In the UK we have a unique system of primary care, centred around the GP practice. The GP is often the first port of call for patients and those important to them whenever there is a problem, and general practice aims to provide a service from 'cradle to grave'. The GP and primary care team are therefore in a unique position to support people through a diagnosis of cancer and beyond, enabling them to lead as full a life as possible.
The GP is one member of a multidisciplinary primary care team that is part of a larger community team. The latter includes health and social care professionals such as district nurses and community matrons, community palliative care nurses, mental health workers, social workers, pharmacists and out-of-hours teams.
The term 'patient-centred care' is increasingly being replaced by the term 'person-centred care', which essentially means involving the cancer patient, and taking account of their views, in decisions about their health and care.1 It looks at their illness and personal goals, treating them as an equal in the process. 'I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.'2
For many patients, their cancer journey will start in primary care. Some patients' first presentation is to A&E. We know, however, that outcomes for these patients tend to be poorer; so, for most cancers a GP-managed referral route provides the best experience.3 Providing patient-centred care is imperative for all individuals from the very beginning of their cancer journey. Some may present with an anxiety about cancer, either due to symptoms or, perhaps, as a response to a media campaign or the experience of a friend or relative. Others, however, may present with symptoms that prompt the GP to be suspicious of cancer as a possible diagnosis, without the person having first considered it. Whether it is simply appropriate reassurance that is needed or referral for investigations or via an urgent suspected cancer pathway, clear communication and the provision of all necessary information in the appropriate way are imperative in providing good-quality, truly patient-centred care.
Robust safety netting should be part of any consultation involving a referral to investigate for cancer or to obtain a secondary care opinion. It may come in multiple communication forms including verbal or the provision of appropriate information leaflets, and, like all elements of the consultation, should be tailored to the patient's needs and the level of physician concern. Some patients may present with 'low-risk' symptoms that the GP does not feel need investigating at that time, but that do need to be followed up should they become persistent. Safety netting is just as important for these patients and should involve clear and specific communication.4