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Poor UK cancer survival rates linked to lack of GP direct access to scans

UK cancer survival is worse than in other countries because GPs here are less likely to refer patients straight away and have less direct access to CT and MRI scans, an international survey of GPs has found.

The survey, published in BMJ Open, found only around one in five GPs in England could request CT or MRI scans directly, whereas GPs from other countries with better cancer survival were twice as likely to have direct access to them.

The study looked at survey responses from 2,795 GP from 11 jurisdictions in countries with similar, primary care-led health systems: England, Wales and Northern Ireland in the UK; Denmark, Norway and Sweden; New South Wales and Victoria in Australia; and British Columbia, Manitoba and Ontario in Canada.

By analysing the GPs’ responses to a series of different scenarios for diagnosis of potential lung, colorectal and ovarian cancers, researchers found a correlation between each area’s cancer survival and the GPs’ readiness to investigate cancer, either directly or via referral to secondary care.

More than 70% of GPs in every area reported direct access to blood tests for cancer diagnosis, X-rays and ultrasound.

However, in England, only around 20% of GPs reported direct access to CT scans and MRI whole-body scans – compared with at least 45% and up to 100% in all the non-UK countries with the exception of Denmark, where cancer survival is also relatively poor.

The study authors said their findings offered ‘one of the first possible explanations for the variation in cancer survival’ and suggested ‘some jurisdictions may consider lowering thresholds for primary care physicians to investigate for cancer – either directly, or by specialist referral, to improve outcomes’.

The findings come after NHS England announced plans to speed up early diagnosis in the UK through a range of initiatives including lowering thresholds for cancer referral – to be backed up by planned new NICE guidelines on suspected cancer – and increasing GP direct access to cancer diagnostic tools.

Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, said the study highlighted the need for increased resources and longer consultations for GPs in the UK.

Dr Green said: ‘If the Government wants to improve cancer care, they need to provide GPs with the resources needed to allow for standard appointment lengths of 15 minutes, as well as ensuring ready access to sophisticated investigations. This cannot happen until the proportion of the NHS budget spent on general practice is returned to its historic levels, and the workforce crisis is properly addressed.’

Dr Richard Roope, clinical lead for cancer at the RCGP, also called for increased investment to enable GPs to diagnose cancer more effectively.

Dr Roope said: ‘GPs are often criticised for over-referring as well as under-referring patients. In order to strike the right balance we need to invest in general practice to allow us to employ more GPs and support staff and to give GPs more access to technology that could ultimately save our patients’ lives.’

He added: ‘We also need significant, ongoing public awareness campaigns to educate the public about the causes of cancer – more than 40% of cancers are related to lifestyle choice – and to encourage people who have signs of cancer to approach their GP as early as possible.’

BMJ Open 2015; available online 28 May


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