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Poor UK cancer survival rates linked to lack of GP direct access to scans

UK cancer survival is worse than in other countries because GPs here are less likely to refer patients straight away and have less direct access to CT and MRI scans, an international survey of GPs has found.

The survey, published in BMJ Open, found only around one in five GPs in England could request CT or MRI scans directly, whereas GPs from other countries with better cancer survival were twice as likely to have direct access to them.

The study looked at survey responses from 2,795 GP from 11 jurisdictions in countries with similar, primary care-led health systems: England, Wales and Northern Ireland in the UK; Denmark, Norway and Sweden; New South Wales and Victoria in Australia; and British Columbia, Manitoba and Ontario in Canada.

By analysing the GPs’ responses to a series of different scenarios for diagnosis of potential lung, colorectal and ovarian cancers, researchers found a correlation between each area’s cancer survival and the GPs’ readiness to investigate cancer, either directly or via referral to secondary care.

More than 70% of GPs in every area reported direct access to blood tests for cancer diagnosis, X-rays and ultrasound.

However, in England, only around 20% of GPs reported direct access to CT scans and MRI whole-body scans – compared with at least 45% and up to 100% in all the non-UK countries with the exception of Denmark, where cancer survival is also relatively poor.

The study authors said their findings offered ‘one of the first possible explanations for the variation in cancer survival’ and suggested ‘some jurisdictions may consider lowering thresholds for primary care physicians to investigate for cancer – either directly, or by specialist referral, to improve outcomes’.

The findings come after NHS England announced plans to speed up early diagnosis in the UK through a range of initiatives including lowering thresholds for cancer referral – to be backed up by planned new NICE guidelines on suspected cancer – and increasing GP direct access to cancer diagnostic tools.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the study highlighted the need for increased resources and longer consultations for GPs in the UK.

Dr Green said: ‘If the Government wants to improve cancer care, they need to provide GPs with the resources needed to allow for standard appointment lengths of 15 minutes, as well as ensuring ready access to sophisticated investigations. This cannot happen until the proportion of the NHS budget spent on general practice is returned to its historic levels, and the workforce crisis is properly addressed.’

Dr Richard Roope, clinical lead for cancer at the RCGP, also called for increased investment to enable GPs to diagnose cancer more effectively.

Dr Roope said: ‘GPs are often criticised for over-referring as well as under-referring patients. In order to strike the right balance we need to invest in general practice to allow us to employ more GPs and support staff and to give GPs more access to technology that could ultimately save our patients’ lives.’

He added: ‘We also need significant, ongoing public awareness campaigns to educate the public about the causes of cancer – more than 40% of cancers are related to lifestyle choice – and to encourage people who have signs of cancer to approach their GP as early as possible.’

BMJ Open 2015; available online 28 May

Related images

  • outpatient referrals square PPL- online


Readers' comments (12)

  • I see the Daily hate Mail has twisted it to blame GPs for not referring patients.

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  • The problem is there is not enough money in the system. Referring more patients at an earlier stage for 2 week cancer waits or performing more CT / MRIs at an earlier stage through GP direct access costs more.

    Nobody can squeeze out toothpaste from a tube that is definitely empty. Somehow the Politicians think there is still more toothpaste in there

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  • Vinci Ho

    (1) I always say the two weeks rules in NHS have their blind spots . But they were formulated more by specialists on the basis to avoid inundating secondary care services . Hence , to be more stringent , a lot of 'soul searching' is necessary without marginalising general practitioners as we are stricken by serious shortage of resources (funding , acess to investigations , manpower , recruitment and expertises , the list can go on) collectively pointing towards new immediate investments.
    (2) Access to imaging is certainly an obvious weakness but poor access to specialists' help in the community is far more meaningful. General practice is still far more isolated in the community as a 'dumping ground' for everybody else in NHS. Instead , it should have been the 'headquarter' in a journey of any cancer diagnosis .
    (3) The rule of 7(I call it) for investment in health in UK:
    Less than 7% of the GDP is for NHS, hence health
    Less than 7% of this health budget is for general practice .
    Deplorable and lugubrious ........

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  • Not enough radiologists to do the interpreting.

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  • I read in Pulse a few months ago that it takes an average of 17 days to get a patient sent for an ultrasound and the report back. Here in Australia (apart from those GPs who just have a laptop office ultrasound and upskill and DIY) you send a patient for a scan at 10pm and they are back with report in hand at 1pm. That, more or less, applies to urgent CT as well.

    It (I'm going to put in an anglosaxon intensifier) F**KING staggers me how you guys practice medicine in the UK. How on this F**king earth can you do anything properly!

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  • sorry ...typo....10am, result back at 1pm

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  • To 11:09
    With huge difficulty, hence I will be joining you in Aussie land very shortly.

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  • GP's, there is absolutely no reason to take any risk. Any one who vaguely fits any 2ww criteria needs to be referred. Thats ANY where they can be fitted. There is no excuse for this any more. Secondry care lack of resources are not your problem. Go into every consultation thinking "how can i refer this worried person for tests and ensure nothing is missed" rather than "how can I save money for the NHS and balance my books". Your duty is to your patient first and foremost and no one else. Budgets and waiting lists are NOT your problem.

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  • Sophie borland is the individual responsible for the mail article. It usually is her bashing GP. Her dad was apparently a GP. I'm sure he must be very proud of her

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  • @ 4:06pm

    Completely agree

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