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Bureaucracy and lack of confidence hamper two-week cancer referrals

GPs are failing to refer patients using the Government's two-week wait system for patients with suspected lung cancer because they find it too bureaucratic and may lack confidence in their judgment, according to authors of a new study.

Researchers ­ who believe the guidelines should be revised to make them clearer for GPs ­ warned patients referred outside the Government system wait much longer to be seen by a specialist as urgent slots get booked up.

Meanwhile, a report from the Centre for Policy Studies, an independent political think-tank, has condemned the Government's two-week referral guidelines for all cancers as 'flawed' because they only set a target from GP referral to the first visit to a specialist, rather than to completion of treatment.

A three-year study, presented to the British Thoracic Society meeting earlier this month, found GP referrals for lung cancer rocketed from 286 patients in 1999/2000 ­ just before the Government's two-week wait rule was introduced ­ to 412 in 2001/02 at Nottingham City Hospital.

During the study the cancer diagnosis rate for referrals dropped from 60 to 25 per cent, which researchers said was mainly due to the larger number of referrals and a drop in lung cancer diagnosis nationally.

But 42 per cent of referrals in 2001 were made outside the two-week wait system.

Study leader Dr David Baldwin, a consultant in respiratory medicine at the hospital, said GPs preferred dictating a traditional referral letter to filling out the required form under the new system.

But he warned this led to patients being 'disadvantaged by being made to wait longer as two-week wait slots are ready to go and take precedence'.

Dr Baldwin added some GPs may also feel 'the level of clinical suspicion they have is not sufficient to refer under the two-week wait'.

Dr Nick Summerton, a GP in Scunthorpe and a member of the group that drew up the Government guidelines on lung cancer, said the two-week wait guidance was nothing more than guidance.

'GPs can read it and take note of it if they wish. That is what being a professional GP is about. It is not something GPs should be audited against.'

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