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Background

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In 2011, patients aged 65 and over accounted for 17% of the population, and those aged 85 and over accounted for 2% of the population.1 Nearly two-thirds of cancer diagnoses occur in the over-65s and one-third in people aged 75 and over. By 2020, there will be nearly 2 million people aged 65 and over who have survived a diagnosis of cancer.2

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Consultation rates in primary care are increasing, and the highest rates are among older people. In 2008, estimated rates of GP consultations were reported to be 13.9 per person-year for men and 13.3 per person-year for women in the 85-89 years age group.3

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Primary care and cancer in older people

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The role of the primary care team at a practice level is 'a central and continuing element in cancer care for both the patient and his/her family from primary prevention, pre-symptomatic screening, initial diagnosis through to care and follow up or, in some cases, death and bereavement'.4 The role has since expanded to include commissioning input and survivorship issues.

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The Health and Social Care Act 20125 created two new organizations, the NHS Commissioning Board (NHSCB) and Public Health England, and replaced former primary care trusts with clinical commissioning groups (CCGs). CCGs are clinically led groups formed by member general practices in a geographic area to commission services for the population. The commissioning of cancer services is split among these three bodies:

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  1. The NHSCB commissions specialized services.6

  2. Public Health England commissions cancer screening services.

  3. CCGs commission services for patients with the common cancers, with the exception of radiotherapy, chemotherapy and specialist interventions.

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CCGs work with their local authority's health and well-being board to improve cancer outcomes. The local authority, with its responsibility for public health resources, analyses the prevalence and expected rise in cancer incidence (among other health priorities) to produce the Joint Strategic Needs Assessment, which informs the CCG and NHSCB of its commissioning strategy. The CCG has to take into account historic and forecast needs, plus any case for change or opportunities from research evidence/best practice in the commissioning of cancer services. The process is complex, from setting commissioning intentions to contracting and delivery of services, especially in London, where there are wide variations in cancer outcomes and a large heterogeneous population. The London CCGs have to work in partnership with the London-wide Transforming Cancer Services Team, the local integrated cancer system (London Cancer Alliance or London Cancer) and local clinical groups. The focus is on early detection, reducing pathway variations, improving patient experience, and developing strategies for chemotherapy, radiotherapy and end-of-life care.7

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A major challenge in health services worldwide is the development of an integrated service for the older population with long-term conditions (cardiovascular, respiratory, neurological, musculoskeletal, dementia, etc.), as well as the burden of frailty.8 The Comprehensive ...

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