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GP experts question Government plans to rank GP practices on cancer referrals

GP researchers have questioned the logic behind Government plans to rank practices on their cancer referral times, as they say delays in diagnosing cancer are largely out of GPs’ control.

Writing in the BMJ, they argue such delays are largely down to limitations in current scientific knowledge about symptoms or signs for certain cancers, and organisational problems in the health service.

Earlier in the year, health secretary Jeremy Hunt announced plans to rank GPs according to how quickly they referred patients for cancer.

However a team led by Professor Greg Rubin, professor of general practice and primary care at the University of Durham, argues that having frequent visits to the GP before being referred is a marker of the difficulty in suspecting cancer, rather then poor practice.

The experts explain that frequent visits are often necessary for investigations of non-specific symptoms, while poor communication between primary and secondary care, and patients not wanting to be referred, contribute to delays.

They write: ‘Considered together, these observations suggest that diagnostic difficulty and the need for investigation of poorly differentiated symptoms in primary care are more likely to be the drivers for multiple consultations than poor diagnostic reasoning and suboptimal professional practice.’

Professor Rubin and colleagues say more should be done to get patients to consult their GP sooner with symptoms, and to speed up investigations and treatments in secondary care.

They conclude: ‘We argue that prolonged diagnostic intervals chiefly reflect limitations in scientific knowledge and in the organisation and delivery of healthcare.

‘This understanding is critical for informing the development of novel research strategies and policies to improve diagnostic quality. We advocate a framework  for future research and improvement strategies that recognises the central role of variation in diagnostic difficulty across different cancers and organisational factors. We also advocate better information for the public, the media, and policy makers about the origins of prolonged intervals between presentation and diagnosis of cancer.’

NHS England chief executive Simon Stevens yesterday announced plans yesterday to hold CCGs to account on their survival rates.

BMJ 2014; available online 9 Dec

Readers' comments (2)

  • Vinci Ho

    (1)At least 10-15% cancers are presenting non specifically and falling outside two weeks rule . GPs easily had spent some time beating the bush to find the 'right' tree before referring . Otherwise , referrals could have been rejected or deferred . This is something these ignorant pen-pushers and bureaucrats need to understand.
    (2) Holding CCG to account in terms of cancer survival is politically correct but there is no mentioning about creating more rapid access to imaging and perhaps more aggressive treatments in secondary care.
    (3) The 'correct' education of the public is the catch . As I said , what we have currently is the modern version of Ignorance , one of the Five Giant Evils(William Beveridge). Thanks to our tabloid media , some of them are ,of course, government propaganda channels.

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  • Peter Swinyard

    I regret this is pre-election political spin. We could all succeed in referring all cancers early. Unfortunately, this would require referring every patient with any vague symptoms; this would be unprofessional and not in the best interests of the patient or the NHS.

    Let's start talking about the extraordinary success of GPs succeeding in making diagnoses with difficult access to diagnostics, with variable presentations of symptoms by patients and with the unfavourable signal to noise ratio of many patients who do not have cancer and the few who do. GPs do a brilliant job in this is difficult circumstances. Yes, we could all do better with the right facilities - and we should all look in detail at the precedents with every cancer diagnosis - especially where unexpected - as a learning (not a blame) exercise and try to use education rather than coercion to improve our practices further.

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