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‘Clear link’ between number of GP cancer referrals and mortality

People with cancer are more likely to die if their GPs do not regularly send their patients for an urgent referral for suspected cancer within two weeks, according to research.

The research - by Cancer Research UK and National Institute for Health Research - found that the practices that most often used two-week urgent cancer referrals had 7% fewer deaths than those that used it least.

The study, based on data from 215,284 English cancer patients, found that there was variation in how often GPs used the two-week referral guideline, which was introduced in the early 2000s.

Professor Henrik Moller, epidemiologist at King’s College London and lead author of the research, said: ‘This study shows the first link between using the urgent referral route and deaths in cancer patients.’

He added that there’s a fine line to tread between using the urgent referral route regularly and using it too much – which the NHS isn’t equipped to respond to.

However, he said: ’If GP practices which use the two-week route rarely, were to use it more often, this could reduce deaths of cancer patients.’

NHS England has reprimanded CCGs for offering incentives to GPs for cutting down the number of urgent cancer referrals they make, following Pulse’s investigation that found at least two CCGs were rewarding patients for cutting down referrals, including for cancer.

Readers' comments (11)

  • And how many other conditions would this be true for, from elderly care to diabetes, if anyone was brave enough to ask...

    The CCGs should stop incentivising against referrals immediately. It is immoral and against all principles of good medical practice

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  • Vinci Ho

    Not blowing our horns
    Should see important GPs are to this health service after all.....

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  • Vinci Ho

    In fact , the words are 'vitally important' ,.......

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  • So at what point does referral rate cease to decrease mortality? Surely the issue is 'how much is too much/little'?

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  • The yield rate is so low with two week waits (typically 5% for GI referrals) that it really has become a case of referring everything. If Patients did not have to wait so long for routine appointments the 2WW system would be superfluous. The downside of 2WW is that it is very resource heavy compounding the problem of delayed access to routine referrals. Furthermore, if the patient does not have cancer they go back to the staring line.

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  • Vinci Ho

    Yes , the obssesion of early cancer detection can easily crowd out the resources for referrals of other conditions,

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  • This is common sense

    Agree with the other GPs above. That if it was not such an unacceptably long wait for a routine outpatient appointment, then cancers would be picked up early anyway.

    Why is it that GPs are been told to allow access within 48 hours, and the Government agenda with extended hours and long opening times for GPs, while hospital clinics leave patients waiting for up to 18 weeks just to be seen?

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  • Clearer link between Hunt and NHS agony.

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  • So if you refer everything and anything your pick up rate is high - only thing is the CCGs are bankrupt and will hate you. Rocks and hard places.

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  • Samuel Lewis

    Actually high referrers had a much lower pickup rate, if you mean rate of cancers diagnosed .. the paradox is that low referrers with high "conversion" diagnostic PPVs had higher mortality !! It is probably a mirage due to real-time bias. If its real then we are going to need a tripling of diagnostic investigative capacity. Otherwise an increased referral rate at lower risk thresholds must simply delay the diagnoses we make now. See http://www.bmj.com/content/351/bmj.h5102/rr-4

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