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By Sarah Boseley Health editor
Many more people who go to see their GP with possible cancer symptoms need to be sent for hospital tests if England is to have a hope of bringing survival rates up to the level of equivalent countries, according to a report.
The report by a team from the Health Foundation led by the former national cancer director Sir Mike Richards calls for a radical rethink of the way the NHS deals with the disease.
Crucially, much earlier diagnosis of cancer is essential if fewer people are to die from it, the report says. Either GPs need to be trained and supplied with technology to carry out more tests themselves or their “gatekeeper” role – deciding who will be referred to hospital – may have to be bypassed, it says.
Richards, who spent 14 years as the government’s cancer director before moving to oversee hospital inspection at the Care Quality Commission, said GPs needed support.
“I’m a strong believer in GPs and primary care. It’s a key component of our health service and I don’t want to see anything that undermines that. GPs are under pressure not to refer people on to secondary care. That’s what we have got to change.”
“One-stop shops” dedicated to diagnosing cancer, equipped with all the necessary technology and offering a battery of tests, could offer a solution, he said.
There has been progress over the years since Richards introduced England’s first cancer plan in 2000, but a promise that by 2010 “our five-year survival rates for cancer will compare with the best in Europe” was not met.
More people survive for longer in England, but other countries have also improved. Survival data from the recent Concord-3 study showed the UK as a whole lagging behind Australia, Denmark, Norway and Sweden in six common cancers. It came last in all but prostate cancer, where it was second to last after Denmark. A person diagnosed with colon cancer in the UK had a 60% chance of surviving for five years, compared with 71% in Australia, for instance.
The report identifies early diagnosis as key to changing this. In breast cancer, 97.5% of women referred urgently by their GP (to be seen within two weeks) between 2011 and 2015 survived for 12 months, but only 57.2% of those who arrived as an emergency in hospital did so. The latter patients inevitably had cancers that had progressed further and were harder to treat.
The same sort of split applied in colorectal cancer: 83.1% survival when referred by a GP versus 50.6% of those who went to A&E. In lung cancer the figures were 46.5% versus 16%.
Almost 2 million people a year are now referred by their GP to be seen for diagnosis within two weeks, and 8% of those are found to have cancer. Not all those referred are being seen as quickly as they should be. There was a sharp drop this year below the 93% standard, although Richards said this was probably because of a surge in people going to their GP with suspected cancer.
“It is particularly down to referrals for possible prostate cancer increasing – almost certainly in response to the Bill Turnbull and Stephen Fry effect,” Richards said, referring to diagnoses in the former BBC Breakfast presenter and the former QI host. There was a similar rise in young women going for cervical cancer screening after the death of Jade Goody from cancer in 2009.
The report says hospitals are not investing sufficiently in diagnostic equipment such as CT scanners and MRI machines and the staff to operate them. “We have never found the right incentives to get hospitals to invest in them,” said Richards. The UK is 35th out of 37 countries in the report for numbers of CT scanners and 31st out of 36 for MRI scanners.
The report also says changes initiated by the former health secretary Andrew Lansley affected progress in cancer care. The “disruption caused by the Health and Social Care Act 2012 led to a loss of momentum that is only recently being rebuilt”, it says.
Richards said Theresa May had set an “ambitious” target to increase early cancer detection from 50% to 75% of patients by 2028. He welcomed that but added: “If we are serious about moving the dial on early diagnosis, then setting targets and handing out money will not be enough.”
Andrew Goddard, the president of the Royal College of Physicians, said there were growing pressures on hospital doctors, and immigration restrictions were making recruitment harder, but the entire NHS workforce had to do more and patients should be encouraged to come forward.
“Diagnosing cancers earlier will reduce pressure on acute services and new technology could help with offering screening, but it is essential too that we create a culture of patients not being embarrassed, inhibited by ‘social duty’ or afraid to seek help for their symptoms,” he said.