Editorial
On Sept 30, 2014, UK Prime Minister David Cameron and Health Secretary Jeremy Hunt announced major reforms to the UK’s primary care services whereby everyone will have a named primary care physician and access to general practitioner (GP) services for longer hours, every day of the week. Although these plans will improve acute care, an increasing proportion of GPs’ caseloads is made up of patients with chronic conditions, such as cancer in remission, which require long-term care. The Royal College of GPs (RCGP) 2014 Annual Conference was centred around resilience in general practice, to bolster the profession for the future, a theme backed by the RCGP’s “Put patients first: back general practice” campaign. Findings from a survey of GPs showed that 71% of doctors forecast longer waiting times for appointments and 47% have had to cut back on services. Patients could lose out unless policy makers take into account all aspects of primary care services. The Care Quality Commission (CQC) report on outof-hours care provided by GPs published on Oct 3, 2014, suggested that service provision has improved. However, the 2014 Cancer Patient Experience report by NHS England shows support from GPs or practice nurses is an area for improvement. This apparent shortcoming highlights a difficulty for embattled GPs. They are expected to be at the forefront of early detection of cancer while having to provide long-term care for patients being treated for, recovering from, or indeed dying from cancer. These expectations have to be met with a shrinking workforce and cuts to the primary care budget from around 11% of the NHS budget in 2005–06 to 8·4% currently. The RCGP acknowledged the positive aspects from the CQC report and noted that GPs had achieved positive results with diminished resources, but their campaign calls for primary care to receive a return to a proportion of funding on a par with 2005–06. Several factors suggest that the burden of cancer is likely to increase pressure on primary care services. The positive news that UK cancer mortality is projected to fall from 170 to 142 per 100 000 people from 2010 to 2030 has to be considered against the backdrop of an increasing and ageing population, and improved detection—referrals from primary to secondary care for cancer have increased by 50% over the past 4 years. With more survivors, or patients living with their disease for www.thelancet.com/oncology Vol 15 November 2014
longer, pressure on GP services to adequately support these patients in the community is growing. Acute complications can arise at any time of day or night, and urgent care services may treat patients without full knowledge of any underlying conditions. This issue highlights a major requirement for improvement in NHS services. Currently, medical records are stored in GP practices or in hospitals without real-time shared access, and consultant-to-GP communication occurs by mail—an absurd situation. The Government must invest in a secure method for patients’ electronic records to be jointly updated by physicians managing patient care on a day-to-day basis and emergency providers. Initiatives to better integrate and streamline primary and secondary care should be encouraged. A good example is the Together as One Community project in Whitby, UK, which introduced new services for patients such as pain management and video-conference consultations with consultants from the patients’ GP surgery, thus providing more patientcentred and integrated primary and secondary care. The Netherlands is adopting an integrated approach. In 2011, the Dutch Cancer Society outlined its proposals for reforming primary care for patients with cancer. The recommendations included the drawing up of a care plan by the oncologist, GP, and patient about how to organise case management throughout the chronic phase. The Society suggested implementation of a common care pathway that can respond to patient need arising from both cancer and comorbidities. Most GPs provide excellent support to patients who have had a cancer diagnosis. However, when politicians are drafting plans to implement their headline statements about improved access to primary care for all, they should not only allocate extra resources on a per-person basis, but also take the opportunity to finance and staff GP practices to efficiently manage continuity of care for those who need extra support. Services and robust infrastructure must be put in place, and provision should be linked to demand. Now is a perfect time to revolutionise long-term care for patients with cancer and other non-communicable diseases, but this opportunity must not be squandered by politicians’ poorly conceived, throwaway election promises. ■ The Lancet Oncology
Jim Varney/Science Photo Library
Provision for cancer patients a priority in primary care reforms
For the Health Secretary’s announcement see http://press. conservatives.com/ post/98811391555/jeremyhunt-speech-to-conservativeparty-conference For details of the Royal College of General Practitioners conference and ‘Put patients first’ campaign see http://www. rcgp.org.uk/ For the Care Quality Commission report see http:// www.cqc.org.uk/sites/default/ files/20140924_gp_out_of_ hours_final.pdf For the Dutch Cancer Society report see http://repository. kwfkankerbestrijding.nl/ PublishingImages/Summary%20 Aftercare%20of%20cancer%20 patient%20(May%202011).pdf
