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A faulty production line

'Urgent cancer referrals should not be refused'

Urgent cancer referrals should not be refused, but GPs must remember they can use alternative routes to make sure patients are seen urgently, argues Professor Greg Rubin

These reports of urgent referrals being bounced or downgraded bear out what I have heard anecdotally.

Although it is widely held that once an urgent, so called two-week wait referral is made it should be accepted as such, a lot of the two-week wait pathways use a proforma – and if a patient doesn’t meet the criteria then that may be used as a reason for the referral management centre or hospital to bounce them.

I do not agree with GP urgent referrals being sent back, but it is understandable that trusts or CCGs take steps to manage entry into two-week wait referral system. Secondary care has finite resources and the urgent referral pathway is heavily performance managed, with trusts facing significant penalties if they breach wait targets.

Also referral management is not necessarily about limiting referrals – it may also be about making sure the right people go into the right pathway.

These pressures to manage referrals are going to be accentuated with the draft NICE guidance on suspected cancer, currently out for consultation. Many more people may become eligible for urgent referral and without some change in resource allocation to support the proposed guidance the system will fall down – CCGs are going to have to commission services that enable the guidelines to be implemented.

However, GPs should remember that NICE guidance makes it quite clear there are other ways that you can make sure a patient is seen urgently. These include speaking to a consultant and discussing the case, and referring the patient urgently but not on a two-week wait referral proforma. 

Usually if GPs talk to a specialist about a patient they are worried about, that patient will be seen – but I don’t think that option is used as often as it should.

Professor Greg Rubin is professor of general practice and primary care at the University of Durham and head of the National Audit of Cancer Diagnosis in Primary Care

Readers' comments (4)

  • "Secondary care has finite resources"....unlike Primary care which is infinite and can absorb anything. Thanks mate, really useful. well done.

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  • sorry:
    if its not 2 week wait and done urgently first 'urgent' doesnt mean much to my local consultants: it means they can play games and see the pt in 2-3 months time. if a cancer is missed : blame will be with GP for NOT referring under the 2 week referral criteria.
    secondly: dear Prof: speak to agent Hunt who has been slaying GP reputations for last 1year including on cancer referrals. remember the name and shame the drs/surgeries who perform poorly on cancer survival.
    thirdly: if a mistake happens: a GP sends the referral as urgent but get seens in 2-3 months and a cancer dx made: the consultant will also blame the GP for not doing the 2 week referral and hence medicolegal challenge for GP.
    rather than asking us to take the risks:
    why do secondary care take some responsibility and at their own risk downgrade the referral ( ' it dont think they will have the courage to do so') or ask J Hunt to fund the service appropriately.

    NHS is running out of money and hence the above issues. Pts demands have escalated in last 5 years have been a GP. When a GP will get into trouble with GMC non of you will come to support and say that you did suggest urgent referrals rather than 2 week wait.

    suspecting a cancer = 2 week wait referral (NICE guidelines are very clear). if not clear enough study the medicolegal challenges GPs hae faced with delayed dx of cancers; GMC has them all.

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  • isn't this simple just send back the 2 week referral, make patient aware, allow patient to chase it and they will be seen

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  • Vinci Ho

    I agree to some extent that there has to be pressure and demands , particularly demands outstripping supplies ,before something can be invested and done but(always a but) ,
    Where is this pressure directed towards? Not to GPs , not to our secondary colleagues . Pressure is straight towards politicians and bureaucrats .
    Are you comfortable with that??
    What is the penalty to these people if the appropriate investment is not guaranteed ? This is the unique time in the history when the whole medical profession should be standing up to put these people to account or else there should be an overwhelming vote of no confidence ,no matter which political party they represent.

    Without the guaranteed and well evident investments , this can easily turn a politically correct diplomacy into a dangerously flawed hypocrisy eroding further into an extremely over stretched NHS . Efficiency saving has been proved evidently a hypocrisy.......

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