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General practice care crucial in helping patients with rare cancers

The Royal Australian College of General Practitioners (RACGP) has called on government to institute key reforms to help GPs and practice teams improve the health and wellbeing of people diagnosed with rare and less common cancers.

It comes following the College’s submission to the Senate Standing Committees on Community Affairs inquiry into equitable access to diagnosis and treatment for individuals with rare and less common cancers, including neuroendocrine cancer.

Chair of the RACGP Expert Committee on Quality Care, Professor Mark Morgan, said that GPs must be front and centre when it comes to helping people with rare cancers.

“GPs play a vital role in the diagnosis, screening, treatment and care coordination of patients with a rare cancer, and government policy must reflect that,” he said.

“As outlined in the National Strategy Action Plan for Rare Diseases, GPs are often the first point of contact for people with rare diseases and if we are included in the care of patients with cancer this will ultimately improve the quality of care they receive and their overall wellbeing.

“It is vital that patients with cancer are encouraged to see their GP during their treatment to monitor progress and ensure that other health conditions and preventive screens are not overlooked. We shouldn’t just be focussed on treating cancer in isolation, other health activities and interventions must also be front of mind as part of a shared care model to improve care for people with complex chronic conditions. GPs are key to multidisciplinary teams and care coordination, and we need models in place to enable GPs and other health professionals to work collaboratively at the top of their scope, so that patients get the best outcomes.

“Greater investment in general practice care would also make a real difference. This year’s federal Budget, including a new Medicare Benefits Schedule item for consultations lasting more than an hour, was a positive step forward. However, the job is not done because the MBS still rewards shorter, episodic care rather than long-term management of complex diseases.

“The MBS also doesn’t adequately support direct communication between GPs and other specialist providers leading to an over reliance on periodic letters or waiting for MBS-funded consultation visits. Basically, patient care coordination is not funded under this system. It’s important to keep in mind that patients might benefit from opportunities to engage in physical activity or being connected to a peer support group. They might need to receive care from specialist teams based within a hospital and allied health providers in the community.

“GP teams are ideally placed to connect all these services, but current funding models are inadequate. Particularly when it comes to rare cancers, we may need to undertake further research and talk to other health professionals caring for the patient. So, what we really need is more investment in the MBS and the introduction of payment models to better support longer complex consultations and shared care to get the best possible results for our patients.

“Making clinical information more accessible for GPs would also be very beneficial. The College backs expanding HealthPathways, a system developed through Primary Health Networks, which features links to clinical guidance for assessing and managing a patient with a particular symptom or condition and locally relevant information on referrals to existing services and specialists.

“Ask any GP and they will tell you that rare and less common cancers can be challenging to diagnose and it’s difficult to identify patients who are at higher risk of rare cancers to institute regular surveillance. In addition to further research into rare and less common cancers, we also back further funding to investigate the feasibility of an urgent cancer referral system that includes people with suspected rare and less common cancers, like the one that operates in the United Kingdom. Under that system, anyone with symptoms that might indicate cancer is seen by a relevant specialist within two weeks, which means patients benefit from early diagnosis and earlier access to treatment.

“We have come a long way in Australia in treating and caring for people with rare and less common cancers, but there is still great room for improvement. The College looks forward to working with government to ensure all possible measures are in place to help patients with cancer get the best possible care.”

The RACGP is currently updating the Guidelines for preventive activities in general practice 9th edition (the Red book). The Red Book provides the general practice team with guidance on screening, case finding and proactive preventive care. These guidelines do not receive any public funding but are critical source of advice to GPs and other health professionals. Public funding would enable the RACGP to invest greater resources in the development and implementation of the guideline’s recommendations.

Visit www.racgp.org.au.