Respiratory symptoms awareness campaign: Impact on health services

GPs have a pivotal role as the gatekeepers to investigation and referral, but the task is a difficult one as the number of new diagnoses encountered each year is typically very small. To put it into perspective, approximately 5% of all primary care consultations are for cough and 1.5% of the population consult with their GP for fatigue each year. However, a GP would typically expect to encounter a new lung cancer approximately once every 8 months.[1] Recognising new symptoms can be particularly difficult in the presence of a co-existing respiratory disease (such as chronic obstructive pulmonary disease), but we hope that more people with respiratory conditions are diagnosed early and are treated promptly. There are a few things you can do to support the campaign:

Talk about the campaign

People that may have previously ignored or found excuses for their signs and symptoms may be prompted by this campaign to present at your surgery. However, they may still be fearful and we know that they don’t always find it easy to communicate their symptoms effectively and may worry about wasting the GP’s time. Even if the patient doesn’t have cancer, it’s a great opportunity to discuss prevention or lifestyle changes, such as smoking cessation.

Talk Cancer training: If you have colleagues who you feel would like to be more confident talking about cancer, Cancer Research UK provide workshops that can help them feel more comfortable raising the subject. The training programme is designed to build their confidence when talking to people about the ways to reduce the risk of cancer, spotting cancer early and screening. The training is suitable for:

• Practice staff nurses, healthcare assistants and receptionists
• Pharmacists and pharmacy teams
• Health trainers

For more information, visit the website.

Make the most of available resources and tools

The NICE guidance for the referral of suspected cancers was updated in 2015. There is also a wealth of other information to support you, including:

• NICE guidelines for cardiovascular conditions and respiratory conditions
• Cancer decision support tools, including lung cancer risk assessment tools (RATs) and QCancer
• BMJ learning online education tools – ‘Suspected lung cancer: when you should refer’ and ‘Tackling late diagnosis of cancer’
• ‘Direct access to diagnostic tests for cancer: best practice referral pathways for general practitioners’
• Read the Evaluation of the NHS breathlessness pilots – NHS England report and Diagnosing breathlessness
• Cancer Research UK has produced an interactive desk easel for GPs, which summarises the NG12 guidelines. GPs can access the summary from their computer and click through to the recommendations for each symptom group: Download the interactive desk easel
• NICE suspected cancer referral guidelines in a number of different formats, including infographic, table and text versions – you can download the posters, or order them for free from the CRUK publications website.

Work with your GP lead

Your CCG may have a GP cancer lead, who can give you further information relating to your area. If you would like the details of the GP lead in your area, contact partnerships@phe.gov.uk with ‘GP lead query’ in the subject line. Many GPs have found it useful to work more closely with secondary care clinicians to make improvements to patient pathways.

Test your knowledge

Get extra CPD points and test your knowledge about early diagnosis of lung cancer. The BMJ have produced a learning module in association with NICE: 'Suspected lung cancer: when you should refer'. The module aims to help you familiarise yourself with the typical presenting features of lung cancer; identify unusual presentations of lung cancer; and know when to refer patients with suspected lung cancer. A further module on ‘Tackling late diagnosis of cancer - in association with the Department of Health’ is also accredited and available on BMJ Learning.

A quiz from Cancer Research UK and Doctors.net.uk features 10 questions that let you test your knowledge on diagnosing lung and bowel cancer. In addition to the quiz, there are other tools, information and guidance to support you. Doctors.net.uk is open to all GPs and Secondary Care Clinicians – if you’re not a member already it’s quick and easy to sign up.

References

1. William Hamilton and Deborah Sharp:Diagnosis of lung cancer in primary care: a structured review; Family  Practice volume 21; issue 6; pp 605-611

The campaign encourages those with persistent symptoms to see their GP, but nurses also have a crucial role to play. People can delay going to see their GP for a variety of reasons. They may not realise their symptoms are serious; may worry about wasting the GP’s time; or if they suspect cancer, may fear the diagnosis and treatment.

Patients may be more willing to discuss symptoms with a nurse. They might speak to a nurse initially, to see if an appointment with the GP is warranted; they may feel they have more time to explain their symptoms and how they feel; or they may find it easier to talk to nurses, especially if it’s a nurse they see regularly.

