Written evidence submitted by Cancer Research UK (RTR0098)

 

Key points

 

  1. What are the main steps that must be taken to recruit the extra staff that are needed across the health and social care sectors in the short, medium and long-term?

 

  1.                                                                                                                                                                                                                                                              The NHS cancer workforce – the professions key to the diagnosis and treatment of cancer – suffers from chronic shortages which are a significant barrier to achieving Government cancer ambitions and improving cancer outcomes for patients. Prior to the pandemic, around one in ten posts across the NHS in England were vacant, and it was estimated that with no action taken, this would rise to one in seven by 2023/24.[i] Staff shortages are evident in professions vital to the timely diagnosis and treatment of cancer.[ii],[iii]

 

  1. Long term investment in medical education and training is the single most important step needed in growing the cancer workforce to meet patient need. At the 2021 Comprehensive Spending Review (CSR), the Government announced there will be ‘hundreds of millions of pounds of additional funding’ to build a bigger, better trained NHS workforce.[iv] This was a promising commitment, but it is still far from clear how much this means in practice or how this money will be targeted – meaning we don’t yet know whether this increased investment will see growing numbers of staff in the cancer workforce.

 

  1. Prior to the CSR, Cancer Research UK (CRUK) modelled the long-term investment in medical education and training needed to grow the cancer workforce by 45% by 2029 – as estimated in Health Education England’s (HEE) 2017 Cancer Workforce Plan as being necessary to deliver world class cancer outcomes. This modelling estimated that the Government would have to invest an additional £216 million in medical workforce education and training over the Spending Review period for key cancer professions.

 

  1. Recruiting and training the health workforce is a long process, with it taking a minimum of three to five years to train newly qualified staff as specialists in key cancer professions. Because of this long process, this investment is needed now – otherwise we push the benefits of this investment even further into the future, with cancer patients bearing the cost of this delay.

 

  1. Clear responsibility for projecting future demand and planning to grow the cancer workforce is also vital to recruit the staff needed in the cancer workforce. The UK Government’s Health and Care Bill proposes a duty for the Secretary of State for Health and Social Care to publish a report every Parliament setting out roles and responsibilities to support greater clarity and transparency around workforce planning. However, there is no detail on how this duty would ensure that steps would then be taken to grow the cancer workforce in line with growing demand. Additionally, reporting every Parliament, rather than more frequently, will not provide the clarity needed to project future demand and grow the cancer workforce accordingly.

 

  1. The recently rejected amendment 10 to the Health and Care Bill tabled by Jeremy Hunt MP and supported by organisations across the health and care sector, including CRUK, could have helped address this. By mandating regular, independently verified projections of the future supply and demand of the health and social care workforce, it would have ensured more accountability in workforce planning – making it more likely the right numbers of staff would be recruited. The amendment has now been re-tabled in the House of Lords by Baroness Cumberledge. CRUK continues to believe this amendment is necessary and urges the Government to accept it.
  2. The Government must also take other opportunities in the coming months to provide this clarity and transparency regarding workforce planning, for example in the Elective Recovery Plan, or HEE Framework 15.

 

Health Education England’s merger into NHS England

  1. In 2021, the Government announced that HEE is to be merged into NHS England by April 2023. This could have significant implications for the recruitment, training and retention of the cancer workforce in the future – and it is important that the opportunities the merger provides are taken, and the risks avoided.

 

  1. Having recruitment and training under the same roof as service provision has the potential to make workforce planning clearer and make it easier to develop an effective workforce strategy. This could foster a more coherent workforce policy, aligned with the needs of service users. However, this will not happen unless workforce policy is given the priority within NHSE that the challenges it faces merit.

