The majority of GPs in this study considered that they had a clear role in cancer prevention, albeit within a wider health promotion agenda, focusing specifically on smoking cessation and cervical screening. The main reason cited for this limitation in their role was time constraints and imposed government targets. Despite this, the GPs in this study also considered that the primary care consultation did provide a good opportunity for cancer prevention activity and that there is potential to develop cancer prevention within this setting, acknowledging the need for alternative models of cancer prevention provision.
Disease prevention and health promotion are recognised tasks in the daily practice of all general practitioners (GPs) . A recent suggested definition of general practice emphasized the role of GPs in prevention, stating that “the general practitioner engages with autonomous individuals across the fields of prevention, diagnosis, cure, care and palliation using and integrating the sciences of biomedicine, medical, psychology and medical sociology” . It can be argued that this indicates a need for not only ensuring that preventive health care is part of everyday practice in primary care but also the importance of developing an increasing understanding of biopsychosocial approaches to health care. This need for a re-orientation towards prevention also fits with the increasing evidence that recommendations from family practitioners can increase substantially the likelihood of patients undertaking preventive activities , alongside the view that a lack of such recommendations has been linked with patient noncompliance . Despite this call for a possible reorientation towards prevention, the findings also indicated that GPs considered that they were primarily interventionist rather than preventionist in their clinical practice. The main reason cited was the need to address the patients’ problems at consultation and that the time available limited the opportunity to engage in prevention activities, unless directly linked to the presenting problem.
The findings showed that the principal activities undertaken by GPs and explicitly linked to cancer prevention were smoking cessation and cervical screening. Whilst this finding in relation to smoking cessation, is similar to other studies that have examined both GPs and nurses in primary care [17, 33] a significant issue is that caution is needed to ensure this moves beyond merely routinistic practice and that GPs don’t consider such discussions too time-consuming and ineffective . This is vital in light of the evidence, where tobacco use is recognised as the single most important risk factor for cancer . It was also noted that whilst the majority of GPs in this study did address the other important risk factors for cancer e.g. alcohol consumption, obesity, diet and physical exercise, there was a substantial sample of GPs who did not provide information on these factors, despite the importance of these risk factors having been previously identified in the literature [6, 8–11]. This is a significant issue as perhaps GPs may not be convinced by the evidence base on these risk factors. For example, Broton et al’s  multinational European survey, found that more than half of the GPs were sceptical of helping patients decrease alcohol consumption, achieve or maintain normal weight and practice regular physical exercise. McAvoy , however, contended that this scepticism around helping patients’ achieve lifestyle changes could be alleviated following the provision of education, advice and support for general practitioners.
The two main barriers identified for the actual and potential role of the GP in cancer prevention were remuneration and issues related to workload and time. Whilst the importance of these factors are not new and have been previously identified as the most important barriers for overall health promotion in primary care in a World Health Organisation survey of over 2300 GPs in 16 countries , of significance is that the evidence base on the importance of remuneration is inadequate. This is further compounded by the complexity of health care systems making international comparisons difficult. In order to try to address this, Dahrouge et al.  examined the impact of remuneration and organisational factors on completing preventive activities in primary care settings. They undertook a cross sectional survey to compare the delivery of preventive services by practices (n=137 practice; 288 family physicians) in four different primary care funding models in Canada. They found that no funding model was clearly associated with superior preventive care. Rather factors such as physician characteristics and practice structure were stronger predictors of performance. For example, practices with one or more female physicians, a smaller patient load and an electronic reminder system had superior prevention scores. This raises some questions around the rhetoric of the importance of remuneration as an important barrier for cancer prevention activities in primary care and the need to balance this with other factors such as practice structure and physician characteristics.
It was also noted that whilst the cancer prevention activities performed by GPs were viewed as opportunistic, the GPs considered that the primary care consultation did provide a good opportunity for cancer prevention activity. This reflects international research indicating that that consultations in primary health care are “ideal for health promotion” . Almost all GPs in this study agreed with empowering individuals to take responsibility for making decisions regarding health issues and providing patients with information about better lifestyle choices. While identifying lack of time as a critical limiting factor, the GPs indicated that significant efforts were and should be made to encourage patients to take personal responsibility for lifestyle choices and changing their behaviours. However, the GPs indicated a need for training around behavioural change, specifically on theories of motivation and action. The development of such activities raises questions around alternative models that extend beyond the current model of face to face patient care. These include possibilities around group activities, the use of technology and other forms of information, social media and social network sites may offer significant potential to inform and influence health behaviours in cancer prevention but this remains an area that is underexploited. Furthermore, other alternatives could include developing the role of both clinical and non-clinical professionals (such as health educators and dietician counsellors) working together to provide both illness care and wellness care respectively and concurrently. The findings also indicated that GPs perceived nurses to be better placed to provide cancer prevention activities. This form of practice will require the development of new relationships between GPs and nurse practitioners that build on their complementary strengths with a clearer focus on which services can be best provided, and by whom .