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Guest Blog: Noel Baxter gives us a GP's perspective on cancer care

 
 

Guest Blog: Noel Baxter gives us a GP's perspective on cancer care

 
 

Local GP Noel Baxter got involved in the early stages of development of www.cancercaremap.org and helped us consider the needs of the directory to help doctors signpost cancer care and support services to their patients. Here he gives us a unique insight into how he sees the resource can really make a difference.

 

“I have worked in south-east London as a GP since 2002, and for the last eight years have also been involved in service re-development and health strategy in my home borough, Southwark. You might imagine, then, that I have the insider knowledge needed to signpost a patient to whatever service they need, for both clinical and psycho-social needs. In the case of very common problems like depression, anxiety, high blood pressure, diabetes or asthma, I do: I know the people in the relevant service by name, the building it runs from, even the number of the bus you need to get there.

When it comes to less common clinical problems, and non–clinical services that can help my patients live with their conditions, my knowledge gets patchier. I feel less confident recommending those services to my patients in case the service doesn’t exist any more, or because I just don’t know if it will suit the patient I am seeing.

I know that it’s not just me experiencing this. I recently attended a meeting about the needs of locum and sessional GPs working in Southwark. What the meeting hosts actually wanted was an easily accessible, up-to-date directory of services, that would enable them to support patients by enhancing the clinical care provided, either in general practice or other services. We are lucky in south-east London to enjoy several clinical institutions of excellence - but what is it like for patients in-between clinical visits? Who can help them live with their conditions better, and get more value from the excellent clinical care provided?

When people live with and are being treated for cancer, GPs know that the care given beyond clinical interventions is so important. That is why I joined Dimbleby Cancer Care’s project to develop a directory of non-clinical cancer care services.

I don’t think it is common knowledge among the general public that the relationship GPs have with cancer is very complicated. This may come as a shock to many people, but GPs don’t really see or do much cancer. The relationship can be tinged with negative personal and professional experiences. We do have experiences, too, of picking up a patient’s cancer earlier than was expected, which can completely change people’s view of you in the local community.

The incidence of new cases of cancer is 272.9 in every 100,000 people in the UK. That means that, in Southwark, where 300,000 people are registered with a GP, that translates to around 800 new cases of cancer each year. We have a ratio of about one GP for every 1,800 people in Southwark, so we have roughly 160 GPs – if they all worked full-time. If they did, they would see five new cases of cancer each year. However, most GPs, including myself, now work part- time, so we have more GPs seeing less of less common conditions. We also have a much younger population in Southwark and other inner-London boroughs than in the UK generally, so it is therefore likely that Southwark GPs see significantly less than 5 new cases of cancer each year.

It’s important that people understand our lack of interaction with cancer, as well as our desire to better help the ones we do interact with benefit from non-clinical cancer support. Talking about this openly helps us make the case for tools we can use in this work - and www.cancercaremap.org is the answer to that.
 

Noel Baxter at one of the initial User Group workshops for www.cancercaremap.org

We do, of course, spend every working day considering whether the hacking cough is in fact lung cancer, the blood in the wee is bladder cancer, or whether the lump is lymphoma. It rarely is, but we have to treat it seriously and it is that element of cancer – the risk of – that you want us to focus on. When a cancer is diagnosed, we often lose contact with the patient when they go into the care of an oncology team. People with cancer are kept busy, moving from tests to therapies to clinics. That is the priority for them, quite naturally, while the other work GPs do, helping to manage blood pressure, control cholesterol, family planning, becomes less important to them. People return to us in their survivorship, or when we are asked to collaborate with palliative care teams in people’s homes.

As a GP in a practice providing care for about 10,000 people in Southwark, each of my colleagues might be personally responsible for working with families for at most 3-5 patients each year who may be dying with cancer at home. Our palliative and cancer specialist colleagues know their subject, but we know the wider family and the community around them, and we will be there after the specialists have gone - either in survivorship or trying to help their families in bereavement. So tools to help GPs get this right are very much wanted. We definitely need that help.

While the media tells us that the focus for GPs, screening science and epidemiology is on getting better at diagnosing cancer, GPs have an equal need for tools to support patients and families after cancer diagnosis, during survivorship and at the end of life. For that reason, www.cancercaremap.org is very much welcomed by GPs."

Noel Baxter is a practising GP and clinical director for quality and service improvement at NHS Southwark Clinical Commissioning Group

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