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Loosen up the referral rules

The two-week rule is back in the spotlight this week, with the release of one of the largest evaluations of its effects to date.

What grim reading it makes. In the two years after the rule's much-trumpeted introduction, urgent referrals for lung cancer leapt

42 per cent, average waiting times went up, but the proportion of referrals that turned out to be cancer plummeted. Oh, and cancers were not detected any earlier


As GPs know well, a lever pulled by a Whitehall policy wonk can have unpredictable, frustrating and damaging effects in the real and complex world of the NHS.

But then GPs have long argued that the two-week rule is the bluntest of tools – one that chooses clinical priorities by inflexible formula rather than sound medical opinion.

Patients the real losers

The new study highlights the plight of the real losers, who are not ministers, or indeed doctors, but patients – whether those referred through other routes than the

two-week rule or with unpleasant diseases that happen not to be cancer.

As with so many clever Government initiatives, the effect

on patients is undemocratic and unfair. Hospitals blessed with money, new staff and plush new diagnostic facilities will probably cope with referral inflation. Many others will not.

Surely it is time to allow clinical priorities to be determined by clinical experts, and not by the

rigid flow charts of referral rules.

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