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GPs go forth

Hospital consultants warned after bouncing suspected cancer cases back to GPs

Exclusive An NHS England local area team has had to contact hospital clinicians about their referral practice after GPs raised the alarm that patients with suspected cancer were being ‘bounced’ back for re-referral.

Local leaders across the country have told Pulse that they brought the issue up with their local area teams after concerns that patient safety was being put at risk.

In the south coast of England, NHS England’s Wessex Cancer Network sent a letter to hospitals saying the behaviour was ‘inappropriate’ and ‘against patients’ best interests’ after receiving reports that hospitals across the region had been ‘sporadically’ asking GPs to refer patients with suspected cancer via the two-week wait referral pathway.

Local GP leaders said that they suspected ‘heavy handed’ attempts to drive down consultant-to-consultant referrals in the past were responsible for the behaviour, which was causing ‘unnecessary delays’ for patients.

Pulse revealed in December that urgent GP cancer referrals sent via the two-week wait pathway were being ‘bounced’ or downgraded to non-urgent, in some cases leading to delays in cancer diagnoses.

But the action by the NHS England Wessex area team is the first example of managers rebuking hospitals for bouncing suspected cancer cases back to GPs.

A spokesperson for NHS England Wessex area team said: ‘Secondary care clinicians who suspect that a patient may have an underlying cancer, should refer the patient directly to the appropriate local cancer specialist.

‘This prevents unnecessary delay in diagnosis and treatment, and is in line with cancer waiting time guidance. The local strategic clinical network has reminded clinicians of this process, maintaining the best interests of the patient and further clarifying that in such cases, a referral back to the patient’s GP is both inappropriate and unnecessary.’

Dr Nigel Watson, chief executive of Wessex LMC, that such a pattern was being observed across the south coast of England.

He said: ‘It’s happening sporadically, but in more than one hospital. So GPs have got quite frustrated… I think what’s happened is that, in the past, to try and stop inter-consultant referrals, there was quite a heavy hand to stop this happening, and then some consultants believe that they weren’t allowed to refer.’

Dr Watson added: ‘It is a complete waste of time, because somebody is seeing the patient, thinking they might have cancer, then bouncing them back to the practice to write the letter. So it’s a delay for the patient, and it’s just unnecessary and the person seeing the patient has got all the details they need.’

GPC negotiator Dr Beth McCarron-Nash said it was happening in Cornwall too and it was ‘unacceptable’.

She added: ‘The patient appears to have been missed in this picture. The heavy handed approach and drive to balance books appears to be more important than good clinical care. This is madness and should be challenged as it compromises safe patient care.  We raised our concerns and things are improving. The needs of the patient and common sense must come first.’

Dr John Ashcroft, executive officer at Derby and Derbyshire LMC, said he would be proposing a motion to tackle it at the next LMCs conference.

Dr Ashcroft said: ‘It’s much broader than just those with suspected cancer, there are many other serious conditions, and less serious conditions where the patient journey is affected by this policy.

‘It adds delays, and confusion to the patient’s journey, wastes appointments and causes huge amount of extra admin work for doctors and staff. It’s also demeaning to our hospital colleagues.’

Pulse revealed in 2013 that CCGs across the country had been piling pressure on to GPs by blocking non-urgent ‘inter-consultant’ referrals on a range of conditions in a bid to cut their spending and achieve their QIPP savings targets.

Readers' comments (23)

  • Vinci Ho

    Who has created this mess in the first place?Not GPs ,not consultants.
    Thanks to the slippery slope fallacy of efficiency saving .Of course , this mess is amplified by thousand times when there is a paranoia of something horribly wrong would happen , e.g. missing a lot of cancer diagnoses.

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  • As a Wessex GP, I can confirm that this is true. The other thing is that if you refer a patient on a 2 week wait for a suspected cancer, the only thing you often get is a nurse-led clinic offereing a "procedure" and NOT a clinical opinion. I went to a talk where a Consultant warned NOT to expect a clinical opinion but rather simply a procedure. If the procedure is negative, the patient is simply "bounced back".
    What, in effect, happens is that you get a binary result ie you often don't get told what the problem is but rather what it isn't.
    I know that GPs in other areas would not tolerate this but here in Wessex, GPs have, in my opinion, unusually little influence compared to other areas-and I know many GP friends in other areas and from discussions this seems the case.
    In effect, nobody could care less about our opinion.

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  • This is an outrage-of course it won't reach The Daily Mail because Jeremy Hunt's "media command centre" is only instructed to "terrorise GPs". The remit is that whatever happens in the NHS, it must always be the fault of GPs and all the ills of the NHS and moreover society are down to GPs.

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  • Agreed with above, everything is the fault of GPs-Bankers and Terrorists are one thing but they really are public enemy number 1...just ask THE DAILY MAIL.

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  • I'm unsure why Daily Mail journalists are given such easy access to this website which is for medical professionals only and which clearly doesn't apply to them.

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  • Bouncing back patients is quite frequent and the scale of idiotic. Nurse lead clinics are a dangerous thing and lead to mortalities and two of my patients are probably sitting in heaven and discussing this issue.

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  • The reason you get free public access to Pulse is that it generates increased web traffic and therefore increased ad revenue for it's owners.I see no problem with that.As far as the Daily Mail is concerned let the mad dogs bark and if it indeed represents people's views then the public will get the NHS that it deserves.

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  • this should be no problem as i'm sure the innovative NHSE would push diagnosis, investigation and treatment of cancers to primary as GPs know the patient best, they each get 100 billion each from the public, all have golden pensions, and have plenty time as they all play golf instead of seeing patients and they all drive Bentleys. If only they would stop playing golf and drive 'normal' cars they the NHS will be saved.

    i'm sure the GMC can come up with some guidance in the updated Duties of a Doctor

    1. though shalt not play golf
    2. though shalt not drive a Bentley
    3. though shalt inspect Central heating
    4. though shalt check if patients are lonely
    5. though shalt take over all cancer care ... actually though shalt do all secondary care as well !

    yes i'm cynical and fed up.

    i'm just hoping the monstrosity that the nhs has become will finally keel over and we can get on doing clinical care.

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  • This is probably happening all over, it is about time we started treating patients not targets.

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  • It is a very "submissive culture" down South-even the reception staff boss us around all day...and the CCG....basically.....we just do as we are told.....or else.....

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