 

  1. Once HEE is merged into the NHSE, medical education and training budgets must be protected. HEE’s budget was cut by 25% in real terms between 2013/14 and 2019/20, while the NHS England budget has been protected.[v] This has contributed to the workforce challenges evident today – with HEE lacking the resources to deliver the workforce growth to meet rising demand. By moving HEE within this protected budget, it could help avoid similar cuts in the future. However, NHSE is a huge organisation with many competing interests for funding. Prior to the establishment of HEE, medical education and training budgets were often cut to fund other short-term goals.[vi] NHSE is currently under significant pressure to meet goals such as cutting the elective backlog, and it is vital that medical education and training budgets do not suffer as a result.

 

  1. Finally, as with any service reorganisation, this will likely lead to disruption in HEE and NHSE. Given the pressing challenges faced across workforce recruitment, retention and training in the NHS, it is vital that merging at a time when the workforce challenges the NHS faces are so great does not interfere with the work being done in both organisations to tackle them.

 

  1. What is the correct balance between domestic and international recruitment of health and social care workers in the short, medium and long term?

 

  1. International recruitment is an important source of staff for the NHS, helping cancer patients receive the care they deserve. However, the ongoing global workforce crisis has demonstrated that this is not a completely reliable or sustainable source of supply for the cancer workforce. As such, it is vital that in the short, medium and long term, the Government is training sufficient domestic staff numbers to meet the needs of cancer patients.

 

  1. What are the principal factors driving staff to leave the health and social care sectors and what could be done to address them?

 

Workforce burnout

  1. Workforce burnout, caused by years of staff shortages and the toll taken by the pandemic, could harm retention in the cancer workforce. The NHS Staff Survey found that the proportion of staff reporting feeling unwell as a result of work-related stress rising from 36.8% in 2016 to 40.3% in 2019 – showing that even before the pandemic wellbeing was deteriorating. But COVID-19 has further damaged the wellbeing of a cancer workforce, with the 2020 NHS Staff Survey reporting this figure had risen to 44%.[vii] In October, NHS Providers found that 99% of Trusts were concerned about current levels of burnout across the workforce.[viii] This has been reflected in record numbers of staff leaving the NHS – with more than 27,000, approximately 2% of the entire workforce, leaving in the third quarter of 2021.[ix]

 

  1. Of that 27,000, the single biggest reason for staff leaving apart from contracts ending was concerns about their work-life balance. This demonstrates how a lack of capacity in itself drives burnout, and harms retention. In the medium and long term, sustained investment to grow the NHS workforce, as outlined earlier in this submission, is vital to any NHS workforce retention strategy.

 

  1. In the short and medium term, even a fraction of staff leaving would significantly compound existing workforce challenges. In coming years, supporting wellbeing will be crucial to ensuring that the health workforce does not lose its existing capacity. Measures that may support this include scaled-up and targeted mental health support for staff including the continued funding and support for mental health and wellbeing hubs[x] established last year and increasing the availability of learning and development opportunities for staff.

 

  1. Normalising and embedding flexible working practices is one area that can aid wellbeing and retention in the health workforce. The NHS People Plan aimed to achieve ‘flexibility by default’, through measures such as e-rostering, the support of management and a cultural shift in which conversations about flexible working are normalised.[xi] Recent polling found that flexible working was, according to health and care leaders, one of the most beneficial changes to maintain after the pandemic.[xii] It can support the wellbeing of the cancer workforce, for example by allowing a better work-life balance and giving staff greater professional autonomy.

 

  1. ‘Flexibility by default’, however, remains a long way from reality and in many cases barriers remain. The BMA has reported that in some areas, staff were unable to deliver productive clinical work from home due to inadequate IT equipment.[xiii] Similarly, the 2020 NHS Staff Survey found some suggestions that flexible working capabilities were not adopted universally – nationally or within organisations themselves.[xiv] Funding will be required to overcome these barriers and ensure the flexible working provisions are fairly distributed.

 

  1. A more comprehensive understanding of why people are leaving the cancer workforce is a prerequisite to an effective plan to reduce this. Both nationally and locally, comprehensive and standardised data on why people leave jobs in the cancer workforce should be collected, to feed into future policies that aim to minimise burnout and maximise retention.

