My Role as a General Practitioner with a Specialist Interest in Neuroendocrine Tumours

The role of GP with a specialist interest (SI) in NETs at The Christie NHS Hospital Trust was the “first such post” nationally. This new position was deemed essential for a better collaboration with general practice; improving early diagnosis, better understanding of the disease and quicker referral pathways.

As a GP in a busy semi-rural ageing population, a 10-minute consultation is used to triage the patient and determine the patient’s best course of action. Symptoms of neuroendocrine tumours are often difficult to diagnose: vague, non-specific and can mimic much commoner conditions. My objectives from the two years was to comprehend a GP’s baseline knowledge of managing a NET patient, providing education and advice, “building bridges” between primary and tertiary care and being an advocate for both patients and GPs.

During the 2 years, under the authority of Professor Juan Valle, Dr Richard Hubner and Dr Mairead McNamara, I participated in weekly NET clinics. This was a wonderful opportunity to learn about the complex nature of the disease through detailed MDT meetings, reviewing patients’ histories, scans and pathology. Consulting with the patients and discussing their ongoing management/treatment. Most importantly, it was about collaborating with an inspiring, hard-working and fun-loving team whom I have so enjoyed learning from.

An abstract, “The role of a GP with a Special Interest in Neuroendocrine Tumours (NET); working within a European NET Centre of Excellence to devise peer-to-peer GP awareness training” was submitted to the RCGP Annual Conference October 2016. This piece of work, as a poster was presented and had a lot of interest from other GPs wanting to understand my role.

My audit, reviewing GPs of 64 sequential NET patients were surveyed and this demonstrated a gap in knowledge and potential learning needs. A poster showing this was presented at UKINETS Annual meeting in London 2015.

Further learning forums included a NET Patient Foundation day – as a part of a panel to discuss the primary care perspective; and a GP Trainee study day (80 trainees) with Professor Valle discussing a patient with a neuroendocrine tumour and presenting complaint, referral pathway etc.

Together with Lynn McCallum (CNS), we have devised a “new patient information sheet” for the GP to be aware of treatment plan and possible complications.
A BMJ article is in the “pipeline” in the section, “Easily missed” – this will highlight where possible NETs could be picked up earlier – this is a joint paper with Dr Lamarca, medical oncologist.

I am also the primary care representative on the UKINETS Executive committee.
As part of the team, I hope I have brought some knowledge and a different perspective to look at the “whole” patient, holistically as well as medically. It has been a wonderful privilege.  Since leaving the NET world, I am now GP cancer lead at The School of Oncology at The Christie. I am embarking on an exciting new project: a joint venture with Manchester university on an MSc in Primary care oncology…. NET education will be heavily discussed in this innovative project!

Rebecca Leon

The Christie NHS Trust