The cancer backlog is a scandal – and it’s even worse than you think

Even in these surreal times, there are still things that are beyond belief. A GP emailed me last night to say that he had spoken on the phone to a woman with a cough who wanted to book a face-to-face appointment asap to get a worrying, persistent pain checked out. She had a negative lateral flow test. The GP was away today so he asked the surgery’s receptionist to book the woman in with a colleague. “Sorry, Doctor X will not see anyone with a cough,” came the reply.

“How are doctors not going to see people with a cough in WINTER?” asks the GP. “It makes me so mad.”

Last week, ministers confirmed that the Infection Fatality Rate of Covid is now just 0.096 per cent. The pandemic of panic should be well and truly over. GPS should resume the in-person appointments which the Royal College of GPS has tried to maintain they have been doing all along, when we know that’s simply not true.

So recalcitrant has the profession been, however, that the Prime Minister himself had to weigh in, yesterday. A No10 spokesman said that every patient had the right to a face-to-face appointment. The“poor me!” fit of the vapours from the British Medical Association has already begun.

Yet the consequences of our corona obsession become starker by the day. A report yesterday by University College London said that the pandemic is likely to have caused an extra 10,000 cancer deaths. A lack of emergency referrals by GPS since the first lockdown is a major factor, with researchers claiming that neglect is likely to have resulted in 40,000 late diagnoses.

We are already seeing the calamitous effects of delay. One radiographer tells me there is a mood of depression and helplessness in her oncology unit. “Normally, we would be scanning people and finding Stage 1 and Stage 2 cancers, then recommending a course of treatment. Now we are seeing people coming in with Stage 4, and there’s not a lot that can be done, except palliative care. Many are younger people. It’s desperate.”

Younger people like Jessica Brady. A beautiful York University graduate, 27-year-old Jessica first complained of abdominal pain last summer but was repeatedly denied an in-person appointment with a GP, virtually diagnosed with a kidney infection and prescribed antibiotics. As her symptoms worsened, Jess was given more antibiotics, steroids and an inhaler by four different GPS.

Her mother, Andrea Brady, told the House of Commons’ health and social care committee last week that multiple doctors didn’t put the jigsaw pieces together until five months later, by which time cancer had raced through the woman’s body like a forest fire. Jessica was only finally seen in person when she bombarded her local surgery with more than 20 calls, and a GP suggested she needed a gastroscopy. Had that procedure happened a few months earlier, her cancer might have been contained.

“Jess was a very gentle, sweet person,” her mum recalled, “but she really did attribute her late diagnosis to the slow reaction of her GP surgery… She needed a face-to-face appointment really early on, with people making notes.” Even after seeing a GP in person, it was not until she sought private health care that she was diagnosed with Stage 4 cancer of the lungs, bones, spine and liver. Three weeks later, she was dead.

Responding to Jessica’s case, Dr Richard Roope, clinical adviser for cancer at the Royal College of GPS, told MPS: “In general practice we talk about learning events, and this is the mother of all learning events… I think the narrative that we’ve heard is in a way a manifestation of essentially demand outstripping supply. That all GPS could

A GP who won’t see a patient with a cough has lost sight of what it means to be a doctor

do more if we had more time, and if there were more GPS we could give more time to each patient.”

What a morally bankrupt, shamelessly buck-passing response. Andrea Brady, the only mother that matters here, knows full well that her beloved child lost her life too soon because GPS persisted with a system of virtual triage, fervently advanced by Matt Hancock, which failed to pick up key symptoms. It is not a question of “demand outstripping supply”. It is a question of GPS, who before the pandemic saw 80 per cent of patients in person and now see only 57 per cent, putting their own comfort and safety above the well-being of a precious young woman.

Too many GPS are part of a pandemic phenomenon which has been called ERM, or Elite Risk Minimisation. While district nurses, paramedics, pharmacists, physios and general practice nurses have soldiered on like the poor bloody infantry, never ceasing to see patients in person, the officer class has preferred to keep a safe distance. It’s an attitude which, as Health Secretary Sajid Javid said, was understandable at the start of lockdown, when we were dealing with an unknown virus, but which is now totally inexcusable.

I’m told that the situation may be even more dire than University College London predicted. Professor Gordon Wishart, one of the UK’S leading cancer experts, reckons 10,000 excess cancer deaths is a very low estimate. “I think it will be closer to 25,000 deaths over the next five years,” he says. Professor Wishart points to The Lancet Oncology paper published last year. “Delays in diagnosis in NHS England suggested a 10 per cent increase in excess deaths from lung, bowel and breast cancer over the next five years. However, we then had a second lockdown [when more patients will not have seen a GP] and there are still significant delays to accessing NHS screenings and other cancer services.”

Let that sink in. A lack of access to face-to-face appointments, coupled with a fear of coming forward to burden the NHS, could be responsible for the unnecessary deaths from cancer of 25,000 men, women and children. To that sad toll, you can add tens of thousands of future fatalities from stroke, diabetes and heart failure. Back at the start of the pandemic, I said that lockdown could end up killing more people than Covid. I wish I had been wrong.

The stage is set for a battle between doctors’ trade unions on the one hand and patients and the Government on the other. Will GPS continue to ignore the letter from NHS England, brought about by a Telegraph campaign, which told them they must all ensure they are offering face-to-face appointments? As the Covid risk diminishes for the vaccinated majority of the population, will GPS insist that they must be “safe” when it means sticking with phone and online consultations, which are clearly less safe for the sick people who depend on them?

I agree that we need thousands more GPS to bring us into line with primarycare provision in other countries. Doctors’ lists should be a lot shorter to guarantee a good standard of care. The public would have been deeply sympathetic to their cause, but we are haemorrhaging faith in people who were once held in such high regard. A severe case of ERM has led to a loss of feeling in the caring profession which, increasingly, seems to care only for itself. A GP who declares that they won’t see any patient with a cough has lost sight of what it means to be a doctor. For God’s sake, get yourself a box of tissues and some Strepsils. Physicians, heal yourselves!