 

An ageing workforce

  1. The NHS also has an aging workforce in many areas – and that is exacerbated by an increasing trend of early retirement. According to the BMA, 13% of secondary care doctors and 18% of GPs will be reaching minimum retirement age in the next decade.[xv] This could equate to a combined loss of 25,494 doctors through natural attrition alone. Another BMA survey found that 6 out of 10 consultants intend to retire before or at the age of 60.[xvi] The Royal College of Pathologists have found that around one third of pathologists are 55 or over, warning that when senior consultants retire there will not be enough trainees to replace them in numbers, let alone experience.[xvii]

 

  1. Allowing staff considering retirement the option of working part-time may aid retention. The RCR have found that on average, Clinical Oncologists working less-than-full-time retired three years later than their full-time colleagues – 59 compared to 62.[xviii] Working in this way has become more common in the last five years, with the proportion over 55 doing so rising from 3 in 10 in 2015, to 4 in 10 in 2020. Healthcare providers should ensure that the option to work less-than-full-time is available to staff, particularly those approaching retirement, while future workforce planning should account for this growing preference when projecting the future supply of staff needed. More generally, healthcare providers should consider modifying the job plans of those nearing retirement – for example by making on-call duties opt-in rather than opt-out.

 

  1. Are there specific roles, and/or geographical locations, where recruitment and retention are a particular problem and what could be done to address this?

 

Geographical locations

  1. Health inequalities can stem from geographical variation in the health workforce. For example, within the clinical oncology workforce, growth over the last 5 years has averaged around 3% but been minimal in the East and North West of England.[xix]

 

  1. Recent studies have shown regional variation in both the distribution of the primary care workforce and turnover rates of GPs, with the most deprived areas being the worst affected.[xx],[xxi] General practice in areas of high socioeconomic deprivation is relatively underfunded and under-doctored.[xxii] Given the pivotal role of primary care in the early diagnosis of cancer and the increased incidence of cancer in areas of deprivation, inequitable primary care workforce may have implications for driving cancer inequalities.

 

  1. More targeted policies addressing workforce inequalities are needed in order to expand access to primary care and reduce health inequalities and we believe health should be a key element of the Government’s Levelling Up ambitions. Financial incentives have been used to attempt to attract GP trainees to areas that have been historically struggled to fill training places – with the Targeted Enhanced Recruitment Scheme, which gives trainees a £20,000 salary supplement, in place since 2016.[xxiii] In 2018/19, the scheme filled all 265 of its posts, suggesting it has had some success in recruiting GPs to hard-to-recruit areas.[xxiv]

 

  1. Even before the pandemic, systemic and long-standing gaps in capacity in diagnostic services were putting a strain on the cancer pathway. As shown in in the diagrams below breaking down diagnostic waiting times in radiology and endoscopy by Clinical Commissioning Group (CCG), there is regional variation in the proportion of patients waiting over 6 weeks for key diagnostic tests.

  1. While the number of people waiting over 6 weeks for an endoscopy increased rapidly from March 2020 until May 2020 for all regions, some regions such as the North West experienced a greater increase and were slower to recover. The pandemic may have increased this disparity and some areas appear to have recovered their diagnostic services more quickly than others. Health system resilience and the ability of services to tackle the backlog will likely be influenced by existing pressures on the system including workforce shortages, as well as factors directly related to COVID-19 such as staff sickness and redeployment and level of hospitalisations. Investment is needed to help level up services and secure current and future capacity needs.

