GP 10-Minute Appointments ‘Making It Harder to Spot Gynaecological Cancers’

Pressure on Welsh GPs to provide more appointments is making it harder to carry out thorough checks for gynaecological cancers, doctors have warned.

Some GPs say 10-minute consultations do not always provide enough time to properly explore women's symptoms, take a detailed medical history and carry out sensitive examinations.

Dr Amara Naseem said her consultations regularly overrun because a thorough assessment can take around 20 minutes.

She warned that rushed appointments could risk women not discussing symptoms or avoiding future appointments if examinations are uncomfortable or not handled sensitively.

When 10 minutes isn't enough

Naseem works in a diverse and deprived community where she says uptake of some screening programmes is already low.

She said consultations involving women's health can require additional time, particularly when an internal examination is necessary.

That time can be important not only for the examination itself, but for explaining what is happening, addressing concerns and, where necessary, working with interpreters.

Naseem said the pressure she felt was increasingly focused on providing more appointments rather than the quality of each consultation.

She warned that reducing complex women's health consultations to a short appointment could create problems when symptoms need careful investigation.

Cancer symptoms can be difficult to identify

Gynaecological cancers can present with symptoms that may also have much less serious explanations.

Bloating, for example, can be associated with conditions such as irritable bowel syndrome as well as some cancers.

Research by cancer charity Tenovus, supporting Claire's Campaign, found that around half of 100 GPs surveyed across Wales considered limited consultation time a major concern.

Around a third also expressed concerns about the possibility of over-referring patients for further investigation to rule out cancer, at a time when hospitals are already under considerable pressure.

Currently, about 95% of patients referred onto the suspected cancer pathway are subsequently told they do not have cancer.

But doctors say the challenge is identifying those patients who do have cancer at an early stage.

A wider problem in women's health

Lowri Griffiths of Tenovus said Wales needed to be more ambitious in its approach to gynaecological healthcare.

She highlighted concerns that both incidence and mortality rates for gynaecological cancers in Wales are higher than the UK average.

Griffiths welcomed plans to increase GP numbers but warned that additional doctors alone would not solve the problem.

She argued that pressure in both primary care and hospitals needed to be addressed.

"If we don't address both the primary care setting and the hospital setting, the system won't work," she said.

Inequality is part of the picture

Dr Kathrin Thomas, a former GP and public health specialist, said GP numbers in Wales had "almost flat-lined" while workloads had increased.

She said the pressures were particularly severe in disadvantaged communities, where there can be fewer doctors and nurses despite greater healthcare needs.

Thomas became involved with Claire's Campaign after her friend Claire O'Shea received a late diagnosis of gynaecological cancer.

O'Shea, from Cardiff, died last year aged 42.

Thomas said there remained significant inequalities in cancer outcomes between women living in more affluent areas and those in poorer communities.

Cervical cancer, she said, was a particular concern.

More than cervical cancer

Around 1,200 women are diagnosed with gynaecological cancer in Wales each year, while approximately 470 die from one of these cancers.

These include cancers of the womb, ovaries, cervix, vulva and vagina.

Cervical cancer is currently the only gynaecological cancer for which there is a screening programme.

Screening does not detect the other types of gynaecological cancer.

Thomas said cancer outcomes had improved significantly over the decades but argued that Wales was still struggling to achieve the outcomes seen in some wealthier countries.

Treatment waiting times have improved — but remain below target

There has been progress in waiting times for gynaecological cancer treatment.

The proportion of patients treated within 62 days has increased from 34% to 51.3% over the past year.

However, the latest figure across all cancers in Wales was 60.1%, below the national target of 75%.

That means the pressure does not end when a GP refers a patient.

The NHS must also have the capacity to investigate, diagnose and treat patients quickly.

The importance of seeing the same GP

Continuity of care was another issue repeatedly highlighted in the Tenovus survey.

Thomas said patients who have continuity with the same healthcare team can have better outcomes.

For Maria Bailey, being able to see a GP who knew her helped identify that something was wrong.

The 55-year-old from Pencoed had experienced increased tiredness and light vaginal bleeding, initially putting the symptoms down to working longer hours and the menopause.

When the bleeding became heavier, with large clots, she contacted her GP.

An internal examination and further tests discovered a 4cm tumour and grade two cervical cancer.

Bailey subsequently underwent chemotherapy, radiotherapy and brachytherapy in Swansea and Cardiff.

She said she felt fortunate that her GP knew her well enough to recognise that her symptoms were unusual for her.

Turning treatment into support for others

Following her treatment, Bailey began raising money to help other patients facing cancer treatment.

She created "Bailey's bags" containing practical items such as water bottles, sweets to help with the metallic taste caused by treatment, foldable fans, neck cushions, USB battery packs and medication boxes.

The bags are being donated to cancer centres.

For Bailey, the initiative grew from her own experience of discovering that there was little practical information available about what patients might need when starting treatment.

Welsh Government response

The Welsh Government said it remained committed to strengthening primary care as the foundation of NHS Wales.

It said health boards had been urged to move more resources towards primary and community care, while a further primary care summit was planned to monitor progress.

The government also said it was updating its women's health plan and implementing a 10-year national cancer strategy focused on prevention, earlier diagnosis and treatment.

It has also pledged to recruit up to 100 additional GPs.

The bigger question

The debate over 10-minute GP appointments is ultimately about more than the length of a consultation.

It is about whether the NHS has enough time and capacity to identify potentially serious illness before it becomes harder to treat.

For gynaecological cancers, symptoms can be difficult to distinguish from more common and less serious conditions.

A thorough conversation, a careful examination and continuity of care can therefore matter enormously.

But GPs are working within a system under pressure, with limited appointment capacity on one side and overstretched hospitals on the other.

The challenge for Wales is to make sure that the drive for more appointments does not come at the expense of the quality of care provided within them.

Ten minutes may be enough for some consultations.

For others, it may not be enough to ask the right questions, carry out the necessary checks and give a patient the time they need to be heard.

And when the condition being considered is cancer, that difference could matter.