John Sanfey is the Revalidation Lead for NHS England, North West London Area Team and is the Chambers Lead Partner for Central South London, and instigated the cancer diagnosis and led it until recently.
Last year, the London appraisal teams asked GPs to prioritise cancer in their choice of case study within appraisal. There were three reasons: firstly, poor evidence of reflection is the most common reason for deferral of revalidation decisions. Secondly, cancer outcomes in the UK are below those expected in relation to similar countries, especially so in London. The third reason was that clinicians are often unfairly held to blame for the poor figures. The most positive solution to all these problems is for clinicians to become better at reflecting on clinical cases, and to use their professional reflection to drive development within the health service.
The appraisal teams made no attempt to collect information brought to appraisals, which remain private conversations, and rightly so. However, it is clear from appraiser feedback that a large number of useful observations on preventable cancer delays have been made, and that there is considerable potential to improve pathways. Many little delays result from clumsy interaction between primary and secondary care and should, in theory, be easily remedied.