 

 

 

Roles

  1. Today, workforce shortages in diagnostic services present the greatest gap in the cancer workforce, acting as a bottleneck in the cancer pathway. The 2020 radiologist census by the Royal College of Radiologists (RCR) found that the radiology workforce across the UK is now short-staffed by 33% and needs almost 2,000 more consultants. Without more training, investment in new models of care and better retention and recruitment they estimate that by 2025 this shortfall will hit 44%.[xxv]

 

  1. Shortages in the diagnostic workforce are having clear impact on the care patients receive. Important cancer waiting times targets are being routinely missed in all four UK nations. In England, almost 55,000 patients should have been diagnosed quicker or started their treatment sooner in the last six years, but were not because the NHS continued to miss its target to treat 85% of cancer patients within two months of their urgent suspected cancer referral.[xxvi] Diagnostic workforce shortages are among the most significant barriers to the Government achieving the NHS Long Term Plan ambition to diagnose 75% of cancers at an early stage by 2028, for which we are well off track and to delivering its manifesto commitment to increase cancer survival.[xxvii]

 

  1. The recent CSR saw welcome investment in capital, including £2.3 billion across the next three years for transforming diagnostic services by setting up at least 100 new Community Diagnostic Centres (CDCs) across England. But it is not yet clear how these centres will be staffed, either in terms of where the workforce will come from or how it will be funded. Without clarity and greater workforce capacity, CDCs will not deliver the increase in diagnostic capacity and improvements patient experience that the Government hopes. Following the 2021 Spending Review, the Government must invest to grow the diagnostics workforce, while NHS England and Health Education England must ensure that CDCs have an adequate supply of staff without negatively impacting current diagnostic services at acute sites. 

 

  1. The adoption of skill-mix approaches – where roles and responsibilities of a team are designed around the needs of the patient, rather than traditional organisational boundaries – in the diagnostic workforce can help increase capacity. Training radiographers to report on images in a chosen speciality that would have traditionally been interpreted by a radiologist can free up radiologists to spend their time on the most complex reporting. Similarly, biomedical scientists can be trained to do some steps in the preparation and interpretation of histopathological samples that would traditionally have been done by histopathologists.

 

  1. To deliver these benefits, national and local health leaders should tackle the barriers to adopting skill-mix approaches. NHS Trusts and Health Boards should consider whether they are able to backfill the roles of upskilled staff and, if not, take steps to enable this, for example by recruiting more support workers. In driving the implementation of skill-mix approaches, it is important health leaders have the support of the cancer workforce, meaning patient safety and staff wellbeing – not cost – should be at the heart of the case they make. And HEE should design training courses flexibly to maximise their availability, aiming to reduce the geographical and financial barriers to participation.

 

  1. Innovative new technologies also have the potential to ease some of the burden on parts of the diagnostic workforce, for example, by triaging patients to reduce demand for the areas of the cancer workforce suffering from backlogs, or by reducing the administrative burden on the workforce. The quantitative Faecal Immunochemical Test (qFIT) and use of Cytosponge are examples of triage tools that have been used over the course of the pandemic to help health professionals triage patients based on their risk of having cancer. These tools should be utilised as beneficial, although ongoing research and service evaluation is essential in informing their use. For innovation to improve workforce capacity, system leaders need to support and invest in the adoption and spread of innovation as well as the initial development.

 

  1. While the shortages in the cancer workforce are most acute in diagnostics, they are evident across key cancer professions. By 2035, the number of people estimated to be diagnosed with cancer in the UK is expected to reach over half a million per year, an increase of 40% since 2015.[xxviii] Of these, 46% will be over 75 (up from 36% in 2015), meaning that thousands more patients will be presenting with more complex needs.[xxix],[xxx] This will increase the burden on a treatment workforce already suffering from shortages.[xxxi] And despite repeated commitments by the Government to grow the primary care workforce, the BMA estimates that the number of fully qualified full-time equivalent GPs in England has fallen by 1,803 since 2015.[xxxii] The Government must also tackle shortages evident in the treatments and primary care workforce.

 

  1. What should be in the next iteration of the NHS People Plan, and a people plan for the social care sector, to address the recruitment, training and retention of staff?

