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GPs risk legal action over cancer referrals

By Daniel Cressey

A substantial proportion of GPs are risking legal action by failing to follow cancer referral guidelines, a survey published by NICE reveals.

Individual recommendations within the institute's most recent guidance are ignored by as many as a third of GPs, the survey of 202 doctors found.

The results came as a new NHS study sounded a warning over delays in cancer referral, finding they were among the most common reasons for legal action against GPs.

Dr Tim Ringrose, who conducted the survey of adherence to NICE, told Pulse: 'It is a concern. Not recognising symptoms of malignancy can have catastrophic consequences.'

Dr Ringrose, honorary senior clinical lecturer at Warwick Hospital and director of professional relations at doctors.net, conducted the research to evaluate the website's training module on NICE cancer referral guidelines.

He said: 'The difficulty is doctors are very busy ­ they're aware of guidelines coming out but they don't find them accessible.'

Medical defence bodies warned GPs would be on thin ice if they ended up in court over failure to refer a patient who met guideline criteria.

Dr John Holden, medicolegal adviser at the Medical Defence Union, said: 'We'd expect our members to be aware of guidelines. Ignorance would be a poor defence, but a reasoned and justifiable decision may be acceptable.'

Only 70 per cent of GPs agreed with NICE that dyspepsia along with persistent vomiting would merit urgent referral for endoscopy or to a specialist.

Even fewer would refer women with persistent inter-menstrual bleeding and a normal pelvic examination on suspicion of gynaecological cancer.

The research also found 11 per cent of GPs did not know the maximum waiting time recommended by NICE for patients with suspected cancer was two weeks. Knowledge improved as a result of the modules and NICE is considering the results.

Meanwhile, a study published on the NHS Research Findings Register found cancers ranked alongside congenital problems and pregnancy complications as the most common sources of actionable error, most often because of delays in diagnosis.

Dr Hamish Meldrum, GPC chair, said: 'As generalists, everyone expects you to be up to date with everything in every area. GPs are inundated ­ it's very difficult to assimilate everything.'

dcressey@cmpi.biz

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