Written evidence submitted by Macmillan Cancer Support (FGP0306)

1. Macmillan Cancer Support is a registered charity providing information and support for people with cancer. There are around 3 million people currently living with cancer across the UK with over 360,000 people receiving a cancer diagnosis every year.[1] Macmillan plays a key role in supporting the NHS workforce. Over the past ten years Macmillan has invested £386 million in the NHS. Macmillan funds nearly 12,000 Macmillan nurses, doctors and other health professionals.[2]

2. Summary of recommendations

2.1.    The Government and NHS England must deliver a fully funded long-term work force plan to grow and support the NHS workforce and ensure it is sustainable.

2.2.     The Government must urgently ramp up efforts to deliver on its commitment to recruit 6,000 additional GPs by 2024, and further bolster our primary care workforce. This includes not just GPs, but also the wider primary care team who can offer vital support to people living with cancer. 

2.3.    Guidance from national policy makers should reflect the importance of personalised care across the cancer journey, with multidisciplinary team (MDT) working across primary and secondary care prioritised to join up care. Local commissioners and system leaders should raise awareness of learning and good practice around multidisciplinary team working in primary care.

3. What are the main barriers to accessing general practice and how can these be tackled?

3.1.    Appropriate and timely access to general practice, as well as broader primary care services, is vitally important for people living with cancer.

3.2.    Primary care is the single biggest and most important route to diagnosis for many people living with cancer. In 2017, approximately 63% of cancer referrals came via GP referral, including through the two-week wait pathway[3].

3.3.    Macmillan estimate that there are more than 47,000 people currently missing a cancer diagnosis in the UK, with fears that delays and disruptions caused by the pandemic are leading to more people being diagnosed later[4]. Access to GP services can help to ensure appropriate and timely referrals and enable earlier diagnoses.

3.4.    GPs and primary care teams also play a big role in supporting people across the cancer pathway, including cancer management, follow up care after treatment and at end of life. This role is set to increase – the number of people living with cancer is expected to reach 4 million by 2040[5]. People with cancer often require coordinated and personalised care from their GPs, in collaboration with secondary care teams, to support their health needs. Easy access to primary care services is a key component of this.

3.5.    It is vital that people with cancer can have a Cancer Care Review to discuss key elements of their care with a primary care practitioner, including their treatment, physical and mental health, wider wellbeing and financial support. Macmillan Cancer Support has been working with healthcare professionals to enable them to refer patients directly into services we offer for people living with cancer, helping individuals get access to the right support as quickly as possible. It is therefore key that the importance of cancer care reviews is reflected in policy and guidance.

3.6.    Temporary changes were made to QOF indicators related to Cancer Care Reviews in late 2021 to facilitate the Covid-19 booster drive. These changes must be short-term in nature. In the longer-term there must be an expectation that these reviews continue to be carried out, using the national standardised template that Macmillan have developed and that is referenced in QOF guidance.

3.7.    There have been rapid changes to the ways in which many people access primary care during the pandemic, including greater numbers of virtual appointments. Macmillan Cancer Support has been working closely with NHS England and others to help GPs and patients make the most effective use of new ways of working in primary care, including virtual appointments.  This has included developing guidance such as our ten top tips for virtual consultations in primary care[6].

3.8.    Data from Macmillan’s March 2021 YouGov survey of people living with cancer shows that a return to face to face consultations is the most popular priority for the NHS post-pandemic, but nearly a third are keen to continue with virtual consultations.[7] - this finding included all consultations, not just those with GPs. ​

3.9.    However, the majority of respondents to our survey were satisfied with the experience they did have of video (76% satisfied) or phone (88% satisfied) consultations with a GP[8]. Further work will be needed to fully understand the impact of the increase in virtual consultations across all aspects of care, including determining appropriate routes of consultation for personalised care.

3.10. Issues with access to primary care in any format are being impacted by sustained pressure on the primary care workforce. 

3.11. Recommendation: The Government has made a welcome commitment to recruit 6,000 additional GPs by 2024, but it must urgently ramp up efforts to deliver on this promise, and further bolster our primary care workforce. This includes not just GPs, but also the wider primary care team who can offer vital support to people living with cancer, including nurses, Allied Health Professionals such as dieticians physiotherapists and paramedics, and link workers.

4. Has the development of Primary Care Networks improved the delivery of proactive, personalised, coordinated and integrated care and reduced the administrative burden on GPs?

4.1.    Primary Care Networks (PCNs) are an important vehicle for improving the care people living with cancer receive from their GPs. We support the ongoing recruitment of additional roles in primary care to help with this improvement and call for government commitments on numbers of new roles to be honoured.

4.2.    The wider primary care workforce, through PCNs, can support the delivery of personalised care for people living with cancer, including conducting Cancer Care Reviews. This can help to alleviate pressure on GPs.

4.3.    The presence of additional roles like ‘navigators’ and social prescribing link workers can increase the effectiveness of team-working and integration of care[9]. In an example of good practice, Cheshire and Merseyside Cancer Alliance have developed dedicated ‘navigators’ employed by GP practices to carry out Holistic Needs Assessments (HNAs), which inform care plans, consultations and Cancer Care Reviews.

4.4.    Good multidisciplinary working across primary care and secondary care is particularly important following referral back into primary care. This transition often causes issues for people living with cancer, including GPs not receiving treatment summaries, or not being made aware that their patients have been discharged and what their ongoing care needs will be[10].

4.5.    Recommendation: Guidance from national policy makers should reflect the importance of personalised care across the cancer journey, with multidisciplinary team (MDT) working across primary and secondary care prioritised to join up care. Local commissioners and system leaders should raise awareness of learning and good practice around multidisciplinary team working in primary care.

For further information on this submission, please contact EWillis@macmillan.org.uk