 

  1. The last NHS People Plan, published in 2020, reflects many of CRUK’s workforce policy priorities. However, many of the positive commitments it made are yet to be implemented or funded. Notably, it states that “when the government further clarifies the available budget to expand the workforce and make sure that education and training is fit for the future – as expected to be set out in the forthcoming spending review – more details will follow.” We are still waiting for that detail.

 

  1. The next People Plan should seek to go further than the previous iteration, exploring how staff can be supported to deliver the best care possible and grow the NHS workforce to meet current and future demand for services.

 

  1. For example, it should highlight the role participation in research can have in supporting wellbeing and retention across the health workforce. The enthusiasm for research in the cancer workforce offers significant opportunity to expand the NHS’s capacity to deliver life-saving and innovative research that drives forward improvements in care quality and patient outcomes.

 

  1. However, this opportunity is being limited by the scarcity of support and resources available to NHS researchers, with 60% of research directors saying there is insufficient funding to support NHS research studies.[xxxiii] CRUK’s report Creating Time for Research found that NHS staff struggle to conduct research because they face an inadequate supply of dedicated research time and funding, limited opportunities to begin and build research careers, and an organisational culture that insufficiently promotes research within the NHS. [xxxiv]

 

  1. To address these challenges, and unlock research capacity in the NHS workforce, the Government must now increase investment in research staff and infrastructure – developing pathways for research careers, and strengthening national- and organisational-level research cultures.

 

  1. Finally, the next iteration of the NHS People Plan should have a greater focus on how to equip the health workforce with the skills needed to deliver the future of cancer care. For example, genomics is rapidly changing the cancer pathway – with the potential to improve screening, diagnosis and treatments. To achieve this, a healthcare workforce with role-appropriate and up-to-date genomics knowledge is needed. This requires expansion of the workforce as well as training and development of existing staff.

 

  1. What is the role of integrated care systems in ensuring that local health and care organisations attract and retain staff with the right mix of skills?

 

  1. Integrated Care Systems (ICSs) have an important role to play in supporting workforce retention within their systems, particularly through their convening and facilitation role. One opportunity for this is protecting time for staff work together and upskill. When facilitated by Cancer Alliances, this has encouraged peer support between staff, as well as providing the opportunity to share learnings. 

 

  1. To support retention and ensure the right balance of skills across the system, ICSs should also consider providing funding and opportunities to support the workforce to work differently and maximise capacity. For example, funding can be provided which enables staff to lead on efforts to work more effectively, such as developing new ways of working. Opportunities for staff to provide training for other parts of the workforce can also support retention efforts. Upskilling helps maximise capacity and provide opportunities to learn new skills and work across different settings. ICSs have a critical role to play in facilitating this work across boundaries, ensuring all staff are able to access these opportunities.

 

  1. ICSs must also consider their role in in building a culture of system working and setting system-wide priorities. Creating a culture of openness, which recognises that trusts are facing major challenges, can encourage leaders to be candid in sharing their experiences and areas they are struggling with, with systems sharing solutions and responding as one, which can be an important part of supporting and retaining staff. The role and resources of ICSs are therefore important from moving away any sense of competition in systems to supporting the workforce to deliver to their capacity and collaborate as a system.

 

 

About Cancer Research UK (CRUK)

Cancer Research UK (CRUK) is the world’s largest cancer charity dedicated to saving lives through research. We support research into over 200 types of cancer, and our vision is to bring forward the day when all cancers are cured. Our long-term investment in state-of-the-art facilities has helped to create a thriving network of research at 90 laboratories and institutions in more than 40 towns and cities across the UK, supporting the work of over 4,000 scientists, doctors and nurses. In 2020/21, Cancer Research UK invested £421 million on new and ongoing research projects into the causes and treatments for cancer.

 

For more information, please contact Abigail Lever (Westminster Public Affairs Officer) at Abigail.lever@cancer.org.uk.