There are lots of opportunities for nurses to speak to patients and keep a look out for those most at risk. For example, during an initial appointment with someone who has just joined your practice; when caring for patients with long-term conditions in the community; as part of health checks; or when delivering smoking cessation support. In some cases nurses know patients very well, so are in a good position to notice an unexplained or persistent symptom.

Some other things you can do:

Make every contact count

You are well placed to be vigilant for patients who may have concerns about respiratory symptoms. The campaign could have prompted people who have ignored the symptoms of a persistent cough or breathlessness to talk to you; however they may be afraid, embarrassed, or worried about what might follow.

• If a patient comes to see you about something unrelated, e.g. a new patient check or a specialist clinic, or if you are treating patients with a long-term condition, ask if they have any other concerns
• Use these opportunities to discuss healthy lifestyle changes too
• Have campaign leaflets at hand in clinics and when out in the local community (these will be available ahead of the 2016 campaign)
• Display public facing respiratory symptoms materials such as leaflets, posters and symptom cards. These will be available free of charge via the PHE Campaign Resource Centre or via the orderline on: 0300 123 1002

Give permission

Our target audience can delay going to see their GP and often seek permission to make an appointment. Where relevant, encourage patients to visit their GP. Suggest they see their GP again if their symptom doesn’t go away. For extra reassurance, tell them to mention that the nurse sent them. It may be the nudge they need to get themselves checked out. Recommend they come back and tell you how they got on.

Encourage your colleagues to support the campaign 

• Encourage people you work with to watch the TV adverts and listen to the radio ads when they are available on NHS Choices
• Brief health care assistants about the campaign and ask them to keep it in mind in their day-to-day work and direct all colleagues to the materials that will be available
• Be prepared for more patients mentioning symptoms to you as a result of the campaign.
• View guidance on ‘safety netting’ to support you in making sure patients with persistent symptoms continue to be followed up. Reassure patients that if symptoms persist following an initial visit with their GP, they should make a further GP appointment.

Talk about it

Talk Cancer training: If you would like to be more confident talking about cancer, Cancer Research UK provide workshops that can help you feel more comfortable raising the subject. The training programme is designed to build your confidence when talking to people about the ways to reduce the risk of cancer, spotting cancer early and screening. For more information, visit the website.

Campaign materials will be available free of charge on the Campaign Resource Centre or via the orderline on: 0300 123 1002

Brief colleagues 

Your whole team needs to be aware of this campaign and why it’s running, tell your patient groups too. More information will be available ahead of the campaign, in the meantime encourage people to review the autumn 2014 campaign materials. Encourage everyone to view the adverts on NHS Choices to understand what your patients will be seeing during the campaign.

Inform receptionists there may be an increase in the number of patients requesting appointments, it is essential patients are welcomed when they seek help. From research we know that, for various reasons, making a GP appointment is a significant barrier to many people, for example, they don’t want to waste the GP’s time or think they won’t be able to get an appointment easily.

Prepare for the campaign

It’s difficult to predict exactly how many more patients will come through your doors as a result of the campaign but we anticipate that this will be manageable. Results from the first national lung cancer campaign (May – Jun 2012) showed the following overall increase in the number of patients presenting with a cough during the campaign period:

• An analysis of 486 GP practices showed that there was a 63% increase in attendances for cough in over 50s during the campaign period compared with the same period the previous year (equivalent to three visits per practice, per week).

We recommend you review the uplift in GP appointments experienced during the previous national campaigns, as demand in services is likely to have varied across the country. This will help you to plan for the campaign.

Be prepared for an increase in the number of people sent for diagnostic tests and referred via the urgent two-week wait (2WW) referral system too. Regional lung cancer campaign (Oct – Nov 2011):

• Pilot areas saw a statistically significant 30% increase in urgent GP referrals for suspected lung cancer during Oct – Dec 2011 when compared to the same period in the previous year.

National lung (May – Jun 2012):

• Urgent GP referrals for suspected lung cancer saw a statistically significant increase of 32% in May – July 2012 when compared to the same period in the previous year.

