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Cancer care threatened by 'unrelenting pressure' in primary care, warns charity

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Practice nurses and GPs are working under such “unrelenting pressure” that it is threatening the cancer care they are able to provide, which in some cases is forcing patients to attend accident and emergency instead, a charity has warned.

Bigger workloads, vacancies in key roles, and increasingly complex cases are all contributing to the problems, said the charity Macmillan its new report From the Frontline.

“The story of NHS cancer care in 2017 so far is one of unrelenting pressure”

Lynda Thomas

Survey results included in the report suggested around half of UK practice nurses and GPs were not confident that the NHS workforce was able to provide adequate care to cancer patients due to the pressures.

The charity’s poll of 154 GPs and 103 nurses revealed that 44% believed the strain on services meant cancer patients were not always being treated as early as they should be.

More than a third (37%) also said it meant that some cancer patients were going to emergency departments, because they could not get help elsewhere.

In addition, the charity warned that some nurses and GPs had revealed they were considering leaving their roles due to reduced job satisfaction, consistently working above normal hours and becoming increasingly tired, anxious and burnt out.

“[You] have to work harder and faster and there is a risk of taking on roles that you are not adequately prepared for,” said one nurse quoted in the report.

“Attending A&E should be a rare event for someone being treated for cancer, but this could be becoming worryingly routine”

Lynda Thomas

As a result of the increasing complexity of cancer cases, many patients were not receiving the individual support they need, due to a lack of time among healthcare professionals, according to the report.

Another nurse said her lung cancer team was supposed to have one clinical nurse specialist for every 80 new cases per year. However, she told Macmillan that she currently had two clinical nurse specialists covering 249 patients diagnosed in 2015.

The impact of rising vacancy rates in the NHS more generally was also being “keenly felt” by healthcare professionals caring for cancer patients, noted the report, with workforce shortages on wards leading to specialist nurses filling gaps in more general staff.

The staffing problems also extended beyond acute and primary care settings into community teams, warned the charity.

On top of a “lack of practice nurses suitably trained, and thus confident in managing patients with cancer, [there is also a] lack of district nursing service provision”, said one GP in the report.

Governments across the UK must “urgently” address the pressure on services and set out plans to ensure the NHS cancer workforce is equipped to meet future challenges, said Macmillan.

Lynda Thomas

Lynda Thomas

Lynda Thomas

The charity’s chief executive, Lynda Thomas, said: “The story of NHS cancer care in 2017 so far is one of unrelenting pressure, and it is now clear that many hardworking doctors and nurses are seriously concerned about how the health service is coping with the pressures placed on it.

“Attending A&E because they can’t get help elsewhere or waiting too long for treatment should be a rare event for someone being treated for cancer, but this research suggests this could be becoming worryingly routine,” she said.

Demand for cancer services is set to increase over the coming years, as more people were diagnosed, noted Ms Thomas.

“The NHS aspires to deliver world class cancer care for patients, but this will not happen without enough staff with the right skills. There is an urgent need to address these pressures and set out a renewed vision for the cancer workforce to ensure it is equipped to meet future challenges,” she warned.

Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said primary care teams would “certainly empathise with some of the concerns highlighted” by Macmillan.

“None of us are strangers to intense workload and workforce pressures facing general practice across the country – and the potential impact this has on our patients,” she said.

helen stokes lampard blog image

helen stokes lampard blog image

Helen Stokes-Lampard

Professor Stokes-Lampard said the Macmillan figures “should be a wake-up call” to NHS England and the government. 

However, she noted that 75% of patients found to have cancer were referred after only one or two consultations and the proportion of cancers diagnosed as an emergency has dropped from 25% to 20% over the last five years.

She added: “Cancer is an enduring priority for the college, and we have worked with Cancer Research UK and Macmillan to develop resources to support GPs and our teams to deliver the care our patients with cancer need and deserve, at every stage of their illness.”



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