Pulse February 2019 issue - Page 11

Analysis Lowered cancer thresholds What the plan says GPs will have lower thresholds for referral as well as access to rapid diagnostic centres that will be be rolled out from 2019. In 2020, a new 28-day target for defi nitive diagnosis or ruling out of cancer will be introduced. NHS England also wants to maximise the number of cancers found through screening (see box, left) so that by 2028, the proportion diagnosed at stages 1 and 2 rises from 50% to 75%. This includes the use of personalised and risk- stratifi ed screening and testing family members of cancer patients who are at increased risk. What it means The goals will be a stretch given that the latest fi gures on waiting time targets for cancer treatment following referral from a GP or from a screening programme are at an all-time low. A recent NHS England report found the national standard for cancer patients to start treatment within two months of an urgent GP referral has been breached in every quarter since 2014, with GPs and cancer experts warning the problem will only worsen as the number of cancer patients grows while resources and workforce dwindle. However, GPs have been recognised as the main driver behind improved rates of early diagnosis after analysis last year by the National Cancer Registration and Analysis Service found fewer patients are presenting for the fi rst time as an emergency. Research is being done on diff erent models of rapid access to diagnostics but so far there is no defi nitive evidence that they boost cancer outcomes. More evaluation is likely to be needed on which tests will be included and on the access criteria. What GPs say Professor Willie Hamilton, professor of primary care diagnostics at the University of Exeter, said diagnosing 75% of cancers at stages 1 or 2 ‘will be a tough target and is probably aspirational rather than achievable’. He added that faster diagnosis would depend on where the clock starts: ‘It is more likely that this 28-day clock will start with a two-week wait type urgent referral, so the pressure is on timely defi nitive investigation rather than on GPs to refer more “possible” patients.’ Diagnosing 75% of cancers at stages 1 and 2 will be tough Professor Willie Hamilton 11 Payment for reduced referral What the plan says Primary care networks – which all practices must join from April – will be able to take part in a new ‘shared savings’ scheme to ‘benefi t from actions to reduce avoidable A&E attendance, admissions and delayed discharge, streamlining patient pathways to reduce avoidable outpatient visits and overmedication through pharmacist review’. What it means Several CCGs already run such schemes, with the savings reinvested in primary care. Some GPs have warned against direct fi nancial incentives not to refer, particularly if a target is set. Proponents say the schemes shift resources from secondary to primary care. What GPs say BMA GP Committee prescribing lead Dr Andrew Green said: ‘Where the proposals increase practices’ workload, resources must be provided. However, this should be linked to the commissioned activity, not to reduction targets.’ Urgent care What the plan says A single multidisciplinary clinical assessment service (CAS) within integrated NHS 111, ambulance dispatch and GP out-of-hours services will be embedded from 2019/20. The urgent treatment centre model will be in place by 2020 as an A&E alternative. NHS support to care home residents will be upgraded by 2023/24, with better GP links. What it means The CAS will provide advice, treatment and referral, and also support for community health professionals to make decisions about care that will avoid unnecessary A&E trips. GPs and other community healthcare staff will be expected to use the service to make referrals for an urgent response from community health services. What GPs say Imperial College London head of primary care Professor Azeem Majeed said: ‘The single access point for urgent care will simplify the process of getting advice. Better care for people in care homes is vital; the level of social care, nursing and medical input they need is lacking in many parts of the UK.’ Pulse February 2019