[i] NHS England and Improvement, 2019. Interim NHS People Plan. Accessed December 2021 via https://www.longtermplan.nhs.uk/wpcontent/uploads/2019/05/Interim-NHS-People-Plan_June2019.pdf

[ii] Royal College of Radiologists. 2021. Clinical radiology UK workforce census 2020 report. Accessed August 2021 via https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-radiology-ukworkforce-census-2020-report.pdf

[iii] Royal College of Radiologists. 2021. Clinical oncology UK workforce census 2020 report. Accessed August 2021 via https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-oncology-ukworkforce-census-2020-report.pdf

[iv] M. Sample, 2021. Spending Review 2021: Promising commitments, unanswered questions. Cancer Research UK. Accessed December 2021 via https://news.cancerresearchuk.org/2021/10/27/spending-review-2021-promising-commitments-but-a-lot-of-unanswered-questions/

[v] M. Warner, B. Zaranko, 2021. Pressures on the NHS. IFS. Accessed January 2022 via https://ifs.org.uk/uploads/Green-Budget-2021-Pressures-on-the-NHS.pdf

[vi] The Guardian, 2007. Government unveils new deal for NHS workforce training. Accessed January 2022 via https://www.theguardian.com/society/2007/may/24/health.highereducation

[vii] NHS England, 2021. NHS Staff Survey 2020 National results briefing. Accessed August 2021 via https://www.nhsstaffsurveyresults.com/wp-content/uploads/2021/03/ST20-national-briefing-doc.pdf

[viii] NHS Providers, 2021. Trust leaders fear staff burnout as winter pressures loom. Accessed December 2021 via https://nhsproviders.org/news-blogs/news/trust-leaders-fear-staff-burnout-as-winter-pressures-loom

[ix] i, 2022. Record numbers of NHS staff quit as frontline medics battle Covid pandemic trauma. Accessed January 2022 via https://inews.co.uk/news/health/nhs-staff-quit-record-numbers-ptsd-covid-pandemic-trauma-1387115

[x] The Guardian. 2021. NHS sets up mental health hubs for staff traumatised by Covid. Accessed January 2022 via https://www.theguardian.com/society/2021/feb/22/nhs-sets-up-mental-health-hubs-for-staff-traumatised-by-covid

[xi] NHS England. 2020. We are the NHS: People Plan for 2020/2021 – action for us all. Accessed August 2021 via https://www.england.nhs.uk/wp-content/uploads/2020/07/We-Are-The-NHS-Action-For-All-Of-Us-FINALMarch-21.pdf

[xii] P. Patel, C. Thomas, H. Quilter-Pinner, 2021. State of Health and Care: The NHS Long Term Plan after COVID19. IPPR. Accessed August 2021 via https://www.ippr.org/files/2021-03/state-of-health-and-care-mar21.pdf

[xiii] BMA, 2020. Consultant workforce shortages and solutions: now and in the future. Accessed August 2021 via https://www.bma.org.uk/media/3429/bma-consultant-workforce-shortages-and-solutions-oct-2020.pdf

[xiv] NHS England, 2021. NHS Staff Survey 2020 National results briefing. Accessed August 2021 via https://www.nhsstaffsurveyresults.com/wp-content/uploads/2021/03/ST20-national-briefing-doc.pdf

[xv] BMA, 2021. Medical staffing in England: a defining moment for doctors and patients. Accessed December 2021 via https://www.bma.org.uk/media/4316/bma-medical-staffing-report-in-england-july-2021.pdf

[xvi] BMA, 2020. Consultant workforce shortages and solutions: Now and in the future. Accessed December 2021 via https://www.bma.org.uk/media/3429/bma-consultant-workforce-shortages-and-solutions-oct-2020.pdf

[xvii] RCPath, 2021. HEE Strategic Framework Call for Evidence 2021: summary response. Accessed December 2021 via https://www.rcpath.org/uploads/assets/fcb04da2-89d4-425f-8da2f12db2be18b8/HEE-Strategic-Framework-Call-for-Evidence-2021-RCPath-summary-response.pdf

