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‘Little difference’ in antipsychotics

Hardhitting audit finds rule led to surge in referrals and cancer waits

By Emma Wilkinson

The two-week rule for cancer referral has led to spiralling waiting times and a huge surge in urgent referrals, a damning new lung cancer audit concludes.

Introduction of the rule has ‘failed to reduce waiting times' and had a ‘negative effect' on many patients, the researchers warned.

Urgent referrals for lung cancer leapt 42 per cent in the two years after the introduction of the rule, the analysis of 1,044 patients revealed.

Median waiting times jumped from seven to nine days over the course of the two-year period, with the increase particularly sharp in the 38 per cent of patients referred outside the scheme.

But the study, published online by the British Journal of Cancer, found the proportion of referrals that turned out to be cancer plummeted from 78 to 46 per cent – and there was no change in the stage at which cancers were diagnosed.

Study leader Dr David Baldwin, consultant respiratory physician at Nottingham City Hospital where the audit was conducted, said: ‘We were seeing more patients and median wait times went up each year.

‘The people who didn't get referred through the two-week wait suffered most. The introduction of the two-week wait and the Department of Health guidelines has so far failed to achieve its primary objective of reducing waiting times.'

Dr Baldwin said investment locally had improved the situation since the audit, in 2000/2, but this was ‘not necessarily reflected nationally'.

Professor Richard Lewis, consultant in chest conditions in Worcester, agreed introduction of the two-week wait had been damaging.

‘In my experience it makes people wait longer. It used to be doctor-to-doctor referrals and now it is doctor-to-clerk referrals. We also get less information sent through. I don't see any benefit to myself or the patient.'

Dr Kevin Gruffydd-Jones, a GP in Box, Wiltshire, and education lead for the General Practice Airways Group, warned the two-week target had also caused delays for patients with non-cancer lung conditions.

‘We need to give the clinical decision-making back to the clinician. There are patients with other conditions who need to be seen urgently.'

He said some GPs were forced to refer all urgent patients for ‘suspected cancer' to get around the system.

ewilkinson@cmpinformation.com

•Comment, page 84

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