Question to the Department of Health and Social Care:

To ask the Secretary of State for Health, what steps he is taking to ensure that GPs have improved and timely access to a range of diagnostic tests where cancer is suspected in presenting patients.

Improving Outcomes: A Strategy for Cancer (January 2011) is backed by an additional £750 million over the four year Spending Review period including over £450 million to achieve early diagnosis. The earlier diagnosis money is designed to support improved direct general practitioner (GP) access to four key diagnostic tests to support the diagnosis of brain tumours, bowel, lung, and ovarian cancers; and increased testing and treatment costs in secondary care. GPs are able to access these tests directly in cases where the two-week urgent referral pathway is not appropriate but a patient’s symptoms require further investigation. The intention is that more people presenting with relevant symptoms will be tested and at an earlier stage.

In 2012, the Department published ‘Direct access to diagnostic tests for cancer: best practice referral pathways for general practitioners’ to provide criteria for accessing these diagnostic tests. NHS England monitors the use of these diagnostic tests through the Diagnostic Imaging Dataset. We delivered a record 1.6 million diagnostic tests in July 2014 compared to 1.2 million in May 2010.

The earlier diagnosis money also supports centrally led Be Clear on Cancer (BCOC) symptom awareness campaigns to raise the public’s awareness of cancer symptoms and encourage people with persistent symptoms to go to the doctor. Since 2011 the Department and Public Health England (since 2013) in partnership with NHS England (including NHS Improving Quality) and other stakeholders have run national BCOC campaigns for bladder and kidney, bowel, breast and lung cancers; regional campaigns for ovarian, oesophagogastric cancers, and local pilot campaigns to raise awareness of four symptoms of unexplained bleeding, lump, pain, and weight loss; and awareness of skin and prostate cancers. As part of the BCOC campaign process, the Department, Public Health England, and NHS England have worked with Cancer Research UK and other partners to develop briefing sheets to support GPs and other healthcare professionals during the campaigns.

More generally, to increase awareness of cancer amongst GPs, the Department supported British Medical Journal (BMJ) Learning to develop and launch an on-line learning tool for GPs in 2012. The tool offers accredited professional development and includes four modules - tackling late diagnosis; risk assessment tools; cancer pathway and the role of primary care; and diagnosing osteosarcoma and brain tumours in children with an additional section on communication skills. The tool can be accessed at:

http://learning.bmj.com/learning/home.html.

In 2013, Macmillan Cancer Support, partly funded by the Department, piloted an electronic cancer decision support (CDS) tool for GPs to use in their routine practice. It is designed to help GPs recognise the symptoms of cancer and identify patients that they might not otherwise refer urgently for suspected cancer. The CDS covers lung, colorectal, oesophagogastric, ovarian and pancreatic cancers and a new symptom checker for melanoma. Following the pilot, Macmillan Cancer Support is now able to offer the tool, free of charge to all GPs in the United Kingdom.

In addition to this, since 2005, the Referral Guidelines for Suspected Cancer, published by the National Institute for Health and Care Excellence (NICE) has supported GPs to identify patients with the symptoms of suspected cancer and urgently refer them as appropriate. NICE is in the process of updating this guidance to ensure that it reflects the latest evidence and the anticipated publication date for the revised guidelines is May 2015.