer and almost 5-fold in prostate cancer,’ the study said.

The researchers explained that ‘poor access to GPs may be an indication of disconnection from primary care such as failure to register with a GP after relocation’, and the combination of ‘prolonged disengagement’ and ‘poor accessibility’ reduces the likelihood of seeking care or reporting symptoms related to cancer.

Family Doctor Association chair Dr Peter Swinyard said these findings are ‘interesting’ when considering that many small practices are closing or merging with neighbouring practices, leaving patients with further to travel to see their GP.

He said: ‘There is no doubt that having a surgery within a pram-push from where people live and a constant therapeutic relationship with a medical team – not just the GP – leads to better and safer outcomes.

‘People may be embarrassed to express their symptoms if it is a strange GP in a faraway surgery when they may feel more comfortable with a known physician to say “I’m sure it’s nothing but…”’

Study researcher from the University of East Anglia Dr Peninah Murage, who specialises in environmental epidemiology, said that while the study did not assess the impacts of practice closure or amalgamations, there is a ‘possibility that service centralisation into fewer units may lead to later diagnosis in patients who would consequently live farther from their doctor.’

She said: ‘Individuals who are socially and economically deprived will be the worst affected, and ultimately, this may have a negative impact on other clinical outcomes including poorer cancer survival.’

Earlier this year, Pulse revealed that over a million patients had to move surgeries in the last five years due to nearly 450 practice closures.

Despite this, small practices are the least likely to receive NHS England resilience funding.

The BMA has warned that more than 600 GP practices will close in England if the Government fails to increase funding for general practice.