Promote the new campaign 

Display campaign materials (these will be available over the coming months), and encourage your colleagues to talk about the campaign. TV advertising is incredibly powerful at raising awareness of symptoms, but it is often face-to-face discussions that influence behaviour change. Talking might prompt someone to make an appointment or open up about their symptoms.

Visit the public-facing website for the campaign and watch the TV ads and listen to radio ads when they are available on NHS Choices

Talk about it

Talk Cancer training: If you would like to be more confident talking about cancer, Cancer Research UK provide workshops that can help you feel more comfortable raising the subject. The training programme is designed to build your confidence when talking to people about the ways to reduce the risk of cancer, spotting cancer early and screening. For more information, visit the website.

Campaign materials will be available free of charge on the Campaign Resource Centre or via the orderline on: 0300 123 1002

If you’re a pharmacist, talk to the customer about how long they’ve had symptoms or how long they have been using non-prescription medicines, and finally whether they have visited their GP. We know that people may delay going to see their GP for a variety of reasons. They may not realise their symptoms are serious; they may worry about wasting the GP's time; if they suspect cancer, they may fear the diagnosis and treatment; or they may be embarrassed. Where relevant, be confident and give them permission to visit their GP. If you feel comfortable, tell the customer to mention that their pharmacist sent them. It may be the push they need to get themselves checked out.

If you are a pharmacy counter assistant or member of the pharmacy team, be confident and follow your normal protocol. You may be concerned about a customer and feel uncomfortable talking to them, if so, ask your pharmacist to speak to them or, if that isn’t possible, encourage the customer to go to see their GP. Chances are it’s nothing to worry about, but if it is cancer, COPD or heart disease, it’s better for it to be detected early.

One source of support in raising the subject of cancer with patients is the British Oncology Pharmacy Association’s e-Learning Centre. The centre has training for both pharmacists and for pharmacy team members about raising awareness of cancer in a pharmacy setting, with a whole module on lung cancer. This is free to access once you have registered on the website.

Some other tips include:

Make it part of your day

During your regular consultations, such as medicine-use reviews, when advising on OTC medicines or providing a repeat prescription, ask customers if they have seen the campaign. They may have already seen the ads or information and have come to ask you about symptoms before seeing their GP.

Give permission 

Our target audience can put off seeing their GP for a number of reasons, and are looking for an 'excuse' or ’permission’ to make an appointment. Where relevant, encourage customers to see their GP. If you feel comfortable, tell them they can mention that the pharmacist sent them.

Promote the campaign 

Put up posters in your pharmacy and have some campaign leaflets readily available for customers. Chat to your friends, family, customers and colleagues about Be Clear on Cancer.

Campaign materials will be available free of charge on the Campaign Resource Centre or via the orderline on: 0300 123 1002

Talk about it 

Tell your friends, family, customers and colleagues about the campaign. We need to talk about it, and this campaign gives us all the chance to do that. If your customer/patient complains about a persistent cough or breathlessness, urge them to visit their doctor.

Talk Cancer training: If you would like to be more confident talking about cancer, Cancer Research UK provide workshops that can help you feel more comfortable raising the subject. The training programme is designed to help build your confidence when talking to people about the ways to reduce the risk of cancer, spotting cancer early and screening. For more information, visit the website. 

As with previous campaigns, NHS England will be working with Strategic Clinical Networks to help ensure the NHS is prepared for the campaign, whilst Public Health England will work with local authorities and other stakeholders.

Please use the information available to plan for the campaign, please keep checking back as these pages will be updated ahead of the 2016 campaign and will include:

• Further information in advance of the campaign to help the NHS prepare for and support activity, including planning for a possible increase in demand for services.
• An overview briefing sheet, outlining essential campaign information
• Take a look at the NHS Choices respiratory symptoms website and familiarise yourself with the key messages. Direct members of the public to these pages so that they can find out more about respiratory symptoms
• Campaign materials such as posters and leaflets are being developed and will be available from the PHE Campaign Resource Centre. To request posters and leaflets visit the Campaign Resource Centre
• For more information, or if you have any queries, please email the Partnerships team at partnerships@phe.gov.uk.

Please share this information with colleagues and local teams to enable them to put plans in place to help promote the campaign locally, and ensure that services are ready to respond.