GP 10-minute appointment slots 'making it harder to do cancer checks'

Pressure to provide more GP appointments is making it harder to include checks for gynaecological cancers within the 10-minute slots, doctors have said.

Dr Amara Naseem says her clinics always overrun as it takes about 20 minutes to sensitively take a detailed history and carry out internal examinations.

A reduced number of practices in her area means she has taken on more patients and fears there is a risk that women will not raise gynaecological symptoms or attend screenings if appointments are rushed, painful or not handled well.

The Welsh government said it was increasing investment in primary care and recruiting up to 100 extra GPs.

Research by cancer charity Tenovus, in support of Claire's Campaign, found about half of the 100 GPs surveyed across Wales felt limited consultation time was a major concern.

A third also had concerns about "over-referring" people for further testing to rule out cancers, given hospitals are already overstretched.

Currently, 95% of patients put on the suspected cancer pathway are later told they do not have cancer.

But doctors said teasing out the cancer cases at an early stage could be challenging when symptoms such as bloating are hard to distinguish from benign conditions including irritable bowel syndrome.

Naseem said the pressure from the Welsh government was to "offer more appointments to the patient, rather than about the quality of the treatment".

Lowri Griffiths of Tenovus said incidence and mortality rates for gynaecological cancers in Wales were higher than the UK average - something she added the Welsh government needed "to get to grips with".

Pledges to increase GP numbers were promising, she said, "but unless we address both the primary care setting and the hospital setting, the system won't work".

Naseem said many women's health issues may require an internal examination, which requires time to be done "in an empathetic and sensitive way".

She added: "I'm working in a very diverse community, also in a deprived community, where uptake of screening is already low."

She said in communities where myths existed around screening, time is also required to explain what is involved and allay fears and potentially work with interpreters.

Dr Kathrin Thomas, a former GP and public health specialist, got involved in Claire's Campaign when her friend Claire O'Shea was given a late diagnosis for a gynaecological cancer.

Claire, from Cardiff, died last year, aged 42.

Thomas said GP numbers in Wales had "almost flat-lined" while the workload had increased, especially in more disadvantaged areas where there were "fewer doctors, fewer nurses and the healthcare needs are much greater".

She is also involved with Deep End Cymru - a network of GP practices in the most deprived areas.

"We've got a big difference in the cancer experience in more deprived communities - cervical cancer in particular," she said.

"There's a wide inequity between women in more affluent areas and women in poorer areas."

Of the 1,200 women diagnosed, about 470 patients die from a gynaecological cancer, either of the womb (uterine), ovary, cervix, vulva or vagina, in Wales each year.

Screening is only available for cervical cancer and it does not detect other cancers.

"Cancer outcomes are improving dramatically over the decades, but we're struggling in Wales to get the outcomes that other richer countries are getting," said Thomas.

The waiting times for gynaecological cancer treatment in Wales have improved significantly over the past year, from 34% of patients being treated within 62 days, to 51.3%.

However, the most recent Wales average for all cancers was 60.1% against a target of 75%.

Thomas said continuity of care came up repeatedly among the Tenovus survey of GPs.

"You have a 20% less chance of dying if you have the same team that looks after you," she said.

Maria Bailey feels being able to see the same GP was a factor in her own cervical cancer diagnosis.

"I feel really lucky that she took me seriously from the off. She knows me - she knew I was alarmed and [the symptoms] weren't normal for me. She took it very seriously," she said.

The 55-year-old from Pencoed, Bridgend county, experienced increased fatigue and light vaginal bleeding but put it down to working extra hours and the menopause.

But in February she spoke to her GP after the bleeding intensified.

"It was heavy bleeding and quite large clots, which I've never had before - they looked like baby seals and that was really alarming."

An internal examination followed by a raft of further tests uncovered a 4cm (1.5in) tumour and grade 2 cancer around her cervix.

"I was in shock, but as soon as they said it wasn't life-threatening, that was it. It was just one gear - and that was go."

Maria underwent chemotherapy, radiotherapy and brachytherapy across centres in Swansea and Cardiff and has since been raising money to provide essential provisions for others going through treatment for cervical cancer.

"I'm quite an organised person and don't like walking into anything blind," she said.

But an online search for advice about the things needed when starting treatment yielded very little.

She has now donated several "Bailey's bags" to two cancer centres containing items such as a water bottle, strong-flavoured sweets to overcome the metallic taste treatment can leave, a foldable fan, neck cushion, battery pack for USB devices and a medication box.

The Welsh government said: "We're committed to strengthening primary care as the foundation of the NHS in Wales.

"We've urged health boards to shift more resources towards primary and community care, with a further primary care summit planned to track their progress.

"We're updating our women's health plan to make sure women's voices are heard, and transforming how the NHS prevents, diagnoses and treats cancer through our 10-year national cancer strategy, with a focus on earlier diagnosis."