InnovAiT: Education and inspiration for general practice

Early detection of cancer is crucial to improve patients' chances of survival. Unfortunately, early signs of cancer are often easier to see with the benefit of hindsight than they are at the time of presentation. Although cancer is common, cancer diagnosis is a relatively rare occurrence for an individual GP and referral from primary to secondary care is often triggered by a GP's awareness of ‘alarm symptoms’ or ‘red flags’ that are considered to predict malignant disease. It is important to have a lower threshold for investigating cancer in people with recognized risk factors for the disease, such as smoking. Failure to respond to treatment as expected (for example, a chest infection that does not settle with antibiotics), or symptoms that are getting progressively worse should raise suspicion of a possible diagnosis of cancer in any patient.

Mortality is decreasing for most cancers and the overall 5-year survival rate has now reached 50% (Fig. 1). The 5-year survival rate in women (56%) is higher than that in men (43%) and this gender gap is also seen for 10-year survival rates (52% for women versus 39% for men). Figure 2 shows 5-year survival rates for common cancers in the UK. The highest 5-year survival rate for men is for testicular cancer (96%) and for women is for malignant melanoma (87%).

Although most oncology care takes place in secondary care, many patients are treated as outpatients. Oncology emergencies may occur when the patient is at home and the GP is often called. Therefore, it is important to know how to handle the common emergencies likely to arise. Remember that you are part of a team. For example, in many areas, there is a district or community nursing team available 24 hours a day who can be called upon to provide emergency nursing care, such as replacement dressings, or to attend to syringe drivers that have stopped functioning.

A diagnosis of cancer can be devastating for both the patient and his or her family. Cancer can arise out of the blue and often affects people who have been fit and healthy until diagnosis. It may affect young people as well as the elderly. Patients and families have support needs that may vary over time and according to the progress of their disease and treatment. Try to tailor information and advice to the individual's needs and continue to provide support throughout the patient's illness. This article is intended as a broad guide to the types of support available for cancer patients in the UK. It is not intended as a comprehensive reference and cannot include the many excellent local services available in different parts of the UK for such patients.

Today, along with opticians, dentists and pharmacists, general practitioners (GPs) form the ‘front line’ of the NHS providing primary medical care and acting as ‘gatekeepers’ to the secondary care system. Around 97% of the British population is registered with a GP. Patients register with a practice of their choice in their area—whole families are often registered with the same practice. Once registered, patients stay with that practice for an average of 12 years.

In most countries and cultures of the world, alcohol consumption is tolerated and commonplace. In the UK, alcohol is an integral feature of many aspects of British culture. However, the consumption of alcohol is a major public health issue:

90% of the alcohol-related work in the NHS occurs in primary care—with 259 million alcohol-related consultations each year in the UK

The overall cost burden to the NHS from alcohol-related problems is calculated to be £1.7 billion, and the loss to the economy due to premature death from alcohol misuse is estimated to be ∼ £2.4 billion each year. However, the annual revenue to the Treasury in alcohol duties and VAT totals £13.3 billion.

In recent years, official statistics have shown a sharp rise in alcohol consumption, both in terms of overall per capita consumption and an increased prevalence of hazardous and harmful patterns of drinking, notably among women and young people. It was in response to this situation that the government published the Alcohol Harm Reduction Strategy for England in 2004.

The definition of drug misuse varies according to perspective, cultural practices and beliefs and local legislation. Attitudes to drugs also change with time as is evident by the political debate in recent years regarding drug legislation and, in particular, the use of cannabis. For the purposes of this article, drug misuse refers to the use of illegal drugs and the misuse, whether deliberate or unintentional, of prescribed drugs and substances such as solvents.

As a GP, it is important to know the regulations surrounding controlled drugs, both to be able to give patients advice and to enable you to prescribe controlled drugs safely. This article aims to outline the major pieces of legislation governing prescribing and usage of controlled drugs and to highlight good practice.