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Bevan Exemplar Cohort 2 Projects

Supporting Cancer Services in Primary Care

Elise Lang

Velindre NHS Trust


1 in 2 people are expected to develop cancer in their lifetime, by 2020 150,000 people in Wales will be living after a cancer diagnosis (5% of the population). For those who have completed their treatment cancer must be managed in collaboration with primary care as a chronic condition – this is often more appropriate for patients and supports prudent use of limited health resources. To facilitate this there needs to be in-creased support for primary care.


We are helping a cohort of interested GPs to develop a special interest in oncology to become local specialists in their communities. We are also delivering training across the board to primary care clinicians to increase knowledge in all areas of cancer, from referral criteria to long-term consequences of treatment.

The aim is to be a leading UK educational centre for oncology supporting, medical students, GP trainees and primary care teams to deliver excellent holistic patient care locally and to help support recruitment and retention of clinicians to primary care in Wales.

Planning and development:

As part of the Macmillan framework for cancer, I have been working in Velindre Cancer Centre alongside clinical staff and their ‘Transforming Cancer Services’ team. We have been reviewing their relationships with primary care and forging new approaches. We have reviewed the content and timeliness of information shared with primary care and are improving communication in both directions.

We have adapted the content of the primary care letter to a more standardised format with salient points and information highlighted. We have surveyed the general practitioners in South Wales to identify their appetite for further learning and the format that that should take. We are changing ways of working and adapting to the current and future population’s non-surgical cancer needs.

A total of 198 GPs responded to our engagement survey and provided feedback on current service and requirements of potential learning opportunities.

The data identified learning needs, 40 GPs provided their contact details to be contacted directly about educational opportunities. Further meetings involving Macmillan and Velindre have proposed a direction of travel and we will be hosting an educational event in September.

Moving forward we will be looking towards universities to consider developing a postgraduate level qualification in primary care oncology.

We will be developing roles for some of these GPs To work with the cancer centre in out-patient departments and learning from each other to provide excellent patient care.

Fit with Prudent Health:

Prudent Principle 1: Empowering primary care to manage oncology follow up and survivors, utilising the resources already available in primary care. Improving well being of patients through access to local services and availability of local GP champions. It will reduce travel time to attend specialist clinics, when they can see a GP locally;

Prudent Principle 2: This allows staff to be focused on acute, priority patients and allows cancer survivors care to be handed back to empowered GPs. It will reduce follow up appointments in the specialist setting, therefore freeing specialist time to focus on acute/new patients;

Prudent Principle 3: General practice is perfectly positioned to manage cancer survivors and request appropriate investigations as they have been advised to do through educational events. Including investigation and referral onwards, or management locally, avoid repetition of tests, eg through better communication/info sharing; and,

Prudent Principle 4: Standardised training for GP champions should remove variation in management and close liaison with oncology leads should support clinicians through more difficult cases.