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
