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DH to target ultrasound delays to improve speed of cancer diagnosis

By Nigel Praities

Exclusive: A Department of Health audit of GP cancer referrals has identified long waiting times for ultrasound results as a key barrier to faster diagnosis, Pulse can reveal.

Early findings from the national audit of cancer diagnosis in primary care – led for the Government by the RCGP – suggest delays of weeks or months for scan results after GP referral are preventing cancers being identified more promptly.

The finding is set to shape the DH's planned rollout of direct GP access to cancer diagnostics, with cancer tsar Professor Mike Richards telling Pulse he regarded ultrasound as one of the key priorities for national rollout in primary care alongside endoscopy.

Professor Greg Rubin, professor of general practice at Durham University, who is running the national audit for the RCGP, said ‘anecdotal reports' from the 14,000 GPs taking part in the audit suggested access to ultrasound was a serious problem.

‘It is relatively uncommon for GPs to say better access to investigations would have made a difference, but in conversations it is ultrasound that is the sticking point.

‘Some GPs may get results in a week or so, but some wait for several weeks, even months before they get the result back.

‘Better access [is important] because ultrasound is used for cancers that present with vague symptoms that are often difficult to disentangle from more common conditions, typically ovarian and pancreatic cancers,' he said.

The DH has pledged to provide direct GP access to a range of diagnostics as part of its plan to guarantee suspected cancer patients access to a specialist within one week of their GP consultation.

Professor Steve Field, chair of the RCGP, told a college roundtable debate on cancer diagnosis – co-chaired by Pulse – that he saw no reason why every GP should not have access to ultrasound in their surgeries: ‘Can we train nurses to use vaginal ultrasound, to rapidly diagnose ovarian cancer?'

Professor Richards said direct access ultrasound was ‘exactly what we need' to meet the Government's one-week target for cancer referrals.

‘Things have changed dramatically – 10 years ago the idea that a mammogram could be reported by anybody than a doctor would have been impossible.

‘If you look at large practices in the States or Kaiser Permanente, they would undoubtedly be doing ultrasound and flexible sigmoidoscopy on site. Both tests can relatively easily be done.'

Increased focus on cancer diagnosis

- In the NHS Constitution, patients have right to be seen by a cancer specialist within two weeks from a GP referral

- The Government has pledged to reduce this to one week within five years and – where the two-week wait does not apply – to give GPs access to a greater range of diagnostics to speed up the referral of patients with suspected cancer

- In its recent report on cancer, the Government pledged to look at whether direct access to ultrasound, computer tomography, MRI and endoscopy was appropriate for GPs, based on the results of the RCGP national cancer diagnosis audit

Dr Kalpesh Shah: a GP pioneering direct access to transvaginal ultrasound in the community PROFESSOR GREG RUBIN


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