This site is intended for health professionals only


Cancer strategy hands GPs access to diagnostic tests



By Lilian Anekwe

All GPs are to be given access to key diagnostic tests for cancer, as part of a £750m drive announced by the Government to improve cancer survival rates.

The Department of Health will invest £450m over the next four years to ensure GPs can refer patients with suspected cancer directly for tests. Over two million extra tests will be funded, including chest X-rays, ultrasound, flexible sigmoidoscopy, colonoscopy and MRI scans.

It comes after Pulse revealed in October that a DH-led analysis of the diagnoses of over 18,000 cancers detected in 1,000 UK practices found lack of GP access to diagnostic tests delayed detection of cancer in a ‘significant minority’ of cases – and led to avoidable delays in a fifth of cases in some areas.

The new strategy for cancer, published today by health secretary Andrew Lansley, makes it clear it will be down to GP consortia to commission the additional direct access tests for their area.

Consortia will also be given free rein to use other approaches, such as ramping up their use of the urgent referral pathway, so long as improvements on cancer survival and other outcome measures on which consortia performance will be judged are achieved.

‘What matters is that earlier diagnosis is delivered, and that survival rates improve,’ the strategy states. ‘That is what the NHS will be held to account for delivering.’

Consortia will also be responsible for performance-managing their local GPs and all performance data will be published, the strategy revealed.

‘The DH will also ensure that data is routinely collected about GP usage of these tests, so that GPs can benchmark their use of them. This data will be published, alongside data about GPs’ usage of the two-week urgent referral pathway, as there will be a balance between how GPs use these two approaches to cancer diagnosis.’

Ministers believe 5,000 lives a year would be saved if UK cancer survival rates were raised to the level of the European average by 2015, and 10,000 lives a year would be saved if UK rates were improved to the level of the highest achieved in Europe.

But in an impact assessment published alongside the strategy document modelling work done by the DH on breast, colorectal, lung, prostate and skin cancer shows improving early detection is not likely to be cost-saving.

‘The modelling found that earlier diagnosis is generally cost-effective, but not cost-saving. If people are diagnosed earlier, either through screening programmes or through their general practice, the main benefit is a substantial improvement in health outcomes,’ the impact assessment says.

‘There is not a cost reduction, rather an increase in NHS costs – a large increase in testing costs generally offset by a modest reduction in treatment costs.’

Dr Nick Brown, a GP in Chippenham, Wiltshire and cancer lead for NHS Wiltshire, said he doubted the investment would improve outcomes: ‘If GPs see someone with suspected cancer they are required and almost invariably do refer patients under two week cancer rules. Patients are seen and dealt with fairly swiftly.’

‘I was rather hoping the Government was getting away from national directives spraying money around from the centre. Whatever spare money there is needs to be focused very purposefully in areas where we know there is a need and not in a very broad brush “do some more investigations and with a bit of luck you’ll find some more cancer” way.’

GPs will be given much greater access to diagnostic tests for cancer GPs will be given much greater access to diagnostic tests for cancer Other plans outlined in the cancer strategy

– improving the information patients receive about the services and treatments available
– accelerating work to incentivise payments, including the development of tariffs for chemotherapy and radiotherapy;
– piloting a national cancer survivorship survey in 2011;
– piloting data collection on the number of women with secondary breast cancer;
– implementing HPV testing as triage for women with mild or borderline cervical screening test results;
– supporting cancer research through providing £4.7 million funding for a policy research unit on cancer awareness, screening and early diagnosis.

Source: Department of Health