GPs need to ‘shift mindset’ to where ‘our threshold for referral’ for potential cancer ‘is lower’, RCGP chair Professor Martin Marshall has told MPs
Professor Marshall was giving evidence to a House of Commons health and social care committee inquiry investigating the NHS backlog’s impact on mental health, general practice and long Covid care when he made the comments.
Committee chair Jeremy Hunt had asked ‘how open the college would be’ to ‘moving to a system’ similar to the one in France, ‘where people have direct access to specialists and cancer diagnostic tests without having to go through their GP as a gatekeeper’.
In response, Professor Marshall said that in the past GPs were trained to ‘pick up the red flags, the important symptoms, and refer those on’ but not ‘refer the many people who have symptoms that could be cancer but where it’s highly unlikely, because the NHS would collapse if that’s what we did’.
But now, GPs need to ‘shift that mindset’ to where their ‘threshold for referral is lower’.
Professor Marshall said he is ‘fully in favour’ of proposed community diagnostic hubs, as ‘we have to have’ better access to early investigations, especially in the community.
But he did not go as far as suggesting everyone is able to self-refer, arguing that if ‘everyone who potentially has symptoms of cancer’ was given an appointment for a scan or with the oncology team, ‘the NHS would collapse overnight’.
‘Our ability as primary clinicians to filter and make judgements is an important part of the sustainability [of the NHS],’ he added.
Current NICE guidance on the threshold for a cancer referral is a 3% chance the patient has cancer.
When asked to further explain the comments, the RCGP told Pulse that Professor Marshall was not calling for a lowering of the NICE guideline threshold, but did not clarify if he meant GPs should lower their threshold in an attitudinal sense.
Last week, health secretary Sajid Javid told MPs in the House of Commons that ‘through the pandemic there have been 300,000 fewer urgent cancer referrals than were expected’, which could potentially mean ‘as many as 20,000 missed cancer diagnoses’.
But it comes as new research, published yesterday in the British Journal of General Practice, found that urgent two-week wait referrals for suspected cancer by GPs have more than doubled over ten years.
In 2018/19 there were over 2.2 million urgent referrals, and in 2009/2010, there were 903,011.
The 2.2 million urgent referrals in 2018/19 resulted in 163,000 people diagnosed with cancer – half of all cancers registered in England that year.
The paper found that an extra 66,172 additional cancer diagnoses were made after GP urgent referral in 2018/2019 compared to 2009/2010, a 68% increase in cancers picked up.
Approximately seven in 100 people urgently referred are diagnosed with cancer.
Lead author Dr Thomas Round, an East London GP and researcher at King’s College London, said: ‘While we saw a drop in urgent referrals during the height of the pandemic, these have now recovered to pre-pandemic levels.
‘This is a testament to busy GPs and their teams who are delivering over a million appointments every day.’
Improved artificial intelligence (AI) and training of receptionists would also aid GPs in improving rates of early cancer diagnosis, RCGP’s adviser suggested to MPs last week.
Dr Richard Roope, clinical adviser for cancer to RCGP, was providing evidence to the House of Commons health and social care committee’s inquiry into late cancer diagnosis in the NHS.
Click to complete relevant cancer CPD modules on Pulse Learning.