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GP urgent cancer referrals under scrutiny

By Lilian Anekwe

Huge variation in two-week GP referrals and rising emergency admissions are key factors in the failure to improve outcomes for patients with cancer, say Government auditors.

In a wide-ranging deconstruction of the the delivery of the Department of Health’s flagship Cancer Reform Strategy, led by the cancer tsar Professor Mike Richards, the National Audit Office (NAO) said a more efficient delivery of services would save the NHS hundreds of millions of pounds each year.

The Department of Health spent £5.1 billion cost of cancer services in 2008/9, but this did not include the costs of services which may not result in a patient being diagnosed with cancer such as diagnostics, screening, and activity in primary care; which the NAO estimated cost an additional £1.2 billion.

A failure to routinely monitor GPs’ use of the two week wait pathway, which rose by 44% from 627,000 in 2006/7 to 904,000 in 2009/10, was singled out as a key PCT failing.

Figures from the National Cancer Intelligence Network showed that the urgent GP referral rate varied almost fourfold across PCTs and by more than eightfold between GP practices in England.

The proportion of cancer patients diagnosed through urgent referral as a proportion of total patients diagnosed per GP practice ranges from under 10% to over 80%.

‘We explored the way in which urgent referral data is used by PCTs. 80% reported that they monitor variations in the use of urgent referral by GPs in their area, and 76% compare these variations with other PCT areas. 60% of PCTs reported that information on such variations had not influenced their commissioning of cancer services.’

The report also found that though an aim of the strategy was to minimise emergency admissions for cancer.

‘While the rate of increase has been reduced, emergency admissions are still increasing. There is wide variation between PCTs in the extent of emergency admissions and poor understanding of the reasons for them.’

The NAO said this encouraged PCTs – and later GP consortia – to benchmark themselves with other areas and build more cost effective services.

David Stout, director of the NHS Confederation’s Primary Care Trust Network responded to the report saying: ‘It is really important not to ignore the major improvements made in cancer care and to acknowledge the role primary care trusts have played in driving this. However, we fully recognise that further progress is required in a number of areas.

‘PCTs have often been hampered in achieving good value for money by inconsistent national data sets, the quality of coding, and cumbersome payment systems. It is vital that these national problems are recognised by the Department of Health. The Government needs to understand and act on what is holding back local organisations.’

Professor Mike Richards led the Cancer Reform Strategy