General practitioners have important roles in cancer

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7259.510/b (Published 19 August 2000) Cite this as: BMJ 2000;321:510
  1. Mike Sadler, medical director, Hampshire NHS Direct (mikesa{at}epulse.net)
  1. Winchester SO22 5DH

    EDITOR—Summerton rightly states that general practitioners have an important role in cancer care, emphasising the issue of early detection by screening and the prompt recognition of specific symptoms.1 It is important, however, to ensure that work on cancer care and primary care does not become dominated by referral guidelines and pathways or by the medical model of care.

    In 1998 I was a member of a multidisciplinary working group on cancer and primary care set up by the Department of Health. The group considered the role of primary care in its broader context and made 19 recommendations; those relating to referral formed only a small, though important, subset. Unfortunately, the report, which was completed last year, has not been published.

    Several key recommendations may be lost if attention is deflected to the production of new referral guidance.

    • Available evidence on the community epidemiology of symptoms potentially related to cancer should be reviewed, with primary research being commissioned where evidence is lacking

    • Existing local referral guidelines for rapid access clinics for suspected cancer should be evaluated

    • Nationally produced referral guidelines should indicate the appropriateness of preliminary investigation in primary care

    • Commissioners of cancer services should incorporate quality standards for communication between primary and secondary care into service agreements with cancer units and centres

    • A strategy for palliative care should be formally discussed and agreed at health authority level in the context of the health improvement programme

    • Local directories of cancer and palliative care services should be compiled and disseminated

    • Primary care teams should have 24 hour access to specialist advice and to admission to a specialist palliative care unit

    • There should be access to 24 hour community nursing care

    • Palliative care should be a core element of staff training in residential and nursing homes.

    Primary care teams have essential parts to play when a patient has cancer. The Calman-Hine report noted that “the primary care team is a central and continuing element in cancer care, for both the patient and his or her family, from primary prevention, pre-symptomatic screening, initial diagnosis, through to care and follow-up or, in some cases, death and bereavement.”2 Excessive emphasis on early detection may undermine the development of the other elements of high quality care.


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