Cancer genetics in rural primary care: a pilot nurse-led service using a new mobile IT system.

Somerset has a relatively high incidence of cancer. The county is very rural with pockets of deprivation and sizeable areas of poor access to services. The Cancer Plan advocates early identification of cancer and identified the genetic revolution as having the potential to predict risk, and detect and diagnose cancer early. This innovative Public Health led pilot takes specialist cancer genetics services into primary care. It explores a new service model that is patient focused, provides services close to home and reduces hospital visits and pressure on genetics departments. People who believe they are at increased risk of developing cancer, due to family history, are assessed by nurse specialists at their local surgery and triaged into population, medium and high risk groups. Patient pathways have been streamlined for breast, ovarian and colorectal cancers, which are known to have a genetic link and there may be advantage in increased surveillance and/or genetic testing. People are given the opportunity to understand their personal level of risk and make choices about lifestyles and interventions. To support the delivery of cancer genetics services in primary care a bespoke software package has been developed building on a commercial programme already established in many genetics departments. Electronic transmission of pedigrees from primary to tertiary care assists the lean pathways and the incorporation of a new risk calculator based on NICE guidelines for familial breast cancer is being assessed.