In the second of our new series asking the health service ‘tsars' for their thoughts on GP commissioning, we speak to Professor Sir Mike Richards, national clinical director for cancer
Why should cancer be a priority for GP commissioners?
Cancer is a common condition. In the UK, one in three people will get it at some point in their life. One in four will die from cancer and at any one time, 2 million people are alive who have had a diagnosis of cancer.
We spend about £5bn a year on care for cancer patients. It is an area where we can and must do better because survival rates are below those of comparable countries in Europe.
What has GP commissioning done well in terms of cancer?
PBC was relatively under-developed in terms of cancer, but I'm keen to work with GP commissioners to take that forward. The area that has probably done the best, and has scope for doing more, is end-of-life care.
What could it do better?
We need to think carefully about where GP commissioning makes sense, and where commissioners need to seek advice from cancer networks.
What's held GP commissioning back in the area of cancer and what will change this?
We need more high quality, readily accessible information for commissioners, which means looking at what areas they need advice on and where they can go for support.
What's impressed you about GP commissioning?
Where GP commissioning is working well is in engaging clinicians to develop better care pathways for patients, and there are a lot of good examples of this around the country.
In the past, the approach has tended to be about purchasing a number of procedures, rather than thinking about a care pathway, specifically ‘how do we want a patient to get from A to B to C?'. Having clear care pathways is particularly important in cancer because we need to consider who is responsible for doing the diagnostic tests and how the patient goes from surgery to radiotherapy to chemotherapy. Commissioning across a care pathway makes a lot of sense.
Is there anything that worries you about primary care clinicians involved in commissioning?
There are areas where it's going to be extremely difficult for GP commissioners to have sufficient knowledge of particular fields – such as complex chemotherapy – in order to commission wisely.
How would GPs commission cancer services in your ideal world?
We need to decide which aspects of cancer GPs have the expertise to commission services for, and which would be better commissioned at a regional or national level.
My belief is that GPs will be better at commissioning services for aspects of cancer care they deal with more frequently, rather than those where they are less experienced.
Having clarity about what aspects should be commissioned at consortium level, regionally and nationally, would be helpful, and I'm keen to work with commissioners to identify what that might look like.
What three things could commissioners do that would most improve cancer outcomes?
Early diagnosis, early diagnosis and early diagnosis. By which I mean, making sure that screening uptake is maximised – there is a strong evidence base that screening saves lives. We also need to ensure that awareness of cancer and the importance of early diagnosis are known at local community level, and that GPs have access to diagnostic tests.
Is there anything on the way that GP commissioners should look out for?
The National Cancer Action team has developed an electronic cancer commissioning toolkit. This includes information on incidence, mortality, survival rates, use of the two-week wait referral route, screening uptake, hospital admissions and bed days.
The toolkit is still not very user friendly, so we're working to make it easier by producing standardised reports that relate to a particular area or group of practices. We hope to have easily accessible, standardised outputs in time for the next commissioning round in the autumn.
Professor Sir Mike Richards: Cancer is an area where we can and must do better Professor Sir Mike Richards: Cancer is an area where we can and must do better
