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Health: Secondary Care

Volume 754: debated on Thursday 26 June 2014


Asked by

To ask Her Majesty’s Government what steps they will take to help to remove barriers to access to secondary care for symptomatic patients so they are identified and can start treatment earlier.

My Lords, GPs act as the gateway to and co-ordinator of patient care. GPs hold patients’ medical records and understand their health history. The GP will be able to work with patients and their carers to make an informed decision about whether a specialist referral is necessary, and to recommend appropriate hospitals or clinics. Early diagnosis can improve outcomes and treatment. We are therefore raising awareness of key symptoms and supporting GPs to assess patients more effectively.

My Lords, I thank the Minister for his reply. Is he aware that some GPs are being penalised by CCGs for sending patients on for diagnosis? Is that not totally wrong and does it not cause late diagnosis, which is always more expensive in every way?

My Lords, I agree with the noble Baroness that early diagnosis is vital for just about every condition one can think of, particularly cancer. I am not aware that GPs are being penalised. I am very concerned to hear that, and if I may I will take the point she has made back with me and write to her about it. I would be very concerned if that practice was taking place. Particularly on cancer, we are keen to see GPs referring more. Indeed, that is what they have been doing, quite markedly, over the past four years: there was a 51% increase in cancer referrals over that period.

My Lords, would the Minister agree that one of the essential elements for early diagnosis was time—time to spend with the patient and hear exactly what their symptoms are? How does that tie in with the current reports about pressure on GP surgeries and time?

The noble Baroness makes a very good point. We know that GPs in many areas of the country are under pressure and we know how hard they are working. It was with that knowledge that we agreed with the profession that we would remove from the GP contract for 2014-15 more than a third of the quality and outcomes framework’s indicators, which GPs told us were taking up too much time and resulting in a bureaucratic burden. The aim of that was to free up more time for GPs. On top of that we have the Prime Minister’s challenge fund of £50 million, which will test out new ways for GPs to give access to patients—for example, through innovative means such as Skype and e-mail.

My Lords, early treatment is key to improving our low cancer survival rates. Lung cancer remains the biggest cancer killer. It has a 5% 10-year survival rate and 33% of all cases are emergency presentations. What progress has been made on improving early diagnosis?

My noble friend is right. This is absolutely central to raising our performance as a country in successfully treating cancer. We are doing several things. We have piloted a tool to help GPs to identify patients whom they might not otherwise refer urgently for suspected cancer. The tool covered lung cancer, as well as others. Across England, 502 GP practices took part in the pilot. Initial indications are that the tool is extremely helpful. There is also an e-learning tool that offers accredited professional development for GPs. The Royal College of General Practitioners has also identified cancer as an enduring priority. It is working with Cancer Research UK and other partners in promoting models of best practice.

My Lords, I declare my interests as professor of surgery at University College, London, and chairman of UCLPartners. Better integrating primary and secondary care is crucial to ensuring patient safety, improved clinical outcomes and the most effective resource utilisation. What progress has been made in defining whole pathway metrics for integrated care to best inform rational commissioning of these services?

Several things are in train. One of those, as the noble Lord will know, was reflected in the legislative reform order that we debated in the Moses Room two days ago. It will cut down the administrative burden of joint commissioning by NHS England and CCGs, as well as the burden currently being experienced by CCGs in joint commissioning between themselves. More importantly, we need to incentivise the system for integrated care, and that is what the better care fund is designed to do. It will ensure that patients receive joined-up care, whether that is in acute settings, in the community or, indeed, from social care.

My Lords, the noble Earl will know that a number of trusts like my own, which is Barnet and Chase Farm, are trying to remove the barriers that still exist between providers of secondary care and of primary care. What help can the Government give to make sure that primary care is better funded and reinforced so that people do not have to come into hospital, and so that we have an absolutely seamless pathway of care?

We have said that preparations for the better care fund in 2015-16 should most definitely include a dialogue between commissioners and providers, and that there should be a whole system approach to incentivising the treatment of patients in the community. Of course, that will involve hospitals such as that of the noble Baroness, which I had the pleasure of visiting this week, informing themselves on how they can assist in the effort to do what we all want to do, which is to see patients treated in the best environment possible.

At a time when GPs seem to be very budget conscious and worried about everything, can the Minister assure me that there are no perverse incentives that would tend to deter them from making these secondary referrals early? That is very important.

I am not aware of any disincentives in that sense. Indeed, the rate of referrals has gone up dramatically, particularly for cancer, which seems to indicate that GPs are not afraid to refer when they feel that they need to.

My Lords, governance, early diagnosis and visits to the general practitioner are all very well but, as the noble Earl will understand, many cancers such as lung cancer, which has just been mentioned, and pancreatic cancer depend on relatively silent tumours that are not going to be diagnosed on a clinical basis anyway. Surely the need is for markers for these diseases. What are the Government planning to do to increase research in this area, to ensure that we have markers for these diseases?

Cancer research is a major priority for my department. Investment in cancer research by the National Institute for Health Research has risen from £101 million in 2010-11 to £133 million in 2012-13. However, that is only what my department is doing. As I am sure he is aware, a whole range of work is going on across many different types of cancer, which we regard as a priority.