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Controlling the cancer message

19 Jul 2013

The issue involves guidelines for GPs following-up patients Pic: Garo/Phanie/Rex

Dr Muiris Houston

After recent controversy over agreeing guidelines for GPs following-up patients with breast cancer, Dr Muiris Houston believes the NCCP needs to maintain its independence ahead of possible further budgetary cuts.

I was sorry to see the National Cancer Care Programme (NCCP) get itself tied up in knots recently. Under Prof Tom Keane, the organisation got off to a flying start; not least because he ensured it was structured as an entity quite separate from the monolith that is the HSE.

So headlines in the media such as ‘Breast cancer patients may have to pay for aftercare, say doctors’ because they were not being resourced to do so were extremely upsetting for patients. For the NCCP it was a PR disaster.

Transfer programme

Prof Keane’s successor, Dr Susan O’Reilly, reportedly told RTÉ’s Drivetime programme that an agreement had been reached with the ICGP for the roll-out of a transfer programme for patients who had completed their initial treatment for breast cancer to move from secondary to primary care.

However, this drew a sharp response from the ICGP, which strongly refuted that it had a role in negotiating GPs’ terms and conditions in any rolling-out of such a plan.

The College’s Chair of Communications Dr Darach Ó Ciardha said: “It is important to clarify that the ICGP engaged with the NCCP on clinical matters pertinent to this proposal, while at all times stating that this would have a workload implication for GPs. This matter was acknowledged by the NCCP.”

Dr Darach Ó Ciardha, ICGP

And just in case there was any doubt, he said it had kept the IMO fully up to date on its engagement with the NCCP.

“The ICGP acted appropriately at all times and will refute any implication to the contrary in the strongest possible terms. It is regrettable that this dispute has arisen and we would urge the NCCP and the HSE to enter meaningful discussions with the IMO to bring this matter to a speedy conclusion”, Dr Ó Ciardha added. And crucially, he said the ICGP regretted any concern that these developments may have raised for patients.

The IMO and the ICGP were caught out some years back when a HSE spokesperson told RTÉ that the ICGP had agreed to new vaccination programme arrangements that were clearly the province of the doctors’ trade union. But they weren’t going to fall for that gambit again.

Clinical assessments

From a clinical perspective, the issue involves guidelines for GPs in following-up patients who have completed their initial treatment for breast cancer. They need an annual clinical assessment and yearly mammograms. But it has now emerged that the IMO had written to Dr O’Reilly in April when it became aware of the ICGP discussions to point out that there were workload issues that needed to be addressed.

So if it decided to railroad the issue in the way that it seems, this was, at the very least, unwise of the NCCP. If so, it suggests to me an organisation that feels it is no longer independent of the HSE and one that may be slipping into the bad habits and dysfunctional modus operandi of its funding parent.

Keane vision

It now needs to stiffen its spine and to realise that Prof Keane put a lot of effort into achieving a major level of independence for the NCCP when he agreed to return from Canada to set it up.

Without nurturing this independence, it will be unable to assert its authority when it is asked to make cuts to cancer services. We are at a point now where the next swathe of cutbacks will impact directly on patient safety. The NCCP must be seen to uphold the safety of patients as its foremost raison d’être.

And may I respectfully suggest that the NCCP considers availing of the services of an external communications expert — someone perhaps of the stature of Ms Terry Prone? The Communications Clinic guru won’t just sharpen up everyone’s media and interview skills, but she is also renowned for her strategic nous.

It could be just what the doctor ordered in advance of the budgetary attrition that lies ahead.

19 July 2013

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