Continuity of care so that all patients see the same GP with whom they build up a relationship over time could help reduce delays in the diagnosis of cancer in primary care. In an essay published by the Journal of the Royal Society of Medicine, a team of primary care experts write that this, together with longer consultations and better distribution of information to GPs about referral pathways or new services could have a wide reaching impact on the early diagnosis of cancer and survival. Yet, write the authors, recent changes in the structure of the NHS and the continuing pressure on limited resources and increasing demand means this may be difficult to implement.
Late diagnosis is a major contributing factor to poor cancer survival rates in the UK and it has been suggested that over 10,000 deaths a year might be avoided if survival rates matched the best in Europe.
Patients themselves may be a factor in delayed diagnosis, for example by not recognising or responding to warning symptoms. But clinician and health system related factors could also be contributing to delayed cancer diagnosis in primary care. In their essay, the authors suggest interventions that, if implemented successfully, could contribute not only to improved early cancer diagnosis and survival, but also to a safe, productive and rewarding working environment for GPs.
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 Royal College of General Practitioners, 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.
Other suggestions made by the authors include patient access to their records and ultimately patient held records, which may improve continuity. "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," commented Dr Round.