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GPs have been unfairly blamed for failures in cancer referral on the basis of wildly varying and poorly collected data, new Government-funded research concludes.

Practices were also being left in the dark over the appropriateness of referrals, with many audits apparently failing to feed information back.

The MPs' committee of public accounts recently launched a bruising attack on GPs over their cancer referrals, accusing them of 'complacency' and

'arrogance' over their failings.

But the new systematic review of referral audits suggests the criticisms were based

on poor-quality evidence. It found 'wide variation' in the proportion of referrals deem-ed to conform to guidelines.

Different audits rated between 9 and 97 per cent of skin cancer referrals as conforming to guidelines, and between zero and 100 per cent of referrals for brain cancer.

In 70 per cent of the audits, there was no evidence that results were being fed back to GPs, even though this is a key requirement under the two-week referral guidelines.

Study leader Paul Wilson, a research fellow at the centre for reviews and dissemination, University of York, said many cancer audits were poorly conducted and the lack of feedback made it hard for GPs to adjust practice. 'If we're going to improve existing practices around the two-week wait it's clear that GPs have to be informed,' he said.

Dr Pawan Randev, chair of the Cancer Primary Care Working Group, called for mandatory implementation of a 'national system of audit', with agreed criteria and terms of feedback.

Dr Randev, a locum GP in Amersham, Buckinghamshire, said: 'If GPs are to perform better at diagnosing cancer, structured feedback with educational support is essential.'

Dr Tony Brzezicki, primary care lead for the South-West London Cancer Network and a GP in Croydon, said: 'The MPs' criticisms are unfounded. At least 75 per cent of referrals are appropriate.'

The review of 241 cancer referral audits was published in Quality and Safety in Health Care (February).

By Nerys Hairon

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