GPs need more training to ‘improve their diagnostic skills’ for gynaecological cancers, according to the Welsh Health and Social Care Committee.
The committee of Welsh Members of the Senedd (MS) has made a number of recommendations to improve women’s experiences of the gynae cancer pathway.
Their inquiry found that women presenting to their GP with symptoms are being ‘made to feel like a neurotic nuisance’, and that although not all women have a negative experience, there can be ‘tragic consequences’ when things go wrong.
Primary care formed a substantial part of the report, with the committee saying ‘too many women are being sent away with a misdiagnosis’ such as irritable bowel syndrome (IBS).
They also claimed that the number of women being diagnosed with a gynae cancer after emergency admission ‘suggests that something is going wrong in primary care’.
The RCGP told the inquiry that GPs’ awareness in this area is ‘not at desired levels’ and agreed that more education is needed in primary care.
Responding to the report’s publication yesterday, RCGP Cymru Wales said it is ‘sobering’ and ‘raises important challenges’ for GPs.
However, they highlighted the link to workload pressures in general practice, with 25 fewer practices than at the start of 2020 and a steady fall in the number of full-time equivalent GPs.
They said: ‘We would never want our patients to feel that their concerns have not been taken seriously, and our responsibility to keep up to date with NICE Guidelines is a key part of our duty of care to our patients. We are already creating additional professional education opportunities in this field.
‘It is impossible to detach the findings of this report from the broader issue of the unsustainable workload in general practice. RCGP has campaigned for longer consultation times and improved patient access, but for both of these to be achieved we need more GPs.’
The committee recognised the ‘enormous pressure’ GPs in Wales are under and also that identifying symptoms of gynaecological cancers can be difficult as they are ‘easily mistaken’ for other health problems.
But they highlighted their concerns that some GPs ‘may struggle’ to follow NICE guidelines.
‘GPs have a duty of care to their patients, and as such, should be expected to keep up to date with the latest developments in their field,’ the Members of the Senedd said.
NHS Wales deputy chief medical officer Professor Chris Jones told the committee that GPs are ‘doing really well’, but recognised that gynae cancers ‘are very difficult to diagnose clinically’.
He added: ‘You, I think, know very well that, particularly for ovarian cancer, which has the lowest survival rate, the symptoms are very non-specific.
‘You have no symptoms in the early phase, but then even in the later phase the symptoms are very non-specific—abdominal bloating, urinary frequency, this type of thing—and it’s very difficult, I think, then, for a GP sometimes to distinguish what warrants a referral.’
The inquiry also heard evidence from stakeholders such as the Target Ovarian Cancer charity, who claimed that 43% of GPs in Wales believe that ovarian cancer symptoms only present in the late stages of disease.
Wales minister for health and social services Eluned Morgan said GPs ‘generally’ pick up around eight cases of gynaecological cancer a year, but have to refer over 100 in order to do this.
She added: ‘So, it’s very difficult for GPs, who’ve got eight minutes to assess, “Right, do they meet the threshold?”
‘And one of the things we’ve got now, of course, are rapid diagnostic centres. So, where they don’t quite meet the threshold of cancer suspicion, there’s a mechanism for them to go down a different route through the rapid diagnostic centres.’
Committee recommendations involving GPs
Recommendation 1. The Welsh Government should work with the relevant health professional bodies and health boards to promote gender sensitivity and cultural competence among healthcare professionals. This ‘relationship-based care’ model should include ensuring there is adequate time for appointments to thoroughly address patients’ concerns, and encouraging empathetic communication between patients and healthcare professionals, acknowledging the unique health needs and experiences of women.
Recommendation 14. The Welsh Government should work with the relevant professional bodies and NHS Wales to:
- ensure continuing medical education opportunities have an appropriate focus on gynaecological cancers. This should include a conference/webinar to update GPs on the latest guidelines and diagnostic techniques focused on gynaecological cancers to take place by the end of March 2024;
- ensure the clinical guidelines that outline the symptoms and risk factors associated with gynaecological cancers are clear and being implemented. This should include an audit of GP referrals and patient outcomes related to gynaecological cancers to provide feedback to GPs to help them improve their diagnostic skills;
- provide GPs with support from secondary care to assist them in the assessment and referral of patients with potential gynaecological cancer.
Recommendation 15. The Welsh Government, in conjunction with the Wales Cancer Network, should commission an urgent review of the incidence, trends and high-risk populations in relation to emergency presentations with a gynaecological cancer, broken down by each of the gynaecological cancers. This review should include access to primary care, symptom recognition amongst GPs, misdiagnosis and communication and referral processes. The findings should be shared with the Committee within six months of the publication of this report.
The committee also called on the Welsh Government to boost cervical screening HPV vaccination, and to urgently publish a women’s health plan for Wales.
NHS England has recently set a target to eliminate cervical cancer by 2040 and announced a new vaccination drive.
As part of a parliamentary debate, MPs highlighted a ‘deficit in knowledge’ among GPs with regards to menopause.
GPs need more of everything
How disrespectful. Nobody says noctors need more training?! And honestly this is where the problem lies.
Why not put more Gynaecological Surgeons in Primary Care, alongside the other Noctors?
That should fix something.
Was that really the report from the Royal College of Gynaecological Practitioners?
Actually, it really would help if the Gynaecological Practitioners to be sent into Primary Care could request USS scans for us, since currently GPs are not allowed to, and GYnae waiting lists in hospital, are Soooo long.
Can Pulse please audit in the last 12/12 how many times they have run a story headed “GPs need more training In…”?
Yes every specialty pleads we should always think lung cancer, bone cancer, breast cancer, renal cancer, ovarian cancer, bladder cancer, Bowel cancee prostate cancer on every patient who comes in for a 10 minute consultation.
Not to mention Metabolic disease, cvd etc
As others have already said what about the noctors training?
How offensive. Good luck getting more GPs in Wales with that kind of attitude. We are not specialists.
What exactly did we do during our Gynae attachment at Medical School?
Dear Dr Munro, if you have forgotten what you did in medical school Gynae attachment, you exemplify the need for more training for GPs in Gynaecology! Don’t let the RCGP know about it, or they will be around to test you to see what else you have forgotten and need to retrain in…..
No problem. What training would you like us to drop in order to do this?