GPs Sceptical About Health Service Reforms

New Survey Reveals Cancer Is Top Priority

GPs have expressed overwhelming scepticism about the health service reforms ¹ due to take effect in April 1999. Just one in eight GPs believes the proposed 'primary care groups' ² will make it easier to meet their patients' needs while nearly half think it will make it harder. Asked about their budgeting priorities, GPs put high quality cancer care and palliative care at the top of the list. These are the findings of a MORI survey ³ of around nine hundred GPs in England, commissioned by national cancer charity Macmillan Cancer Relief and published today (Tuesday 17th November).

Cancer Pledge

GPs showed a very low (just 2%) spontaneous awareness of the NHS White Paper's 'Cancer Pledge' ¹, which sets out to guarantee that by the year 2000 everyone with suspected cancer will be able to see a specialist within two weeks of their GP deciding they need to be seen urgently and requesting an appointment. Scepticism was expressed about the pledge: It sounds good....doesn't it? But I think it is less than practical," one GP commented. Another said: That is window dressing."

Cancer Care - GPs' Top Priority

The survey highlights GPs' certainty about the need to improve cancer care services. In a selection of budgeting priorities, 'the provision of high quality cancer care and palliative care for all cancer patients' was chosen as the highest priority, above nine other options including 'supporting a specialist geriatric service in the community' and 'expanded community care for the mentally ill, including more home treatment facilities'.

Communication Problems

GPs also expressed concern about gaps in communication in cancer care between hospitals and GPs. One GP summed up the situation: There is a community team and a hospital team...I think the two teams are quite separate." Another said: There are so many professionals involved that sometimes communication suffers." GPs, by their own admission, are not always aware of patient progress which can hinder their ability to offer sufficient support. One GP commented: Sometimes we lose touch with people who are under hospital care."

Living with Cancer

GPs often see cancer patients pre-diagnosis, then again only if the disease reaches a terminal stage. Perhaps because of this, some GPs in the MORI qualitative research associate cancer with terminal care. One GP commented: It tends to be when the hospital reaches the point where they say 'we have done all we can do for this person, we are going to refer them back to their GP and on to the hospice' that I become much more involved." This often means that many GPs do not become involved in caring for their patients during a vital part of their 'cancer journey' - the time they are living with the illness.

GPs expressed frustration at being unable to offer the psychological and emotional support that patients often need, tempered with concerns about their time constraints. Some acknowledged the need for more training and support in these areas, with one in four saying 'developing counselling skills' was one of the ways they would like to spend their five training days, and a similar proportion saying they would like to find out more about cancer care and its treatment.

Possible Solutions

Macmillan Cancer Relief recognises the need for a multi-faceted solution to address some of the shortfalls in cancer care. One of the possible solutions is the 'tracker nurse' concept which was tested in the survey. The 'tracker nurse', currently being piloted by Macmillan Cancer Relief, is an oncology nurse ⁴ who is based in the community to support GP practices. The nurse liaises with the hospital and the GP, effectively tracking the patient's progress and co-ordinating their cancer care. Eighty six per cent of GPs agreed this concept is a good idea and as many as half described it as a very good idea. Macmillan is also funding nineteen GP Facilitators ⁵, part of whose remit is to educate community health teams in all areas of cancer care.

Nicholas Young, Chief Executive of Macmillan Cancer Relief, said: Some worrying findings have come out of this research. GPs are in the front line when it comes to caring for cancer patients - they're the gatekeepers to cancer services so we must make sure they have the support they need to do their job. We're really encouraged that they're so keen to do more to help cancer patients but it is clear that communications within the health service as a whole need to be improved, and GPs need more specialist support and training in cancer care."

Macmillan is working towards the time when every person in the land has equal and ready access to the best information, treatment and care for cancer and where unnecessary levels of fear are set aside. There is a Macmillan Cancer Relief telephone information line on 0845-601 6161.

Technical details

1. The New NHS: Modern - Dependable 1997
2. As part of the Government's plans to replace the NHS internal market and end GP fundholding, Primary Care Groups (PCGs) - groupings of GP practices covering populations of around 100,000 - will be set up in all parts of the country to commission health services for local patients. PCGs will have control over resources, but will have to account for how they have used them in improving efficiency.
3. MORI conducted 20 face-to-face in-depth interviews with GPs across Great Britain in the first qualitative phase of the research, from 3-29 June 1998. This was followed by 883 face-to-face interviews among a representative sample of GPs using omnibus methodology from 3 August to 9 October 1998.
4. A nurse who specialises in the treatment and care of people with cancer
5. Macmillan GP facilitators were established in 1992. There are currently 19 GP Facilitators in post. These are GPs with a special interest in cancer treatment and care who work as educators, sharing their knowledge and skills with colleagues in the community. They also help to strengthen links between GPs and local hospitals, cancer centres, specialist in-patient units, social services and Macmillan nurses. In this way they play an important part in improving continuity of care for people with cancer.