Cancer can present quickly, or slowly, as an acute same day appointment and a booked one, and in Casualty. We don’t know the historic ratios, but the press will vilify GPs anyway.

GPs are not getting a good press. As access to care, appointments and tests all collapse, NHSreality is expecting some form of public protest at the invidiousness of a two tier system by default. The Times reporting is factual, but the Mail and others is disgraceful. Sorting the wheat from the chaff when there are so many appointments is a skill. We can always get better; but we can never be perfect. Cancer can present quickly, or slowly, as an acute same day appointment and a booked one, and in Casualty We don’t know the historic ratios, but the press will vilify GPs anyway. What ratios would the tabloids accept, given that the recent government demands have been for QOF and chronic disease management? A cancer diagnosis is usually retrospective for a GP… If only there was adequate (or over) capacity and enough time to consult with your GP – instead we have had rationing by deliberate undercapacity.

Image result for perfect doctor cartoon

Chris Smyth in the Times 25th April reports: Thousands of cancer cases found at A&E

Thousands of patients have cancer diagnosed in hospital accident and emergency departments because they have not managed to see a GP, a study has found.

Men and the poor are particularly likely to fall into this category, as well as the elderly, who tended to “normalise” their symptoms, the researchers said.

Previous research has found that about a fifth of the 357,000 cancer cases seen in Britain each year are picked up in A&E. By this time cancers are often advanced, cutting the chances of successful treatment and survival.

In the new study of the 4,647 patients whose cancers were picked up in A&E, 1,349, or 29 per cent, had not seen a GP. This was most common with cancers such as brain tumours, which have few early symptoms. Nearly half of these patients had not seen their doctor before visiting hospital.

Of those who had seen a GP before A&E, 41 per cent had done so three or more times. Lung cancer patients were more likely to have symptoms missed by family doctors, as were those suffering from multiple myeloma, a type of bone marrow cancer.

About a third of prostate cancer patients had sought help three or more times, suggesting that GPs are not spotting those cases that do not have typical symptoms.

Georgios Lyratzopoulos, of University College London, senior author of the paper, said: “A lot of these patients [who have not seen a GP before] will have tumours which had given very little or nothing away before they came in as an emergency. The classic scenario is that someone is well, then has an epileptic fit and are diagnosed with a brain tumour.”

He added that “your propensity to seek help is determined by who you are. The fear of wasting the doctor’s time could be at play . . . Certainly for older people that may be part of the problem.”

Dr Lyratzopoulos said that his study could not directly look at the effect of a lack of appointments at GP surgeries, but he argued that “different people’s different tolerances of waiting times” could explain why some gave up if they were faced with a wait of days or even weeks to see their doctor.

Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “GPs take their role in diagnosing cancer as early as possible very seriously and we would urge patients who experience any concerning or persistent symptoms to book an appointment with their GP. Family doctors would be helped by increased access to new and improved diagnostic tools.”

 

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This entry was posted in A Personal View, General Practitioners, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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