Friday 30th September 2016
Mac Voice, the magazine for Macmillan professionals: Autumn 2016
People being seen in the right manner, at the right time: these are some of the benefits of a GP triage system that Dr Mary McCarthy has helped establish
I am a full-time GP in Longton, which is a highly deprived area in Stoke-on-Trent. The area has a high incidence of cancer, and in particular lung cancer, which is partly due to the history of the pottery industry and mining. I have also worked for more than 15 years in what is now the local Clinical Commissioning Group (CCG) as cancer lead in practice, and more recently as a Macmillan lead.
Our Trust has a very good respiratory and lung cancer department, but they were being affected by the number of two week urgent referrals from GPs. The numbers were overwhelming and they were failing to meet targets.
One result of this change has been less patient anxiety, because around 25% of patients are now not referred on following the CT scan. Previously, those people would have had a further worried wait to find out their results.
The efficiency of the respiratory team on seeing the right patient at the right time has also been a lot better, so their targets are being met.
The old pathway
Our usual lung cancer referral pathway from GP to secondary care was:
- GP arranged for a patient to have a chest x-ray.
- X-ray showed possible abnormality.
- GP made an urgent two-week referral to secondary care.
Upon being seen in secondary care, all of these patients were triaged by having a CT scan. In 25% of cases, the CT scan showed there was actually no abnormality to be investigated.
How we improved the process
To streamline this pathway, we negotiated that:
- All abnormal chest x-rays lead directly to a CT scan without GP intervention (all arranged by chest x-ray providers).
- The CT result is sent to the GP.
- If the CT result is abnormal, the GP makes an urgent two-week referral.
Making this change wasn’t easy. We started by looking at the data, then I met with the service manager and lead consultant doctor, who were fantastic. For any pathways to change, you have to have the local trust on board and working with you.
We also have various providers doing chest x-rays so needed to negotiate them all going through the same system, with CT scans carried out at the same place and reported on in a very quick manner. The turnaround should be within 48 hours and the GP then gets that result and actions it.
It has taken around 18 months to establish a robust system. We have had some issues where in certain cases people have needed an EGFR (Estimated Glomerular Filtration Rate) blood test before their CT scan, which needs to be referred back to the GP, unintentionally adding to their workload.
We have also had problems when locum radiologists have not been duly informed of our local pathway.
Whenever problems such as these have arisen, we have learned from them and taken steps to make improvements to the pathway.
Supporting patients and GPs
Systems such as these should be simple for the patient, robust so that the process is repeatable wherever they are, and they should make the GP’s life easier. GPs are under pressure at the moment, and changing a pathway is difficult in these conditions. I believe we could do so much more in general practice if we had the manpower. The current lack of GPs could have a massive impact on patient pathways and how people attend and are placed into the system.
Dr Mary McCarthy
Macmillan GP Stoke-on-Trent