Jun 30 2014

To tackle disparities don’t blame GPs

Jeremy Hunt has proposed that GPs who fail to diagnose cancer should be named and shamed. This seems to be an utterly nonsensical idea. Surely, the different rates of detection of cancer, which show UK lagging behind other countries in the early detection of cancer cannot be attributed to GPs failing to spot the symptoms?

GPs are highly trained professionals who get presented with a multitude of health problems from their patients every single day. Of those people who present approximately 330,000 people (source: Cancer UK 2014)  are diagnosed annually with cancer.  Of these cases 50% are accounted for by the four most common cancers of bowel, lung, breast and prostate, the remainder can be from a large and very diverse range of cancers. People who present with cancer frequently have symptoms that could denote any number of complaints, and it must be important to consider common explanations as well as more severe and rare causes. In addition, some people with cancer can present with atypical symptoms. Therefore it seems to me that it must be expected, and acceptable, that even with the best performing GP that they may need to see someone several times before they can determine the cause of the problem, or refer on for specialist opinions.

GPs in most cases perform a brilliant job, but as with all jobs requiring human interpretation they may occasionally get it wrong. My worry with this proposal is that GPs will be completely deskilled. To mitigate against the risk they will simply refer on everyone. This will place an enormous strain on specialist services, and also mean that GPs, over time, will become little more that secretariats. The resulting pressure on secondary care will mean that those people will potentially have to wait much longer to be diagnosed, threatening their chances of long-term survival.

This seems therefore to be entirely the wrong solution. Instead, should we not look much more closely at the discrepancies in areas, and work more intensely to tackle the higher propensity for cancer that people from deprived areas have to develop cancer. We must ensure that health promotion is targeted, with motivating messages to ensure that people are equipped to reduce their chances of developing cancers (stop smoking, healthy eating etc.), but also that when invited to participate in screening that they chose to attend, and if they do develop worrisome symptoms that they understand the importance of seeking medical advice. Part of the encouragement in getting help is to ensure that they trust and respect GPs. Something Jeremy Hunt seems to be threatening in a most unwelcome manner.