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Better AI and receptionist training would boost early GP cancer diagnosis, MPs told

by Simon Osborne
17 September 2021

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Improved artificial intelligence (AI) and training of receptionists would aid GPs in improving rates of early cancer diagnosis, the RCGP’s adviser has suggested to MPs.

Dr Richard Roope, clinical adviser for cancer to RCGP, was giving evidence to the House of Commons health and social care committee as part of its inquiry into late cancer diagnosis in the NHS.

The hearing, on Tuesday 14 September, also heard from a bereaved mother who called for all GP practices to have a dedicated cancer diagnosis lead.

It comes as health secretary Sajid Javid highlighted data in a speech today suggesting that ‘through the pandemic there have been 300,000 fewer urgent cancer referrals than were expected – and this could mean as many as 20,000 missed cancer diagnoses’.

Dr Roope told the committee: ‘I think there have been huge benefits to the e-consult system and one of the things that can be incorporated into that is actually developing the AI.

‘If you put into the e-consult you have abdominal pain it then automatically asks you the questions that will allow you to develop what is essentially a risk score.

‘That has huge potential if that can be achieved within the computer systems and the software.’

But Dr Roope stressed that digital consultations must not incorrectly give patients the impression their GP practice is closed.

He said: ‘It is important that general practice is seen to be open. There were certainly a lot of media reports during the early months of the pandemic that we were all on leave and weren’t there but the fact that we have empty waiting rooms doesn’t mean that we’re not working.

‘So I think there is a balance, and we will achieve that in the months ahead, where we still have the e-consult system which some people find incredibly helpful – certainly in my practice 80% of patients have found it better than what we had before but 20% have found it a real challenge.

‘But to support those who have maybe less IT literacy and access it is really important to have an alternate route into general practice so you can have that timely first assessment.’

Dr Roope suggested better training for receptionists should be considered to help improve access for patients who do need to see a doctor face to face.

He told the committee: ‘I think we need to train our receptionists so they are alert to worrying symptoms.

‘We need to develop a culture where patients are happy to discuss their symptoms with the receptionist who, in a way, is doing a very elementary triage role.

‘One of the benefits of the e-consult system is we’ve got away from “is it urgent for today” because of course patients may not know if it’s urgent for today because they don’t necessarily know the severity of their symptoms.

‘So the e-consult system has enabled that very early clinical triage is probably better than the receptionist triage.

‘But if you don’t have that IT then you still need the receptionist trained to pick up on those key symptoms and then route patients appropriately.’

The hearing also heard bereaved mother Andrea Brady call for all GP practices to have designated cancer specialists, after her daughter died following a series of misdiagnoses.

Mrs Brady said Jessica, 27, was ill for six months but was unable to get a face-to-face consultation with her GP because of lockdown restrictions.

She was prescribed antibiotics and at one stage was told she was suffering from long Covid.

But the radio-frequency engineer was eventually diagnosed with stage four adenocarcinoma, with an unknown primary, which had spread to her spine, liver, stomach, lungs and lymph nodes.

Mrs Brady said: ‘It was incredibly challenging for Jess, just navigating the whole system of e-consult procedures.

‘Receptionists were often very dismissive, quite rude and patronising which was very upsetting for Jess because she was really poorly.

‘We feel, and Jess felt, that nobody listened, nobody took it seriously and more than anything she needed a face-to-face appointment really early on with people making notes.

‘And during that time she wasn’t seen by one designated doctor – four different doctors spoke to Jess and prescribed medication and no one person was looking at the whole picture and putting the pieces of the jigsaw together.

‘Jess was a very gentle, sweet person but she really did attribute her late diagnosis to the slow reactions of her GP surgery.’

Dr Roope described the case as ‘tragic’ and said such personal stories had the ‘potential to change how we do things’.

He told the committee: ‘In  general practice we talk about learning events and this is the mother of all learning events and there is so much we can learn from it.

‘No GP gets up in the morning to miss a diagnosis. We are there to help our patients and enable access to the best treatment and the best diagnostics in a timely fashion but I think there are things we can do better.

‘I think this case is, in a way, a manifestation of essentially demand outstripping supply.

‘All GPs could do more if we had more time and if there were more GPs we could give more time to each patient.’

In May, NHS England controversially urged GPs to offer all patients face-to-face appointments if that was their preference and insisted receptions must be open for walk-ins.

But the BMA warned that many GP practices were ‘not yet safe’ for walk-in patients due to unsuitable reception areas.

Earlier this week, the health secretary insisted the Government would take action to ensure GPs offered in-person appointments.

But a Pulse survey last week found that around 80% of GPs felt a return to pre-pandemic levels of face-to-face appointments was not necessary or possible.

Click to complete relevant cancer CPD modules on Pulse Learning.

This story first appeared on our sister title, Pulse.