The general practice perspective on cancer services in Lothian

Objectives. The aim of the present study was to obtain views from general p ractices about current and potential improvements to services for patients with suspected lung, large bower, non-melanoma skin and breast cancer. Method. A questionnaire study was carried out of 134 general practices with in the Lothian Health Board boundary. Information was sought about referral choices, communication, quality of care, liaison between community and hos pital, health promotion, treatment outcomes and palliative care. Main outco me measures were determinants of primary care referral behaviour and clinic al investigation strategies, and perception of quality in secondary care an d health promotion services. Results. Seventy-nine general practices (59%) returned completed questionna ires. One-fifth of practices maintained a cancer register, and 85% provide patient information about cancer prevention. Initial management was disease dependent. Most cases of suspected lung cancer, about half of suspected co lorectal cancer cases and very few cases of suspected breast cancer were in vestigated in primary care before referral to hospital. Hospital referral d epended on knowledge of local services. A minority of practices wanted refe rral guidelines. It was estimated that 92% of lung and breast cancer cases, 68% of colorectal cancers and 35% of skin cancers are seen within 4 weeks. Breast cancer care was rated more highly than that for other cancers. One- third ranked community nursing support as 'excellent' and 10-15% described it as 'fair' or 'poor'; 77% describe palliative care as 'excellent' or 'goo d'. Fifty-one percent believe that communication with hospital is 'excellen t' or 'good'. Practices were sometimes unaware of the hospital's post-diagn osis management plan; communication was often too slow and practices often received 'poor' advice about symptom control. Eighty percent thought that h ospital follow-up for breast, colorectal and lung cancer should be routine; 20% thought that it was indicated for non-melanomatous skin cancer. Conclusions. Communication problems between primary and secondary sectors n eed to be tackled innovatively and the perceived quality variation in servi ces addressed-perhaps by developing local guidelines. Practices would welco me further education about health promotion resources and cancer epidemiolo gy.