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GPs buried under trusts' workload dump

Trusts breaching GP urgent cancer referral targets every quarter

The national standard that calls for cancer patients to start treatment within two months of an urgent GP referral has been breached every quarter since 2014, an NHS England report has found.

Between July and September last year, nearly three quarters of treatment providers failed to meet the target - which requires 85% of patients with an urgent referral to begin treatment within 62 days.

Some regions reported just 42% of patients had started within the required timeframe.

GPs and cancer experts have warned the problem will only get worse, as the number of cancer patients grows, while resources and workforce dwindle.

The data, published in conjunction with Office for National Statistics, showed 41,315 patients began treatment for cancer between July and September 2018 (quarter two, 2018/19) following an urgent GP referral

But of these, just 78.6% were treated within 62 days of referral, compared with 82.2% in the same period the year before.

The report said: ‘The national operational standard was breached in quarter two 2018/19 by 6.4 percentage points. This is the nineteenth quarter that has breached in a row since quarter four 2013/14 fell below the operational standard by 0.6 percentage points.’

It added: ‘Out of 150 providers which treated at least five patients, 111 (74%) failed to meet the operational standard for this requirement. The proportion of patients commencing their first definitive treatment within 62 days varies from 42% to 100% by provider.’

The report also found:

  • In quarter two of 2018/19, 554,619 patients were seen by specialists after an urgent GP referral for suspected cancer
  • 91.6% of these patients were seen within 14 days of referral, which is below the 93% standard. This is compared with 93.9% in the same period in 2017/18, 
  • Out of 154 providers that saw five or more patients, 102 saw at least 93% of patients within 14 days

The two-week urgent GP referral target was missed for the first time on record last year, after only 91.4% of patients with suspected cancer urgently referred by a GP were seen within 14 days.

In Northern Ireland the figures are even more stark with only 61% of patients referred urgently starting treatment within the 62-day target – the lowest figure since 2010.

BMA GP Committee clinical and prescribing lead Dr Andrew Green described the figures as a 'further illustration of the strains the whole system is under at the moment'.

He said: 'GPs are being encouraged to reduce the thresholds at which we refer or investigate for suspected cancer to try to increase early diagnosis. This is the correct thing to do but will increase the pressure on the secondary sector.

'From the patient’s point of view, the time between referral to hospital and the start of treatment is one of the most emotionally stressful times of their entire illness, and so it is important to realise that behind these statistics lies a huge amount of patient distress, in addition to poorer clinical outcomes.'

GP cancer expert Professor Willie Hamilton, professor of primary care diagnostics at the University of Exeter, said: 'The number of two-week wait appointments is going up and up very quickly. The absolute number seen within the time frame is probably higher than before, but it's quite difficult for some departments to cope with the increasing numbers.

'The background to this is that some areas are struggling to recruit. We know there are difficulties with endoscopy and radiology - both those areas have seen a tremendous explosion in the amount of work they are expected to do, and they are cruicial for the investigation of a lot of cancer.'

Dr Emma Crosbie, honorary consultant gynaecological oncologist at the University of Manchester, said: ‘It has been suggested that one of the main reasons why the UK falls behind its European cousins in cancer survival outcomes is the prolonged delay between initial presentation to the GP and first treatment, and as demonstrated in this report, the situation is getting worse.'

Last year, experts praised GPs for their increased vigilance after national figures showed more cancer patients in England were diagnosed early and fewer presented for the first time as an emergency.

And in November, NHS England announced a 'major overhaul' of national cancer screening programmes, a move which GPs hope will ensure the most appropriate patients are targeted.

Readers' comments (5)

  • Setting standards will not compensate for a depleted workforce,all that will do is accelerate the exodus.They will reap what they have sown over the last 8+ years.

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  • My guess is that the older the patient the longer they wait. We know that decisions about fitness for treatment and diagnostics are more complex in the elderly but that only means we should be slicker in getting this age group sorted not slower.

    Do we know what the spread of the delay is in various age groups?

    The older you are the less time you have to spare?

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  • Always terribly difficult to clarify in one's mind what this all means.

    Explaining it to a patient is a daily chore,but made more difficult because I struggle to understand it myself.

    It is of course easy to explain the fear anxiety and indeed dread,a patient can be reasonably told the waiting time will destroy their summer,leaving them with little else on their mind.For a man of about 70 this represents approximately 10% of the remaining summers of his life.

    However,what does it actually mean in terms of life expectancy,more radical treatment,ongoing morbidity,further impairment.It appears to be very difficult to quantify this,and without concrete figures counselling patients becomes guesswork.

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  • Just keep setting unrealistic standards and publishing guidance without being realistic of staff numbers, investigation speed and resources available and all the funds starts going to the lawyers. People will leave the profession at an even faster rate.Just like Dr Bawa Garba. 6 wards on 4 levels to cover. An impossible task.

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  • Vinci Ho

    The arithmetic just never adds up . Politicians and technocrats could not swallow pride and the fact that we have been crap as far as cancer survivals ( compared with our European counterparts, for instance) are concerned. The immediate jerk reflex was forcing GPs to lower the index of suspicion and set a very low threshold to refer by two weeks rule.
    Fine . But ( always a but) that was not met by the adequately proportional increase in resources( time , money , manpower and expertise) in diagnostic and treatment services ( primarily in secondary care).
    Squeezing GP to shorten the time of ‘first symptom to being referred( by 2 week rule)’ is cheap but the real beast to conquer is the ‘referral to treatment time’(RTT).
    The ‘academics’ should have seen this from day one and lobbying the government in a different way . Rather , the workload(and demands) in general practice( in chasing the shadows of ‘presumed cancerous’) had spiralled up and that at least , to some extent , contributed to the recruitment and retention crisis in general practice.

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