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UK GPs are ‘bending the rules’ on cancer guidelines to benefit patients

Some 90% of UK GPs say they would ignore clinical guidance and send their patients for tests if they suspected cancer but the symptoms did not fit the criteria for urgent referral. 

A new study on the international variation on adherence to cancer-specific referral diagnostic guidelines, led by researchers in the University of Oxford, found that 20% of these GPs said they would ‘record the patient’s history in such a way that allowed them to fit the guidelines for urgent referral’.

GPs in England, Northern Ireland and Wales are less likely to follow recommendations than their non-UK counterparts, the study, published in the British Journal of General Practice also found.

Significantly, the study found no link between adherence to guideline recommendations for definitive action and one-year cancer survival rates.

The research aimed to explain the variation in cancer survival between nations with comparable health systems by exploring the international differences between clinical guidelines and their thresholds for referral, the definitive action they recommend, and guideline adherence by clinicians.

Study lead author Dr Brian Nicholson, a GP and clinical fellow in Oxford University’s Nuffield Department of Primary Care Health Sciences, said: ‘‘What’s interesting here is the tendency for GPs to ”bend the rule”’ to ensure patients presenting with concerning symptoms, who do not fit rigid referral criteria, get rapid assessment anyway. This suggests some GPs shared the view of patients, who would prefer to be investigated for suspected cancer at a much lower risk threshold than was recommended at the time of the study.’

Dr Nicholson added: ‘The new 2015 NICE guideline reduces the suspected cancer referral threshold for GPs to allow for more referrals. Since our data suggests that GPs would sometimes already operate outside the guidelines, perhaps the lower threshold used in the new guideline more closely represents current GP best practice.’


Readers' comments (10)

  • GPs have to be more careful than NICE as we are accountable and NICE is not.
    An example is a 44 year old with change in bowel habit or a 29 year old with recurrent rectal bleeding who does not qualify for 2ww colorectal.
    Have had a patient die of bowel cancer at 30 - thankfully, he was diagnosed in time. Would NICE take responsibility for missed diagnosis. The tendency to blame GPs is from all sides and even from a Consultant Surgeon who did a second colonoscopy - the first one being normal six months earlier- and found cancer.This esteemed specialist blamed the GP that he had referred patient for colonoscopy to the wrong consultant and only his clinic had the expertise.

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  • Oddly this story hasn't been covered by the Daily Mail.

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    UK GPs are ‘bending the rules’ on cancer guidelines to benefit patients ----

    So does this make them good doctors or bad doctors?

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  • Dr Juneja (12th. Feb. 2016), is absolutely correct. All advice seems to be given by people who are not clinically responsible, to people who are clinically responsible. This applies particularly to NICE and CONSULTANTS. Consultants would happily allow GPs to take the blame for delayed diagnosis, rather than see extra patients to be on the safe side.

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  • Bob Hodges

    Our local hospital rejected a referral from me in a lady with post-menopausal bleeding because she wasn't 55. She was 54 and 6 months old.

    I sent her to Birmingham instead, and she's had a hysterectomy for endometrial cancer.

    I am PROUD to bend these stupid rules and even tell white lies if I see fit, if I believe it to be in the benefit of the individual patient sat in room with me, when my guts (that have worked 60+ hour weeks for 16 years) get that feeling.

    If anyone wants to fight about it. I'm WELL UP FOR IT.

    Come and have a go if you think you're hard enough.

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  • Of course we do. I've seen people one day off the 2ww age being diagnosed with cancer. If I hadn't referred they might be dead now. #proudtobemilitant

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  • This is what makes us doctors. These are guidelines not rules.

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  • Instinct and clinical acumen must always beat tick box protocols.
    I have lied on 2 week wait forms, justified in retrospect.
    Patient care must never suffer because of protocols, politics and targets.

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  • You may find that doctors in other countries have quicker and more effective diagnostic access for patients not fitting strict "guidelines", which in this country are interpreted rather as rules by admin staff processing the referrals. Therefor there is no need to bend the rules for the patients benefit.

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  • Samuel Lewis

    Dear Bob Hodges,

    Can I be your fight manager ?

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