[xviii] Royal College of Radiologists. 2021. Clinical oncology UK workforce census 2020 report. Accessed August 2021 via https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-oncology-ukworkforce-census-2020-report.pdf

[xix] Royal College of Radiologists. 2021. Clinical oncology UK workforce census 2020 report. Accessed August 2021 via https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-oncology-ukworkforce-census-2020-report.pdf

[xx] Nussbaum C, Massou E, Fisher R, Morciano M, Harmer R, Ford J. 2021. Inequalities in the distribution of the general practice workforce in England: a practice-level longitudinal analysis. BJGP Open. Accessed August 2021 via https://pubmed.ncbi.nlm.nih.gov/34404634/

[xxi] Parisi R, Lau Y, Bower P, et al. 2021. Rates of turnover among general practitioners: a retrospective study of all English general practices between 2007 and 2019. BMJ Open. Accessed August 2021 via https://bmjopen.bmj.com/content/11/8/e049827

[xxii] R. Fisher. 2021. ‘Levelling up’ general practice in England. The Health Foundation. Accessed August 2021 via https://www.health.org.uk/publications/long-reads/levelling-up-general-practice-in-england

[xxiii] NHS England, 2021. Targeted Enhanced Recruitment Scheme. Accessed December 2021 via https://www.england.nhs.uk/gp/the-best-place-to-work/starting-your-career/recruitment/

[xxiv] A. Rimmer, 2019. Golden hellos have heloed areas get more GPs. BMJ. Accessed December 2021 via https://www.bmj.com/content/364/bmj.l319

[xxv] Royal College of Radiologists. 2021. Clinical radiology UK workforce census 2020 report. Accessed August 2021 via https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-radiology-ukworkforce-census-2020-report.pdf

[xxvi] Cancer Research UK, 2021. Cancer target missed for 55,000 patients over 6 years. Accessed November 2021 via https://news.cancerresearchuk.org/2021/09/22/cancer-target-missed-for-55000-patients-over-six-years/

[xxvii] CRUK, 2021. Early Diagnosis Initiative. Accessed January 2022 via https://www.cancerresearchuk.org/health-professional/diagnosis/early-diagnosis-initiative

[xxviii] CRUK, 2016. Annual UK cancer cases set to soar to half a million in less than 20 years. Accessed August 2021 via https://news.cancerresearchuk.org/2016/10/12/annual-uk-cancer-cases-set-to-soar-to-half-a-million-inless-than-20-years/

[xxix] Smittenaar et al., Cancer Incidence and Mortality Projections in the UK until 2035. British Journal of Cancer, 2016. DOI: 10.1038/bjc.2016.304

[xxx] CRUK, 2018. Advancing care, advancing years: improving cancer treatment and care for an ageing population. Accessed August 2021 via https://www.cancerresearchuk.org/sites/default/files/advancing_care_advancing_years_full-report.pdf

[xxxi] RCR, 2021. Clinical oncology UK workforce census report 2020. Accessed January 2022 via https://www.rcr.ac.uk/system/files/publication/field_publication_files/clinical-oncology-uk-workforce-census-2020-report.pdf

[xxxii] BMA, 2021. Pressures in general practice. Accessed December 2021 via  https://www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice

[xxxiii] Peckham, S. (2021). Creating Time for Research: Identifying and improving the capacity of healthcare staff to conduct research. Cancer Research UK. Accessed December 2021 via https://www.cancerresearchuk.org/sites/default/files/creating_time_for_research_february_2021_-_full_report-v2.pdf

[xxxiv] Peckham, S. (2021). Creating Time for Research: Identifying and improving the capacity of healthcare staff to conduct research. Cancer Research UK. Accessed December 2021 via https://www.cancerresearchuk.org/sites/default/files/creating_time_for_research_february_2021_-_full_report-v2.pdf

 

Jan 2022