Dr. Jerome Coffey:

This is down to the foresight of my predecessors in the cancer control programme, Professor Tom Keane, Dr. Susan O'Reilly and Mr. Tony O'Brien. From the beginning there has been engagement with primary care. Electronic referrals are being introduced very broadly across the HSE. However, cancer control got there first with electronic referrals to the cancer centres for breast, lung and prostate cancers specifically. At the same time as resourcing software developments for GPs and the hard-copy referrals, there was work with the Irish College of General Practitioners and we have GPs on staff in the national cancer control programme to work out what the criteria are that mean it is urgent or non-urgent and that it should not be referred to the system. That is very important in getting patients referred appropriately and correctly into the system in order to get diagnosed and managed.

The next thing we need to work on is follow-up post-treatment. The latter is in the whole area of survivorship, which is being addressed by the cancer strategy. When someone is finished treatment, is well and there is no evidence of any active disease, his or her follow-up should not necessarily be in a hospital. The close-to-home principle applies. It needs to be community or primary care but there needs to be a linkage so that the information relevant to the care is transmitted to primary care without any effort. There needs to be a dialogue if a patient in follow-up in primary care has a problem and needs to get back into the system very quickly. All of that is critical. It is worth noting that the cancer control programme has made one if not two submissions to the negotiations relating to the GP contract and has made the point that resources need to be put into primary care in order to take the pressure off, but it is also more appropriate.