“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.