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On Sept 30, 2014, UK Prime Minister David Cameron and Health Secretary Jeremy Hunt announced major reforms to the UK’s primary care services whereby everyone will have a named primary care physician and access to general practitioner (GP) services for longer hours, every day of the week. Although these plans will improve acute care, an increasing proportion of GPs’ caseloads is made up of patients with chronic conditions, such as cancer in remission, which require long-term care. The Royal College of GPs (RCGP) 2014 Annual Conference was centred around resilience in general practice, to bolster the profession for the future, a theme backed by the RCGP’s “Put patients first: back general practice” campaign. Findings from a survey of GPs showed that 71% of doctors forecast longer waiting times for appointments and 47% have had to cut back on services. Patients could lose out unless policy makers take into account all aspects of primary care services. The Care Quality Commission (CQC) report on outof-hours care provided by GPs published on Oct 3, 2014, suggested that service provision has improved. However, the 2014 Cancer Patient Experience report by NHS England shows support from GPs or practice nurses is an area for improvement. This apparent shortcoming highlights a difficulty for embattled GPs. They are expected to be at the forefront of early detection of cancer while having to provide long-term care for patients being treated for, recovering from, or indeed dying from cancer. These expectations have to be met with a shrinking workforce and cuts to the primary care budget from around 11% of the NHS budget in 2005–06 to 8·4% currently. The RCGP acknowledged the positive aspects from the CQC report and noted that GPs had achieved positive results with diminished resources, but their campaign calls for primary care to receive a return to a proportion of funding on a par with 2005–06. Several factors suggest that the burden of cancer is likely to increase pressure on primary care services. The positive news that UK cancer mortality is projected to fall from 170 to 142 per 100 000 people from 2010 to 2030 has to be considered against the backdrop of an increasing and ageing population, and improved detection—referrals from primary to secondary care for cancer have increased by 50% over the past 4 years. With more survivors, or patients living with their disease for www.thelancet.com/oncology Vol 15 November 2014
longer, pressure on GP services to adequately support these patients in the community is growing. Acute complications can arise at any time of day or night, and urgent care services may treat patients without full knowledge of any underlying conditions. This issue highlights a major requirement for improvement in NHS services. Currently, medical records are stored in GP practices or in hospitals without real-time shared access, and consultant-to-GP communication occurs by mail—an absurd situation. The Government must invest in a secure method for patients’ electronic records to be jointly updated by physicians managing patient care on a day-to-day basis and emergency providers. Initiatives to better integrate and streamline primary and secondary care should be encouraged. A good example is the Together as One Community project in Whitby, UK, which introduced new services for patients such as pain management and video-conference consultations with consultants from the patients’ GP surgery, thus providing more patientcentred and integrated primary and secondary care. The Netherlands is adopting an integrated approach. In 2011, the Dutch Cancer Society outlined its proposals for reforming primary care for patients with cancer. The recommendations included the drawing up of a care plan by the oncologist, GP, and patient about how to organise case management throughout the chronic phase. The Society suggested implementation of a common care pathway that can respond to patient need arising from both cancer and comorbidities. Most GPs provide excellent support to patients who have had a cancer diagnosis. However, when politicians are drafting plans to implement their headline statements about improved access to primary care for all, they should not only allocate extra resources on a per-person basis, but also take the opportunity to finance and staff GP practices to efficiently manage continuity of care for those who need extra support. Services and robust infrastructure must be put in place, and provision should be linked to demand. Now is a perfect time to revolutionise long-term care for patients with cancer and other non-communicable diseases, but this opportunity must not be squandered by politicians’ poorly conceived, throwaway election promises. ■ The Lancet Oncology
Jim Varney/Science Photo Library
Provision for cancer patients a priority in primary care reforms
For the Health Secretary’s announcement see http://press. conservatives.com/ post/98811391555/jeremyhunt-speech-to-conservativeparty-conference For details of the Royal College of General Practitioners conference and ‘Put patients first’ campaign see http://www. rcgp.org.uk/ For the Care Quality Commission report see http:// www.cqc.org.uk/sites/default/ files/20140924_gp_out_of_ hours_final.pdf For the Dutch Cancer Society report see http://repository. kwfkankerbestrijding.nl/ PublishingImages/Summary%20 Aftercare%20of%20cancer%20 patient%20(May%202011).pdf
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